Female Genital Mutilation (FGM) Enhanced Dataset

Female Genital Mutilation (FGM) Enhanced Dataset April 2016 to March 2017, England, experimental statistics Published 4 July 2017 The Female Genital Mutilation (FGM) Enhanced Dataset (SCCI 2026) supports the Department of Health s FGM Prevention Programme by presenting a national picture of the prevalence of FGM in England. Key findings Between April 2016 and March 2017 there were 9,179 attendances 2 reported at NHS trusts and GP practices where FGM was identified or a procedure for FGM was undertaken. 87 per cent of these attendances were in midwifery or obstetrics services, where this was reported. Data for the treatment area was recorded for six in every ten attendances. The average age at attendance was 31 years. 95 per cent of the women and girls first recorded in the data in 2016/17 had undergone FGM before they were 18 years old. This information was recorded for three in ten women and girls. 13% Setting 33% 54% Midwifery Service Obstetrics Other Author: Clinical Audit and Registries Management Service, NHS Digital Responsible Statistician: Peter Knighton Copyright 2017 Health and Social Care Information Centre. NHS Digital Copyright is a trading 2016, name Health of the Health and Social and Social Care Care Information Information Centre. Centre. 1

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 - March 2017, experimental statistics Contents Key findings 1 Introduction 4 About the Data 6 Chapter 1: Submissions 9 Number of submitting organisations 9 Number of attendances 9 Chapter 2: Newly recorded women and girls, and total attendances 10 FGM Type 11 Age at attendance 12 Age undertaken 13 Age undertaken by type 14 Country of birth 15 Country of birth by type 16 Country where FGM was undertaken 17 Country where FGM was undertaken by type 18 Country where FGM was undertaken by age undertaken 19 Daughters under the age of 18 20 Daughters born at this attendance 21 Deinfibulation 22 Health Implications 23 Illegalities of FGM 24 Chapter 3: Additional Information 25 Treatment function 25 Data completeness and validity 26 Submissions and Attendances 27 Individual Country Information 31 Chapter 4: Reference 33 Notes 33 Definitions 40 Copyright 2017, Health and Social Care Information Centre. 2

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 - March 2017, experimental statistics This is an Experimental Statistics publication This document is published by NHS Digital, part of the Government Statistical Service Experimental statistics are official statistics which are published in order to involve users and stakeholders in their development and as a means to build in quality at an early stage. It is important that users understand that limitations may apply to the interpretation of this data. More details are given in the report. All official statistics should comply with the UK Statistics Authority s Code of Practice for Official Statistics which promotes the production and dissemination of official statistics that inform decision making. Find out more about the Code of Practice for Official Statistics at www.statisticsauthority.gov.uk/assessment/code-of-practice Find out more about Experimental Statistics at https://gss.civilservice.gov.uk/wp-content/uploads/2016/02/guidanceon-experimental-statistics_1.0.pdf ISBN 978-1-78734-052-7 This report is of particular interest to the Department of Health in support of the FGM Prevention Programme. It may also be of interest to healthcare providers and commissioners to monitor the quality and effectiveness of services, to researchers and charities working on this subject and to members of the public. Copyright 2017, Health and Social Care Information Centre. 3

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 - March 2017, experimental statistics Introduction Female Genital Mutilation (FGM) refers to procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. FGM has been illegal in the United Kingdom (UK) since 1985, with the law being strengthened in 2003 to prevent girls travelling from the UK and undergoing FGM abroad. The FGM Enhanced Dataset (FGMED) supports the Department of Health s FGM Prevention Programme by presenting a national picture of the prevalence of FGM in England. Data is collected by healthcare providers in England, including acute hospital providers, mental health providers and GP practices. This annual report covers attendances between April 2016 and March 2017. Additional analyses and breakdowns by Local Authority, NHS Trust and Clinical Commissioning Group (CCG) are provided on the publication landing page. The Data Quality Statement accompanying this report provides further information on the publication and data. The technical standard (SCCI 2026) for the dataset provides further information on the collection. Organisations were requested to ensure all data up to the end of March 2017 was complete in the collection system by the beginning of May 2017. The collection system allows updates to historic information. The extract for this report was taken on 19 June 2017. Participation 123 NHS trusts and 74 GP practices submitted one or more FGM attendance record. It is mandatory for acute hospital providers, mental health providers and GP practices to submit to the FGMED (SCCI 2026 Information Standards Notice). Comparison with previous year s report An Annual Report covering the 2015-16 collection year was published on 21 July 2016. Caution needs to be taken when making comparisons with this report. In the first year of collection organisations were not mandated to submit data for the full period. It became mandatory for all acute trusts to collect and submit to the FGM Enhanced Dataset from 1 July 2015 and for all mental health trusts and GP practices, from 1 October 2015. Further information on the number of organisations submitting can be found in table 1.1. Data completeness also remains an issue in this second annual report. There has been an improvement in many data fields, but variability between years, in addition to low completeness in most cases, could make comparisons unreliable. Further information on data completeness can be found in table 3.2. Copyright 2017, Health and Social Care Information Centre. 4

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 - March 2017, experimental statistics Given these limitations, this report focuses on activity within this year. The figures quoted for 2015-16 are based on the database as it was at the beginning of May 2017. As such they may differ from previously published figures. For the first two years the concepts of newly identified cases and attandances have been important. As the data matures a look at unique women and girls, whether they are newly recorded or not, will become more meaningful. In the next year of quarterly reports this is something that it is planned will be reported on. Copyright 2017, Health and Social Care Information Centre. 5

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 - March 2017, experimental statistics About the Data 1. About the Data: When is the data collected? Data is collected when the FGM is identified in a healthcare setting. Nearly 90% of these attendances are in Midwifery and Obstetric services. *Within healthcare data this is referred to as Treatment Function. It is known in 59 per cent of records in the FGM Enhanced Dataset. 2. About the Data: Age when FGM was Under 1 1-4 5-9 10-17 18+... carried out 18 21 44 12 5 31 Known... newly recorded 97 100 0% 20% 40% 60% 80% 100% 0% 25% 50% 75% 100% a The average age at attendance was 31. 95 per cent of the women and girls were under 18 when the FGM was undertaken Of these, the FGM was undertaken c over 10 years ago in 98 per cent of cases. a Mean and median of 31, mode of 30. b We are aware that records for some babies without FGM have been entered into the dataset in error and are working with the affected organisations to delete these records. c Age at undertaking is recorded as within an age band in the data. The median of the age band has been used for this calculation. Values are only known for 30 per cent of women and girls. Copyright 2017, Health and Social Care Information Centre. 6 b.

