Female Genital Mutilation

This guidance is for all practitioners (paid or unpaid) who work with children (including the unborn child), and those who work with adults who are parents/carers and who therefore hold responsibility for safeguarding and promoting the welfare of children. It is intended to be read alongside the Children and Young People (Jersey) Law 2022, the commensurate Statutory Guidance and the Jersey Children's First Framework (JCF). Practitioners must follow the Statutory Guidance on sharing information (which follows Data Protection (Jersey) Law 2018) and SPB Jersey Child Protection Procedures and Children and Young People Safeguarding Referrals Procedures.

FGM comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.

FGM has been classified by the World Health Organisation (WHO) into four types:

• Type 1 - Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and/or the prepuce (the fold of skin surrounding the clitoris);
• Type 2 - Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are the  lips  that surround the vagina);
• Type 3 - Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer labia, with or without removal of the clitoris;
• Type 4 - Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterising the genital area.

Other common names for FGM are explained here.

For more detail, please refer to the United Kingdom (UK) Multi agency Statutory Guidance on Female Genital Mutilation April 2016.

Click here to access the GOV.UK website for Female Genital Mutilation.

Under the Sexual Offences (Jersey) Law 2018, FGM means the excision, infibulation or other mutilation of the whole or any part of the labia majora, minora or clitoris. This definition covers all of the acts covered by the WHO definition of FGM, including reinfibulation.

Carrying out FGM is an offence under the Sexual Offences (Jersey) Law 2018. It is also an offence to assist someone else to carry out FGM including aiding, abetting, counselling or procuring the carrying out of FGM. A person in Jersey who arranges for an act of FGM to be carried out on a person habitually resident in Jersey, by a person who is resident outside Jersey may commit this offence. A person who carries out FGM or who assists with carrying out FGM is liable to imprisonment for 14 years and an unlimited fine.

It is also an offence for a person who is responsible for a child to fail to prevent FGM being carried out. A person will be responsible for a child, if the person has parental responsibility for the child or is an adult who has assumed responsibility for caring for a chid in the manner of a parent. A person who commits this offence is liable to imprisonment of 7 years and an unlimited fine.

Regulated Professionals' Duty to Notify the police of apparent FGM of a Child

A regulated professional  must notify the police, if in the course of their work they are:

1. Informed by a child that FGM (however described) has been carried out on a child; or
2. Observe physical signs of a child that appear to show that FGM has been carried out on a child.

See Section 8, Actions.

The law identifies those regulated professionals as:

• Teachers, (Education (Jersey) Law 1999);
• Social workers (Health Care (Registration) (Jersey) Law 1995);
• Doctors, midwives, nurses, specialist community public health nurses and those practitioners registrable within the meaning of Health Care (Registration) (Jersey) Law 1995;
• Or any person working as a trainee in any of those occupations;
• Any practitioner registered to administer body piercing or tattooing (Piercing and Tattooing (Jersey) Law 2002).

While there are specific roles and responsibilities described in the Sexual Offences (Jersey) Law for those regulated professionals. It remains the case that all practitioners have a responsibility to safeguard the welfare of children and young people. Any practitioner who is made aware of a child or young person who has experienced or is at risk of FGM must take action, to protect their welfare, (Children and Young People (Jersey) Law 2022 and commensurate Statutory Guidance) - (see See Section 8, Actions.).

The Royal Court may, on application of the Attorney General make an FGM Protection Order for the purpose of:

1. Protecting a person against the commission of a FGM offence;
2. Protecting a person against whom such an offence has been committed.

The Attorney General may make the application in proceedings brought for that purpose or in any other proceedings, including criminal proceedings, proceedings under the Children (Jersey) Law 2002 or proceedings between the parents of a child.

Where the law allows orders to be made by court to protect people from FGM, an offence is committed if someone breaches such an order.  
See Guide to Sexual Offences (Jersey) Law 2018.

It is important to note that Article 28 of the Sexual Offences (Jersey) Law 2018 describes surgical procedures that will not amount to FGM if they are performed by a relevant practitioner (e.g. A Doctor or a Midwife) if:

• The patient is in any stage of labour, or has just given birth, the operation is for a medical purpose connected with the labour or birth;
• The operation is necessary for the patient's physical or mental health (in determining whether an operation is necessary for a person's mental health it is immaterial whether that person or any other person believes that the operation is required for a matter of custom or ritual);
• By virtue of the operation or a process of which the operation forms a part, the patient is a transgender person.

All nurses and doctor in Jersey are legally required to be registered under local legislation and through their governing bodies they are required to have access to guidance on FGM. Registration in Jersey is dependent on nurses and midwives being registered with the Nursing and Midwifery Council (NMC) and the Jersey Care Commission, similarly doctors holding General Medical Council (GMC) registration with a licence to practise must also be registered with the Jersey Care Commission on island.

