7th Report - Female genital mutilation

Survivors of female genital mutilation (FGM) experience profound physical, emotional and psychosexual consequences and require specialised care and support to manage these impacts. Despite this, survivors may not be aware that the health complications they experience are a consequence of FGM, meaning awareness among survivors of the long-term health implications of FGM is vital. (Conclusion, Paragraph 18)

Services for FGM survivors and access to them remains inconsistent across the UK. While some variation in access to services may be expected in line with local prevalence, there is a lack of effective referral pathways. This has created a postcode lottery that risks leaving women and girls without the essential support and care they need. (Conclusion, Paragraph 19)

The NHS should use Women’s Health Hubs, as well as other relevant points of contact such as sexual health services and sexual assault referral centres, to raise awareness among survivors of the potential consequences of FGM and the benefits of seeking medical advice. (Recommendation, Paragraph 20)

The Government should ensure that all FGM survivors can access the essential support and care they need in a timely manner. While some variation in service provision may be necessary to reflect local prevalence rates, higher-prevalence areas should offer funded multidisciplinary services that allow quick access to specialist care. In lower-prevalence areas, there must be clear referral pathways in all relevant healthcare settings including General Practice, Women’s Health Hubs and sexual health services to ensure women can access care without delay. The NHS must take steps to ensure that advice on when certain procedures, such as deinfibulation, can be accessed reflects the latest NHS guidance. (Recommendation, Paragraph 21) 41

There is a notable lack of data on spending on FGM services but evidence to this Committee indicates that funding for FGM services may have reduced and remains precarious. There are also concerns that the integration of FGM services within the wider women’s health agenda has led to a reduced focus. (Conclusion, Paragraph 22)

Integrated Care Boards (ICBs) should ensure sufficient funding is available to meet local demand for services tailored to the needs of FGM survivors. Spending on FGM services should be published and data collected at a local and national level to help build up a comprehensive picture of demand for and funding of FGM services. (Recommendation, Paragraph 23)

FGM survivors often suffer psychosexual, emotional and mental health complications from undergoing FGM. However, many FGM survivors do not have access to appropriate counselling services, with many FGM services not offering any counselling to FGM survivors and others offering counselling which is not appropriate or tailored for their needs. (Conclusion, Paragraph 27)

The Government should ensure that all FGM Support Clinics offer specialist counselling support to FGM survivors in appropriate settings, provided by counsellors who are trained in the specific challenges of FGM. There should be clear referral pathways to this counselling for women who access FGM services through Women’s Health Hubs. (Recommendation, Paragraph 28)

Evidence suggests some FGM survivors are experiencing shame or humiliation in healthcare settings, reducing the likelihood of them engaging further with healthcare services essential to their physical and mental wellbeing. Training for midwives and healthcare professionals is not mandatory and often does not include practical advice on how to ask questions and discuss FGM in a culturally sensitive manner, which makes it difficult for healthcare professionals to deliver services effectively. (Conclusion, Paragraph 33)

FGM training should be made mandatory for midwives and other healthcare professionals working in services where they are likely to encounter FGM survivors. That training should include how to treat survivors with appropriate sensitivity. Staff working in FGM Specialist Clinics and Women’s Health Hubs should be able to signpost survivors to non-health related local services where necessary such as those that can offer support relating to gender-based violence, insecure housing, and language barriers. (Recommendation, Paragraph 34)

FGM survivors are not consistently being made aware that they are entitled to interpretation services. However, interpretation services that are available can be unsuitable and interpreters can lack the necessary 42 proficiency to advocate on behalf of survivors. This can lead to survivors relying on family members which can prevent open communication. (Conclusion, Paragraph 36)

FGM Specialist Clinics and Women’s Health Hubs should ensure that women are informed of their right to have an interpreter. Those interpreters must be appropriately trained and sensitive to the cultural sensitivities around FGM. (Recommendation, Paragraph 37) Reconstructive surgery

