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1.4.24 Female Genital Mutilation


Children Missing Education Procedure


In February 2018, in Related Guidance, a link was added to the DoH page on 'Safeguarding Women and Girls at Risk of FGM', which includes the guidance plus additional resources including a safeguarding pathway and risk assessment tools.

In Section 3, Referral and Assessment, additional information was added in relation to local arrangements for medical assessments.


  1. Introduction
  2. Legal Position
  3. Referral and Assessment
  4. Reporting Cases of Female Genital Mutilation
  5. Assessment
  6. Related Guidance

    Appendix 1: FGM Pathway (Flowchart)

1. Introduction

Female genital mutilation (FGM) is a collective term for procedures which include the removal of part or all of the external female genitalia for cultural or other non-therapeutic reasons. The practice is medically unnecessary, extremely painful and has serious health consequences, both at the time when the mutilation is carried out and in later life. The procedure is typically performed on girls aged between 4 and 13, but in some cases it is performed on newborn infants or on young women before marriage or pregnancy.

FGM is much more common than is generally realised both worldwide and in the U.K. It is deeply embedded into the culture of communities and intervention by statutory agencies may be resented.

FGM cannot be left to personal preference or cultural custom as it is an extremely harmful practice which violates basic human rights.

It is reportedly practiced in 28 African countries and in parts of the Middle and Far East, but it is increasingly found in Western Europe and other developed countries primarily among immigrant and refugee communities.

FGM has been classified by the World Health Organisation (WHO) into four types:

  • Type 1 – Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris);
  • Type 2 – Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are the ‘lips’ that surround the vagina);
  • Type 3 – Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris; and
  • Type 4 – Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterising the genital area.

2. Legal Position

FGM has been a criminal offence in the U.K. since the Prohibition of Female Circumcision Act 1985 was passed. The Female Genital Mutilation Act 2003 replaced the 1985 Act and made it an offence for the first time for UK nationals or permanent UK residents to carry out FGM abroad, or to aid, abet, counsel or procure the carrying out of FGM abroad, even in countries where the practice is legal. 

The Female Genital Mutilation Act 2003 was amended by the Serious Crime Act 2015. 

With effect from 3 May 2015, the law is extended so that:

  • A non-UK national who is ‘habitually resident’ in the UK and commits such an offence abroad can now face a maximum penalty of 14 years imprisonment. It is also an offence to assist a non-UK resident to carry out FGM overseas on a girl who is habitually, rather than only permanently, resident in the UK. This follows a number of cases where victims were unable to get justice as FGM was committed by those not permanently residing in the UK;
  • A new offence is created of failing to protect a girl from the risk of FGM. Anyone convicted can face imprisonment for up to seven years and/or an unlimited fine;
  • Anonymity for victims of FGM. Anyone identifying a victim can be subject to an unlimited fine.

On 17 July 2015, Female Genital Mutilation Protection Orders came into force.

Female Genital Mutilation Protection Orders are obtained in the Family Court like Forced Marriage Protection Orders. If you are concerned that someone may be taken abroad for FGM you can apply for a Protection Order. The terms of the order can be flexible and the court can include whatever terms it considers necessary and appropriate to protect the girl or woman.

From 31 October 2015, the new ‘mandatory reporting’ duty for professionals working in the ‘regulated professions’ comes into force. This requires them to notify the police if they discover that an act of FGM appears to have been carried out on a girl who is under 18 (either if they have visually confirmed it or it has been verbally disclosed by an affected girl). ‘Regulated professionals’ will cover healthcare professionals, teachers and social care workers. The only exception to the duty is if the professional knows that another individual from their profession has already made a report - there is no requirement to make a second.

Government Guidance Mandatory Reporting of Female Genital Mutilation – Procedural Information provides that social workers should not under any circumstances examine a girl for signs of FGM.

For the purposes of the duty, the relevant age is the girl’s age at the time of the disclosure or identification of FGM – it does not apply where a woman aged 18 or over discloses she had FGM when she was under 18.

