Guidance

Female genital mutilation (FGM): migrant health guide

Advice and guidance on the health needs of migrant patients for healthcare practitioners.

Main messages

The WHO estimates that between 100 million and 140 million girls and women worldwide have been affected by female genital mutilation (FGM). The practice is particularly common in some African countries.

FGM has long term implications for physical, sexual, and psychological health, and girls and women who have been affected may need referral to specialist services.

FGM is illegal in the UK.

If FGM is identified through the delivery of healthcare services, it is mandatory to record FGM in the patient’s healthcare record.

Children born in the UK may be at risk of FGM when they travel with their families to visit friends and relatives in countries where this practice is common.

It is illegal to take girls who are UK nationals or UK residents abroad for FGM whether or not it is lawful in that country.

If you are concerned that a girl may be at risk of FGM contact the NSPCC anonymously.

NSPCC

Contact about children at risk of FGM

If you know someone in immediate danger, contact the police.

If they have already been taken abroad, call the Foreign and Commonwealth Office on 020 7008 1500.

You can apply to get a protection order from the court to keep someone you know safe from FGM.

As of 31 October 2015, a new mandatory reporting duty for FGM was introduced via the Serious Crime Act 2015 following a public consultation.

The duty requires all regulated health and social care professionals and teachers in England and Wales to report known cases of FGM in under 18-year-olds to the police. In cases where the woman is over 18, professionals should follow local safeguarding procedures .

Background

Female genital mutilation (FGM) refers to all procedures involving partial or total removal of the external female genitalia, or other injury to the female genital organs, for non-medical reasons.

The WHO estimates that over 125 million girls and women have been subjected to FGM in the 29 countries in Africa and the Middle East where FGM is concentrated.

In the UK, it is estimated that:

  • around 137,000 women have undergone FGM
  • some 60,000 girls under 15 years old are at risk

The prevalence of FGM varies between countries and regions, and is largely based on ethnic group. The reported prevalence is over 90% in some countries, for example Egypt, Somalia and Guinea.

Communities that practice FGM describe a variety of social and religious reasons for the practice.

The procedure is generally carried out on girls under the age of 15 years, but the actual age varies and can take place anytime from birth up to labour with their first child.

NHS England and the Department of Health state that there is no requirement for NHS staff to ask every girl and woman whether they have had FGM. Staff should be aware of the risk factors and use their professional judgment.

If FGM is identified, NHS staff must record FGM in a patient’s healthcare record.

Types of FGM

A WHO and UN interagency statement on eliminating FGM classified female genital mutilation into 4 types:

Type I

Partial or total removal of the clitoris and/or the prepuce (clitoridectomy).

Type II

Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).

Type III

Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation).

Type IV

All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization.

Prevalence of FGM

Country Estimated prevalence of FGM¹ (%)
Somalia 98
Egypt 91
Sierra Leone 88
Sudan 88
Eritrea 89
Ethiopia 74
Gambia 76

¹in girls and women aged 15 to 49 years

Associated health risks

Short-term

FGM can have a number of short-term health implications:

  • severe pain and shock
  • infection
  • urinary retention
  • injury to adjacent tissues
  • haemorrhage

Long-term

Long-term implications can include:

  • extensive damage of the external reproductive system
  • uterine, vaginal and pelvic infections
  • cysts and neuromas
  • increased risk of vesico vaginal fistula
  • complications in pregnancy and child birth
  • psychological damage
  • sexual dysfunction
  • difficulties during menstruation

Treatment

Women and children who have had FGM may need access to a variety of specialist services, such as:

  • counselling and psychiatric support through statutory or voluntary services because of psychological trauma, relationship or psycho-sexual difficulties
  • infertility
  • uro-gynaecological services including surgical reversal of infibulation (known as deinfibulation)
  • interpreter service with workers who appreciate the problems facing affected girls and women

It is very important that women do not find themselves relying on family members for interpretation when dealing with health care professionals. Children cannot serve as interpreters.

Resources

UK advice on female genital mutilation includes:

The FGM National Clinical Group is a UK charity that works with women who have been affected by FGM and other related difficulties.

The Foundation for Women’s Health, Research and Development (FORWARD) is an international non-governmental organisation (NGO) that works to advance and protect the sexual and reproductive health and human rights of African girls and women.

NHS Choices ‘FGM health services’ includes:

  • how to access clinics offering specialist FGM services in the UK
  • organisations that provide help and support in the UK
  • guidance for professionals

WHO has produced publications on ‘female genital mutilation (FGM) and harmful practices’.

Published 31 August 2014
Last updated 27 June 2017 + show all updates
  1. Updated and made editorial changes to meet GOV.UK style.
  2. Revised following updates to Cabinet Office guidance.
  3. Updated estimated figures and links to resources about FGM.
  4. First published.