Female Genital Mutilation

1. Female Genital Mutilation

2. Aims of the workshop We will look at: • Types of FGM • The origin and history of FGM • Children at risk • How to recognise if FGM has happened or is going to happen • Health implications of FGM • The law and FGM • Role of safeguarding and referral processes • PSHE education and FGM

3. Key Facts • Female genital mutilation (FGM) is the partial or total removal of external female genitalia for non-medical reasons. It's also known as female circumcisionor cutting. • This procedure has no health benefits. • FGM is mostly carried out on young girls sometimes between infancy and age 15. • Often FGM takes place in the parents country of origin and the child is taken abroad at the beginning of the school holidays (usually summer holidays) so to allow time for healing. • FGM is a violation of the human rights of girls and women.

4. Female Genital Mutilation – A victims journey

5. I only became aware of how much I’d been affected psychologically by female genital mutilation (FGM) when I fell pregnant. I was severely depressed and I hated being vaginally examined; it was my worst nightmare. And I remember the doctors wondering: why is she so scared? I realized later it was my body experiencing flashbacks, reminding me of what had happened to me when I was six. The day I was cut, in Somalia, I had no idea what was about to happen. When I woke up there were so many people in the house I thought we were celebrating something. But it wasn’t my birthday. The neighbour’s daughter turned to me and said “You must be really looking forward to this”. As she spoke I heard my sister screaming. It was an out of body experience; this girl was saying I was going to be cut and I thought, that’s not right, but I was in shock. Someone said: “Go get Leyla, it’s her turn”. I was pinned onto the table by four women. They said “it's not going to be painful, silly girl”. Apparently they gave me an injection to numb it, but I felt everything, I felt my flesh being cut off.

6. After you're cut you're given presents, chocolates, sweets – me and my sister actually got gold watches. You’re abused, but you're rewarded for it. It leaves you with a massive sense of confusion about people you trust. Years later when I was training to be a therapist I confronted my mother. She had believed it was the right thing to do at the time, but she also protected me. She told everyone that I had gone through Type 3 (the most severe form) rather than Type 2. By having this conversation and receiving her apology, I was freed from this confusion. I knew that I would never let my daughter go through this ordeal.

7. FGM is a form of identity. Women in my community worry that they won’t be considered a good Somali woman if they haven’t undergone FGM.  But let’s be clear: this is a practice that controls women's sexuality, and it continues today because we still live in an environment where women are restricted. People need to be educated. I didn’t know how much FGM had affected me psychologically until I had the right knowledge. No child is going to come out and testify against their parents. At the same time we need to exercise the law because FGM is a human rights violation and these girls deserve justice. But we need to recognize that if you arrest a mother, she might also be a victim.  Our focus now must be on prevention. The UK government needs to implement the multi agency guidelines that it has published and make them mandatory. We have this great tool but it’s collecting dust. Our schools are not talking about this; the NHS is not talking about this. Teachers should be trained to notice the little girl who can’t sit on the floor properly. Or the girl who takes 20 minutes to urinate, but no-one questions why, so she gets detention.

8. When I started counseling survivors of FGM, I made an assumption that all women would have the same story, but I actually don't know two similar accounts. One woman I spoke to can’t have children. She was told she had to be cut to be a perfect woman, but at that moment her right to motherhood was also cut from her. The counseling I provide is a space for these women to make sense of what happened to them, to acknowledge that they suffered a form of child abuse. I’m now hoping to train therapists so they can identify survivors of FGM and help them deal with its complications. My 11-year-old daughter recently said to me: “I'm so grateful you never made me go through something like this”.  She's my biggest accomplishment. Leyla Hussein Independent Newspaper October 2013

9. What age is FGM carried out? Who carries out FGM? • Any age – can be any age up to marriage and beyond (key age 5-13) • Usually the child’s grandmother or aunt carries out FGM or in some communities there is a named “cutter”. • It is often carried out with no anaesthetic and the child will often be held down by family/loved ones while this is being completed.