The duty does not apply where there is merely a suspicion that a girl is at risk of undergoing FGM.

The duty only applies to cases directly disclosed by the victim: it does not apply where a disclosure is made by a third party such as a parent, guardian or sibling.

The Guidance states that complying with the duty “does not breach any confidentiality requirement or other restriction on disclosure which might otherwise apply.”

A failure to report the discovery in the course of their work could result in a referral to the relevant professional body.

3. Referral and Assessment

Suspicions may arise in a number of ways that a child is being prepared for FGM to take place abroad. 

If any agency becomes aware of a child who may have been subjected to or is at risk of FGM they must make a referral to One Call.

All professionals need to consider whether any other indicators exist that FGM may have or has already taken place, for example:

  • Preparations are being made to take a long holiday - arranging vaccinations or planning an absence from school;
  • The child has changed in behaviour after a prolonged absence from school; or
  • The child has health problems, particularly bladder or menstrual problems.

There may be older women in the family who have already had the procedure and this may prompt concern as to the potential risk of harm to other female children in the same family.

The Children’s Social Care Services team will liaise with the Paediatric services where it is believed that FGM has already taken place to ensure that a Medical Assessment takes place.

The medical assessment of children where there are concerns FGM has taken place is undertaken by the Forensic Team based at the Royal Victoria Infirmary, Newcastle. This team can be contacted 9am to 5pm on 0191 282 4753. Medical assessment for children who have undergone FGM can be very distressing for the child and medical assessments need to be planned around the child’s needs.

It should be remembered that this is a one-off act of abuse to a child, although it will have lifelong consequences, and can be highly dangerous at the time of the procedure and directly afterwards. 

4. Reporting Cases of Female Genital Mutilation

As from April 2014, NHS Hospitals are required to record:

  • If a patient has had Female Genital Mutilation;
  • If there is a family history of Female Genital Mutilation;
  • If a Female Genital Mutilation-related procedure has been carried out on a patient.

From September 2014 all acute hospitals must report this data centrally to the Department of Health on a monthly basis. This is the first stage of a wider ranging programme of work in development to improve the way in which the NHS will respond to the health needs of girls and women who have suffered Female Genital Mutilation and actively support prevention.

See also Information Standards Board for Health and Social Care Female Genital Mutilation Prevalence Datasheet Specification

5. Assessment

Children’s Social Care Services in consultation with the Police will undertake a Section 47 Enquiry if it has reason to believe that a child is likely to suffer or has suffered FGM.

Where a child has been identified as at risk of significant harm, it may not always be appropriate to remove the child from an otherwise loving family environment. Parents and carers may genuinely believe that it is in the girl’s best interest to conform to their prevailing custom.

Where a child appears to be in immediate danger of mutilation, legal advice should be sought and consideration should be given, for example, to seeking an Emergency Protection Order or a Prohibited Steps Order, making it clear to the family that they will be breaking the law if they arrange for the child to have the procedure.

6. Related Guidance

Multi-Agency Statutory Guidance on Female Genital Mutilation (2016)

Female Genital Mutilation Risk and Safeguarding – Guidance for Professionals (DoH)

DoH page on 'Safeguarding Women and Girls at Risk of FGM', which includes the guidance plus additional resources including a safeguarding pathway and risk assessment tools.

FGM Protection Orders: Factsheet

Statement opposing Female Genital Mutilation (Health passport)

Domestic Violence and Abuse - How Health Services, Social Care and the organisations They Work With Can Respond Effectively, NICE, 2014

Government Guidance - Female Genital Mutilation: Resource Pack

Information Standards Board for Health and Social Care Female Genital Mutilation Prevalence Datasheet Specification

Mandatory Reporting of Female Genital Mutilation – Procedural Information

Female Genital Mutilation and its Management: Royal College of Obstetricians and Gynaecologists 2015

Female Genital Mutilation (FGM): A Councillor’s Guide

Appendix 1: FGM Pathway (Flowchart)

Click here to view Appendix 1: FGM Pathway (Flowchart)