FGM Safeguarding and Risk Assessment Tool
Introduct
ion
The aim is to help make an initial assessment of risk, and then support the on-going assessment of women and
children who come from FGM practising communities (using parts 1 to 3). For a list of communities where FGM is
prevalent please see part 8.
INTRODUCTORY QUESTIONS (for further guidance on talking about FGM please see part 6):
(1) Do you or your partner come from a community where cutting or circumcision is practised? (See part 8 for
map. Please remember you might need to consider that this relates to their parent’s country of origin)
(2) Have you been cut? It may be appropriate to use other terms or phrases (see part 7 for local terms).
*If they answer YES to questions (1) or (2) please complete one of the risk templates.
PART ONE: For an adult woman (18 years or over)
(a) PREGNANT WOMAN ask the introductory questions.
If the answer is YES to either question, use part 1(a) to support your discussions.
(b) NON-PREGNANT WOMAN where you suspect FGM; for example if a woman presents with physical symptoms
or emotional behaviour that triggers a concern (e.g. frequent urinary tract infections, severe menstrual pain,
infertility, symptoms of PTSD such as depression, anxiety, flashbacks or reluctance to have genital examination
etc); or if FGM is discovered through the standard delivery of care (e.g. when placing a urinary catheter, carrying
out a smear test, discussions during social care assessments etc.), ask the introduction questions.
If the answer is YES to either question, use part 1(b) to support your discussions.
PART TWO: For a CHILD (under 18 years)
Ask the introductory questions (see above) to either the child directly or the parent or legal guardian depending
upon the situation.
If the answer to either question is yes OR you suspect that the child might be at risk of FGM, use part 2 to support
your discussions.
PART THREE: For a CHILD (under 18 years)
Ask the introductory questions (see above) to either the child directly or the parent or legal guardian depending
upon the situation.
If the answer to either question is yes OR you suspect that the child has had FGM (see part 4), use part 3 to
support your discussions.
In all circumstances:
The woman and family must be informed of the law in the UK and the health consequences of practising
FGM.
Ensure all discussions are approached with due sensitivity and are non-judgemental.
Any action must meet all statutory and professionals responsibilities in relation to safeguarding, and be in
line with local processes and arrangements.
Using this guidance does not replace the need for professional judgement in relation to the circumstances
presented.
Signpost the woman and her family to local support services that focus on prevention of FGM through
education and effective engagement such as the Ending FGM in Coventry Service.
e-mail: Coventryhaven@btconnect.com
Tel: 02476444077
Website: www.coventryhaven.co.uk
GUIDANCE
The framework is designed to support professionals to identify and consider risks relating to female genital
mutilation, and to support the discussion with the patient and family members.
It should be used to help assess whether the client you are working with is either at risk of harm in relation to FGM
or has had FGM, and whether she has children who are potentially at risk of FGM, or if there are other children in
the family/close friends who might be at risk.
If when asking questions based on this guide, any answer gives you cause for concern, you should continue the
discussion in this area, and consider asking other related questions to further explore this concern. Please
remember either the assessment or the information obtained must be recorded within the patient’s record. The
templates also require that you record when and by whom it and at what point in the patient’s pathway this has
been completed.
Having used the guide, you will need to decide:
Do I need to make a referral through my local safeguarding processes, and is that an urgent or standard
referral?
Do I need to seek help from my local safeguarding lead or other professional support before making my
decision? Note, you may wish to consult with a colleague at a Multi-Agency Safeguarding Hub, Child
ren’s
So
cial Services or the local Police Force for additional support.
If I do not believe the risk has altered since my last contact with the family, or if the risk is not at the point
where
I need to refer to an external body, then you must ensure you record and share information abou
t
your decision accordingly.
An URGENT referral should be made, out of normal hours if necessary, if a child or young adult shows signs of very
recently having undergone FGM. This may allow for the police to collect physical evidence.
An urgent referral should also be made if the professional believes that there are plans perhaps to travel abroad
which present a risk that a child is imminently likely to undergo FGM if allowed to leave your care.
In urgent cases, Children’s Social Care and the Police will consider what action to take. One option is to take out an
Emergency Child Protection Order. If required, an EPO is an order made under Section 44 of the Children Act 1989
enabling a child to be removed to a place of safety where there is evidence that the child is in “imminent danger”.
As of 31 October 2015 there is a mandatory reporting duty which requires regulated health and social care
professionals and teachers in England and Wales to report ‘known’ cases of FGM in under 18s which they identify
in the course of their professional work to the police. ‘Known’ cases are those where either a girl informs the
person that an act of FGM – however described – has been carried out on her, or where the person observes
physical signs on a girl appearing to show that an act of FGM has been carried out and the person has no reason
to believe that the act was, or was part of, a surgical operation. For further information please click here
Part One (a): PREGNANT WOMEN
This is to help you make a decision as to whether the unborn child (or other female children in the
family) are at risk of FGM or
whether the woman herself is at risk of further harm in relation to her FGM.