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 - March 2017, experimental statistics 3. About the Data: Country of birth 88 4 8 46 Known FGM carried out 89 4 7 26 0% 20% 40% 60% 80% 100% Africa UK Other 0% 25% 50% 75% 100% Where both values were known, 87 per cent of women and girls were born and had FGM undertaken in an African country. The majority of cases undertaken in the UK are known to be piercings. 4. About the Data: Attendance and Newly Recorded Newly Recorded women and girls with FGM are those who have had their information collected in the FGM Enhanced Dataset for the first time. Newly recorded does not necessarily mean that the attendance is the woman or girl s first attendance for FGM, or that the FGM was undertaken recently. Attendances refers to all attendances in the reporting period where FGM was identified. A woman or girl may have one or more attendances in the reporting period. This category includes both newly recorded and previously identified women and girls. 5. About the Data: Data Suppression The data is suppressed to minimise the risk of individuals being identified. Numbers of 5 or more are rounded to the nearest 5. Zeroes, and numbers 1 to 4 are replaced with *. National numbers are shown unsuppressed in many cases. Copyright 2017, Health and Social Care Information Centre. 7

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 - March 2017, experimental statistics 6. About the Data: Data Quality Not all data fields are complete in the FGM Enhanced Dataset. Much of the data presented in this report is accompanied by a chart or table entry detailing the completeness. Copyright 2017, Health and Social Care Information Centre. 8

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 - March 2017, experimental statistics Chapter 1: Submissions Number of submitting organisations Table 1.1: Number of organisations submitting attendance data by year, England, April 2015 to March 2017 Organisation type 2015/16 2016/17 Any time NHS trust 120 123 137 providing mental health services 1 16 13 19 not providing mental health services 1 104 110 118 GP practice 57 74 96 177 197 233 Notes: 1. Trusts that provide mental health services are derived from the Care Quality Commission (CQC). Trusts that provide mental health services may also provide other health services. Number of attendances Table 1.2: Number of attendances by year, England, April 2015 to March 2017 Number Year Newly recorded 1 attendances 2 2015/16 6,080 9,223 2016/17 5,391 9,179 11,471 18,402 Notes: 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. Women and girls may have one or more attendances in the stated period. This includes both newly recorded and previously recorded women and girls. An attendance will be when a woman or girl with FGM has had treatment for her FGM or given birth to a baby girl, or when FGM has been identified. Additional information on data submissions can be found in Chapter 3. Copyright 2017, Health and Social Care Information Centre. 9

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 - March 2017, experimental statistics Chapter 2: Newly recorded women and girls, and total attendances The following chapter provides one page summaries of key FGM Enhanced Dataset (FGMED) variables split by either NHS Commissioning Region (NHSCR), FGM Type, or Age that FGM was Undertaken. Copyright 2017, Health and Social Care Information Centre. 10

Not recorded 4 Type Unknown Type 1 Type 2 Type 3 Type 4 History of FGM Type 3 FGM Type 3 - Reinfibulation identified Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics FGM Type Figure 2.1: Newly recorded 1 women and girls: by FGM Type, England, April 2016 to March 2017 Definitions Notes Table 2.1: Newly recorded 1 women and girls: by FGM Type, England, April 2016 to March 2017 Commissioning region 2 FGM Type 3 London 210 1,355 360 275 265 45 45 10 2,560 Midlands and East of England 50 390 215 195 145 70 10 * 1,070 North of England 50 630 150 175 90 70 * 10 1,175 South of England 50 285 95 50 40 20 35 * 580 361 2,660 819 694 542 203 94 18 5,391 At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Caution! Only 44% of newly recorded women and girls have a known 5 FGM Type recorded. Regionally, the proportion of known values varies between 39 and 59 per cent. Copyright 2017, Health and Social Care Information Centre. 11

Unknown Under 16 16-17 18-24 25-29 30-34 35-39 40-44 45-49 50+ Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Age at attendance Figure 2.2: Newly recorded 1 women and girls by age at attendance, England, April 2016 to March 2017 Definitions Notes Table 2.2: Newly recorded 1 women and girls: by age at attendance, England, April 2016 to March 2017 Commissioning region 2 Age at attendance 3 London * 85 15 245 635 775 515 225 50 20 2,560 Midlands and East of England * 10 * 140 295 320 200 75 20 10 1,070 North of England * 20 5 165 330 335 200 80 20 15 1,175 South of England * * * 75 140 190 125 40 * * 580 2 114 25 625 1,400 1,624 1,039 419 95 48 5,391 At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Almost 100% of newly recorded women and girls have a known 5 date of birth recorded. Almost three-fifths of the newly recorded cases of FGM involved women aged 30 and over at the time of their attendance. Copyright 2017, Health and Social Care Information Centre. 12

