Written evidence submitted by
Foundation for Women’s Health Research and Development (FORWARD UK)

Contents

Declaration of Interest

Background

The Context of FGM in the UK

The effectiveness of the existing UK legislative framework on FGM and the barriers to achieving a successful prosecution in the UK

Recommendations

Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?

Exploring the respective roles of the police, health, education and social care professionals, and the third sector: how can multi-agency co-operation be improved?

How can the systems for collecting and sharing information on FGM be improved?

How effective are existing efforts to raise awareness of FGM?

How can the available support and services be improved for women and girls in the UK who have suffered FGM?

Conclusion:

Recommendations:

Declaration of Interest

1. FORWARD is an African Diaspora women led campaign and support organisation with a vision that African women and girls live in dignity, are healthy, have choices and equal opportunities. Our goals include preventing gender based violence, in particular female genital mutilation (FGM) child marriages and related health complications and human rights violations; improving access to sexual and reproductive health services; skills and livelihood options; strengthening knowledge base and capacity of project partners and enhancing voice and leadership of Diaspora African women in the UK.

2. FORWARD is responding to this Select Committee inquiry as the lead agency working on FGM in the UK. We promote a comprehensive approach to tackling FGM, working nationally and abroad to ensure dignity and rights of African women and girls. We provide public education and training to shift understanding of this practice. We generate evidence, information and resources to influence and shape policy and professional responses to FGM. We facilitate leadership development, empowerment and build confidence of women and girls, communities and young people support at local level to bring about attitudinal and behaviour change. As a legacy organisation we have supported programmes within the UK and Africa and nurtured a number of activists in the field including founders of Daughters of Eve, Orchid Project and 28 Too Many.

Background

3. FGM is a human rights violation which has been on the UK policy agenda for the past two decades. The UK government has submitted several reports to human rights treaty bodies in particular CEDAW detailing its efforts to respond to discrimination against women and specific actions in relation to FGM. 
4. The UK has sponsored the UN General Assembly Resolution on Intensifying efforts for the elimination of FGM which emphasise “the need to develop, support and implement comprehensive and integrated strategies for the prevention” of FGM (para 15).

5. The UK is signatory to the Council of Europe Convention on preventing and combating violence against women and domestic violence. The Istanbul Convention requires States to prevent, prosecute and eliminate physical, psychological; and sexual violence, including FGM. To implement these obligations, States Parties are required to adopt state-wide effective, comprehensive and co-ordinated policies that would comprise all relevant measures to prevent and combat FGM and all other forms of violence against women, and that would form part of a holistic response to violence against women.
1. The Convention also foresees an obligation for States parties to legislate to recognize FGM as a criminal offence, including the act of coercing or procuring a woman or girl to undergo the procedure “voluntarily” (Article 38). According to the Convention FGM should be punishable by effective, proportionate and dissuasive sanctions (Article 45). However, the Convention insists on the fact that consideration should be given first and foremost to the child’s best interest in accordance with the UN Convention on Rights of the Child. Prison sentences, large fines or long separations from the parents/family may have a serious impact on the child’s well-being and must therefore be weighed against other options.
2. In its thematic paper on Legislative reform to support the abandonment of Female Genital Mutilation/Cutting (August 2010), UNICEF recalls that the Convention on the Rights of the Child (in Article 9.1) “provides that unless necessary for the best interest of the child and determined by competent authorities according to the law, a child should not be separated from his or her parents. Only when the girl appears to be at high risk, and if the parent after multiple warnings is assessed as not responding to other interventions, should long-term alternative care options be considered.”  Efforts should be made to change the underlying beliefs that perpetuate FGM.

6. In 2000, the UK organised the first Parliamentary Hearing on FGM, by the All Party Parliamentary Group on Population, Development and Reproductive Health which brought together lead organisations working in the field, local authorities, medical professionals as well as UN agencies and WHO experts with the aim to produce recommendations for future strategies on FGM for the UK.  35 key recommendations were made focusing on legislative changes; education policy; sustainable funding for community based work and health strategy. The majority of these recommended actions were never translated into policy action.

The Context of FGM in the UK

7. According to the latest UNICEF report on Female Genital Mutilation (2013), FGM continues in 29 countries in Africa, as well as some in the Middle East.

