(FGM) Introduction to the basics of Female Genital Mutilation - Peggy Mulongo - Safeguarding Children in Stockport
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Introduction to the basics
of
Female Genital Mutilation
(FGM)
Peggy Mulongo
Health & Wellbeing Manager
Cross-cultural mental health Practitioner (CMHP)
PhD can, MSc, DipHi, RMN
NESTAC
• A registered charity established in Greater Manchester since
2003.
• Enable community-led projects which actively engage ethnic
minority populations, particularly women and young girls
affected by Gender-Based Violence (GBV), with a focus on FGM.
• Initiated two main FGM services across Greater Manchester:
The SOS (FGM adult service) and
THE GUARDIAN PROJECT(FGM CYP service)
• Provide a specialised cross-cultural therapeutic support to those
affected or at risk of FGM, and for all other forms of GBV.
• Three culturally adapted therapeutic clinics across Greater
Manchester, providing individual and group therapies in
Manchester, Salford and Rochdale.
• Our services are free of charge and accessible to all local
authorities.
Emotional Content • Safeguarding training can be challenging and emotionally charged. • FGM can be a particularly sensitive and difficult - it’s important to take care of yourself and others in this space. • Confidentiality - any personal or professionals issue that arise should be treated confidentially
Getting to know you! • Talk to your partner about a holiday you are looking forward to • Talk to your partner about a hobby that you have • Talk to your partner about your genitalia
QUIZ New S t e p For A f ri c a n Com m unity
Knowledge Quiz
1. How many women have experienced FGM, globally?
a) 2 million
b) 50 million
c) 200 million
2. How many girls living in the UK could be at risk of FGM?
a) 1,000
b) 10,000
c) 60,000
New S t e p For A f ri c a n Com m unity
[True or False]
1. FGM is only carried out in African countries:
2. There is only one form of FGM:
3. FGM only affects a girl’s physical health:
4. The effects of FGM are only short term and then the girl will heal:
5. FGM is required by the Quran:
6. FGM is illegal in the UK:
7. We cannot do anything to change the views on FGM:
New S t e p For A f ri c a n Com m unity
What is Female Genital Mutilation?
(FGM)
Describe functions of all parts of the
natural female genitalia
Describe all different types of FGM
What is Female Genital Mutilation?
(FGM)
The terms “Female Genital Mutilation", “Female
Genital Cutting“; Female Circumcision” and
“Female Genital Mutilation/Cutting" refer to all
procedures involving partial or total removal of the
external female genitalia or other injury to the
female genital organs for non-medical reasons.
(World Health Organization 2008)
New S t e p For A f ri c a n Com m unity
Female genitalia
Urethra Clitoris
Outer (labia majora)
Inner (labia minora)
Vagin lips
a
www.forwarduk.org.ukHow does FGM usually happen?
Girls between the ages of 5 – 12; average age is between 5 – 8
Mainly by older women in the community – ‘circumcisers’ or
‘excisors’
Traditionally without sterilized equipment or anaesthetics
Increase in the medicalization of FGM; which poses new challenges
UK girls are taken on “holiday” sometimes talking about attending
a ceremony or becoming a woman
Communities in the UK are believed to
have their own practitioners herewww.forwarduk.org.uk
www.forwarduk.org.uk
www.forwarduk.org.uk
FGM Type 4 All other harmful procedures to the female genitalia for non-medical purposes, for example: Pricking Piercing Incision Scrapping Cauterization (burning) Pulling (Labia elongation)
Origin of FGM
- From the 5th century BC: in Ethiopia or Egypt.
(Smith 1995)
- Other sources indicate that FGM existed in
Egypt as early as 163 BC.
(Hosken 1993)
New S t e p For A f ri c a n Com m unityFGM PREVALENCE
UNICEF estimates that at least 200 million girls and women
have experienced FGM in at least 29 countries in the Africa
and the Middle East
30 million girls are at risk in the next decade
FGM is reported amongst Bohra Muslims in India, Pakistan
and East Africa; in Malaysia, Indonesia, Sri Lanka, Yemen,
Iran and through certain Kurdish communities.
Although there is no data there is anecdotal evidence FGM
takes place in Columbia, Oman and Saudi Arabia.
New S t e p For A f ri c a n Com m unityFGM Prevalence in Africa New S t e p For A f ri c a n Com m unity
FGM Prevalence in the Middle East,
South-East and South Asia
(UNICEF, 2013)
FGM is prevalent in parts of:
the Middle East
some Muslim populations of:
Southeast
South Asia
High FGM rates have been reported
in Yemen and Kurdish region of Iraq (IRIN, 2008}.