Not recorded Did not say Under 1 1 and under 5 5 and under 10 10 and under 15 15 and under 18 18 and over Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Age undertaken Figure 2.3: Newly recorded 1 women and girls by age FGM was undertaken, England, April 2016 to March 2017 Definitions Notes Table 2.3: Newly recorded 1 women and girls: by age FGM was undertaken, England, April 2016 to March 2017 Commissioning region 2 Age FGM was undertaken 3 London 1,415 250 115 195 450 100 10 20 2,560 Midlands and East of England 485 210 110 90 130 20 * 30 1,070 North of England 370 545 60 45 90 30 5 25 1,175 South of England 330 115 10 20 70 25 * 10 580 2,603 1,115 299 355 739 173 21 86 5,391 At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Caution! Only 31% of newly recorded women and girls have a known 5 age when FGM was undertaken. The age undertaken was under 10 in over four-fifths of the newly recorded cases. Copyright 2017, Health and Social Care Information Centre. 13

Not recorded Did not say Under 1 1 and under 5 5 and under 10 10 and under 15 15 and under 18 18 and over Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Age undertaken by type Definitions Figure 2.4: Newly recorded 1 women and girls by age FGM was undertaken, by type, England, April 2016 to March 2017 Notes Table 2.4: Newly recorded 1 women and girls by age FGM was undertaken, by type, England, April 2016 to March 2017 FGM Type 2 Age FGM was undertaken 3 Type 1 320 150 75 95 130 40 * 5 820 Type 2 180 135 105 75 150 35 * 10 695 Type 3 and others 195 130 30 60 195 40 * 5 655 Type 4 70 45 10 * 15 * * 55 205 Not Recorded or Unknown 1,835 655 80 125 250 60 10 10 3,020 2,603 1,115 299 355 739 173 21 86 5,391 At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Caution! Only 31% of newly recorded women and girls have a known 5 age when FGM was undertaken. The age undertaken was under 10 in over four-fifths of the newly recorded cases. Copyright 2017, Health and Social Care Information Centre. 14

Not recorded 4 Not stated or unknown 5 Eastern Africa Northern Africa Western Africa Rest of Africa 7 United Kingdom Rest of Europe Western Asia Rest of Asia 8 Rest of the world 9 Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Country of birth Figure 2.5: Newly recorded 1 women and girls by country of birth, England, April 2016 to March 2017 Definitions Notes Table 2.5: Newly recorded 1 women and girls by country of birth, England, April 2016 to March 2017 Commissioning region 2 Country of birth 3 London 1,015 655 685 55 110 * 15 * 20 5 * 2,560 Midlands and East of England 245 135 260 140 145 * 55 5 70 10 * 1,070 North of England 295 250 250 105 175 15 25 * 40 15 * 1,175 South of England 250 40 145 35 70 * 20 * 10 5 * 580 1,803 1,084 1,338 339 505 20 112 13 135 40 2 5,391 At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Caution! Only 46% of newly recorded women and girls have a known 6 country of birth recorded. Regionally, the proportion of known values varies between 35 and 64 per cent. Copyright 2017, Health and Social Care Information Centre. 15

Not recorded 4 Not stated or unknown 5 Eastern Africa Northern Africa Western Africa Rest of Africa 7 United Kingdom Rest of Europe Western Asia Rest of Asia 8 Rest of the world 9 Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Country of birth by type Figure 2.6: Newly recorded 1 women and girls by country of birth, by type, England, April 2016 to March 2017 Definitions Notes Table 2.6: Newly recorded 1 women and girls by country of birth, by type, England, April 2016 to March 2017 FGM Type 2 Country of birth 3 Type 1 200 130 240 60 120 5 10 * 40 10 * 820 Type 2 95 125 245 80 135 * 5 * 10 * * 695 Type 3 and others 80 85 370 85 20 * * * 5 * * 655 Type 4 45 35 15 5 10 * 85 * * 5 * 205 Not Recorded or Unknown 1,380 715 470 110 225 10 10 10 75 20 * 3,020 1,803 1,084 1,338 339 505 20 112 13 135 40 2 5,391 59% of women and girls born in the UK were recorded as having genital piercing. 24% did not have a type recorded or had type 4 recorded, that did not specifiy, but could have been, a piercing. At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Copyright 2017, Health and Social Care Information Centre. 16

Not recorded 4 Not stated or unknown 5 Eastern Africa Northern Africa Western Africa Rest of Africa 7 United Kingdom Rest of Europe Western Asia Rest of Asia 8 Rest of the world 9 Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Country where FGM was undertaken Definitions Figure 2.7: Newly recorded 1 women and girls by country where FGM was undertaken, England, April 2016 to March 2017 Notes Table 2.7: Newly recorded 1 women and girls by country where FGM was undertaken, England, April 2016 to March 2017 Commissioning region 2 Country where FGM was undertaken 3 London 1.360 665 420 35 60 * 5 * 10 * * 2,560 Midlands and East of England 375 395 110 55 80 * 25 * 25 5 * 1,070 North of England 280 480 140 80 125 5 20 * 30 15 * 1,175 South of England 290 165 55 20 40 * 5 * * 5 * 580 2.309 1.698 725 192 305 7 57 * 64 32 * 5,391 At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Caution! Only 26% of newly recorded women and girls have a known 6 country where FGM was undertaken recorded. Regionally, the proportion of known values varies between 21 and 35 per cent. Copyright 2017, Health and Social Care Information Centre. 17

Not recorded 4 Not stated or unknown 5 Eastern Africa Northern Africa Western Africa Rest of Africa 7 United Kingdom Rest of Europe Western Asia Rest of Asia 8 Rest of the world 9 Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Country where FGM was undertaken by type Definitions Notes Figure 2.8: Newly recorded 1 women and girls by country where FGM was undertaken, by type, England, April 2016 to March 2017 Table 2.8: Newly recorded 1 women and girls by country where FGM was undertaken, by type, England, April 2016 to March 2017 FGM Type 2 Country where FGM was undertaken 3 84% of cases of FGM carried out in the UK were recorded as genital piercing. Type 1 290 255 130 35 65 * * * 25 10 * 820 Type 2 175 210 150 55 95 * * * 5 * * 695 Type 3 and others 165 220 205 50 10 * * * * * * 655 Type 4 70 55 10 * 5 * 50 * * 10 * 205 Not Recorded or Unknown 1,605 955 230 55 130 * * * 30 15 * 3,020 2,309 1,698 725 192 305 7 57 * 64 32 * 5,391 At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Copyright 2017, Health and Social Care Information Centre. 18