Many women who have undergone FGM seek reconstructive surgery to reverse FGM as far as possible. It is clear that the NHS is equipped to perform this surgery as it delivers it for other medical conditions. We acknowledge that the current medical evidence supporting reconstructive surgery for FGM survivors may be limited. However, it is unreasonable for the Government to cite a lack of evidence as a barrier to reconstructive surgery while simultaneously failing to invest in the research necessary to generate such evidence. (Conclusion, Paragraph 43)

The Government should facilitate and fund research into the effectiveness of reconstructive surgery for FGM survivors as a matter of priority. If evidence indicates that the surgery is effective, then the NHS should provide it. (Recommendation, Paragraph 44) Estimating the prevalence of FGM

To tackle FGM and be able to provide services based on need, the Government, local authorities and healthcare providers need to understand the prevalence of FGM within the UK. The most recent study on FGM prevalence in England and Wales was published in 2015 and was based on 2011 census data. It is a significant oversight that the Government lacks up-to-date information on the current prevalence of FGM nationwide and per locality. This gap undermines the Government’s, local authorities and healthcare providers’ ability to provide services to women in need. (Conclusion, Paragraph 49)

The Government should immediately commission research into the number of women with FGM in the UK, including on prevalence within local areas. It must make this data accessible so that local authorities and health providers can provide their services accordingly. The NHS should ensure that data on the country of birth and the country where FGM was undertaken for individuals is consistently recorded and published. 43 This will help build a picture of how many women and girls born in the UK have undergone FGM and how many have undergone FGM in the UK. (Recommendation, Paragraph 50) Preventing FGM

It is a matter of serious concern that evidence given to us and available data indicate both that FGM is taking place in the UK and that UK citizens or residents are being taken abroad to undergo FGM. The Government must allocate sufficient resources to tackle this form of gender-based violence and, in most circumstances, violent child abuse. While the UK Government has taken steps to prevent and address FGM, variations in funding on tackling FGM over recent years risk the consistency and long-term impact of this work. (Conclusion, Paragraph 58)

Grassroots organisations, often run by FGM survivors from the affected communities, perform vital work in supporting FGM survivors and combatting FGM. However, they receive limited funding, must compete against one another, and can lack the capacity or expertise necessary to secure funding in complex application processes. (Conclusion, Paragraph 59)

Given the ongoing risk of FGM in the UK, we recommend the Home Office restore funding to previous levels—we recommend an annual spend of at least £2 million—and commit to sustained funding for initiatives aimed at preventing and tackling FGM. Targeted support should be provided to local authorities with higher levels of FGM prevalence to ensure they can respond effectively to local needs. Funding should also continue to be allocated to public awareness campaigns and to services which play a key role in prevention and support, including by reinstating funding to the NSPCC FGM helpline. (Recommendation, Paragraph 60)

The Government and local authorities should actively engage with and provide sustainable funding to small and grassroots organisations working on FGM to ensure they are able to carry out their work. The Government should ensure that applications for funding are accessible and inclusive for organisations that lack the resources to navigate complex tendering processes. (Recommendation, Paragraph 61)

Education on FGM in schools is an essential means of preventing FGM. It can equip girls to advocate on behalf of themselves and to challenge prevailing orthodoxies on behalf of others. We welcome the current and future guidance on RHSE which includes content on the physical and emotional damage caused by FGM, where to find support, and the law, to be taught by the end of secondary education. (Conclusion, Paragraph 64) 44

Education among communities can be an effective tool in challenging the beliefs that fuel FGM and in raising awareness of the serious health impacts of FGM. The effectiveness of these campaigns is likely to be increased when influential people within the community, such as religious leaders, are included in education and prevention efforts. (Conclusion, Paragraph 67)