Among other West Asian countries,
FGM has been locally reported.
Overall FGM prevalence rate is unknown.
New S t e p For A f ri c a n Com m unityFGM Prevalence in Iraqi Kurdistan Region (IKR)
(Shabila, N., 2015)
FGM is prevalent in 3 distinct areas:
•Duhok: 4%
•Arbil governorate: 58%
•Sulaymania governorate: 70%
(in some specific rural areas)
New S t e p For A f ri c a n Com m unitysocial
cohesion
Hygiene & Social
aesthetics acceptance
Why FGM is Custom &
purification
practiced tradition
Desexualising religious
women reasons
honour
&
survival4 forms of abuse reminder
Emotional
Physical
Sexual
Neglect
Definitions can be found in the multi agency child protection
procedures at: www.greatermanchesterscb.org
New S t e p For A f ri c a n Com m unityFGM: HEALTH CONSEQUENCES New S t e p For A f ri c a n Com m unity
Short term health risks New S t e p For A f ri c a n Com m unity
UK CONTEXT OF FEMALE GENITAL
MUTILATION
Statistics and legislation
STOCKPORT SAFEGUARDING CHILDREN BOARDFGM Prevalence in the UK and GM 137,000 women living in England and Wales are estimated to have undergone FGM and 60,000 girls under the age of 15 are at risk. Greater Manchester is one of 6 hot spot areas in the UK 210 cases were identified in Greater Manchester from Jan – Mar 18; 10 cases were aged under 18 years old
FGM – LEGISLATION AND SAFEGUARDING New S t e p For A f ri c a n Com m unity
FGM – Legal Position
Prohibition of Female Circumcision Act 1985
Female Genital Mutilation Act 2003:
Added extraterritoriality
However this only protected ‘British citizens’ and ‘permanent residents’
It is also illegal to ‘aid’ ‘abet’ ‘counsel’ or ‘procure’
Carries a penalty of up to 14 years imprisonment and/or a £10,000 fine
Serious Crime Act 2015:
Extended extra-territorial protection to include ‘habitual residents’
Anonymity for victims and makes identifying individuals in publicity a
criminal offence
Parental Liability - creates an offence of failing to protect a girl (under
16) at risk of FGM; 7 years imprisonment
FGM Protection OrdersFGM Mandatory Reporting Duty
From 31st of October 2015, all regulated health and social care
professionals and teachers are required to report all known or
disclosed cases of FGM directly to the police (through 101).
This only applies to those under the age of 18.
This is a personal duty and can not be transferred to anyone else.
Failure to follow the duty can result in disciplinary procedures.
This does not include suspected or ‘at risk’ cases – follow your usual
safeguarding procedures in both cases.
Mandatory reporting should be seen as in addition to your
safeguarding procedures as opposed to instead of your
safeguarding procedures.Limitations with the FGM Law There is no age limit First UK case been convicted in February 2019 (11 yr. imprisonment). Re-infibulation Designer Vaginas Clitoral Piercings
Safeguarding: everyone’s responsibility
protecting children from maltreatment;
preventing impairment of children's health or
development;
ensuring that children grow up in circumstances consistent
with the provision of safe and effective care; and
taking action to enable all children to have the best
outcomes.
Source: DfE, 2013 Working Together to Safeguard Children
New S t e p For A f ri c a n Com m unityDifficulties in identifying FGM It’s a one-off event Rarely reasons for routine examination of girls’ genitalia Culture does not enable girls to discuss FGM openly
Girls are at increased risk of FGM if: Family come from a community that practices FGM – particularly a high prevalence community Mother has undergone FGM; Older daughters have undergone FGM; Mother and/or family believe that FGM is integral to cultural or religious identity The mother-in-law has a great deal of influence in the household; No-one has ever raised the issue of FGM with the family Children are being taken away for a prolonger period
Indications that FGM may have taken place….. A child may spend long periods of time away from the classroom during the day with bladder or menstrual problems Prolonged absences from School plus a noticeable behaviour change The child requiring to be excused from physical exercise without the support of their GP Recurrent urinary tract infections
What do I do? FGM is a child protection issue All females in a family should be considered within any assessment Managers must ensure that awareness of FGM is in place and staff are familiar with the agenda and indicators of risk and abuse FGM Greater Manchester Referral Pathway: http://greatermanchesterscb.proceduresonline.com/pdfs/gm_fgm_pathway.pdf
What do I do? Families who practice FGM don’t think of it as abuse. Professionals need to give families advice and information that is sensitive to their culture and beliefs but they need to make it clear that FGM is illegal.
