The World Health Organisation classifies FGM into four major types:
Type 1 – clitoridectomy: removing part of, or the entire, clitoris.
Type 2 – excision: partial or entire removal of the clitoris and the inner labia, with or without removal of the outer labia.
Type 3 – infibulation: narrowing of the vaginal opening through the creation of a covering seal, formed by cutting and reforming the labia, with or without removal of the clitoris.
Type 4 – other harmful procedures done to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and burning.
Short term effects and long term consequences of FGM
Short term effects include: severe pain, shock, bleeding, wound infections, inability to urinate, damage to other organs, and possibly death.
Long term consequences include: vaginal and pelvic infections, menstrual problems, difficulties passing urine and persistent urine infections, kidney damage and possible failure, cysts and abscesses, infertility, complications during pregnancy and childbirth, and the need for later surgery.
Girls and women who have been subjected to FGM may suffer psychological harm and trauma, including depression, anxiety, flashbacks, substance misuse and/or self-harm.
What does the law say about FGM?
FGM is illegal in the UK and has been a criminal offence since 1985. The Female Genital Mutilation Act 2003 strengthened existing law to make it an offence to arrange for a child to be taken abroad for FGM, and for UK nationals or permanent UK residents to abet, counsel, procure, or undertake FGM abroad, even in countries where the practice is legal. The Serious Crime Act 2015 extends this protection to girls under the age of 18 who are ‘habitually resident’ (or on short temporary stays), such as students and refugees.
The Serious Crime Act also creates a new offence of failing to protect a girl from FGM. If an offence of FGM is committed against a girl under the age of 16, each person who is responsible for the girl at the time the FGM occurred will be liable under this new offence, where the maximum penalty is seven years imprisonment, a fine, or both. A ‘responsible’ person will have parental responsibility for the girl, and frequent contact.
The 2015 Act also enables the High Court or family courts to make a Female Genital Mutilation Protection Order for individuals who are victims, or at risk, of FGM, similar to Forced Marriage Protection Orders (see the one minute guide on forced marriage). Victims or those at risk, or relevant third parties (including local authorities), can apply for the Orders, which set restrictions to protect an individual.
In addition, under the new Act, practitioners in regulated professions (health, teaching, social work) now have a mandatory duty to notify the police when they identify that an act of FGM appears to have been carried out on a girl under the age of 18. The duty applies when the practitioner is either informed by the girl, or where the practitioner has observed physical signs. Failing to comply with the duty will be dealt with through existing disciplinary measures which may include referral to the relevant professional regulator.
In Middlesbrough, regulated profession practitioners should complete a SAFER referral form (available on the Tees CPP website) and send to the Middlesbrough Multi Agency Children's Hub using the secure email address MiddlesbroughMACH@middlesbrough.gov.uk.
Practitioners, particularly those working in schools and in health services, should be aware of, and consider, potential indicators that FGM may be going to take place, or has already taken place, for example:
- preparations for the child to take a long holiday - arranging vaccinations or planning an absence from school
- a change in the child's behaviour after a prolonged absence from school, including being withdrawn, crying, or being away from class for long periods
- the child has bladder or menstrual problems, and/or may have difficulty walking, sitting, or standing
