Safeguarding in Southwark – Community Southwark Event

1. Safeguarding in Southwark – Community Southwark Event FGM – A Local response Presenters : Clarisser Cupid – Designated Nurse for Safeguarding NHS Southwark CCG Angela Craggs - Detective Inspector Police Child Abuse Investigation team April Bald – Assistant Director – Safeguarding , Children’s Services October 2016

2. A collaborative approach Understanding FGM its prevalence and profile of practicing communities in Southwark A safeguarding issue - Roles and responsibilities Next steps – Community engagement is key

3. What is Female Genital Mutilation (FGM)? The World Health Organization (WHO) defines Female Genital Mutilation (FGM) as: “All procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons” (2014). • FGM is a violation of the childand woman. • It is child abuse and illegal in the UK • The practice is mostly carried out by traditional circumcisers, who often play other central roles in communities, such as attending childbirths. They are held in very high esteem in the community

4. FGM • FGM involves procedures that include the partial or total removal of the external female genital organs • cultural or other non-therapeutic reasons. • medically unnecessary • extremely painful • has serious health consequences, at the time when the mutilation is carried out and later life.

5. Terminology does this matter? • Female Genital Mutilation (FGM)- describes the gravity and harm of the act. It is an advocacy term, used in legal documents including laws but may be viewed as negative i.e. The UK The FGM Act 2003 • Female circumcisionis an inappropriate term widely used by some communities • Female Genital Cutting (FGC) viewed as a compromise option and non judgemental – used primarily by US agencies • Sunnahincreasingly used by communities as more acceptable form of FGM

6. Types Type 1:Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris). Type 11:Excision: Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are "the lips" that surround the vagina). Type 111:Infibulation:Narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris. This is the most extreme type of FGM

7. Types TYPE IV Unclassified: includes • Pricking, piercing or incising of the clitoris and/or labia • Stretching of the clitoris and/or labia • Cauterization by burning of the clitoris and surrounding tissue • Scraping of tissue surrounding the vaginal orifice or cutting of the vagina • Introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purposes of tightening or narrowing it

8. The Southwark Picture – Public Health • “Estimation of FGM…notoriously difficult to measure due to reluctance of women to disclose….language barriers…potentially wrong assumption that the prevalence…amongst a migrant population is the same as…their home country.” • But: • National policy/practice focus • Mandatory reporting

9. Estimates of Southwark FGM population 2,733 6,933 At risk or affected 0-14 year old females At risk or affected females 4,200 At risk or affected 15-49 year old females London 28.2 per 1,000 15-49 year old females Southwark 57.5 per 1,000 15-49 year old females Source: Prevalence of National and local FGM estimates by Dr Alison MacFarlane, City University, Jul 2015

10. Other data sources HSCIC Data collection Existing routine data sources - Maternity • FGM cases (2010-15) for S+L, KCH found: -Variation by ethnicity e.g. Somali bookings, Eritrean, and Nigerian - FGM types 321 (55%) type 1, 132 (23%) type II and 87 (15%) type III.

11. Requirements from Health 1st April 2014 the first FGM Prevalence Dataset was published All clinical staff MUST record in patient healthcare records when it is identified that a patient has had FGM and demographic data All Acute NHS Trusts inc GP and MH trusts must provide monthly returns of FGM prevalence

12. Statutory Guidance Working Together to Safeguard Children – A guide to interagency working to safeguard and promote the welfare of children 2011 Supplementary Guidance = Multi Agency Practice Guidelines for front line professionals 2012 United Nations recognised it as a human rights violation April 2016 Working Together - Role to prevent FGM and support those affected by the practice October 2015 FGM Mandatory Reporting, the new professional duty to report cases of FGM in girls u18 to the police   FGM is child abuse , a form of violence against women and girls . Need to be dealt with as part of existing safeguarding procedures .

15. Case examples 17 year old Sierra-Leonean presented at Sexual health clinic – had unprotected sex with older man – She had had FGM aged 10 whilst back home . Adult sister ( Sierra-Leone ) who had FGM called – concerned about 10 yr sibling. Police – friend of pregnant Polish woman expecting a girl – Nigerian partner wanted her to have FGM Immigration at Heathrow – Nigerian Child travelling with mother who had paraphernalia in bag indicating possible cutting instruments Mother ( Mali ) victim of FGM gives birth and discloses she will agree to this happening to daughter Mother called HV from home country – husbands family threatening FGM, he’s taken passports

16. It is an offence in the UK to subject a girl or woman to FGM Offence to assist a girl to commit FGM on herself [S2] Offence for someone in the UK to arrange or assist FGM outside of UK even if carried out by a person who isn’t a UK national or resident [S3] NO AGE LIMIT - ‘Girl = woman’ Defence = If it is a surgical operation necessary for physical / mental health Mental health does not include belief that FGM is required as a matter of custom or ritual Consent is not a defence Penalty is 14 years imprisonment To date – no convictions in the UK FGM Act 2003

17. Measures since May 2015 Extension of extra-territorial liability to "habitual" UK residents Lifelong victim anonymity Parents and guardians liability for failing to protect a child from FGM Civil Protection Orders for FGM Mandatory reporting for relevant professionals

18. Police Investigation ABE Interview child/children and any female siblings if applicable. Consider significant witnesses. Medical Examination Assistance via intermediaries or Community/Voluntary organisations Investigative Strategy – identify established excisors and any intelligence opportunities Second Strategy meeting and continual liaison with other Agencies Consider Cultural and Community Resources Unit (CCRU) Contact details found on intranet Interpreters Liaise with local Crime Scene Management Consider assistance from international agencies and other agencies (i.e. Foreign Commonwealth Office, International Social Services, Borders and Immigration agency Early consultation between the police and CPS Counselling & support to any girl who has undergone FGM

19. MPS Response Project Azure Dedicated SPOCS on each CAIT team Training for Police/UKBF/Health/Education Operation Limelight NSPCC Helpline Protocol with CPS

20. Next steps - What works • Victim centred and multi agency approach • Investing in community based organisations to safeguard children through community based preventative work • Recruit , train , support community champions / advocates • Provide safe space to discuss , debate , sensitive • raise awareness through champions , media , events • Incorporate FGM into other messages-–mainstream the message eg sexual health , violence against woman and girls

21. Next steps • Work with religious leaders – confront misconceptions • Work with young people( girls and boys ) using rights based approach – schools key • Avoid associating with single ethnic / religious group – work with mixed groups • Need survivors voice at the forefront to inform practice and policy

22. Next steps • increase confidence in community to reject the procedure • increase workforce knowledge and skills • coordinated interventions / innovative commissioning • Community profile – understanding the social norms • Engage High Commissions • Increased use of Orders to protect and increased focus on the offenders