The 1989 Convention on the Rights of the Child ratified in Jersey protects against all forms of mental and physical violence and maltreatment (article 19.1); to freedom from torture or cruel, inhuman or degrading treatment (article 37a). This requires Jersey to take all effective and appropriate measures to abolish traditional practices prejudicial to the health of children (article 24.3). FGM is recognised internationally as a violation of the human rights of girls and women where it reflects deep-rooted inequality.

See also United Nations Population Fund   Promoting Gender Equality FAQ - FGM.

The rights of women and girls are enshrined by various universal and regional instruments including the Universal Declaration of Human Rights, the United Nations Convention on the Elimination of all Forms of Discrimination Against women, the European Convention on the Rights of the Child, the African Charter on Human and People's Rights and the protocol on the rights of women in Africa. All these documents highlight the right for girls and women to live free from gender discrimination, free from torture, to live in dignity and with bodily integrity with aims to promote equality, peace, freedom and justice.

As a result of immigration and refugee movements, FGM is now being practiced by ethnic minority populations in many parts of the world, such as the UK, USA, Canada, Europe, Australia and New Zealand.

FORWARD estimates that as many as 6,500 girls are at risk of FGM within the UK every year.

The UK Home Office have published a fact sheet (see here) which  identifies the communities and countries where girls and woman are more at risk, these are:

African Communities

• Somali;
• Ethiopia;
• Sudanese;
• Nigeria;
• Kenya;
• Sierria Leon;
• Eritrea;
• Egypt.

Non-African Communities

• Yemeni;
• Indonesia;
• Kurdish-inhabited area;
• Afghanistan;
• Pakistan.

The person who performs FGM, (often another woman) will often have had no medical training, using instruments (which are not sterile) such as knives, scissors, glass or razor blades. Children are rarely given anaesthetic, antiseptic or antibiotic treatment. The procedure is typically performed on girls aged between infancy and before puberty starts, in some cases it is performed on new-born infants or on young women before marriage or during pregnancy.

FGM has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and it interferes with the natural functions of girls' and women's bodies. Although all forms of FGM are associated with increased risk of health complications, the risk is greater with more severe forms of FGM.

Immediate complications of FGM can include:

• Death;
• Severe pain and shock;
• Excessive bleeding (haemorrhage);
• Genital tissue swelling;
• Fever;
• Uterus, vaginal and pelvic infections;
• Cysts and Neuromas;
• Increased risk of Fistula;
• Increased risk of HIV and AIDS;
• Urinary retention;
• Wound healing problems;
• Complications in Childbirth;
• Difficulties in Menstruation;
• Infertility;
• Injury to surrounding genital tissue;
• Broken limbs from being held down.

Long-term complications can include:

• Urinary problems (painful urination, urinary tract infections);
• Vaginal problems (discharge, itching, bacterial vaginosis and other infections);
• Menstrual problems (painful menstruations, difficulty in passing menstrual blood, etc.);
• Scar tissue;
• Sexual Dysfunction and psychosexual problems pain during intercourse, decreased satisfaction, etc.
• Increased risk of childbirth complications (difficult delivery, excessive bleeding, caesarean section, need to resuscitate the baby) and newborn deaths;
• The need for later surgeries for example, the sealing or narrowing of the vaginal opening (type 3) may lead to the practice of cutting open the sealed vagina later to allow for sexual intercourse and childbirth (deinfibulation). Sometimes genital tissue is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing both immediate and long-term risks, (See Sexual Offences (Jersey) Law 2018- Article 28);
• Trauma and Flashbacks;
• Depression and post-natal depression;
• Psychological problems (anxiety, post-traumatic stress disorder, low self-esteem).

In addition to these health consequences there are considerable social consequences of FGM (see further information here).

The following indicator list is not exhaustive. These warning signs may indicate FGM and/or other types of abuse (please see SPB Recognising Signs of Abuse and Neglect, Forced marriage, Honour Based Violence, Domestic Abuse).

The Continuum of Children's Needs provides practitioners with clear direction and advice about what to do and how to respond to children who are at risk of significant harm. It also includes information regarding the criteria, including the level of need, for when a child should be referred to the Children and Families HUB (see Section 8, Actions).

The following are signs that the child may be at risk of FGM:

• Their mother has experienced FGM;
• A relative known as a  cutter  may visit from abroad;
• A special occasion or ceremony takes place where a girl becomes a woman or is prepared for marriage;
• A female child is born to a woman who has undergone FGM or whose older sibling or cousin has undergone FGM;
• The family belongs to a community in which FGM is practised, listed above;
• The family arrange a long holiday overseas or visits a family abroad during the summer holidays;
• A girl has an unexpected or long absence from school;
• The family indicate that there are strong levels of influence held by elders and/or elders engage in bringing up female children;
• Where a girl from a practising community is withdrawn from Sex and Relationship Education; they may be at risk from their parents wishing to keep them uninformed about their body and rights.