Indicator
Yes
No
Details
CONSIDER RISK
Woman originates from a community known to practice FGM
Woman has undergone FGM herself
Husband/partner comes from a community known to practice
FGM
A female family elder is involved/will be involved in care of
children/unborn child or is influential in the family
Woman/family has limited integration in UK community
Woman and/or husband/partner have limited/no understanding of
harm of FGM or UK law
Woman’s nieces of siblings and/or in-laws have undergone FGM
Woman has failed to attend follow-up appointment with an FGM
clinic / FGM related appointment (if known)
Woman’s husband/partner/other family member are very
dominant in the family and have been present /involved virtually
during consultations with the woman
Woman is reluctant to undergo genital examination (healthcare
setting only)
SIGNIFICANT OR IMMEDIATE RISK
Woman already has daughters have undergone FGM
Woman requesting reinfibulation following childbirth
Woman is considered to be a vulnerable adult and therefore issues
of mental capacity and consent should be considered if she is
found to have FGM
Woman says that FGM is integral to cultural or religious identity
Family are already known to social care services if known, and
you have identified FGM within a family, you must share this
information with social services
ACTION
Ask more questions if one indicator
leads to a potential area of concern,
continue the discussion in this area.
Consider risk if one or more
indicators are identified, you need to
consider what action to take. If unsure
whether the level of risk requires
referral at this point, discuss with your
named/designated safeguarding lead.
Significant or Immediate risk if you
identify one or more serious or
immediate risk, or the other risks are,
by your judgement, sufficient to be
considered serious, you should look to
refer to Social Services/CAIT
team/Police/MASH, in accordance
with your local safeguarding
procedures.
If the risk of harm is imminent,
emergency measures may be required
and any action taken must reflect the
required urgency.
In all cases:
Share information of any
identified risk with the patient’s
GP
Document in notes
Discuss the health complications
of FGM and the law in the UK
Part One (b): NON PREGNANT ADULT WOMEN (over 18)
This is to help you make a decision as to whether the unborn child (or other
female children in the family) are at risk of FGM or whether the woman herself is
at risk of further harm in relation to her FGM.
Indicator
Yes
No
Details
CONSIDER RISK
Woman originates from a community known to practice FGM
Woman already has daughters who have undergone FGM who
are over 18 years of age
Husband/partner comes from a community known to practice
FGM
Grandmother (maternal or paternal) is influential in family or
female family elder is involved in care of children
Woman and family have limited integration in UK community
Woman’s husband/partner/other family member may be very
dominant in the family and have been present during consultations
with the woman
Woman/family have limited/no understanding of harm of FGM or
UK law
Woman’s nieces (by sibling or in-laws) have undergone FGM.
(Please note: if they are under 18 years you have a professional
duty of care to refer to social care)
Woman has failed to attend follow-up appointment with an FGM
clinic/FGM related appointment (if known)
Family are already known to social services if known, and you
have identified FGM
SIGNIFICANT OR IMMEDIATE RISK
Woman already has daughters who have undergone FGM who
are under 18 years of age
Woman is considered to be a vulnerable adult and therefore issues
of mental capacity and consent should be triggered if she is found
to have FGM
Woman/family believe FGM is integral to cultural or religious
identity
ACTION
Ask more questions if one indicator leads
to a potential area of concern, continue the
discussion in this area.
Consider risk if one or more indicators are
identified, you need to consider what action
to take. If unsure whether the level of risk
requires referral at this point, discuss with
your named/designated safeguarding lead.
Significant or Immediate risk if you
identify one or more serious or immediate
risk, or the other risks are, by your
judgement, sufficient to be considered
serious, you should look to refer to Social
Services/CAIT team/Police/MASH, in
accordance with your local safeguarding
procedures.
If the risk of harm is imminent, emergency
measures may be required and any action
taken must reflect the required urgency.
In all cases:
Share information of any identified risk
with the patient’s GP
Document in notes
Discuss the health complications of
FGM and the law in the UK
Part 2: CHILD/YOUNG ADULT (under 18 years old)
This is to help when considering whether a child is AT RISK of FGM, or whether
there are other children in the family for whom a risk assessment may be
required.