Not recorded 4 Not stated or unknown 5 Eastern Africa Northern Africa Western Africa Rest of Africa 7 United Kingdom Rest of Europe Western Asia Rest of Asia 8 Rest of the world 9 Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Country where FGM was undertaken by age undertaken Figure 2.9: Newly recorded 1 women and girls by country FGM was undertaken, by age undertaken, England, April 2016 to March 2017 Definitions Notes Table 2.9: Newly recorded 1 women and girls by country FGM was undertaken, by age undertaken, England, April 2016 to March 2017 Age FGM undertaken 2 Country where FGM was undertaken 3 Under 5 20 230 210 35 120 * * * 25 15 * 655 5 and under 10 40 295 255 75 55 * * * 10 5 * 740 10 and under 17 5 80 55 25 25 * * * 5 * * 195 18 and over 5 25 * * * * 45 * * * * 85 Not Recorded or Unknown 2,240 1,065 205 60 100 5 10 * 25 10 * 3,720 2,309 1,698 725 192 305 7 57 * 64 32 * 5,391 At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Caution! Only 26% of newly recorded women and girls have a known 6 country where FGM was undertaken recorded. Copyright 2017, Health and Social Care Information Centre. 19

Not recorded 4 Not stated or unknown 5 No Daughters 1 Daughter 2 Daughters 3 or more Daughters Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Daughters under the age of 18 Figure 2.10: Newly recorded 1 women by number of daughters under 18, England, April 2016 to March 2017 Definitions Notes Table 2.10: Newly recorded 1 women by number of daughters under 18, England, April 2016 to March 2017 Commissioning region 2 Daughters under 18 3 London 1,320 630 265 180 110 60 2,560 Midlands and East of England 220 475 195 100 50 30 1,070 North of England 90 480 310 175 70 45 1,175 South of England 320 75 95 55 30 10 580 1,948 1,663 870 506 259 145 5,391 At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Caution! Only 33% of newly recorded women and girls have the number of daughters under 18 recorded. Regionally, the proportion of known values varies between 24 and 51 per cent. Copyright 2017, Health and Social Care Information Centre. 20

Not recorded 4 Yes No Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Daughters born at this attendance Definitions Figure 2.11: attendances 1, by whether a daughter was born at the attendance, England, April 2016 to March 2017 Notes Table 2.11: attendances 1, by whether a daughter was born at the attendance, England, April 2016 to March 2017 Commissioning region 2 Daughter(s) born at this attendance 3 London 3,775 115 520 4,415 Midlands and East of England 665 80 965 1,710 North of England 475 165 1,000 1,640 South of England 975 115 330 1415 5,889 474 2,816 9,179 At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Caution! Only 36% of total attendances have a known record of if a daughter was born at the attendance or not. Regionally, the proportion of known values varies between 14 and 71 per cent. Copyright 2017, Health and Social Care Information Centre. 21

Not recorded 4 Yes No Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Deinfibulation Figure 2.12: attendances 1 by deinfibulation status, England, April 2016 to March 2017 Definitions Notes Table 2.12: attendances 1 by deinfibulation status, England, April 2016 to March 2017 Commissioning region 2 Deinfibulation status 3 London 3,300 70 1,040 4,415 Midlands and East of England 540 40 1,130 1,710 North of England 780 25 835 1,640 South of England 1,075 20 320 1,415 5,695 154 3,330 9,179 At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Caution! Only 38% of total attendances have a known 5 deinfibulation status recorded. Regionally, the proportion of known values varies between 24 and 68 per cent. Copyright 2017, Health and Social Care Information Centre. 22

Not recorded 4 Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Yes No Health Implications Figure 2.13: attendances 1 by whether the woman or girl was advised of the health implications of FGM, England, April 2016 to March 2017 Definitions Notes Table 2.13: attendances 1 by whether the woman or girl was advised of the health implications of FGM, England, April 2016 to March 2017 Commissioning region 2 Unknown 5 Health implications advised 3 London 2,610 590 1,180 30 4,415 Midlands and East of England 290 355 1,040 20 1,710 North of England 165 580 855 40 1,640 South of England 940 180 275 15 1,415 4,009 1,706 3,355 109 9,179 At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Caution! Only 38% of total attendances had a record of if the woman or girl was advised of the health implications of FGM. Regionally, the proportion of known values varies between 21 and 62 per cent. Copyright 2017, Health and Social Care Information Centre. 23

Not recorded 4 Yes No Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Illegalities of FGM Figure 2.14: attendances 1 by whether the woman or girl was advised of the illegalities of FGM, England, April 2016 to March 2017 Definitions Notes Table 2.14: attendances 1 by whether the woman or girl was advised of the illegalities of FGM, England, April 2016 to March 2017 Commissioning region 2 Advised of the illegalities of FGM 3 London 2,600 560 1,230 25 4,415 Midlands and East of England 290 305 1,100 15 1,710 North of England 155 575 895 15 1,640 South of England 865 175 375 5 1,415 3,909 1612 3,598 60 9,179 At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Unknown 5 Caution! Only 40% of total attendances had a record of if the woman or girl was advised of the illegalities of FGM. Regionally, the proportion of known values varies between 27 and 65 per cent. Copyright 2017, Health and Social Care Information Centre. 24

