Advice and guidance on the health needs of migrant patients for healthcare practitioners.
The World Health Organization (WHO) estimates that over 200 million girls and women worldwide have been affected by female genital mutilation (FGM). An additional 3 million are at risk of FGM every year. FGM is commonly practiced in 30 countries in Africa, the Middle East and Asia. It is mostly carried out on young girls under 16 years.
FGM has no medical justification or health benefits. It has long term consequences for physical, sexual, and psychological health. Girls and women who have been affected may need referral to specialist services.
FGM is illegal in the UK. 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.
Girls 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.
Health and social care professionals have a mandatory duty to report known cases of FGM in under 18-year-olds to the police. They should also report suspected cases and individuals who are at risk of FGM, and follow safeguarding procedures for women 18 years and over who are affected.
Where possible, refer individuals who have experienced FGM to a National FGM Support Clinic, or encourage self-referral and walk-in appointments.
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.
Communities that practise FGM describe a variety of social and religious reasons for the practice.
The procedure is mostly carried out on girls 0 to 15 years before the onset of puberty, but can also be carried out on older girls and women.
Prevalence of FGM
WHO estimates that over 200 million girls and women have been subjected to FGM in the 30 countries in Africa, the Middle East and Asia 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. The reported prevalence is over 90% in some countries and age groups..
Countries with which UK residents are most likely to have links and which have a high prevalence of FGM, noting that estimates of FGM vary over time and between data sources
|Estimated prevalence of FGM¹ (%)
¹in girls and women aged 15 to 49 years
Types of FGM
FGM can be classified into 4 types:
Partial or total removal of the clitoris and/or the prepuce (clitoridectomy).
Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).
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).
All other harmful procedures to the female genitalia for non-medical purposes, for example, pricking, piercing, incising, scraping and cauterization.
Associated health risks
FGM can have a number of short-term health implications:
- severe pain and shock
- urinary retention
- injury to adjacent tissues
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 childbirth
- psychological damage
- sexual dysfunction
- difficulties during menstruation
Healthcare professionals play a crucial role in the identification of FGM. If FGM is identified through the delivery of healthcare services, it is mandatory to record FGM in the patient’s healthcare record. If the affected individual is under the age of 18, it is also mandatory for all regulated health and care professionals in England and Wales to report to the police. In cases where the woman is aged 18 and over, professionals should follow local safeguarding procedures.
If you know someone in immediate danger, contact the police immediately on 999.
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.
Women and children who have had FGM may need access to a variety of specialist services, such as:
- mental health services, including counselling and psychiatric support through statutory or voluntary services because of psychological trauma, relationship or psycho-sexual difficulties
- uro-gynaecological services including surgical reversal of infibulation (known as deinfibulation)
- infertility treatment
Work with professional interpreters, preferably female. It is inappropriate to use family members or children as interpreters when identifying and treating FGM.
Consider trauma-informed approaches to service provision.
Healthcare professionals can refer individuals to a National FGM Support Clinic, or encourage self-referral and walk-in appointments.
Entitlements to health services
Inform individuals that services for treating a physical or mental condition caused by FGM is free of charge to women and girls regardless of immigration status. This includes maternity services (antenatal, perinatal and postpartum treatment) needed for pregnancy complications that arise as a result of FGM.
UK advice on female genital mutilation includes:
- a resource pack with case studies and links to further information
- an e-learning package on recognising and preventing FGM
- multi-agency statutory guidelines on FGM
The FGM National Clinical Group is a UK charity that works with women who have been affected by FGM and other related difficulties.
The National FGM Centre supports children and young people affected by FGM, breast flattening and child abuse linked to faith or belief. It has a free online knowledge hub, a directory of FGM services available in the UK, and offers professional training and development.
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.
WHO has produced publications on female genital mutilation (FGM) and harmful practices.