Female genital mutilation – care and prevention

Female genital mutilation (FGM) is a procedure where the female genitals are deliberately cut, injured or changed, but where there’s no medical reason for this to be done.

FGM is usually carried out on young girls between infancy and the age of 15, most commonly before puberty starts. It is illegal in the UK and is child abuse.

It’s very painful and can seriously harm the health of women and girls. It can also cause long-term problems with sex, childbirth and mental health.

The FGM Prevention programme

The FGM Prevention programme launched in July 2014 at the Girl Summit, as part of the wider Government commitments to eradicate FGM within a generation.  The programme aims to improve the way in which the NHS responds to the health needs of girls and women who have had FGM, and to actively support prevention, with a motto of ‘care, protect and prevent’.

Within a multi-agency and cross-Governmental approach to tackling FGM, this recognises the unique contribution the NHS must bring to the approach, which is to provide appropriate healthcare services to the women and girls affected, and recognising that NHS professionals have a critical role when it comes to safeguarding women and girls.

One of the key outputs from the FGM Prevention programme has been to introduce standards around what information was recorded within healthcare records about FGM and a collection of this information from across the NHS, collecting from Acute and Mental Health Trusts, and from GPs.

The Department of Health developed the policy, NHS Digital was commissioned to develop and deliver the information standards and the data collection itself, and they continue to analyse and publish anonimised reports from the data. NHS England’s role was to make sure providers were aware they had to collect, what they needed to collect, how to practically implement the policy and what the analysis informed us about provision and commissioning.

The team work most closely with providers, specialist services related to FGM, clinicians and safeguarding professionals but ensure that their work reaches all health staff.

From this work, we know that over 5,700 patients were treated in the NHS between April 15 and March 16 for FGM for the first time, and much more detail is now available to help commissioners understand what is needed by their patient population to inform the provision of services.

Achievements over the last year

Other achievements of the programme, run in partnership between NHS England and the Department of Health in 2016/17 include:

  • A patient and community public health campaign, where over 750K people saw a television broadcast of a community-led video about FGM and why it isn’t needed, with over 660K people seeing the same campaign on Facebook
  • Regional awareness and training events, reaching thousands of healthcare professionals across England
  • New eLearning session by Health Education England hosted on the eLearning for Healthcare about FGM and mental health
  • Continuing with the early adopter phase of the FGM Risk Indicator System (FGM RIS), which shares information safely between appropriate professionals to support ongoing safeguarding of girls potentially at risk of FGM
  • A huge effort to inform professionals of the duty to report to the police if you know that a girl under 18 has had FGM, known as the ‘FGM mandatory reporting duty’.

The work of the group both nationally and in each region has contributed to raising awareness of FGM, training in and help with communication skills in relation to FGM, collecting prevalence data, influencing the process on the  legal duty to report and looking at commissioning of services.

Future plans for the subgroup

The plan is to focus on how to embed all the changes to practice which have been recently introduced, including the FGM mandatory reporting duty, making sure that practice across the NHS is consistent and focused on safeguarding girls from harm.

We also want to look at the mental health needs of patients, to continue developing commissioning guidance and working with commissioners to use this to make sure the services needed are available and to launch the national implementation of the FGM RIS project.

Alongside this, we will continue to review progress made, make sure that the right guidance and support is available to staff. We will work with social care, education and the police colleagues nationally and at a regional level to focus on making FGM prevention a truly multi-agency effort.

FGM – some key statistics and useful documents/links

  • Service standards for commissioning FGM care
  • Between Apr 15 and Mar 16, over 5700 patients with FGM were treated in the NHS for the first time.
  • Where country of birth is known, 10% of patients treated were born outside Africa.
  • Where the FGM Type is known, Types 1 and 2 have the highest incidence (35 and 31 per cent respectively).
  • Over 50% of patients treated in the NHS were treated and live in London
  • More than 200 million girls and women alive today have been cut in the 30 countries in Africa, Middle East and south east Asia where FGM is continues to be practised.
  • FGM is mostly carried out on young girls sometime between infancy and age 15.
  • FGM is a violation of the human rights of girls and women. WHO, February 2014
  • FGM Pocket Guide for Health Professionals
  • FGM Prevention programme publications – policy and guidance for professionals
  • Information for patients