Not recorded 4 Midwifery Service Obstetrics Gynaecology Mental Health Recovery and Rehabilitation Service Paediatric Specialties 5 Genitourinary Medicine Other Specialty 6 Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Chapter 3: Additional Information Treatment function Figure 3.1: attendances 1 by treatment function, England, April 2016 to March 2017 Definitions Notes Table 3.1: attendances 1 by treatment function, England, April 2016 to March 2017 Commissioning region 2 Treatment function 3 London 2,215 1,370 490 105 160 25 * 45 4,415 Midlands and East of England 220 660 700 60 * 30 10 25 1,710 North of England 500 570 385 100 5 40 5 35 1,640 South of England 855 335 205 15 * * * * 1,415 3,790 2,934 1,780 284 169 100 20 102 9,179 At commissioning region level, numbers 0 4 are represented by asterisks, and larger numbers are rounded to the nearest five. National data is not suppressed. Caution! Only 59% of total attendances have a known 5 treatment function area recorded. Regionally, the proportion of known values varies between 40 and 87 per cent. Copyright 2017, Health and Social Care Information Centre. 25

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Data completeness and validity Table 3.2: Data completeness 1 and validity 1, 2015/16 and 2016/17 % complete 1 % valid 1 Field 2015/16 2016/17 2015/16 2016/17 NHS Number 98.0 97.1 98.0 97.1 Organisation that provided care 82.7 80.5 82.7 80.4 Date of Birth 100.0 100.0 99.9 100.0 Postcode of usual address 100.0 100.0 99.8 99.7 Country of birth 52.1 57.3 35.3 40.0 Country of origin 45.5 50.0 25.9 30.4 Region of country of origin 29.1 40.1 4.2 2.4 GP registration code 79.7 75.7 78.6 75.0 Care contact date 100.0 100.0 100.0 100.0 Referral organisation type 65.5 62.8 54.9 52.1 Referral organisation code 72.0 69.9 72.0 69.8 Site of treatment 56.2 59.2 56.1 59.2 Treatment function area 51.5 58.8 51.5 58.8 Pregnancy status 54.3 58.6 42.2 43.7 How was the FGM identified? 78.0 84.8 58.8 64.4 FGM family history? 48.8 57.2 26.3 30.9 Number of daughters the woman has under 18 44.3 53.7 22.7 28.5 Advised on the health implications of FGM? 51.2 56.3 35.1 37.7 Advised on the illegalities of FGM? 52.2 57.4 37.1 39.9 Were any daughters born at this attendance? 28.0 35.8 28.0 35.8 Country of birth of baby's father 40.0 44.8 8.2 10.7 Country of origin of baby's father 38.9 44.2 7.0 11.4 FGM activity identified 91.1 85.5 50.2 43.3 FGM type 4 qualifier 21.2 36.3 21.2 36.3 Deinfibulation undertaken? 36.3 38.0 36.3 38.0 Age range when FGM was undertaken 33.6 41.6 20.3 23.5 Country where FGM was undertaken 42.5 46.3 18.6 19.7 Notes: 1. Completeness is the degree to which the field has been populated. Validity is the degree to which a known value has been populated, i.e. an entry has been made and that entry is not an unknown category. 2. Although data completeness and validity remain low for many fields, they have improved in the past year for the majority of fields. Copyright 2017, Health and Social Care Information Centre. 26

London Midlands and East of England North of England South of England Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Submissions and Attendances Table 3.3: Number of organisations submitting attendance data by NHS commissioning region 1, England, April 2016 to March 2017 Number Organisation type NHS trust 21 37 42 23 123 providing mental health services 2 5 3 4 1 13 not providing mental health services 2 16 34 38 22 110 GP practice 12 24 33 5 74 33 61 75 28 197 Notes: 1. NHS commissioning region is derived from the organisation that submitted the Attendance record. 2. Trusts that provide mental health services are derived from the Care Quality Commission (CQC). Trusts that provide mental health services may also provide other health services. Copyright 2017, Health and Social Care Information Centre. 27

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Table 3.4: Number of attendances by submitting organisation type, England, April 2016 to March 2017 Newly Recorded 1 Number 3 Attendances 2 Organisations 4 NHS trust 5,186 8,928 providing mental health services 5 208 272 not providing mental health services 5 4,978 8,656 GP practice 205 251 5,391 9,179 Notes: 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. Women and girls may have one or more attendances in the stated period. This includes both newly recorded and previously recorded women and girls. An attendance will be when a woman or girl with FGM has had treatment for her FGM or given birth to a baby girl, or when FGM has been identified. 3. Counts include records added after the publication deadline for each quarter. 4. The organisation that submitted the Attendance record. 5. Trusts that provide mental health services are derived from the Care Quality Commission (CQC). Trusts that provide mental health services may also provide other health services. Copyright 2017, Health and Social Care Information Centre. 28

London Midlands and East of England North of England South of England Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Table 3.5: Number of attendances by NHS commissioning region 1, England, April 2016 to March 2017 Number 2 Attendances Newly recorded 3 2,560 1,070 1,175 580 5,391 attendances 4 4,415 1,710 1,640 1,415 9,179 Notes: 1. NHS commissioning region is derived from the woman or girl s postcode of usual address, reverting to care provider or submitting organisation where unavailable. 2. National data has not been suppressed. Data below national level is suppressed: all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. 3. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 4. Women and girls may have one or more attendances in the stated period. This includes both newly recorded and previously recorded women and girls. An attendance will be when a woman or girl with FGM has had treatment for her FGM or given birth to a baby girl, or when FGM has been identified. Copyright 2017, Health and Social Care Information Centre. 29

