The recent conviction of a woman for assisting another person to undertake female genital mutilation (FGM) on a three-year-old British girl during a trip to Kenya, has been hailed as evidence of the success of the duty on nurses, teachers and doctors to report suspected cases of FGM (Weaver, 2023).
It is estimated that more than 200 million girls and women worldwide are currently living with the consequences of FGM, mainly in 30 countries in Africa, the Middle East and Asia (World Health Organization (WHO), 2023).
The practice is recognised internationally as a violation of human rights and constitutes an extreme form of discrimination against women (WHO, 2023). As it is nearly always carried out on minors, it is also a violation of the rights of children and breaches the significant harm threshold necessary for state intervention to protect children.
FGM includes procedures that intentionally alter or injure the female genital organs for non-therapeutic purposes and have no health benefits. There is a worldwide effort to eliminate such practices and nurses are in an ideal position to contribute to this global effort by taking appropriate action where they consider a girl or woman is at risk of being subject to the FGM procedure.
It is essential that nurses are aware of the law relating to FGM and of their personal duty to report suspected cases.
What is FGM?
According to WHO (2023):
‘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.’
The procedure is typically performed on girls aged between 4 and 13 years. However, in some cases FGM is performed on newborn infants or on young women before marriage or pregnancy.
Types of FGM
- Clitoridectomy: partial or total removal of the clitoris and, rarely, the prepuce (the fold of skin surrounding the clitoris) as well
- Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora
- Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, and sometimes outer, labia, with or without removal of the clitoris
- Other types: all other harmful procedures to the female genitalia for non-medical purposes, eg pricking, piercing, incising, scraping and cauterising the genital area.
Prevalence of FGM in the UK
There is a lack of data about the prevalence of FGM in the UK. A report estimating the prevalence of FGM in England and Wales suggested that the numbers are substantial and on the increase. It is estimated that some 103 000 women and girls, mostly first-generation immigrants, refugees and asylum seekers living in Britain, have undergone FGM. The majority of those living in the UK who have experienced FGM or are at risk from it, come from specific countries or have continuing links with those countries. There is an estimated prevalence of some 4.8 per 1000 population (Macfarlane and Dorkenoo, 2015).
Female Genital Mutilation Act 2003
FGM is a violation of the basic human rights of women and children and is unlawful in many countries, including the UK.
The Female Genital Mutilation Act 2003 began as a private member's bill brought forward by the late Ann Clwyd and came into force in March 2004.
Under provisions of the Act, it is an offence for any person to:
- Excise, infibulate or otherwise mutilate the whole or any part of a girl's labia majora, labia minora or clitoris
- Aid, abet, counsel or procure the performance by another person of any of those acts on that other person's body; or
- Aid, abet, counsel or procure a person to excise, infibulate or otherwise mutilate the whole or any part of her own labia majora, labia minora or clitoris.
The Female Genital Mutilation Act 2003 also introduced the concept of ‘extraterritoriality’, making it a criminal offence to take any girl who is a UK national or UK permanent resident to any other country for FGM. This concept underpinned the recent successful prosecution of a woman who arranged for FGM on a British girl in Kenya (Weaver, 2023).
The penalty for carrying out FGM, or arranging to have FGM carried out, is 14 years' imprisonment or a fine or both. Although it is not an offence for a girl to mutilate her own genitalia it is an offence to assist a girl to mutilate her own genitalia according to the Female Genital Mutilation Act 2003, section 2.
Exceptions under the Female Genital Mutilation Act 2003
Under section 2(a) of the 2003 Act, no offence is committed by a registered medical practitioner who performs a surgical operation on a girl that is necessary for her physical or mental health. However, when assessing a girl's mental health, no account can be taken of any belief that the operation is needed as a matter of custom or ritual. Therefore, an FGM operation could not legally occur on the grounds that a girl's mental health would suffer if she did not conform to the custom of her community.
A further exception under section 2(b) of the Female Genital Mutilation Act 2003 allows a surgical operation on a girl who is in any stage of labour, or has just given birth, for purposes connected with the labour or birth. This operation may be carried out by an approved person who can be a registered medical practitioner, a registered midwife or a person undergoing a course of training with a view to becoming such a practitioner or midwife. It remains unlawful to reinfibulate a woman following the birth of her baby.
Offence of assisting a non-UK person overseas to mutilate a girl's genitalia
A person is guilty of an offence if they aid, abet, counsel or procure a person who is not a UK national or permanent UK resident to do a relevant act of FGM outside the UK (Female Genital Mutilation Act 2003, section 3(1)). Therefore, a person in the UK who, for example, arranges for their British national daughter to have an FGM operation carried out abroad, is guilty of an offence.
Penalties for FGM
A person guilty of an offence under Female Genital Mutilation Act 2003 is liable on conviction on indictment (in the Crown Court) to imprisonment for a term not exceeding 14 years or a fine or both. For less serious offences, a person guilty on a summary conviction (in the magistrates court) is liable to imprisonment for a term not exceeding 6 months or a fine not exceeding the statutory maximum or both.
A mother was sentenced to 11 years imprisonment for performing FGM on her daughter (Weaver, 2023).
Duty to report FGM
Regulated health professionals such as nurses have a personal duty to report cases of FGM in girls under 18 years of age. The duty was introduced by section 74 of the Serious Crimes Act 2015, which introduced an amendment to the Female Genital Mutilation Act 2003 (section 5A).
The duty is on the nurse who identifies the FGM or receives a disclosure about FGM to report it to the police. This should be done using the non-emergency crime number and is in addition to the nurse's requirement to report the matter to their safeguarding lead. Nurses must keep a record of their actions and note the police reference number. Failure to comply with the duty is considered unprofessional behaviour and a breach of the Code (Nursing and Midwifery Council, 2018).
Conclusions
FGM violates the most basic human rights of women. Nurses may come into contact with girls who have undergone FGM and have a personal professional duty to report such cases to the police (Female Genital Mutilation Act 2003, section 5A). It is essential that nurses are aware of the law relating to FGM in order to provide advice and assistance to those in their care who may be affected by this unlawful practice. Nurses must also invoke safeguarding procedures and inform their safeguarding lead of the decision to report a case to the police.
KEY POINTS
- Female genital mutilation (FGM) includes procedures that intentionally alter or injure female genital organs for non-therapeutic purposes and have no health benefits
- Under provisions of the Female Genital Mutilation Act 2003 it is an offence to excise, infibulate or otherwise mutilate the whole or any part of a girl's labia majora, labia minora or clitoris
- Nurses have a personal duty to report cases of FGM to the police using the non-emergency number