FGM Screening and Awareness Information

This resource provides guidance to members dealing with suspected cases of female genital mutilation (FGM). It provides screening questions, information on terminology and information about other useful organisations.

The guide was updated in July 2024.[1]  Please read this Screening and Awareness information in conjunction with Resolution’s Guidance Note on Female Genital Mutilation which covers the practice, background and the legal remedies in greater detail.

A potential victim may only have one chance to ask for help. You may only have one chance to provide help, so it is important to get it right on the first occasion. However, it is critical that you remain alert throughout any contact you have as it is known that individuals may not disclose immediately or openly. ‘Screening’ should not be seen as a ‘one-off’ activity/checklist. Professional assessment of risk relies on the practitioner being alert to subtleties that may emerge during the continuing contact with the individual and a level of trust being established.

The practice of Female Genital Mutilation

Female Genital Mutilation (FGM) describes the cutting, pricking, excision, evisceration, elongating or any way of mutilating the genitals of women and girls. FGM is specifically seen as a means of controlling sexual behaviour in women and girls in communities where so-called honour and honour-based culture is related to the maintenance of virginity before marriage.

There is no legitimate basis in religion, culture or practice to support FGM.

In Fornah v Secretary of State for the Home Department [2005] EWCA Civ 680 Auld LJ described FGM as a practice that is  “internationally condemned and in clear violation of Article 3 of the European Convention on Human Rights.

Reasons for the practice of FGM

Whereas it is firmly stated by the United Nations and the World Health Organisation that FGM has no medical or health benefit, FGM is often associated by practitioners with purity, cleanliness and marriage ability. It is also often seen as a rite of passage for girls moving into adulthood. It can be very entrenched as a practice within a family or community and there may be family or community members who believe that it must be preserved.

How it impacts the victims 

The impact of FGM is lifelong, causing physical and psychological injury. It can cause lifelong physical, mental, emotional and psychosexual problems, pain, bleeding and difficulty in childbirth including infant mortality.

The practice described by individual women is almost unfailingly traumatic. It may happen to them as a baby or a young child, at puberty, at the point at which they marry or after the birth of their first child. It can be perpetrated more than once, for example where there have been complications or where it is believed that it hasn’t preserved chastity in the person cut and this can lead to a more severe form of FGM.

Many clients who experience FGM may have associated problems with health, including mental health problems (eg post-traumatic stress disorder), problems with or painful menstruation, repeated infections, difficult and painful intercourse, inability to conceive, problems during pregnancy and in a surprising number of cases, infant mortality.

FGM is a very sensitive issue. As with forced marriage, victims are usually very reluctant to get the families that they love ‘in trouble with the authorities’.

International perspective

FGM is not confined to any particular part of the world. The United Kingdom has long-standing and wide-ranging international legal obligations in relation to FGM. At the Girl Summit 2014, the government pledged to eradicate FGM here and elsewhere in the world within a generation.

In addition to formal international and regional treaties and instruments, the globally accepted Sustainable Development Goals that were put in place for 2015–2030 make specific reference to the elimination of FGM). It is hoped that this will strengthen the hands of governments, NGOs and multi-lateral organisations when implementing anti-FGM policies and legislation.

The number of girls subjected to female genital mutilation (FGM) is believed to have gone up due to the COVID-19 pandemic. UNICEF estimates that coronavirus-related schools closures and disruptions to aid programmes mean a further two million girls were at risk of being circumcised before the end of the decade. UNICEF urged quick and decisive action across the world for girls at risk to be protected by laws, policies and new social norms.

Definitions

FGM is a collective term for a range of procedures that involve partial or total removal of the external female genitalia for non-medical reasons. It is sometimes referred to as female circumcision, or female genital cutting.

The World Health Organisation (WHO) has classified FGM into four types:

  • Type 1: Often referred to as clitoridectomy, this is the partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals), and in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).
  • Type 2: Often referred to as excision, this is the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva), with or without excision of the labia majora (the outer folds of skin of the vulva).
  • Type 3: Often referred to as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoris (clitoridectomy).
  • Type 4: This includes all other harmful procedures to the female genitalia for non-medical purposes, eg pricking, piercing, incising, scraping and cauterizing the genital area.