Not recorded Unknown GP Practice NHS Organisation Self referral Local Authority Other Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Table 3.6: Number of newly recorded 1 women and girls by referring organisation type and commissioning region 2, England, April 2016 to March 2017 Number 3 Commissioning Region 2 London 1,065 460 500 360 125 15 40 2,560 Midlands and East of England 305 160 305 255 15 * 30 1,070 North of England 405 10 120 585 40 * 15 1,175 South of England 250 * 60 200 50 * 10 580 2,024 636 984 1,404 230 17 96 5,391 Notes: 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. NHS commissioning region is derived from the woman or girl s postcode of usual address, reverting to care provider or submitting organisation where unavailable. 3. National data has not been suppressed. Data below national level is suppressed: all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. Copyright 2017, Health and Social Care Information Centre. 30

Not recorded Unknown Type 1 Type 2 Type 3 Type 4 History of FGM Type 3 FGM Type 3 - Reinfibulation identified Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Individual Country Information Table 3.7: Number of newly recorded 1 women and girls by country of birth 2 and FGM type, where the total number for the country is 10 or greater, England, April 2016 to March 2017 FGM Type 3 Continent Sub region Country Africa Eastern Africa Somalia 20 275 130 125 250 5 65 5 875 Africa Northern Africa Sudan (the) 5 90 50 70 75 5 5 * 309 Africa Eastern Africa Eritrea 15 95 65 90 40 * * * 305 Africa Western Africa Nigeria 10 110 65 40 * 5 * * 233 Africa Western Africa Gambia (the) 15 35 20 40 10 * * * 118 Europe Northern Europe United Kingdom (the) * 10 10 5 * 85 * * 112 Africa Eastern Africa Ethiopia * 50 30 25 * * * * 107 Asia Western Asia Iraq 5 50 30 * * * * * 90 Africa Western Africa Sierra Leone * 15 10 20 * * * * 55 Africa Western Africa Guinea * 15 10 15 * * * * 44 Africa Eastern Africa Kenya * 10 15 * * * * * 29 Africa Northern Africa Egypt * 10 10 5 * * * * 28 Africa Western Africa Guinea-Bissau * 5 5 * * * * * 17 Asia Western Asia Saudi Arabia * * * * * * * * 17 Asia Western Asia Yemen * 5 5 * * * * * 17 Asia South-Eastern Asia Malaysia * * 5 * * * * * 13 Notes: 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. Only 46 per cent of newly recorded women and girls have a known country of birth recorded. 3. The total column has not been suppressed. Other columns have been suppressed: all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. Copyright 2017, Health and Social Care Information Centre. 31

Not recorded Unknown Type 1 Type 2 Type 3 Type 4 History of FGM Type 3 FGM Type 3 - Reinfibulation identified Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Table 3.8: Number of newly recorded 1 women and girls by country FGM undertaken 2 and FGM type, where the total number for the country is 10 or greater, England, April 2016 to March 2017 FGM Type 3 Continent Sub region Country Africa Eastern Africa Somalia * 150 65 80 125 5 45 * 474 Africa Northern Africa Sudan (the) * 45 30 45 40 * 5 * 169 Africa Eastern Africa Eritrea * 45 40 50 20 * * * 162 Africa Western Africa Nigeria * 75 35 30 * * * * 147 Africa Western Africa Gambia (the) * 30 10 30 * * * * 71 Africa Eastern Africa Ethiopia * 20 15 15 5 * * * 60 Europe Northern Europe United Kingdom (the) * * * * * 50 * * 57 Asia Western Asia Iraq * 25 20 * * * * * 43 Africa Western Africa Sierra Leone * 10 10 20 * * * * 38 Africa Western Africa Guinea * 5 5 10 * * * * 22 Africa Northern Africa Egypt * 5 5 5 * * * * 21 Africa Eastern Africa Kenya * 10 * * * * * * 16 Asia Western Asia Saudi Arabia * * * * * * * * 10 Notes: 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. Only 26 per cent of newly recorded women and girls have a known country where FGM was undertaken recorded 3. The total column has not been suppressed. Other columns have been suppressed: all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. Copyright 2017, Health and Social Care Information Centre. 32

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Chapter 4: Reference Notes FGM Type (back) 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. Commissioning region is derived from the patient s postcode of usual address, reverting to care provider or submitting organisation where unavailable. 3. National data has been suppressed where it is broken down by more than one category. All data below national level is suppressed. For suppression all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. 4. The 'Not recorded' category includes all cases where no value was returned for this data item. 5. The 'Known' category excludes FGM Type Unknown and all cases where no value was returned for this data item. 6. Definitions of FGM type can be found in the Definitions section at the end of this report. Age at attendance (back) 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. Commissioning region is derived from the patient s postcode of usual address, reverting to care provider or submitting organisation where unavailable. 3. National data has been suppressed where it is broken down by more than one category. All data below national level is suppressed. For suppression all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. 4. When a woman with FGM has given birth to a baby girl, the baby should not be recorded in the dataset unless the baby girl has also been identified with FGM. We are aware that babies have been recorded in the dataset in error, and are working with the effected organisations to delete these records. 5. The 'Known' category excludes all cases where no valid date of birth was returned for this data item. Age undertaken (back) 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. Commissioning region is derived from the patient s postcode of usual address, reverting to care provider or submitting organisation where unavailable. 3. National data has been suppressed where it is broken down by more than one category. All data below national level is suppressed. For suppression all numbers between 0 and 4 are Copyright 2017, Health and Social Care Information Centre. 33