8. In the UK, data from a study conducted by FORWARD[1] indicated that up to 100,000 women and girls are affected by all types of FGM.
9. A new study soon to be released by FORWARD will show that many girls are now subjected to FGM between 5 and 8 years – thus reinforcing the need for youth friendly and appropriate services and support provisions.
10. The political landscape of FGM has also altered significantly in the past three years. The introduction of the Home Office led Violence against Women Action Plan, included mentions of FGM. In addition, the release of the Crown Prosecution Service’s guidance and action plan on FGM, a Westminster Hall debate led by Karl Turner, (Labour MP for Kingston Upon Hull East), and the presence of leading political ambassadors against FGM, such as the previous Female Genital Mutilation APPG Chair, and current Public Health Minister Jane Ellison have led to increased attention and focus on FGM. Significantly, the Department for International Development (DFID) also announced a £35 million fund for FGM related work. The Home office also introduced a £50,000 for community engagement. In addition, since the latter half of 2013 there has been a considerable increase in the media attention devoted to FGM. Media campaigns by the Evening Standard and The Times have highlighted existing gaps in provision of services for women affected by FGM, the lack of sufficient data related to FGM, and that there have been no FGM related prosecutions since the passing of FGM related legislation in 1985.
11. The Guardian has also launched an FGM campaign calling for the Education Secretary, Michael Gove and the Department for Education (DfE) to play its part in the effort to protect girls from FGM.

The effectiveness of the existing UK legislative framework on FGM and the barriers to achieving a successful prosecution in the UK

12. The current legislative framework on the FGM should be reviewed and where necessary strengthened. The Female Genital Mutilation Act whilst a progressive revision on the former legislation (Female Circumcision Act 1985), still includes loopholes, which need to be closed.

13. Language: The language used to define FGM in the Female Genital Mutilation Act is not in line with the World Health Organisation (WHO) definition and needs to be clarified. The WHO defines the procedure as

1. “[comprising] all procedures that involve [the] partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.”[2]

14. This definition can be used to encompass FGM Type I to Type IV. If the Female Genital Mutilation Act was amended to include this definition, there would be no room for contestation for any act of mutilation on the genitalia of girls and women, and would thus further ensure the legislative protection of girls and women.

15. Extraterritoriality: Currently, the Female Genital Mutilation Act states an offense has been committed if either a UK national or permanent resident is taken abroad and an act of FGM is committed against them. However, this provision fails to include residents who are in the UK on temporary visa (such as those on work and student related visas). The act fails to explicitly state that all residents commit an offense should they choose to take a girl, or aid a girl to be taken abroad for an act of FGM to be committed against them means that some girls in the UK are not sufficiently protected by the current legislation.  The UK is a signatory of the Council of Europe Convention on preventing and combating violence against women and domestic violence (Istanbul Convention). Article 38 of the convention states that:

1. Parties shall take the necessary legislative or other measures to ensure that the following intentional conducts are criminalised:

2. excising, infibulating or performing any other mutilation to the whole or any part of a woman’s labia majora, labia minora or clitoris;
3. coercing or procuring a woman to undergo any of the acts listed in point a;
4. inciting, coercing or procuring a girl to undergo any of the acts listed in point a. [3]

16. Recommendation: Article 38 of the Istanbul Convention comprehensively captures all women affected by FGM irrespective of residency. We recommend that the Female Genital Mutilation Act is amended to be in line with the Istanbul convention.

17. Child protection: FGM is a child protection matter, and should be considered within and fully integrated into the current child protection legislative framework. Where relevant, other legislation related to child protection should be used in FGM related cases to enable the safeguarding and protection for survivors.

18. Female Genital Cosmetic Surgery (Labiaplasty): Female Genital Cosmetic Surgery (FGCS) is increasingly popular in the UK. FGCS procedures such as labiaplasty are worryingly similar to Type I and II FGM, and may result in similar health complications such as reduced sensation, infection and bleeding, and wound dehiscence.[4] Whilst currently legal, the practice is mainly performed in the private sector and subject to little regulation. As a result, there is very little activity and outcome data, and the numbers of procedures that have taken place in the private sector are unknown.[5]

19. However, in the past ten years, there has been a fivefold increase in the number of labiaplasty procedures – the most commonly performed type of FGCS - taking place on the NHS.[6] And between 2008 and 2012, 266 labiaplasty procedures were performed on girls under the age of 14 in the NHS.[7] Thus we can legitimately posit that the number of FGCS procedures is going up.

20. A joint position paper by the Royal College of Obstetrics and Gynaecology (RCOG) and the British Society for Paediatric and Adolescent Gynaecology (BritSPAG) stated that:

1. “There is no recognisable disease process warranting surgical treatment and no creditable evidence to demonstrate lasting effectiveness along physical, psychological and sexual parameters.”

