Government action plan ramps up efforts to protect children from FGM
Neil Puffett
Monday, August 4, 2014
Additional funding and raft of legal changes will offer greater protection against female genital mutilation, but many of the measures could be hard to deliver and have unintended consequences, warn experts.
Efforts to eradicate female genital mutilation (FGM) in the UK are gathering pace after a raft of measures to tackle the issue were announced by government.
The scale of the problem is increasingly clear. New research by City University in London estimates there are some 60,000 girls under the age of 14 born in England and Wales to mothers who have undergone FGM - a major risk factor for them becoming victims themselves.
The latest government measures to address the issue (see below) include a £1.4m programme run by NHS England to help care for victims and safeguard those at risk. Meanwhile, new civil orders will be introduced to try and prevent FGM taking place on girls deemed to be in danger; legislation will be changed so parents can be prosecuted for failing to protect their children from FGM; and victims of FGM will be offered anonymity for life.
The government is also considering making it mandatory for professionals to report cases of FGM.
Prevention fund
The measures - not to mention the fact they were launched by Prime Minister David Cameron - are an indication of how seriously the government is taking the issue.
However, the lack of finance attached to the national FGM prevention programme has been criticised. John Cameron, head of child protection at the NSPCC, says the long-term cost implications of FGM are likely to come to the fore as attitudes towards it develop, both in wider society and in the communities within which it is practiced.
"For a teenage girl, losing their clitoris must be a hugely traumatising event, but at the moment it appears that trauma is being suppressed through 'normalisation' of FGM within the family and the community," he says. "We are not seeing children coming to the attention of mental health services or acting out in school.
"So the government not only needs to invest in educating children and communities, it also needs to provide the services that allow FGM victims to talk through what happened to them. I can't see how £1.4m is enough to cover that."
Health services
Andy Elvin, an FGM consultant for the Home Office, agrees the money is "not going to have an enormous impact", but he believes that other work being conducted by health services could be more telling.
Since April, NHS hospitals were required to record if a patient has had FGM and if there is a family history of FGM. And by next month (September), all acute hospitals must report the number of patients with FGM to the Department of Health on a monthly basis.
Elvin says the long-term response to FGM in this area will be developed based on how a two-year trial, launched in June, proceeds. Under the trial, midwives will provide data to children's social workers on all mothers who have undergone FGM themselves.
Social workers will then conduct a risk assessment - in the case of expectant mothers, this will be done alongside health visitors.
The families will receive literature on the long-term physical and mental health impacts of FGM and will be warned that they face prosecution if they allow a child to undergo the practice. In the cases of children deemed to be most at risk, police will be notified, the family will be "flagged" with the UK Border Agency and legal action may be taken to prevent the child from travelling.
"We know that being a daughter of a (FGM) victim is the most significant risk factor for a girl, and we know every woman who has had contact with a midwife it is recorded in their notes whether they have had FGM," Elvin says.
"The problem before was the lack of a joint health and social work assessment meeting, where all cases are considered and an appropriate level of intervention is decided for each case."
Elvin says that if information is shared properly it will give other professionals, such as school nurses, the ability to monitor at-risk children. "It allows an awareness of how a child might be at risk. In the run-up to school holidays, they can be more alert about the child going back to, for instance, sub-Saharan Africa.
"It will make sure all the information is available in a way that it is not at the moment. If schools know nothing about the potential risks to a child, they could miss the warning signs completely."
In terms of proposed FGM orders the government is looking to model them on forced marriage protection orders, which are currently used to protect those who have been, or are at risk of, being forced into marriage. The orders could, in theory, result in a number of restrictions being put in place such as forbidding travel to another country where children undergo FGM.
Practical implications
Cameron says that while civil orders are welcome, the exact way in which they are used could throw up problems.
"The challenge is presenting sufficient evidence (of risk of FGM) to satisfy magistrates (to impose an order)," he says.
"No parent is going to stand up and say they were planning to take their daughter to another country for FGM."
Cameron says parents who arrange for their daughters to undergo FGM are changing tactics in response to efforts to crackdown on the practice. "Anecdotally, we know that people will send their daughter somewhere that is not particularly known as a country for cutting children," he says.
"They are also cutting children at a much younger age.
"There needs to be a strong suspicion (to get an order imposed), so we need an appropriate assessment model or tool to gauge risk."
Cameron says there could also be an issue with the longevity of an order. For example, if an order is made to prevent a 14-year-old girl from leaving the country due to concerns that she will be cut, at what point should the order end?
"Would it be an indefinite order until she is 18?" Cameron asks.
"What we don't want to do is prevent children from having mobility and being able to have a relationship with their extended family."
Another measure is introducing new legislation that will mean parents can be prosecuted if they fail to prevent their daughter being cut. Elvin says this will make it far easier to achieve successful prosecutions. "The law, as it is written at the moment, means you are reliant on the victim's testimony," he says. "Expecting a child to testify against their mother or father is not only unrealistic, there is an argument it is abusive.
"If the offence is simply failure to protect your daughter - on the basis that they were not born with it and you are legally responsible for them - it makes it easier for them to be held criminally responsible."
However, Cameron warns that charging parents for failing to prevent FGM could be counter-productive for the future welfare of the victim. He says parents who allow their child to be cut can be otherwise good and loving parents, and it could be detrimental for their development if they are jailed.
"The vast majority of children at risk of being cut do not come to the attention of local authorities, health services, or the police - they are run-of-the-mill families," he says.
The legislation could also throw up problems in relation to families moving to the UK, as medics are unable to tell exactly when FGM took place. This makes it likely that only UK nationals, who gave birth to their daughter in this country, will be subject to the law.
Intimate examination
An alternative would be to follow the way the issue is dealt with in France, where girls immigrating to the country are intimately examined for signs of FGM. In addition to this, in France, girls of all ethnic backgrounds, are routinely checked in school - a measure that Elvin doubts there would be an appetite for in the UK.
The government is also considering making reporting of FGM mandatory. The fear is that some health professionals who spot the signs of FGM make discretionary decisions not to inform other professionals.
Alan Wood, president of the Association of Directors of Children's Services, says mandatory reporting on its own "is not going to remove or resolve operational issues of conscience and sharing of information unless you deal with the root causes of that".
He adds mandatory reporting should be a last resort: "We have to get people to accept their duty to protect children. If we can't do that, I think mandatory reporting would have to be considered."
GOVERNMENT ACTION PLAN MEASURES TO TACKLE FGM
- A £1.4m FGM prevention programme, launched in partnership with NHS England to help care for survivors and safeguard those at risk
- Police guidance from the College of Policing and an inspection programme by Her Majesty's Inspectorate of Constabulary (HMIC) that will look at how the police handle cases of FGM
- Civil orders designed to protect girls identified as being at risk of FGM
- Legislation so parents can be prosecuted if they fail to prevent their daughter being cut
- Legislation to grant victims of FGM lifelong anonymity from the time an allegation is made
- A specialist FGM service to proactively identify and respond to FGM
- Programmes to prevent child and forced marriage in 12 developing countries
- An international charter calling for the eradication of FGM within a generation
IN NUMBERS
60,000 Number of girls under the age of 14 born in England and Wales to mothers who had undergone FGM*
103,000 Number of women aged 15 to 49, who have migrated to England and Wales, living with the consequences of FGM*
24,000 Number of women aged 50 and over, who have migrated to England and Wales, living with the consequences of FGM*
10,000 Number of girls aged under 15, who have migrated to England and Wales, likely to have undergone FGM*
24,000 Number of girls under 15 in the UK at risk of FGM each year**
Source: *City University London;**World Health Organisation.