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics obscured with an asterisk, and all other numbers are rounded to the nearest five. 4. When a woman with FGM has given birth to a baby girl, the baby should not be recorded in the dataset unless the baby girl has also been identified with FGM. We are aware that babies have been recorded in the dataset in error, and are working with the effected organisations to delete these records. 5. The 'Known' category excludes all cases where no valid Age undertaken was returned for this data item. Age undertaken by type (back) 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. Definitions of FGM type can be found in the Definitions section at the end of this report. 3. National data has been suppressed where it is broken down by more than one category. All data below national level is suppressed. For suppression all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. 4. When a woman with FGM has given birth to a baby girl, the baby should not be recorded in the dataset unless the baby girl has also been identified with FGM. We are aware that babies have been recorded in the dataset in error, and are working with the effected organisations to delete these records. 5. The 'Known' category excludes all cases where no valid Age undertaken was returned for this data item. Country of birth (back) 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. Commissioning region is derived from the patient s postcode of usual address, reverting to care provider or submitting organisation where unavailable. 3. National data has been suppressed where it is broken down by more than one category. All data below national level is suppressed. For suppression all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. 4. The 'Not recorded' category includes all cases where no value was returned for this data item. 5. The 'Not stated or unknown' category includes all cases where a value was returned stating that this data item was unknown. 6. The 'Known' category excludes all cases where the country of birth was reported as not stated or unknown, and cases where no value has been returned for this data item. 7. Rest of Africa includes all cases where the recorded country of birth is in Middle and Southern Africa, according to the UNSD regional mappings. Copyright 2017, Health and Social Care Information Centre. 34

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics 8. Rest of Asia includes all cases where the recorded country of birth is in Central, Eastern, South-Eastern Asia and Southern Asia, according to the UNSD regional mappings. 9. Rest of the world includes all cases where the recorded country of birth is outside of Africa, Asia and Europe, according to the UNSD regional mappings. Country of birth by type (back) 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. Definitions of FGM type can be found in the Definitions section at the end of this report. 3. National data has been suppressed where it is broken down by more than one category. All data below national level is suppressed. For suppression all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. 4. The 'Not recorded' category includes all cases where no value was returned for this data item. 5. The 'Not stated or unknown' category includes all cases where a value was returned stating that this data item was unknown. 6. The 'Known' category excludes all cases where the country of birth was reported as not stated or unknown, and cases where no value has been returned for this data item. 7. Rest of Africa includes all cases where the recorded country of birth is in Middle and Southern Africa, according to the UNSD regional mappings. 8. Rest of Asia includes all cases where the recorded country of birth is in Central, Eastern, South-Eastern Asia and Southern Asia, according to the UNSD regional mappings. 9. Rest of the world includes all cases where the recorded country of birth is outside of Africa, Asia and Europe, according to the UNSD regional mappings. Country where FGM undertaken (back) 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. Commissioning region is derived from the patient s postcode of usual address, reverting to care provider or submitting organisation where unavailable. 3. National data has been suppressed where it is broken down by more than one category. All data below national level is suppressed. For suppression all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. 4. The 'Not recorded' category includes all cases where no value was returned for this data item. 5. The 'Not stated or unknown' category includes all cases where a value was returned stating that this data item was unknown. Copyright 2017, Health and Social Care Information Centre. 35

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics 6. The 'Known' category excludes all cases where the country the FGM was undertaken was reported as not stated or unknown, and cases where no value has been returned for this data item. 7. Rest of Africa includes all cases where the recorded country where FGM was undertaken is in Middle and Southern Africa, according to the UNSD regional mappings. 8. Rest of Asia includes all cases where the recorded country of birth is in Central, Eastern, South-Eastern Asia and Southern Asia, according to the UNSD regional mappings. 9. Rest of the world includes all cases where the recorded country where FGM was undertaken is outside of Africa, Western Asia and Europe, according to the UNSD regional mappings. Country where FGM undertaken by type (back) 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. Definitions of FGM type can be found in the Definitions section at the end of this report. 3. National data has been suppressed where it is broken down by more than one category. All data below national level is suppressed. For suppression all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. 4. The 'Not recorded' category includes all cases where no value was returned for this data item. 5. The 'Not stated or unknown' category includes all cases where a value was returned stating that this data item was unknown. 6. The 'Known' category excludes all cases where the country the FGM was undertaken was reported as not stated or unknown, and cases where no value has been returned for this data item. 7. Rest of Africa includes all cases where the recorded country where FGM was undertaken is in Middle and Southern Africa, according to the UNSD regional mappings. 8. Rest of Asia includes all cases where the recorded country of birth is in Central, Eastern, South-Eastern Asia and Southern Asia, according to the UNSD regional mappings. 9. Rest of the world includes all cases where the recorded country where FGM was undertaken is outside of Africa, Western Asia and Europe, according to the UNSD regional mappings. Country where FGM undertaken by age undertaken (back) 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. Further information on Age FGM undertaken is provided in table 2.3. 3. National data has been suppressed where it is broken down by more than one category. All data below national level is suppressed. For suppression all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. Copyright 2017, Health and Social Care Information Centre. 36

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics 4. The 'Not recorded' category includes all cases where no value was returned for this data item. 5. The 'Not stated or unknown' category includes all cases where a value was returned stating that this data item was unknown. 6. The 'Known' category excludes all cases where the country the FGM was undertaken was reported as not stated or unknown, and cases where no value has been returned for this data item. 7. Rest of Africa includes all cases where the recorded country where FGM was undertaken is in Middle and Southern Africa, according to the UNSD regional mappings. 8. Rest of Asia includes all cases where the recorded country of birth is in Central, Eastern, South-Eastern Asia and Southern Asia, according to the UNSD regional mappings. 9. Rest of the world includes all cases where the recorded country where FGM was undertaken is outside of Africa, Western Asia and Europe, according to the UNSD regional mappings. Daughters under the age of 18 (back) 1. Women and girls first recorded in the FGM Enhanced Dataset during the reporting period. This will include those identified as having FGM and those having treatment for their FGM. 2. Commissioning region is derived from the patient s postcode of usual address, reverting to care provider or submitting organisation where unavailable. 3. National data has been suppressed where it is broken down by more than one category. All data below national level is suppressed. For suppression all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. 4. The 'Not recorded' category includes all cases where no value was returned for this data item. 5. The 'Not stated or unknown' category includes all cases where a value was returned stating that this data item was unknown. Daughters born at this attendance (back) 1. Women and girls may have one or more attendances in the stated period. This includes both newly recorded and previously recorded women and girls. An attendance will be when a woman or girl with FGM has had treatment for her FGM or given birth to a baby girl, or when FGM has been identified. 2. Commissioning region is derived from the patient s postcode of usual address, reverting to care provider or submitting organisation where unavailable. 3. National data has been suppressed where it is broken down by more than one category. All data below national level is suppressed. For suppression all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. 4. The 'Not recorded' category includes all cases where no value was returned for this data item. Copyright 2017, Health and Social Care Information Centre. 37