21. The position paper also made a strong recommendation that the procedure should not be carried out on girls under the age of 18. The medical position as expressed by the RCOG and BritSPAG, as well as increasing evidence to suggest that the procedure may result in similar impacts to FGM, lead us to suggest that the legislative framework regarding FGCS must also be clarified and strengthened. Reference to FGCS should also be made in the Female Genital Mutilation Act. Without it we may be subject to the risk of FGM procedures may take place under the guise of being conducted in a medical environment.

Recommendations

22. We recommend that the third provision of the Female Genital Mutilation Act 2003 is amended and explicitly states that the removal of a girl for FGM to be acted upon her internationally is illegal.

23. We also recommend that the CPS explore other child protection legislation – such as the Children’s Act - to ensure that girls affected by FGM receive full protection and justice through the law.

24. We recommend that the law and regulatory requirements around FGCS are strengthened. We also recommend that FGCS procedures should not be practiced on girls under the age of 18.

Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?

25. FGM is a global problem and affects women and girls living in the UK from FGM affected countries in Africa, Middle East and Asia.  Those at risk are not a homogeneous group and include British citizens born in the UK, migrant groups, asylum seekers, refugees and students and from affected communities.

26. As identified in a FORWARD study on FGM[8] up to 100,000 women and girls in the UK are at risk of FGM. However, this figure is based on a limited number of African communities, and does not represent those at risk from Middle East and Asia communities - including the Dawda Borah communities, and segments of the Kurdish communities who are known to practice FGM. We therefore suspect that the number of women at risk of and affected by FGM is higher.

27. In addition to acknowledging that women and girls from the 28 African FGM affected countries are at risk,[9] FGM must also be considered a form of violence that may affect any girl in the UK. Intermarriage between different ethnicities and cultures broadens the scope of girls at risk. In addition, the mutilation of the female genitalia is a form of abuse and violence – and it may be inflicted on any girl or women for a range of complex reasons.

Exploring the respective roles of the police, health, education and social care professionals, and the third sector: how can multi-agency co-operation be improved?

28. One of the primary duties and roles of the police, health, education and social care professionals is safeguarding. These duties are clearly and comprehensively outlined in the Multi Agency Guidelines: Female Genital Mutilation published by the UK Government. However, these guidelines are currently not statutory and have not been rolled out nationally.

29. In addition, the Children’s Act (2004) clearly outlines that local governments should act as a coordinating body to promote multi-agency co-operation between all officials relevant to improving and enabling the wellbeing and safeguarding of children.[10]

30. There are examples of successful FGM related multiagency cooperation throughout England and Wales that other local authorities can model themselves on. FGM Forums exist in London boroughs such as Islington, Lambeth, Acton and Hackney as well as in cities such as Bristol, Birmingham and Manchester. These forums differ in their representations but generally include safeguarding professionals, teachers and schools professionals, local authority bodies; medical professionals and the police.

31. The action and information sharing practices that exist in such forums are important to ensure that a robust safeguarding system based on prevention, protection, provision of services and support is available for women and girls at risk and affected by FGM. It is also important that there are procedures to enable coordination among these structures, so where necessary, effective sharing and learning of best practice is possible.

32. Training:

33. In addition to the coordinating role that local authorities are responsible for, training and community engagement are also key components to enabling a robust response to FGM. Sufficient training for health and safeguarding professionals is also an obligation as stated in Article 15 of the Istanbul Convention, and Article 25 of the EU Directive on the Rights of Victims of Crime.

34. FORWARD, which is an accredited training centre, has trained over 1,500 professionals from statutory and voluntary organisations in the past year. Many of those who attended the training stated a considerably improved level of preparedness to respond to FGM cases should they arise.

35. Training is also important to help increase some statutory professionals awareness and understanding of FGM. For instance, the recent NSPCC survey for teaching staff about FGM[11] found that 80 per cent of those surveyed said that they were unaware of FGM.

36. We know that high quality training helps professionals understand the necessary reporting procedures for FGM related cases, help people understand that FGM is deep-rooted cultural practice, and helps them identify signs that may prevent a girl from undergoing FGM.

37. We recommend that FGM is streamlined into the statutory safeguarding training, and that all relevant professionals receive standardised training, preferably from an accredited training centre to help better prevent FGM, and protect and support girls and women who may be affected by FGM.

38. Community engagement: Communities must not be bypassed when we consider and create safeguarding frameworks for girls at risk of and affected by FGM. Communities lie at the heart of the continuance of FGM in the UK and beyond. It is therefore important that communities are aware of the reasons why the continued practice of FGM is harmful and a form of violence and physical abuse. A push for prosecutions, without effective community engagement and education programmes will not result in a sustained end to FGM.