The law in England and Wales

FGM is a specific criminal offence in the UK and has been since the Female Circumcision Act 1985 (although it may be contended that it has been illegal at least since the Offences Against the Person Act 1861). This was updated in 2003 with the Female Genital Mutilation Act (FGMA) 2003, which in turn was amended to include extra protection for victims and additional responsibility for professionals by the Serious Crime Act 2015.

FGMA 2003 s1(1) stipulates that a person is guilty of an offence if he excises, infibulates or otherwise mutilates the whole or any part of a girl’s labia majora, labia minora or clitoris.

While  WHO definition (above) was not formally incorporated into the definition of FGM within Female Genital Mutilation Act (FGMA) 2003 s1(1), it was adopted by Sir James Munby, in the matter of Re B and G (Children) (No 2) [2015] EWFC 3.

Sir James Munby observed that knowledge and understanding of the classification and categorisation of the various types of FGM is vital and that the WHO classification is the one widely used for forensic purposes.

Language and cultural differences

Each country will have its own practice and within each country each tribe or ethnic group will have their own words. FGM is frequently used as a collective term for a range of procedures that involve partial or total removal of the external female genitalia for non-medical reasons. It is sometimes referred to as female circumcision, or female genital cutting or simply as cutting.

There is a variety of terms people may use to describe the practice. The words used within practising communities often reflect purification, for example in Mali, the most colloquial term for FGM is Bolokoli (washing your hands). In Arabic often the word Khafd is sometimes used.

Certain ethnic groups in Asian countries practice FGM, including in communities in India, Indonesia, Malaysia, the Maldives, Pakistan and Sri Lanka. In the Middle East, the practice occurs in Oman, the United Arab Emirates and Yemen, as well as in Iraq, Iran, Jordan, Somalia, Sudan, Algeria, Morocco and the State of Palestine. Forward UK have produced a map of the prevalence of FGM (of certain types) in the world.

Given the wide variety of words used by the different communities, you cannot be expected to know them all.

Annex G of the Government’s Multi Agency Guidance sets out a very useful list of terms used for FGM in other languages and the National FGM Centre also has a useful list of the common country/language-specific terms. However, it may not be comprehensive so you should ask the individual what word they use. In practice, most will understand the verb “to cut” and the practice promoted by “the cutter”.

Safeguarding and identifying FGM

The government has published multi-agency statutory guidance on female genital mutilation with guidelines for those with statutory duties to safeguard children and vulnerable adults. All members are advised to make themselves familiar with this document. (Published in 2016 and last updated in July 2020) and the statutory guidance in relation to the safeguarding of children (Published in 2015 and last updated in December 2023).  Please also note the government advice available to practitioners in respect of information sharing.

There is a FGM mandatory reporting duty of regulated health and social care professionals and teachers in England and Wales to the police and/or children’s services with disciplinary consequences if disclosure of “known” cases in under 18s if not made within one month of the professional becoming aware.

In addition, some professionals can be guilty of criminal offences if they are closely involved with children and ought to have known that they were at risk of FGM. This applies more to Cafcass, education and health practitioners and children’s services.

As well as health visitors and other health professionals, teachers are uniquely placed to spot the signs of FGM and it may be that they will be the ones who alert the authority if girls in a particular class are talking about ‘going home for the summer holidays/going home to a family party/special clothes having arrived from abroad’. Please do not assume that another professional has alerted the authorities.

It may be difficult to identify the less intrusive forms of FGM in babies and young children. Examination by skilled practitioners using a colposcope whilst at the same time obtaining diagrams, photographs and notes will be essential forensic practice as outlined in the case of B and G, above.

During pregnancy the existence of FGM may become apparent through the reluctance of a woman to be examined (or the reluctance or refusal of anyone accompanying her to antenatal visits) during the antenatal process.

By the very nature of the issue, FGM happens in private, within families and is often hidden. It occurs in the United Kingdom as well as other parts of the world.