A midwife or obstetrician may become aware at the birth of a child, the woman has had FGM, where this must prompt concern for any daughters, girls or young women in the family. Other warning signs are repeated failure to attend or engage with health and welfare services or the mother of a girl is very reluctant to undergo genital examination, including cervical smears.

Consider whether any other indicators exist that FGM may have or has already taken place, for example the child has:

• Changed in behaviour after a prolonged absence from school;
• Health problems, particularly bladder or menstrual problems;
• Difficulty walking, sitting or standing and may appear to be uncomfortable;
• Appears anxious, quiet or depressed;
• Is reluctant to go to the doctors or have a routine medical examination;
• Asks for help or discloses something has happened to them which raises concerns they may have experienced or at risk of FGM, (although the child may not be explicit or be able to describe what has happened).

If a child or young person reveals FGM, practitioners must:

• Give time and listen carefully to what they are saying;
• Let them know they have done the right thing by telling you;
• Tell them it is not their fault;
• Take them seriously;
• Not confront any alleged abuser or family member at this point;
• Explain to the child or young person that you will make a Children and Family HUB referral in their best interest and the limits of confidentiality in this case;
• Record what has been said to you in the child or young person's words.

It should not be assumed main carers and families from communities where the UN identifies women and girls are at an increased risk of FGM, will practice FGM or want their girls and women to undergo FGM.

Practitioners need to be aware of the risks and indicators of FGM and the increased risk of children who come from identified areas whilst they get to know and appreciate the fuller context for the child.

In discussing FGM with a child's main carers, practitioners must explain the legal position around FGM in Jersey, they should approach this with cultural sensitivity. Further information available on how to broach this complex subject can be found in the UK's Multi agency Statutory Guidance on Female Genital Mutilation April 2016. As family members need to understand that FGM and re-infibulation (the process of resealing the vagina) is illegal.

Practitioners must work in a culturally sensitive way, the culture around justification for FGM may be based on tradition, custom, faith, honour, religion, thoughts beliefs and values. Cultural competence does not mean agreeing with or supporting views nor does it mean ignoring or excusing practices that are against Jersey Law and cause or risk causing significant harm to children and young people.

Where FGM is concerned practitioners should work with the child and young person and their parents/carers in a participatory way. Rather than assuming parents/carers do not have the best interests of their child in mind, it is about working with them to explain that FGM is against the law in Jersey. Explaining the risks to the child now and in their future, to show them that carrying out FGM is not in the best interests of the child or young person. It may be about understanding if there are other adults influencing parent's decision making and how to support them and their child now and in the future from the pressure to conform in relation to these outside influencers.

Please see NSPCC briefing on Culture and Faith: learning from case reviews here.

Challenge must be made on any attempt to justify harm on cultural or religious grounds. It is essential practitioners remain focused on the health, development and welfare of the child or young person and that their rights and needs remain paramount.

Assessments should explore the impact of a person s culture on their life, including spiritual practices, rites/blessings, beliefs and practices surrounding life events, dietary restrictions, personal care, daily rituals, communication social customs and attitudes to health care and support.  
FGM is a complex and sensitive issue that requires practitioners to approach the subject carefully. An accredited and trained female interpreter may be required. Interpreters should ideally be trained in relation to understanding the risk of FGM and in all cases should not be a family member, nor be known to the individual or someone with influence in the individual s community.

In all cases the risk to other female children in the family and extended family must be considered, and all parents/carers should be given information on FGM explaining that it is illegal to:

• To carry FGM out n Jersey or the UK;
• To take their child abroad in order to carry out FGM.

Parents, main carers and families have a statutory responsibility to protect their children from the practice of FGM (at the time of identification of risk or at any time in the future).

FGM remains an illegal procedure when a child reaches adulthood. 

Practitioners should have access to regular Internal Agency Safeguarding Supervision. Agencies should consider multi-agency reflective supervision where cases are complex, stuck or drifting.

Challenge should be welcomed and partnership working depends on resolving professional differences and conflict as soon as possible. Where staff experience professional differences, they must follow the SPB Resolving Professional Difference/Escalation Policy.

AFRUCA (Child Protection of African Children)

National FGM Centre

Forward (Foundation for Women's Health Research and Development)

NSPCC - Fact sheet Female Genital Mutilation (FGM)

Female Genital Mutilation and its Management: Royal College of Obstetricians and Gynaecologists 2009

Female Genital Mutilation: Resource Pack

Female Genital Mutilation Risk and Safeguarding – Guidance for Professionals (DoH)

United Nations Convention on the Rights of the Child

NMC guidance on FGM

GMC guidance on male circumcision

GMC guidance on FGM