39. Communities also play a crucial role in providing ‘legitimate’ advocates for an end to FGM. Community ambassadors and change agents can play an effective role in communicating messages about the dangers and harms of FGM in a way that doesn’t garner suspicion or fear of authorities.

40. Women from FGM affected communities also provide poignant anecdotal evidence about the efficacy of current FGM related services. A recent focus group conducted by FORWARD, identified that many women still do not feel comfortable discussing FGM with their GPs, and many reported near fatal experiences whilst delivering children. This evidence continues to help us design support and health services that are directly tailored and responsive to the needs of women and girls affected by FGM.

41. FORWARD has also garnered qualitative and anecdotal data, which indicates a trend away from, type III FGM (infibulation) towards what many are describing as Sunna (this may vary from Type I FGM to a level of infibulation). This illustrates that engaging religious leaders is a prerequisite in the effort to end FGM.

42. We recommend that:

43. We recommend that support services for women and girls are available throughout the UK, and that they are widely publicised.
44. We recommend that in addition to services addressing the physical implications of FGM, services to support the mental and psychological needs of women and girls affected by FGM are made available.
45. We recommend that commissioning tenders are drafted in consultation with organisations and experts that understand the specificities of FGM – and therefore reflect the needs of women and girls at risk, and survivors of FGM.
46. We also recommend that public communications work is conducted to help broaden the understanding of FGM as a harmful cultural practice – and not a disease.
47. We recommend that all the above measures are contained within, and monitored as part of a National Action Plan on FGM; community engagement is recognised and as key component of a robust plan to FGM. Sustainable funding and guidelines should be produced on community engagement.

How can the systems for collecting and sharing information on FGM be improved?

48. The collection of data related to prevalence and reporting is an important aspect of an effective and systematic response to FGM.  Currently, the UK lacks reliable up-to date data related to the number of women and girls affected by FGM in the UK. The most recent FGM prevalence data was compiled by FORWARD in 2007.[12] It is encouraging that the Department of Health is undertaking a similar study to get a clearer indication of FGM prevalence in the UK. However, the collection of data must take place in a far more systematic way in order for us to continuously have an idea of the number of women affected by FGM in the UK.

49. We also think it is important that clarity is created around reporting procedures related to FGM. The information shared and scaled up to the police must clearly reflect the best interests of the child, and be careful not to result in the immediate criminalisation of women survivors of FGM.

50. We recommend that:

51. The number of women who present at maternity wards and for gynaecological services, and have undergone FGM is collated.

52. A clear pathway for reporting FGM related cases is established and understood by relevant safeguarding professionals.

53. Data collection – along with all other components of a systematic approach to FGM – should form part of a National Action Plan on FGM. This action plan should be Government led, and spearheaded by the Home Office. It should have clearly defined ministerial responsibility, be well resourced and include a framework for monitoring, evaluation and information sharing. The UK can look to other European countries such as Norway, Portugal and Finland as examples of how national action plans can help successfully tackle FGM. The European Communication on FGM, which was released in November 2013, also includes a number of recommendations that can help strengthen the UK’s response to FGM.

54. The UK Government review the recommendations made in the All Party Parliamentary Group on Population, Development and Reproductive Health’s Hearings Report on Female Genital Mutilation (200). Where relevant, we recommend the Government implements these recommendations as part of a UK wide National Action Plan on FGM.

How effective are existing efforts to raise awareness of FGM?

55. Work by Third Sector and community organisations to raise awareness of FGM has achieved considerable success. The UK media has also played a significant role in increasing FGM related awareness amongst the British public. However it is important that targeted awareness raising activities are scaled up. This includes communications activities with community media – including broadcast, print and, where necessary training.

56. In addition, the current Government, and interested parliamentarians have played a part in significantly increasing FGM awareness. Communities must be educated and informed about the legal framework around FGM. This work needs resourcing. In previous years, The Home Office allocated a total fund of £50000 for community engagement – this must be increased in order to secure wide reaching engagement.

How can the available support and services be improved for women and girls in the UK who have suffered FGM?

57. FGM support systems must, at the core, be survivor-centric. This means that support systems – including well women’s clinics must be designed following consultation with women affected by FGM. These services should be well resourced, advertised and sustainable. FGM supported services should also be tailored to cater to different age groups. It is important that in addition to services for women, youth friendly services are made available and widely publicised. Young people may not in fact be able to, or feel comfortable to discuss their support needs with their parents. Provisions should therefore be made for girls to access these services. This may include equipping school nurses with the appropriate training to signpost girls affected by FGM to the appropriate services.

