Local Family Justice Board/MMU Conference
Manchester Business School
11th September 2015
Faye Macrory MBE
Consultant 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?
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FGM is practiced in over 28 African countries
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Parts of the Middle East, Yemen, Syria. in N. Iraq and
other Kurdish areas
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Reported among Bhora Muslims in Pakistan, India and
East Africa, Indonesia, Malaysia, Papua New Guinea
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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:
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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
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haemorrhage
shock
acute urinary retention
damage to other organs
infection
failure to heal
death
Long term complications of FGM:
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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:
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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:
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Trust Lead nominated for FGM Agenda
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FGM Steering Group established
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Online Data collection tool developed and implemented Trustwide. Enhanced Data Set Mandate from April 2015
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FGM standing item on CMFT Adult & Children’s Safeguarding
Groups
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Representation on local and regional forums
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Presenting at local and national conferences
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Distribution of resources
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Training sessions across CMFT
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Expertise of the specialist MW (refugee/asylum seekers)
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Recognition of unmet psychological/mental health needs
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Community engagement identified e.g. SOS Clinic (NESTAC)
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Early referral to SMH Warrell Unit re de-infibulation
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British Journal of Midwifery Awards March 2015
Nursing Times Awards November 2015
Useful websites
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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.elfh.org.uk/programmes/female-genital-mutilation/
Safeguarding:
https://www.gov.uk/government/publications/safeguardingwomen-and-girls-at-risk-of-fgmwww.hsic.gov/fgm/fgm
Commissioning services:
https://www.gov.uk/publications/services-for -women-andgirls-at-risk-of-fgm
GP Practices CAP registration: www.hsic.gov.uk/fgm
https://www.gov.uk/government/consultations/consultation-on-thedraft-statutory-multi-agency-practice-guidance-on-female-genitalmutilation-fgm.
Recent developments:
The Serious Crime Act 2015 strengthens the law around FGM by
extending the extra-territorial jurisdiction of the offence. In
summary:
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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?