Female Genital Mutilation (FGM), also termed ‘cutting’ and ‘female circumcision’, and known by a range of colloquial terms in communities that perform FGM, is a harmful practice, and an abuse of women and girls. FGM is illegal in England, Wales and Northern Ireland, under the FGM Act 2003. In Scotland it is illegal under the Prohibition of FGM (Scotland) Act of 2005. More than 200 million women and girls worldwide are estimated to have suffered Female Genital Mutilation, and 137,000 women and girls in England and Wales are thought to be FGM survivors.
FGM is defined as comprising all procedures involving the partial or total removal of the external female genitalia for non-medical reasons, and therefore includes not only FGM practised for cultural and ethnic reasons, but also genital piercing, genital tattooing and female genital cosmetic surgery carried out for non-medical reasons.
In 2014, the Home Affairs Select Committee on FGM highlighted that there had been no convictions for the offence of FGM, and addressed the need to change the law in order to “improve child protection and increase the likelihood of a successful prosecution”.
Soon after, The Serious Crime Act (2015) became law. This Act enhanced legislative powers in helping to end FGM in England and Wales, with additional provisions amending the FGM Act 2003, one being the FGM Mandatory Reporting duty. The duty came into force on 31st October 2015, and requires regulated health and social care professionals, and teachers in England and Wales, to report ‘known’ cases of FGM in young women and girls under the age of 18 years, which are identified in the course of their professional work, to the police via the 101 (non‑emergency) telephone number. The law requires that the regulated professional explain why a report is being made, and identify the girl or young woman.
‘KNOWN’ cases are defined for the purposes of the Mandatory Reporting duty as either or both of the following:
1. DISCLOSURE: The under 18-year-old girl or young woman informs the regulated professional, using any accepted term for FGM, that an act of FGM has been performed on her. If another individual, including a parent/carer/sibling, reports that FGM has been carried out this duty does not apply;
2. IDENTIFICATION: The regulated professional has observed physical signs consistent with FGM. The duty does not require a full clinical diagnosis confirming FGM before a report is made, and you are not required to undertake a genital examination for these purposes.
While the legislation allows for a report to be made within a month of FGM being disclosed or identified, best practice is for a report to be made no later than the end of the next working day. A report may be delayed, for example, if it may lead to an increased safeguarding risk to the child or others, and advice from colleagues is required prior to making a report. The safety of the child or young adult is of paramount importance. It may not always be safe to inform a child and/or family that a report will be or has been made, in case this leads to an increased risk of serious harm to the child or others. If there is a risk to life or likely serious imminent harm, the case should be reported to the police immediately, including calling 999 if indicated.
Reporting FGM under the duty does not breach patient confidentiality regulations. This is a personal duty, hence, the professional who has identified FGM must make the report, and cannot transfer this duty. Failure to make a report is not a criminal offence and would be considered by the professional’s regulatory body, and may lead to disciplinary proceedings.
For the duty to apply, the girl or young woman must be under 18 at the time that FGM is either disclosed or observed by the regulated professional. The duty does not apply to a risk of FGM or to suspected cases of FGM in women over 18. For all cases, whether they fall into the duty or not, professionals must follow local safeguarding procedures. Cases that do not fall within the duty, whether due to suspected FGM, or a risk of FGM, in women and girls of any age, may in some instances, require police involvement.
The Mandatory Reporting Duty is not to be confused with the requirement for healthcare providers to make an anonymous report of FGM cases to the HSCIC (Health and Social Care Information Centre) for the purposes of gathering statistics and data regarding FGM.
There are about 1,300 101 call handlers in London, and therefore, bearing in mind that calls to make an FGM mandatory report are infrequent, a consistent response cannot be assured, and there have been occasions when uniform officers have been sent to respond to mandatory report calls. In order to ensure that a proportionate response takes place, it is important to convey to the 101 call handler the current level of risk to the child and others (such as siblings). The police will initiate the multi-agency response, in accordance with local safeguarding arrangements. If the police considers the case to be an emergency, action may be taken prior to the multi-agency response. The police will liaise with social care before taking action.
Although national figures are not readily available, between 31st October 2015 and 28th February 2017, 44 mandatory reports were made in London to the Metropolitan Police Service, of which the majority were made by healthcare professionals. Somalia represented the most common country of origin of young women and girls’ reported under the duty, and the majority of reports related to 15-17 year olds. Many reports have related to historic incidents of FGM.
Healthcare professionals have voiced concerns regarding the potential repercussions of the mandatory reporting duty, including the negative impact it may have on their relationships with patients and their families, and the potential consequences of a report for children and their families, such as children being taken into care.
Bearing in mind these concerns, the figures may go some way in reassuring professionals. Thirty-eight of the 44 mandatory reports have resulted in these cases being closed, with no further action being taken by the Police. Four are still under investigation, and in two cases safeguarding actions have led to the implementation of child protection plans within the family unit.
To date, there have been no convictions in England and Wales for the crime of FGM. Healthcare professionals manage the needs of many patients suffering with the complications of FGM, both physical and psychological, and, as such, are well placed to identify FGM, and make a mandatory report of this all too often hidden crime, with a view to contributing to the goal of one day ending this form of abuse against women and girls.
Allen Davis – Inspector – Partnership Team, SOECA Command, Metropolitan Police Service DC 9773 Gillian Squires – FGM Subject Matter Expert, West Midlands Police Service
Dr Sharon Raymond MBBS MRCGP
Named GP for Safeguarding Children in the London area, Independent Safeguarding Trainer