Indicator
Yes
No
Details
CONSIDER RISK
Childs mother has undergone FGM
Other female family members have had FGM
Father comes from a community known to practice FGM
A Family Elder such as Grandmother is very influential within the
family and is/will be involved in the care of the girl
Mother/Family have limited contact with people outside of her
family
Parents have poor access to information about FGM and do not
know about the harmful effects of FGM or UK laww
Parents say that they or a relative will be taking the girl abroad for
a prolonged period this may not only be to a country with high
prevalence, but this would more likely lead to a concern
Girl has spoken about a long holiday to her country of
origin/another country where the practice is prevalent
Girl has attended a travel clinic or equivalent for vaccinations/anti-
malarial medication
FGM is referred to in conversation by the child, family or close
friends of the child (see part 7 for traditional and local terms) the
context of the discussion will be important
Sections missing from the Red book. Consider if the child has
received immunisations, do they attend clinics etc (health
professionals)
Girl withdrawn from PHSE lessons or from learning about FGM
Teacher or School Nurse should have conversation with child
Girl talking about a special procedure or ceremony that is going to
take place or that she is going to become a woman
Family not engaging with professionals (health, school, or other)
Any other safeguarding alert already associated with the family
(Always check whether family are already known to social care
ACTION
Ask more questions if one indicator leads
to a potential area of concern, continue the
discussion in this area.
Consider risk if one or more indicators are
identified, you need to consider what action
to take. If unsure whether the level of risk
requires referral at this point, discuss with
your named/designated safeguarding lead.
Significant or Immediate risk if you
identify one or more serious or immediate
risk, or the other risks are, by your
judgement, sufficient to be considered
serious, you should look to refer to Social
Services/CAIT team/Police/MASH, in
accordance with your local safeguarding
procedures.
If the risk of harm is imminent, emergency
measures may be required and any action
taken must reflect the required urgency.
In all cases:
Share information of any identified risk
with the patient’s GP
Document in notes
Discuss the health complications of
FGM and the law in the UK
SIGNIFICANT OR IMMEDIATE RISK
A child or sibling asks for help
A parent or family member expresses concern that FGM may be
carried out on the child
Girl has confided in another that she is to have a ‘special
procedure’ or to attend a ‘special occasion’. Girl has talked about
going away ‘to become a woman’ or ‘to become like my mum and
sister’
Girl has a sister or other female child relative who has already
undergone FGM
Family/child are already known to social services if known, and
you have identified FGM within a family, you must share this
information with social services
Please remember: any child under 18 who has undergone FGM should be
referred to social services.
ACTION
Ask more questions if one indicator
leads to a potential area of concern,
continue the discussion in this area.
Consider risk if one or more
indicators are identified, you need to
consider what action to take. If unsure
whether the level of risk requires
referral at this point, discuss with your
named/designated safeguarding lead.
Significant or Immediate risk if you
identify one or more serious or
immediate risk, or the other risks are,
by your judgement, sufficient to be
considered serious, you should look to
refer to Social Services/CAIT
team/Police/MASH, in accordance with
your local safeguarding procedures.
If the risk of harm is imminent,
emergency measures may be required
and any action taken must reflect the
required urgency.
In all cases:
Share information of any identified
risk with the patient’s GP
Document in notes
Discuss the health complications of
FGM and the law in the UK
Part 3: CHILD/YOUNG ADULT (under 18 years old)
This is to help when considering whether a child HAS HAD FGM.
Indicator
Yes
No
Details
CONSIDER RISK
Girl is reluctant to undergo any medical examination
Girl has difficulty walking, sitting or standing or looks
uncomfortable
Girl finds it hard to sit still for long periods of time, which was not a
problem previously
Girl presents with frequent urine, menstrual or stomach problems
Girls shows increased emotional and psychological needs e.g.
withdrawal, depression, or significant change in behaviour
Girl avoiding physical exercise or requiring to be excused from PE
lessons without a GP’s letter
Girl has spoken about having been on a long holiday to her country
of origin/another country where the practice is prevalent
Girl spends a long time in the bathroom/toilet/long periods of time
away from the classroom
Girl talks about pain or discomfort between her legs
Girl talks of something somebody did to her that they are not
allowed to talk about
SIGNIFICANT OR IMMEDIATE RISK
Girl asks for help
Girl confides in a professional that FGM has taken place
Mother/family member discloses that female child has had FGM
Family/child are already known to social services if known, and
you have identified FGM within a family, you must share this
information with social services
Please remember: any child under 18 who has undergone FGM should be
referred to social services.
ACTION
Ask more questions if one indicator
leads to a potential area of concern,
continue the discussion in this area.
Consider risk if one or more
indicators are identified, you need to
consider what action to take. If unsure
whether the level of risk requires
referral at this point, discuss with your
named/designated safeguarding lead.
Significant or Immediate risk if you
identify one or more serious or
immediate risk, or the other risks are,
by your judgement, sufficient to be
considered serious, you should look to
refer to Social Services/CAIT
team/Police/MASH, in accordance with
your local safeguarding procedures.
If the risk of harm is imminent,
emergency measures may be required
and any action taken must reflect the
required urgency.