The Government and local authorities should fund community-led education programmes to challenge the cultural and social beliefs that drive FGM. These programmes must be tailored to reflect the specific drivers of FGM within different communities. Education must include the health consequences of FGM and be targeted at those who drive FGM within communities. (Recommendation, Paragraph 68) Preventing FGM: Police work

While some FGM survivors and campaigners believe more needs to be done to secure convictions against perpetrators of FGM, others believe a strong focus on criminalisation can hinder efforts to engage with communities to prevent FGM and support FGM survivors. It is evident that to tackle FGM, the Government, local authorities and police must strike a balance between prevention and prosecution. However, the message needs to be clear that cultural sensitivities are irrelevant when it comes to violent, gender-based abuse, that more often than not is perpetrated against a child, and that survivors will be supported in seeking justice. (Conclusion, Paragraph 73)

The Government should continue to adopt an approach that looks at prevention and prosecution by funding and engaging with prevention efforts in local communities. Alongside this work, criminal justice agencies should review police intervention and CPS prosecution strategies with a view to increasing the prosecution rate for FGM. We acknowledge the challenges this involves, not least the willingness of survivors to testify against family members, but an effective criminal justice deterrent is a vital part of the process in tackling FGM and it is currently missing. (Recommendation, Paragraph 74)

Evidence suggests that safeguarding referrals are low. Professionals often lack the confidence to ask questions and get the necessary information from the families of the women and girls affected. Some professionals may also be reluctant to ask questions due to fears of appearing to be culturally insensitive, and there is a lack of training around asking such questions. (Conclusion, Paragraph 78)

The Government should ensure that professionals, such as teachers and healthcare professionals, are adequately trained to feel confident to ask questions around female genital mutilation in order to increase the number 45 of successful safeguarding referrals for FGM. This training should include how to broach sensitive subjects, and make clear that FGM is practised across a wide range of communities. (Recommendation, Paragraph 79)

Border monitoring is an effective mechanism for preventing FGM being carried out on UK citizens and residents taken abroad. However, evidence suggests that monitoring could be made better through improved training of border officials, better follow-up of suspected cases, and enhanced communication between different agencies. (Conclusion, Paragraph 83)

The Home Office should ensure that border officials have sufficient training on FGM to ensure they can identify potential cases and intervene when necessary. There should also be close engagement between departments, such as the Foreign, Commonwealth and Development Office, Home Office, and the Department for Education, including social services, to ensure that suspected cases are monitored effectively. (Recommendation, Paragraph 84)

FGM Protection Orders (FGMPOs) can be an effective way of supporting FGM survivors and preventing FGM. Although the data on FGM protection orders is incomplete, the number of FGMPOs appears low, especially when compared to estimations of the number of girls at risk of FGM in the UK. (Conclusion, Paragraph 88)

The Ministry of Justice should encourage the use of FGMPOs by working with the Department for Education to increase awareness among children’s social services of FGMPOs and the criteria needed to obtain one. We welcome the MoJ’s plans to ensure that its data on FGM Protection Orders is up to date. (Recommendation, Paragraph 89) Preventing FGM globally

The continued prevalence of FGM globally increases the risk of FGM to current and future UK citizens and residents. Supporting international efforts to end FGM through aid programmes and diplomacy helps the UK fulfil its international obligations to achieving Sustainable Development Goal 5 and is a necessary step to reduce the risk of FGM occurring to UK citizens and residents. The planned reduction in Official Development Assistance (ODA) from 0.5% to 0.3% of GNI in 2027 after the prior reduction from 0.7% risks the effectiveness of these programmes and present a direct risk to the safety of girls in the UK and those overseas. (Conclusion, Paragraph 95)

We call on the Government to protect FGM programmes from further reductions in funding. The Government should inform the Committee of its funding plans for programmes working on reducing FGM over the next spending period, including a comparison with previous periods. It should 46 also provide the Committee with any wider Equality Impact Assessment on the reduction of ODA spending from 0.5 to 0.3% of GNI as a whole. (Recommendation, Paragraph 96) 47