Please also refer to Resolution’s Good Practice Guide on Safeguarding Children and Young People.

Assessment and screening

The one chance rule

A potential victim may only have one chance to ask for help. You may only have one chance to provide help, so it is important to get it right on the first occasion.  Please also be and remain aware that the ‘one chance’ may not necessarily occur on first contact but once the individual has or feels engaged with the professional supporting or advising them.

When raising the issue of FGM or cutting with clients consider that:

  • FGM is a very sensitive issue to the individual and her family because it is an established part of some cultures. It is an intimate injury, and she may be very aware of getting family members or herself into trouble if she either admits it or talks about it, especially to a relative stranger. Where appropriate, she may feel more comfortable talking to another female.
  • You may be dealing with young women (or family members) for whom English is not their first language, so the potential for misunderstanding is high. If you are considering using an interpreter, please be careful about their understanding of FGM, so-called ‘honour’ crimes, and their own background: they should not be a family member, not be known to the individual, and not be someone with influence in the individual’s community.
  • They will need your time and a private, calm atmosphere in which to discuss any concerns you have or that the individual, family members or supporters may have.
Tips for opening up a conversation

What follows are a series of questions you can use as the basis for discussions with girls or women you are concerned may be at risk.

Any discussion needs to be taken at a pace and in a way that is sensitive to the difficulties this subject raises for survivors, victims and potential victims of FGM, or for those who may be at risk of a so-called ‘honour’ crime.

  • Try to start with information gathering questions before moving on to more intimate questioning. This will give the person time to settle and engage with you and their surroundings.
  • Frame your questions carefully so as not to turn a conversation or discussion into a cross-examination. Wherever possible, try to use open questions. In other words, questions that invite the person to give you more than a yes or no answer.
  • Use silences. If someone doesn’t answer you immediately, wait and give them time. Don’t feel you have to jump into silences. They may be about to tell you something very important to them and may need the time to do so.
  • Watch their body language and non-verbal responses carefully. Do the verbal answers tie up with their non-verbal language? If they don’t, use a follow-up acknowledgement, such as: ‘I can see that you found it difficult to answer, could you tell me a bit more about…’, or ‘I wonder if there is something else you need or want to say about that?’, or, ‘I’m just wondering if I might have missed something, is there something else you want to say?’
  • Use acknowledgement often as it helps individuals to feel that they are being heard and their difficulties appreciated. Phrases such as ‘I can see how difficult/upsetting this is for you…’, ‘I can appreciate these are difficult/worrying questions to be asked…’ can be very helpful.
  • Reflecting back what you think has been said ensures there has been a common understanding: ‘So what I’ve heard you say is that…’ It can also help you to build from that reflection to your next question, for example, ‘So what I’ve heard you say is that there are things that happen in your family that you are worried about, could you tell me a bit more about what they are or give me an example?’.
  • Think how you would feel about being asked questions such as those set out below. Would you feel they were intrusive or embarrassing? If so, think about how you would like these questions to be asked of you – what would be important to get right?
  • Please select the questions you use carefully. These are examples and not a set of questions to be asked of every individual.
  • Once you have established that a person is at risk and what the risk is, think about how you can best advise and support them. Remember that legal protection is just that and your client will need additional signposting to sources of help and support. If it is not safe for them to return to their home, please make sure that you have organised an appropriate next step beyond you and the legal protection you can put in place.
Questions to help in any assessment: Screening questions
  • Can you tell me which country you were born in/what is your country of origin? (FGM is concentrated in 27 African countries, Yemen, Iraqi Kurdistan and found elsewhere in Asia and the Middle East and among communities throughout the world. Determining country of origin is a good first step.)
  • Is there a particular tribe, group or community you belong to? (Within individual countries, the risk can vary from group to group, the type of FGM practice may vary group to group, as may the age at which the victim is ‘cut’.)
  • Can you tell me a little about your education? Do you/have you been able to go to school/college?
  • Does your family think it is important to learn English?
  • Do you have any physical, emotional or health problems that you would like to talk about?
  • Who normally makes decisions in your family?
  • What about making decisions about what you can do?
  • Do you normally come and go from the family home as you choose?
  • Do you normally have someone with you/an escort when you go out?
  • If you usually have an escort/someone with you, who would that person normally be?
  • Are you allowed to work?
  • Do girls in your family have the right to choose who they will marry?
  • Has there been any discussion in the family about you being taken back to your home country/country of origin, perhaps for a party?
  • Have any special clothes been bought for you?
  • Is honour important to your family?
  • What sort of things do they think are important?
  • Do you think that anyone in your family might be a risk or danger to you or your children? If so, can you tell me a bit more about what you think that risk or danger might be?
  • Can you tell me what worries you most?
  • Does anyone in your family have a particular traditional role to play? If so, what is it?
  • Can you tell me if anyone in your family believes in or uses magic as a form of healing or as a punishment or threat? (If yes) Could you tell me a bit more about it? Or give me an example?
  • May I ask you if virginity is seen as important before marriage?
  • Can you tell me if your family or community think it is important that you don’t have sex with your partner/the person you are going to marry before you are married?
  • Has anyone in your family or your in-laws used or threatened violence against you?
  • Do you worry that they might?
  • Are there things that happen or are expected of you, or any traditions or practice to do with your religion or culture within your family or community that worry you, especially if they affect you or your daughters?
  • Could you tell me whether there are any traditions in your family?
  • Are there any that might involve cutting women or girls?
  • Do you have older sisters? If so, have they been cut?