In all cases:
Share information of any identified
risk with the patient’s GP
Document in notes
Discuss the health complications of
FGM and the law in the UK
PART 4. What are the signs that a girl may be at risk of FGM or has undergone FGM?
Girl is at Risk of FGM
Suspicions may arise in a number of ways that a child is being prepared for FGM to take place abroad. These include;
Knowing that the family belongs to a community in which FGM is practised
Knowing the family is making preparations for the child to take a holiday, arranging vaccinations or planning absence from school.
The child may talk about a special procedure/ceremony that is going to take place or becoming a woman
FGM has taken place…
Indicators that FGM may already have occurred include;
prolonged absence from school or other activities
noticeable behaviour change on return from absence
bladder or menstrual problems
difficulty sitting still
looking uncomfortable
complain about pain between their legs
talk of something somebody did to them that they are not allowed to talk about
(FGM factsheet, Home Office)
!
(
http://orchidproject.org/category/about4fgc/infographics/)9
!
PART 6. Talking about FGM
FGM is a complex and sensitive issue that requires professionals to approach the subject carefully. When talking about FGM, professionals should:
Ensure that a female professional is available to speak to if the girl or woman would prefer this.
Make no assumptions.
Give the individual time to talk and be willing to listen.
Create an opportunity for the individual to disclose, seeing the individual on their own in private.
Be sensitive to the intimate nature of the subject.
Be sensitive to the fact that the individual may be loyal to their parents.
Be non-judgemental (pointing out the illegality and health risks of the practice, but not blaming the girl or woman).
Get accurate information about the urgency of the situation if the individual is at risk of being subjected to the procedure.
Take detailed notes.
Record FGM in the patient’s healthcare record, as well as details of any conversations.
Use simple language and ask straight forward questions such as:
In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?
“Have you been closed?”
“Were you circumcised?”
“Have you been cut down there?”
Have you yourself ever been circumcised/had your genitals cut?
What do you call this practice (that you had)?
Do you think female circumcision should continue?
Does your husband and his family think that female circumcision should be continued?
Do your female relatives think that female circumcision should be continued?
Be direct, as indirect questions can be confusing and may only serve to compound any underlying embarrassment or discomfort that you or the patient may have. If
any confusion remains, ask leading questions such as:
“Do you experience any pains or difficulties during intercourse?”
“Do you have any problems passing urine?
“How long does it take to pass urine?”
“Do you have any pelvic pain or menstrual difficulties?”
“Have you had any difficulties in childbirth?
PART 7. Traditional and local terms for FGM
Country
Term used for FGM
Language
Meaning
EGYPT
Thara
Arabic
Deriving from the Arabic word ‘tahar’ meaning to clean/purify
Khitan
Arabic
Circumcision used for both FGM and male circumcision
Khifad
Arabic
Deriving from the Arabic word ‘khafad’ meaning to lower (rarely used in everyday
language)
ETHIOPIA
Megrez
Amharic
Circumcision/cutting
Absum
Harrari
Name giving ritual
ERITREA
Mekhnishab
Tigregna
Circumcision/cutting
KENYA
Kutairi
Swahili
Circumcision used for both FGM and male circumcision
Kutairi was ichana
Swahili
Circumcision of girls
NIGERIA
Ibi/Ugwu
Igbo
The act of cutting used for both FGM and male circumcision
Sunna
Mandingo
Religious tradition/obligation for Muslims
SIERRA LEONE
Sunna
Soussou
Religious tradition/obligation for Muslims
Bondo
Temenee/Mandingo/Limba
Integral part of an initiation rite into adulthood for non-Muslims
Bondo/Sonde
Mendee
Integral part of an initiation rite into adulthood for non-Muslims
SOMALIA
Gudiniin
Somali
Circumcision used for both FGM and male circumcision
Halalays
Somali
Deriving from the Arabic word ‘halal’ ie. ‘sanctioned’ – implies purity. Used by
Northern & Arabic speaking Somalis.
Qodiin
Somali
Stitching/tightening/sewing refers to infibulation
SUDAN
Khifad
Arabic
Deriving from the Arabic word ‘khafad’ meaning to lower (rarely used in everyday
language)
Tahoor
Arabic
Deriving from the Arabic word ‘tahar’ meaning to purify
CHAD the Ngama
Bagne
Used by the Sara Madjingaye
Sara subgroup
Gadja
Adapted from ‘ganza’ used in the Central African Republic
GUINEA-BISSAU
Fanadu di Mindjer
Kriolu
‘Circumcision of girls’
GAMBIA
Niaka
Mandinka
Literally to ‘cut /weed clean’
Kuyango
Mandinka
Meaning ‘the affair’ but also the name for the shed built for initiates
Musolula Karoola
Mandinka
Meaning ‘the women’s side’/‘that which concerns women’
PART 8. Countries that practice FGM
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