10. Types of FGM

11. Type 1. Clitoridectomy – total or partial removal of the clitoris and/or the prepuce (skin fold surrounding the clitoris)

12. Type 2. Excision – Partial or total removal of the clitoris and the labia minora with or without the excision of the labia majora

13. Type 3. Infibulation – narrowing of the vaginal orifice with creation of a covering seal by cutting and bringing together (sewing) the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation)

14. Type 4. Other (most likely to cause health implications)- All other harmful traditional practices that mutilate the female genitalia, including pricking, cutting, piercing, incising, scraping and cauterisation.

15. The origins and history of FGM • FGM is a deeply rooted tradition, widely practiced among specific ethnic populations in Africa and parts of the Middle East and Asia. • FGM is believed to have started in 5th century BC and began because men wanted to control women’s sexuality. • It has become ingrained in the culture and accepted as social norm. • Between 125 million and 200 million girls and women alive today have been cut globally. • In the UK there are over 130,000 women living with FGM. • In February 2019 a woman who mutilated her three-year-old daughter became the first person in the UK to be found guilty of female genital mutilation (FGM).

16. Justifications Many affected communities believe that FGM is a necessary custom to ensure that a girl is accepted within the community and eligible for marriage. Other reasons include:- • Perceived health benefits • Preservation of the girls virginity • Cleanliness • Rite of passage into woman-hood • Status in the community • Protection of family honour • Perceived religious justifications (there are no religions that advocate for FGM).

17. Countries where FGM is prevalent • Traditionally, it is carried out in 29 countries in Africa and parts of Asia, Latin America and the Middle East. • Due to migration, FGM is now practiced globally.

19. FGM within the UK • More prevalent in areas with larger communities from FGM practising countries e.g. Birmingham, Manchester, Cardiff. The Independent November 2018 “The number of girls identified as victims of female genital mutilation (FGM) or being at risk has more than doubled in a year as campaigners warn the practice is significantly under-reported. New figures show that FGM was listed in 1,960 social work assessments by councils in 2017/18, compared to 970 cases the previous year.”

20. Female Genital Mutilation – Physical and Mental Health Implications NSPCC Film

21. Physical health implications • Blood loss • Fractures/dislocations during constraint • Injury to adjacent tissues • Severe pain/shock • Infertility • HIV infection • Infection/cysts/urinary retention • Hepatitis • Painful intercourse • Difficulty with childbirth/pregnancy • Difficulty in menstruation • Death

22. Emotional health implications • Depression and post natal depression • Low self esteem • Post traumatic stress disorder • Low libido due to traumatic experience • Flashbacks • Anger towards parents • Can result in affective/anxiety disorders • Psycho-sexual problems

23. Those more at risk • A member of a community whose country of origin practices FGM and that are less integrated into the British society. • Girls who have parents/family who have been subject to FGM. • Girls who have withdrawn from personal, social and health studies as a result of her parents wanting to keep her uninformed about her body and rights.

24. How to recognise if FGM is going to happen • The girl is travelling abroad to visit family for a long period of time, especially at the beginning of the holidays OR the parents advise that the child’s relatives are taking the child out of the country. • Vaccinations may also take place to travel. • The girls elder relatives are visiting from the countryof origin. • The girl may confide in a teacher/friend regarding having a ‘special procedure’ or has a party or presents to celebrate their transition into adulthood or becoming a “woman”.