FGM is often one of a range of issues that the client will present with, including forced marriage and so-called ‘honour’ violence, as well as all other forms of domestic abuse.

Help and guidance available

Guidance
Publications
  • Tackling female genital mutilation in the UK Current response is disproportionate and should be reconsidered, Sarah M Creighton, Zimran, Naana Otoo-Oyortey and Deborah Hodes [BMJ 2019;364:l15 doi: 10.1136/bmj.l15 (Published 7 January 2019).
Organisations
Africans Unite against Child Abuse (AFRUCA)

Promotes the rights and welfare of African children with the belief that culture and religion should never be a reason to abuse children.

Tel (London): 0207 704 2261

Tel (Manchester): 0161 205 9274

Email: [email protected]

FGM Clinic at University College London Hospital

The Forced Marriage Unit

The Forced Marriage Unit (FMU) is a joint Foreign and Commonwealth Office and Home Office unit that leads on the government’s forced marriage policy, outreach and casework.

Tel: 0207 008 1500

Email: [email protected]

Foundation for Women’s Health Research and Development (FORWARD UK)

An organisation that promotes gender equality and safeguarding the rights of African girls and women, specifically in FGM, Child Marriage and Obstetric Fistula practice.

Tel: 0208 960 4000

Email :[email protected]

Health and Social Care Information Centre Female Genital Mutilation Datasets
Imkaan

Imkaan is a UK-based, black feminist organisation dedicated to addressing violence against women and girls.

Tel: 0207 842 8525

Email: [email protected]

Iranian and Kurdish Women’s Rights Organisation (IKWRO)

An organisation that aims to protect Middle Eastern and Afghan women and girls who are at risk of ‘honour’ based violence, forced marriage, child marriage, female genital mutilation and domestic violence and to promote their rights.

Tel: 0207 920 6460

Local Multi-Agency Safeguarding Hubs

Many local authorities have resources and procedures for professionals dealing with FGM and information about  how to refer a child protection matter including risk of, suspected, alleged or disclosed FGM.

National FGM Centre

Funded by the Department for Education, the National FGM Centre provides specialist social care provision on FGM, alongside a knowledge hub with quality-approved resources for frontline professionals and a community-based prevention programme.

Tel: 208 498 7137

NSPCC guidance on FGM

Including dedicated FGM helpline by email [email protected]  and telephone 0800 028 3550

 

[1] Resolution would like to thank Professor Zimran Samuel of Doughty Street Chambers and LSE for his assistance in reviewing and updating this guidance note. We also note the input and work of Cris McCurley and Angela Lake-Carroll in the initial drafting of this guidance and to Dr Naheed Ghauri for additional comments.