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Travel health information for people travelling abroad from the UK

Female Genital Mutilation

Female genital mutilation (FGM) is also known as female genital cutting and female circumcision. 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.

Many FGM affected communities use traditional terms for the procedure, e.g. sunna (FGM Types 1 and 2) and pharonic (FGM Type 3).

FGM is mostly carried out on young girls sometime between infancy and age 15 years and occasionally on adult women.

It is most usually performed by excisors (cutters) without anaesthetic and using razor blades or broken glass.      

The WHO Identifies Four Types of FGM

FGM Type 1

Clitoridectomy: 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).

FGM 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).

FGM 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.

FGM Type 4

Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

Epidemiology

UNICEF estimate that globally 200 million girls and women have been subjected to FGM, with 3 million girls in Africa estimated to be at risk annually.

The practice is most common in the western, eastern, and north-eastern regions of Africa, in some countries in Asia (Indonesia and Malaysia) and the Middle East (see Risk Country List).

There is evidence of increasing global medicalisation of the procedure, with private clinics offering the operation in the Middle East and Far East.

Due to increasing international migration FGM is also practised amongst migrant communities from high FGM prevalence countries, including those living in the UK.

England and Wales

In July 2015, it was estimated that 137 000 girls and women were living with FGM, with 60 000 girls at risk of FGM.

Scotland

Estimates suggest approximately 8000 girls are at risk of FGM, migrants from the following countries contributing the highest numbers: Nigeria, Somalia and Egypt.

Clinical Aspects

FGM has no health benefits, interferes with the natural functions of the female body and harms girls and women in many ways. It has psychological as well as physical consequences.

Psychological Consequences

All those subjected to FGM may suffer short-term or long-term psychological distress, including trauma, anxiety, anger, depression, low self-esteem and even post-traumatic stress disorder.

It can result in problems with relationships including with parents and sexual partners.

Physical Consequences

These vary according to the type of FGM.

Immediate Complications

Can include:  severe pain, shock, haemorrhage (bleeding), tetanus or sepsis (bacterial infection), blood born viral infection, urine retention, open sores in the genital region, injury to nearby genital tissue and even death.

Long-term Consequences

  • recurrent bladder and urinary tract infections;
  • cysts
  • infertility
  • painful intercourse
  • increased risk of childbirth complications and neonatal death
  • fistula and the need for later surgery:
    • for example, the FGM procedure that seals or narrows a vaginal opening needs to be cut open later to allow for sexual intercourse and childbirth. Sometimes it is stitched again several times, hence the woman goes through repeated opening and closing procedures, further increasing and repeating both immediate and long-term risks.

Who is at Risk?

Many girls are taken out of the UK during school holidays to their family’s country of origin for the procedure to be carried out, allowing healing to occur and the procedure to go unnoticed by teachers and health professionals before the girl returns to school.

  • The situation is particularly acute in the long summer school holiday, often regarded as the cutting season.
  • The UK Border Force (UKBF) increases its scrutiny of flights to high risk destinations in West Africa and the Middle East during this period.
  • The UKBF have acknowledged that there is an emerging trend of excisors (cutters) travelling to the UK during the summer to perform the procedure here in the UK, rather than girls being taken overseas.
  • It may be possible that families will practise FGM in the UK when a female family elder is around, particularly when she is visiting from a country of origin.

In 2014 the Home Office Produced Details of how to Identify Those at Risk of FGM

These include:

  • Belonging to an FGM practising community, ethnic group or country.
  • The position of the family and the level of integration within UK society – it is believed that communities less integrated into British society are more likely to carry out FGM.
  • Any girl born to a woman who has been subjected to FGM must be considered to be at risk of FGM, as must other female children in the extended family.
  • Any girl who has a sister who has already undergone FGM must be considered to be at risk of FGM, as must other female children in the extended family.
  • Any girl withdrawn from personal, social and health education may be at risk as a result of her parents wishing to keep her uninformed about her body and rights.

Signs That a Girl is at Imminent Risk of FGM

  • Parents state that they or a relative will take the child out of the country for a prolonged period.
  • Parents seeking to withdraw their children from learning about FGM.
  • A girl may
    • confide that she is to have a special procedure or to attend a special occasion to become a woman
    • request help from a teacher or another adult if she is aware or suspects that she is at immediate risk
    • talk about a long holiday to her country of origin or another country where the practice is prevalent
    • tell other children about it.

FGM is a human rights violation, a form of gender-based violence against females and when performed on girls under 18 years-of-age, it is child abuse.

  • FGM is against the law in the UK

If you, or someone you know, is at risk of FGM you can report this to the police, your doctor/nurse or phone the NSPCC helpline 0800 028 3550.

If you do not want to do this directly you can contact the advocacy groups below for more support and advice.

Resources

Apps

  • Petals – a new web based app designed for young people to learn more about and receives support for FGM.

Advocacy/Awareness Websites

 

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