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Deinfibulation (back) 1. Women and girls may have one or more attendances in the stated period. This includes both newly recorded and previously recorded women and girls. An attendance will be when a woman or girl with FGM has had treatment for her FGM or given birth to a baby girl, or when FGM has been identified. 2. Commissioning region is derived from the patient s postcode of usual address, reverting to care provider or submitting organisation where unavailable. 3. National data has been suppressed where it is broken down by more than one category. All data below national level is suppressed. For suppression all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. 4. The 'Not recorded' category includes all cases where no value was returned for this data item. 5. The 'Known' category excludes all cases where no value was returned for this data item. Health Implications (back) 1. Women and girls may have one or more attendances in the stated period. This includes both newly recorded and previously recorded women and girls. An attendance will be when a woman or girl with FGM has had treatment for her FGM or given birth to a baby girl, or when FGM has been identified. 2. Commissioning region is derived from the patient s postcode of usual address, reverting to care provider or submitting organisation where unavailable. 3. National data has been suppressed where it is broken down by more than one category. All data below national level is suppressed. For suppression all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. 4. The 'Not recorded' category includes all cases where no value was returned for this data item. 5. The 'Unknown' category includes all cases where a value was returned stating that this data item was unknown. Illegalities of FGM (back) 1. Women and girls may have one or more attendances in the stated period. This includes both newly recorded and previously recorded women and girls. An attendance will be when a woman or girl with FGM has had treatment for her FGM or given birth to a baby girl, or when FGM has been identified. 2. Commissioning region is derived from the patient s postcode of usual address, reverting to care provider or submitting organisation where unavailable. 3. National data has been suppressed where it is broken down by more than one category. All data below national level is suppressed. For suppression all numbers between 0 and 4 are obscured with an asterisk, and all other numbers are rounded to the nearest five. Copyright 2017, Health and Social Care Information Centre. 38

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Definitions FGM Type (back) The FGM types defined by the World Health Organisation and used in the FGM Enhanced Dataset are: Type 1: Partial or total removal of the clitoris and/or the prepuce (clitoridectomy). Type 2: Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision). Type 3: Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation). History of Type 3: Current state where a woman or girl had FGM Type 3, but has since been deinfibulated. Type 3 Reinfibulation identified: Current state where a woman or girl has been closed previously, opened and is currently closed again. Type 4: All other harmful procedures to the female genitalia for non-medical purposes, including pricking, piercing, incising, scraping and cauterization. Unknown: When the FGM category could not be ascertained. It is acknowledged that even for experienced healthcare workers who frequently see women and girls with FGM it can still often be difficult to determine the type of FGM that had been undertaken. Are piercings included? Yes. While adult women may choose to have genital piercings, in some communities girls are forced to have them. The World Health Organisation currently defines all female genital piercings as a form of FGM. The data item FGM Type 4 Qualifier allows users to specify that the FGM was a piercing. Genital piercings are classed as FGM Type 4 - Piercing. Copyright 2017, Health and Social Care Information Centre. 40

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics Treatment function (back) Common treatment functions associated with the identification and treatment of FGM include: Midwifery Service: Health services run by midwives to care for women during pregnancy, childbirth and in the postpartum period following childbirth. Midwives typically oversee low risk pregnancies. Obstetrics: Medical services run by doctors that specialise in the care of women during pregnancy, childbirth and in the postpartum period following childbirth. Obstetricians typically oversee more risky pregnancies, including surgical interventions. Mental Health Recovery and Rehabilitation Service: Specialist services that support people with longer term mental health problems, with a focus on rehabilitation and recovery. Gynaecology: The branch of medicine that specialises in the health and maintenance of the female reproductive systems (vagina, uterus and ovaries) and breasts. Genitourinary Medicine: Relates to the care of people's sexual health; offering information, screening, advice and treatment for sexually transmitted infections, including HIV infection. Deinfibulation (back) Infibulation or FGM Type 3 is the narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris. Deinfibulation is the surgical procedure to open up the closed vagina of a woman or girl with FGM Type 3. Deinfibulation is often undertaken to facilitate delivery during childbirth. Reinfibulation is where a woman or girl has been closed previously (infibulated), opened (deinfibulated) and is currently closed again (reinfibulated). Copyright 2017, Health and Social Care Information Centre. 41

Female Genital Mutilation (FGM) Enhanced Dataset: England, April 2016 March 2017, experimental statistics www.digital.nhs.uk 0300 303 5678 enquiries@nhsdigital.nhs.uk @nhsdigital ISBN 978-1-78734-052-7 This publication may be requested in large print or other formats. Published by NHS Digital, part of the Government Statistical Service Copyright 2017 Health and Social Information Centre The Health and Social Care Information Centre is a non-departmental l body created by statute, also known as NHS Digital. You may re-use this document/publication (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. To view this licence visit www.nationalarchives.gov.uk/doc/open-government-licence or write to the Information Policy Team, The National Archives, Kew, Richmond, Surrey, TW9 4DU; or email: psi@nationalarchives.gsi.gov.uk Copyright 2017, Health and Social Care Information Centre. 42