58. In addition, when FGM contracts are being commissioned, it is important that local authorities speak with groups and organisations working to combat FGM ahead of designing their contracts. The work and targets involved in this work must be based on an understanding of the nuances and complexities involved in responding to FGM – and be about positively impacting survivors and women and girls affected by FGM.

59. We must also be committed to pursuing a “do no harm” approach when responding to women and girls affected by FGM. Those affected must not be subject to lines of inquiry, suspicion or blame that we do not place on those who have been affected by other forms of violence and physical abuse. This is particularly important in social work and criminal cases. We must carefully assess the impact that asking a child to “testify” against their parents may on their wellbeing – including the possibility of isolating minors from their wider communities.

60. In addition, the language used to describe FGM should be both culturally sensitive and survivor centric. The use of terms such as “barbaric” or “backward” to describe FGM, as well as referring to the “eradication of FGM” are not helpful- and can also serve to be antagonistic or alienating.[13] FGM is a harmful cultural practice. It is not a disease. We should therefore approach FGM in the same way we approach other harmful practices and social norms.

61. We recommend that:
62. Support services for women and girls are available throughout the UK, and that they are widely publicised.
63. In addition to services addressing the physical implications of FGM, services to support the mental and psychological needs of women and girls affected by FGM are made available.
64. Commissioning tenders are drafted in consultation with organisations and experts that understand the specificities of FGM – and therefore reflect the needs of women and girls at risk, and survivors of FGM.
65. Targeted and strategic public communications work is conducted to help broaden the understanding of FGM as a harmful cultural practice – and not a disease.
66. All the above measures are contained within, and monitored as part of a National Action Plan on FGM.

Conclusion:

67. FGM is a complex and long practised harmful cultural practice. The understanding of FGM and exploration of ways to combat FGM is something that has to be undertaken by activists, statutory professionals and government alike.

68. The UK has made some considerable gains to combat FGM; however it is important that these actions go further. In order to do this, the Government must implement a national, sustainable and coordinated response to FGM – this should be done through the creation of a National Action Plan on FGM.

69. Finally, survivors of FGM and those otherwise affected by FGM must be at the centre of all efforts to end FGM. It is therefore important that all activities and work to end FGM is done in consultation with these women and girls.

Recommendations:

70. The third provision of the Female Genital Mutilation Act is amended and explicitly states that the removal of any girl for FGM to be acted upon her internationally is illegal.

71. The CPS should explore opportunities where other child protection legislation – such as the Children’s Act - to ensure that girls affected by FGM receive full protection and justice through existing legal frameworks.

72. The law and regulatory requirements around FGCS are strengthened. We also recommend that FGCS procedures should not be practiced on girls under the age of 18.

73. The Government’s Multi agency guidelines on FGM are made statutory.

74. all statutory and safeguarding professionals receive training related to FGM

75. Community engagement is recognised and as key component of a robust plan to address FGM. Sustainable funding and guidelines should be produced on community engagement.

76. The number of women who present at maternity wards and for gynaecological services, and have undergone FGM is collated.

77. A clear pathway for reporting FGM related cases is established and understood by relevant safeguarding professionals.

78. Data collection – along with all other components of a systematic approach to FGM – should form part of a National Action Plan on FGM. This action plan should be Government led, and spearheaded by the Home Office. It should have clearly defined ministerial responsibility, be well resourced and include a framework for monitoring, evaluation and information sharing. The UK can look to other European countries such as Norway, Portugal and Finland as examples of how national action plans can help successfully tackle FGM. The European Communication on FGM, which was released in November 2013, also includes a number of recommendations that can help strengthen the UK’s response to FGM.

79. The UK Government review the recommendations made in the All Party Parliamentary Group on Population, Development and Reproductive Health’s Hearings Report on Female Genital Mutilation (200). Where relevant, we recommend the Government implements these recommendations as part of a UK wide National Action Plan on FGM.

We recommend that support services for women and girls are available throughout the UK, and that they are widely publicised.

80. In addition to services addressing the physical implications of FGM, services to support the mental and psychological needs of women and girls affected by FGM are made available.

81. Commissioning tenders are drafted in consultation with organisations and experts that understand the specificities of FGM – and therefore reflect the needs of women and girls at risk, and survivors of FGM.
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82. That public communications work is conducted to help broaden the understanding of FGM as a harmful cultural practice – and not a disease.

83. All the above measures are contained within, and monitored as part of a National Action Plan on FGM.

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