Safeguarding against female genital mutilation is a collective responsibility
Community nurses need to take a more holistic approach to identify and support FGM survivors and young girls who might be at risk.
Community nurses need to take a more holistic approach to identify and support female genital mutilation survivors and young girls who might be at risk
I began working as a specialist nurse with women who had undergone female genital mutilation (FGM) in 1999. Looking back, it often felt as if we were working in isolation with these patients. Things are changing as we take a more holistic approach alongside colleagues in our hospitals, social services, the police – plus key partners and local communities. This transformation helps us now better identify and support FGM survivors and any young girls who may also be at risk.
FGM – the facts
The World Health Organization (WHO) describes FGM as ‘all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons’. There are four types, ranging from a small nick to the clitoral hood, to total removal of the external female genital organs. It is carried out between infancy and adolescence, so we need to safeguard those girls at risk over many years (WHO 2017).
UNICEF (2017) estimates that in more than 30 countries, at least 200 million girls and women have undergone some form of FGM. Closer to home, around 66,000 female babies have been born to FGM survivors across Wales and England (City University 2015).
Survivors of FGM share a multitude of mental and physical health problems: such as persistent urinary tract infections, menstrual irregularities, reproductive tract infections, post-traumatic stress disorder, depression, sexual dysfunction and chronic genital pain.
FGM and the law
Across the UK, FGM is illegal and has been incorporated as a priority by NHS England in its safeguarding frameworks to protect children. As healthcare professionals, teachers and social workers, if we discover a survivor of FGM under 18, we have a mandatory duty to report this to the police.
The FGM Risk Indication System (FGM RIS) has been developed by the NHS to share information and protect young girls, who are assessed to be at risk of FGM. This is a secure central data system, accessed only with permission. Already, GP surgeries across the UK using the EMIS system can view if a child has been identified as being at risk of FGM.
Social services can advise authorised healthcare professionals, caring for these young girls, to add them to the FGM RIS. The system is being implemented into maternity sites across England via the summary care record.
As with any potential case of child abuse, if you are concerned that a girl you care for may be at risk of FGM you need to:
- Contact your local safeguarding lead.
- Undertake a risk assessment (Department of Health 2017).
- Update records.
- Refer as appropriate to social care and the police.
- Advise the girl, her mother and family of the adverse health effects of FGM.
- Explain FGM and the law.
- Research local community support groups.
FGM is a human rights violation. It is child abuse and illegal in the UK. Through improved communication, increased awareness and by working together, we hope to end the practice.
However, as healthcare professionals, we will still see women struggling with the associated physical and psychological consequences of FGM for many years to come.
Together with our partners in the police and social services, the NHS is better placed to safeguard and protect girls at risk of FGM and provide the essential specialist care and support.
- City University London (2015) Prevalance of female genital mutilation in England and Wales: National and local estimates
- Department of Health (2017) FGM safeguarding and risk assessment. Quick guide for health
- WHO (2017) FGM factsheet
- UNICEF (2016) Female genital mutilation/cutting: a global concern
About the author
Jennifer Bourne is project manager FGM Prevention Programme, NHS England