Local Family Justice Board/MMU Conference

Manchester Business School11th September 2015

Faye Macrory MBEConsultant Midwife

Central Manchester University Hospitals NHS Foundation Trust (CMFT)faye.macrory@cmft.nhs.uk

the starting point……………

FGM is the manifestation of gender inequality that is entrenched in social, economic and political structures.

FGM is a form of violence against women and girls.

(WHO 2008)

FGM Act (2003)

It is an offence to excise, infibulate or otherwise mutilate the whole or any part of the labia majora, labia minora or clitoris of another person for non medical reasons, or to aid, abet council or procure any of these acts on that person’s own body.

It is also an offence to take a child out of the Uk for that purpose or to arrange it.

The penalty is up to 14 years imprisonment.

Where is FGM performed?

• FGM is practiced in over 28 African countries

• Parts of the Middle East, Yemen, Syria. in N. Iraq and other Kurdish areas

• Reported among Bhora Muslims in Pakistan, India and East Africa, Indonesia, Malaysia, Papua New Guinea

• Is increasingly encountered among migrant populations

in the UK, Europe, USA, Canada, Australia and New Zealand

Classification of FGM

FGM/C (also called cutting) comprises 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

(WHO 2008)

Terms used: e.g. sunna, kakia, bundu, tara, tahur:- meaning purification

Type 1: Clitoridectomy: partial or total removal of the clitoris

Type 2: Excision: partial or total removal of the clitoris and the labia minora with or without excision of the labia majora

Type 3: Infibulation: narrowing of the vaginal opening through the creation of a covering seal, repositioning outer and inner labia with, or without removal of the clitoris

Type 4:

All other harmful procedures to the female genitalia for non-medical purposes e.g. • pricking • piercing• incising• scraping• cauterizing the genital area• pulling/stretching the labia and clitoris

what about cosmetic surgery??

Why the practice continues:

• custom and tradition• mistaken belief that FGM is a religious requirement• preservation of virginity/chastity• social advantage, especially for marriage• enhancing fertility• hygiene and cleanliness• increasing male sexual pleasure• family honour• sense of belonging to a group vs fear of social exclusion

(WHO 2008)

Short term complications of FGM

• haemorrhage• shock• acute urinary retention• damage to other organs• infection• failure to heal• death

Long term complications of FGM:

• difficulties passing urine/UTI’s• HIV, Hep.B• menstruation difficulties• chronic pelvic infection• infertility• vulva abscess/cyst/calculus/neuroma• keloid scarring/fistula• increased risk during delivery e.g. perineal trauma, PPH

and perinatal death• sexual, psychological and psychosexual difficulties

Health

Many opportunities to identify women affected and girls at risk particularly in:

• A&E/ED• maternity and gynaecology• female surgery• urology/continence team• SARC, GUM, CASH• GPs, HVs, School Nurses

CMFT Action Plan

Key aspects in managing FGM:

• provision of sensitive & appropriate services to all women identified with FGM

• availability of physical and psychological support

• safeguarding infants and girls at risk of FGM

Progress do far:

• Trust Lead nominated for FGM Agenda

• FGM Steering Group established

• Online Data collection tool developed and implemented Trust-wide. Enhanced Data Set Mandate from April 2015

• FGM standing item on CMFT Adult & Children’s Safeguarding Groups

• Representation on local and regional forums

• Presenting at local and national conferences

• Distribution of resources

• Training sessions across CMFT

• Expertise of the specialist MW (refugee/asylum seekers)

• Recognition of unmet psychological/mental health needs

• Community engagement identified e.g. SOS Clinic (NESTAC)

• Early referral to SMH Warrell Unit re de-infibulation

• British Journal of Midwifery Awards March 2015• Nursing Times Awards November 2015

Useful websites• www.fgmnationalgroup.org• www.rcm.org.uk• www.who.int/• www.amnesty.org.uk• www.fgmnetwork.org• www.equalitynow.org• www.dofeve.org• www.nspcc.org.uk• www.endthefear.co.uk/practitioners• www.afruca.org• www.forwarduk.org.uk• www.nestac.org• www.fgmelearning.co.uk

•

Key publications

Data collection: www.hsic.gov.uk/isce/publication/scci2026

Education/e-learning: http://www.e-lfh.org.uk/programmes/female-genital-mutilation/

Safeguarding: https://www.gov.uk/government/publications/safeguarding-women-and-girls-at-risk-of-fgmwww.hsic.gov/fgm/fgm

Commissioning services: https://www.gov.uk/publications/services-for -women-and-girls-at-risk-of-fgm

GP Practices CAP registration: www.hsic.gov.uk/fgm

https://www.gov.uk/government/consultations/consultation-on-the-draft-statutory-multi-agency-practice-guidance-on-female-genital-mutilation-fgm.

Recent developments:

The Serious Crime Act 2015 strengthens the law around FGM by extending the extra-territorial jurisdiction of the offence. In summary:

•extends the extra-territorial reach of FGM offences and providing anonymity to victims•a new offence of failing to protect a girl under 16 from the risk of FGM •provision for FGMPO to protect victims and likely victims •mandatory reporting - new duty on professionals to notify the police of acts of FGM

Any questions?