25. Indications that FGM has taken place • Noticeably appearing withdrawn/ low in mood / change in behaviour • Change in dress from tight to loose fitting clothing • Menstrual problems • Frequent need to visit the toilet or spending longer in the bathroom • Reporting pain after visiting the toilet or complaining about pain between legs • Recurrent urinary tract infections • Prolonged absences from school • Particularly worried to attend medical appointments. • Asking for help but not being specific about what the concern is • Difficulty sitting down comfortably or standing and walking for long periods of time • Talk of something someone did to them, that they are not allowed to talk about

26. Children are taught to believe that: “Genital organs are ugly and dirty” “Genital organs should look flat” “The clitoris will harm babies during childbirth” “No one will want to marry you”

27. The Female Genital Mutilation Act 2003 It is an offence to perform FGM in the UK or abroad, regardless of nationality or residence status. It is an offence to assist the carrying out of FGM in the UK or abroad or assist a girl to carry out FGM herself. Under the 2003 Act, a person is guilty of an offence if they excise, infibulate or otherwise mutilate the whole or any part of a girls or woman’s labia majora, labia minora or clitoris, except for necessary operations performed by a registered medical practitioner on a physical/mental health grounds.

28. The Serious Crime Act 2015 The Serious Crime Act 2015 extended the FGM Act 2003 to make it an offence for anyone with parental or caring responsibility of a girl to fail to protect her from FGM. The act has also made it a legal requirement to regulate Health and Social care professionals and teachers to report visually confirmed or verbally disclosed cases of FGM of girls under 18. This Act can also protect girls from travelling abroad for FGM by the surrendering of their passport. Doctors, nurses, midwives and teachers are legally required to report cases of female genital mutilation (FGM) to the police. Failure to do so will result in disciplinary measures and could ultimately lead to them being barred from working.

29. The Role of Safeguarding

30. Role of safeguarding • FGM is child abuse and a form of violence against women and girls and therefore should be dealt with as part of existing child and adult safeguarding procedures. • FGM needs to be included in safeguarding policies in your school. • Due to the nature of this topic, it is important for school staff members to have supervision/in house support if they are dealing with cases of FGM.

31. PSHE education We need to ensure that we are giving the pupils the skills they need to keep themselves safe. Pupils need to be able to recognise when they and others are confused, worried or at risk. Pupils need to be able to recognise when they need help, who to go to and how to ensure they are listened to. Our aim is to provide pupils with knowledge, understanding, language, skills, strategies, the self-belief and confidence they need to recognise, challenge and protect themselves and others from all forms of exploitation and abuse. We must provide pupils with the knowledge and understanding they need to ensure that their generation recognise abusive acts and help prevent them in the future.

32. Primary: Whilst on morning duty you overhear a parent talking to another parent, they are planning a family holiday to visit relative in Egypt. The mother advises the other parent that they are going to have a special ceremony for their daughter whilst they are there.What should you do immediately? What actions would you take in the longer term?If you felt that you needed further advice who would you speak to?

33. Taking action – your role If you suspect FGM will happen or has happened then: Remember the ‘One Chance Rule’ – it may be your only chance to intervene and assist Contact the police by calling 101, the single non-emergency number - when you call 101, the system will determine your location and connect you to the police force covering that area. Where there is a risk to life or likelihood of serious immediate harm, professionals should report the case immediately to police, including dialing 999 if appropriate. Do not discuss with the child’s parents

34. Taking action – your role You can seek guidance from NSPCC telephone number 08000283550 or via email fgmhelp@nspcc.org.uk Seek advice from Family Operations Hub 0845 6037627 FOH@essex.gcsx.gov.uk Document as per your safeguarding policy

35. Resources Everybody’s Business- new website launched to educate young people about the practice and how it can be prevented. Books- ‘Not now Bernard’- David McKee. ‘The huge bag of worries’ – Virginia Ironside. ‘Once there were giants’ – Martin Waddell. http://forwarduk.org.uk/ https://www.freedomcharity.org.uk/ http://nationalfgmcentre.org.uk/ http://petals.coventry.ac.uk/ - resource/app for children https:www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/female-genital-mutilation-fgm///?utm_source=twitter&utm_medium=tweet&utm_content=fgm_organic_tweet&utm_campaign=twitter_generic