Female Genital Mutilation

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Beverly Harvey
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1 What is it? Female Genital Mutilation Range of cultural practices to alter genitalia WHO divides it into types University College Hospital, London Dr K Robinson, Dr D Hodes, Dr J Simpson th Oct Why is it important? Legal Human rights Safeguarding Physical and psychological consequences Data estimates difficult to commission services Convention on the Rights of the Child (989) Article states: Parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children Milestones Project Azure

Map developed by UNICEF, 7 Practice is on the increase Ref: A Statistical Study to Estimate the Prevalence of Female Genital Mutilation in England and Wales: Summary Report, FORWARD

2 Geographical distribution Statistics FORWARD UK Over, girls under the age of 5 are potentially at risk of FGM in England and Wales., girls aged 8 or younger at high risk of WHO Type III FGM 5, at high risk of WHO Type I or Type II. <%.-5% 5.-5% 5.-75% >75% No data Source: MICS, DHS and other national surveys, 997. Map developed by UNICEF, 7 Practice is on the increase Ref: A Statistical Study to Estimate the Prevalence of Female Genital Mutilation in England and Wales: Summary Report, FORWARD What we did at UCLH Women Age distribution of clinic attenders 5 AttendanceType New Age Distribution of Clinic Attenders Count of LocalPatientIdentifier 8 ClinicListCode SMCW SMC5A SMCA AgeAtEncounter

Attendances between 5 Attendances between 5 and number of patients 5 Children 5 7 8 9 year of clinic attendance Safeguarding Clinic for Children and Young People The safeguarding clinic is a

This tertiary referral clinic is held monthly and accepts referrals from across North London. Referrals can be made by representatives from health or social care.

3 Attendances between 5 Attendances between 5 and number of patients 5 Children year of clinic attendance Safeguarding Clinic for Children and Young People The safeguarding clinic is a comprehensive tertiary clinical service at UCLH dedicated to vulnerable children and young people who have been sexually abused or have problems related to sexual and gynaecological health. This tertiary referral clinic is held monthly and accepts referrals from across North London. Referrals can be made by representatives from health or social care. Children seen include those with long-term/delayed disclosure of sexual abuse, female genital mutilation, trafficked children, street workers, looked after children and those with sexually transmitted infections. We hope that our referring colleagues can use the information we provide to inform and contribute towards the local child protection plan. We also welcome members of local agencies to attend with the child to allow improved communication and training. Role of the paediatrician Diagnosis Physical and psychological consequence Future pregnancies Siblings and collaboration with police Prevention The Team Dr Deborah Hodes: Consultant Community Paediatrician, child protection advisor for University College Hospital and named and designated doctor for child protection in Camden. She has extensive expertise in all aspects of child abuse, regularly works at the Haven and provides support for several boroughs in cases of child sexual abuse. Dr Joanna Begent: Consultant Paediatrician and named doctor for child safeguarding. Her specialist area of interest is adolescent medicine. There is also easy access to play specialists, genitourinary medicine specialists and paediatric gynaecology. Paediatric outcome of referrals in last years Origin of child and location of FGM Origin of Child and where FGM was carried out 8 7 number of cases 5 origin where done Gambian Somalian Ethiopian Zambia Kenya unknown country

Age of FGM and presentation Flow chart to illustrate referral pathway for a woman with FGM detected antenatally age of FGM and presentation (n=) WOMAN WITH FGM Diagnosis of FGM on examination age 8 8

Clinic maternity notes) FGM identified at delivery by midwife or obstetrician (document in maternity notes) Document that mother has FGM identified by neonatal SHO FGM on page where from maternity

4 Age of FGM and presentation Flow chart to illustrate referral pathway for a woman with FGM detected antenatally age of FGM and presentation (n=) WOMAN WITH FGM Diagnosis of FGM on examination age 8 8 age of presentation age at FGM Linear (age of presentation) Linear (age at FGM) FGM identified by direct questioning at antenatal booking Referral made to African appointment (document in Women s Clinic maternity notes) FGM identified at delivery by midwife or obstetrician (document in maternity notes) Document that mother has FGM identified by neonatal SHO FGM on page where from maternity notes neonatal newborn examination is recorded in red book (copy in baby Woman and baby discharged to notes) community. Community midwife made aware of FGM Counselling and/or reversal procedure if required Discussion with woman about FGM, its legal status in the UK and her intention regarding FGM towards any female offspring. Female siblings and other female children to also be considered. If at any point an individual has concerns that a child may be at risk then refer to social services Say no to FGM flyer put into red book by SHO Care of family taken over by health visitor. Health visitor made aware of FGM Implementation Multi professional launch at UCLH Dec 9 Multiple stakeholders with varying priorities Effectiveness only evident in 5+ years Conclusion FGM affects children in UK Important for all professionals working with children from practising communities to think about it to ask about it to develop guidelines for management and prevention Continue close collaboration with adult clinic Continue education and involvement of local community health teams and police Age range of patients 5 Age Range of Patients age of patient year of clinic attendance

5 Flow chart to illustrate referral pathway for a child at risk of FGM Girl at risk Why FGM came to attention Speak to Camden Child Protection Advisor (tel. 75 8) No concerns 7 Refer to Camden Social Care (tel. 797 ) and follow up with written referral within 8 hrs (fax ) st strategy meeting (within days of referral) nd strategy meeting (within days of referral) No action Counselling and medical help offered, if FGM already evident. Younger sisters and unborn girl babies to be considered and protected 5 CP conference No Child Protection Plan Child Protection Plan Voluntary engagement SW to initiate legal steps under Children Act 989:-. Prohibited Steps order. Prohibited Steps order + Supervision Order. Reception into looked after system family dispute sibling/cousin said child said mother alleged What was the word FGM history Pictures Locally collected data Practice we implemented Problems Monitoring Year FGM carried out Year FGM carried out (n=) Relevant legislation Human rights treaties which are relevant to FGM : Article 5 of the Universal Declaration of Human Rights (prohibition of torture or inhuman or degrading treatment); Article of the Convention on the Rights of the Child (CRC) (gender equality); Article 9() of the CRC (prohibition of all forms of mental and physical violence and maltreatment); Article () of the CRC (right to the highest attainable standard of health); Article 7() of the CRC (States must take effective and appropriate measures to abolish traditional practices prejudicial to the health of children) Year FGM carried out Year FGM carried out (n=)

6 Reasons given for practising FGM Ancient beliefs women s fertility, control of sexual and reproductive capacity aesthetic reasons Rite of passage into womanhood

Female Genital Mutilation

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