Support Our Sisters
The SOS Model
Priorities
Engaging and supporting FGM communities
Peer Mentorship / Youth Programme
Holistic therapeutic services for families
Positive change and empowerment
Multi-agency approach
Education
CampaignSupport Our Sisters
The SOS Model
Beneficiaries
Beneficiaries: Apr17-March18
Direct beneficiaries: 543
Frontline workers benefiting: 54 (worked alongside Peer
Mentors)
Other people benefiting: 1437 (Through outreach)
Breakdown by age: (0-10: 69) (11-24: 177) (25-64: 288) (65 +: 9)
Breakdown by gender: Male: 127 Female: 416
Beneficiaries Apr18-Sept18
Direct benefit: 311 Frontline: 47 Outreach: 992FGM prevalence across GM (health data) Borough Apr – Jun 17 Jul – Sep 17 Oct – Dec 17 Jan – Mar 18 Total Bolton 35 50 45 40 170 Bury 5 10 5 10 30 Manchester 75 90 75 100 340 Oldham * 5 5 5 15 Rochdale * 5 5 10 20 Salford 20 20 10 15 65 Stockport * 5 5 15 30 Tameside 5 5 5 10 25 Trafford * 10 5 5 20 Wigan * 5 5 5 15
Sustainability through peer mentorship July 2014: 12 people successfully completed the training June 2015: 15 trained Peer Mentors May 2016: 15 trained Peer Mentors April 2017: 20 trained Peer Mentors November 2017: 25 trained Peer Mentors and Health Advocates (ASPIRE, INSPIRE) November 2018: 20 trained Peer Mentors and Health Advocates (ASPIRE, INSPIRE) Total: trained 107 (7 Male and 100 Female)
SAFEGUARDING AND SUPPORTING YOUNG GIRLS(UNDER 21)
AFFECTED BY FEMALE GENITAL MUTILATION(FGM)Why the Guardian Project?
Priorities
1. Culturally appropriate emotional support.
2. Co-ordinated and quality controlled professional support.
3. Strategic engagement with communities.
4. Review of referral routes.
5. Establishment of data recording practices.
6. Prevention and protection
7. Standard services: Safeguarding, Examination, Support
8. Referrals: 84 cases (Nov2016-Dec2017)
131 cases (Jan2018 – Jan2019)How to refer to The Guardian Project
Email – guardian.project@outlook.com
electronic referral form
Telephone: 07862 279289 / 07449651677
Mon – Fri; 9:30 – 5:30FGM – Useful resources Links:
All about FGM – Legislation
https://www.gov.uk/search?q=FGM
Poster awareness
https://www.gov.uk/government/publications/be-the-mother-who-ends-fgm-poster
(Ending Femal Genital Mutilation: Youtube video)
Case studies
https://www.gov.uk/government/publications/fgm-case-studies
Information Leaflet
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/300167/FGM_leaflet
_v4.pdf
Clinical Guidelines - Leeds
www.londonscb.gov.uk/files/resources/fgm_resources/b_fgm_clinical_guideline_leeds.doc
New S t e p For A f ri c a n Com m unityPsychological impacts (Mulongo et al., 2014)
http://www.academia.edu/13429465/Crossing_borders_Discussing_the_evidence_relating_to_the_
mental_health_needs_of_women_exposed_to_female_genital_mutilation
Clinical Guidelines - Leeds
www.londonscb.gov.uk/files/resources/fgm_resources/b_fgm_clinical_guideline_leeds.doc
First FGM Protection Order
http://www.theguardian.com/society/2015/jul/17/police-obtain-first-fgm-protection-order
Campaign to raise awareness of FGM in schools
http://www.gmpcc.org.uk/news/commissioner-backs-female-genital-mutilation-education-campaign/
GM FGM Protocol, produced by the GM FGM Forum:
http://greatermanchesterscb.proceduresonline.com/chapters/p_fgm.html
Royal College of Nursing FGM Guidance document
http://www.rcn.org.uk/__data/assets/pdf_file/0010/608914/RCNguidance_FGM_WEB2.pdf
New S t e p For A f ri c a n Com m unity‘The International Charter is calling for the eradication of FGM practice within a generation’.
“Yes, we can!”
THANK YOU!
For any further information or to find out how you can get involved in SOS projects to tackle FGM and
support the project
please visit us at:
www.nestac.org
or contact us at: info@nestac.org or call: 01706 868993 / 07862 279289
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