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In July 2024 a new section was added on Other Harmful Practices. The Health and Care Act 2022 has made it illegal to carry out, offer or aid and abet virginity testing or hymenoplasty in any part of the UK. It is also illegal for UK nationals and residents to do these things outside the UK. Information has also been added on Breast Flattening which is an offence as set out in CPS So-Called Honour-Based Abuse Legal Guidance.
Female Genital Mutilation (FGM) is a procedure where the female genital organs are deliberately cut, injured or changed and there is no medical reason for this. It is frequently a very traumatic and violent act and can cause harm in many ways. The practice can cause severe pain, and there may be immediate and/or long-term health consequences, including pain and infection, mental health problems, difficulties in childbirth and/or death.
FGM is a deeply rooted practice, widely carried out among specific ethnic populations in Africa and parts of the Middle East and Asia. It serves as a complex form of social control of women's sexual and reproductive rights.
The age at which FGM is carried out varies enormously according to the community. The procedure may be carried out on new-born infants, during childhood or adolescence or just before marriage or during a woman's first pregnancy. There is no Biblical or Koranic justification for FGM and religious leaders from all faiths have spoken out against the practice.
FGM has been classified by the World Health Organisation (WHO) into four types:
Under the Female Genital Mutilation Act 2003, FGM is a criminal offence - it is child abuse and a form of violence against women and girls and should be treated as such.
Signs that a child may be at risk of FGM:
Signs that FGM may have already taken place:
It is also important to consider whether FGM may have already taken place, for example if:
Remember: this is not an exhaustive list of indicators.
Where there are concerns that FGM has taken place, the Home should inform the child’s social worker.
Since 31 October 2015, when section 74 of the Serious Crime Act 2015 inserted new section 5B into the Female Genital Mutilation Act 2003, specified regulated professionals (including social workers) must report to the police any cases of female genital mutilation in girls under 18 that they come across in their work. The duty applies where the professional either:
Reports should be made using the non emergency 101 telephone number.
'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 necessary for the girl's physical or mental health or for purposes connected with labour or birth.
Reports under the duty should be made as soon as possible after a case is discovered, and best practice is for reports to be made by the close of the next working day. A longer timeframe than the next working day may be appropriate in exceptional cases where, for example, a professional has concerns that a report to the police is likely to result in an immediate safeguarding risk to the child (or another child, e.g. a sibling) and considers that consultation with colleagues or other agencies is necessary prior to the report being made.
Cases of failure to comply with the duty will be dealt with in accordance with the existing performance procedures in place for each profession.
| Remember - Mandatory Reporting does not replace safeguarding children actions; if a professional has concerns that FGM has taken place, they should share this information with their safeguarding lead and make a referral to Children's Social Care. |
For more information on the Mandatory Reporting Duty, please see:
FGM is child abuse and should be treated as such. Professionals should intervene to safeguard girls who may be at risk of FGM or who have been affected by it.
As soon as a girl is identified as at risk of FGM, information should be shared with other agencies (in accordance with local information sharing protocols and Information Sharing Advice for Practitioners Providing Safeguarding Services to Children, Young People, Parents and Carers - DfE. If a professional is unsure whether the level of risk requires Referral to Children's Social Care at this point, they should discuss their concerns with the named/designated safeguarding lead in their organisation. The National FGM Centre's FGM assessment tool is a useful resource to help professionals determine whether a safeguarding referral needs to be made.
All concerns identified and actions agreed should be noted in the child's record.
The level of safeguarding intervention needed will depend on how imminent the risk of harm is. An appropriate course of action should be decided on a case-by-case basis, following a risk assessment, with expert input from all relevant agencies. A victim centred approach should be taken, based on a clear understanding of the needs and views of the child.
A strategy discussion/meeting may be held and this should include relevant health professionals and, if the child is of school age, a school representative.
When a girl is at imminent risk, legal intervention should be considered, including an FGM Protection Order (FGMPO).
Professionals should remember that FGM can be carried out at any age, so identifying at birth that a girl is at risk of FGM means that safeguarding measures adopted may need to remain in place for a number of years over the course of her childhood.
In this situation, professionals should always take opportunities to discuss and understand changes to the girl's/family's circumstances.
Where there are concerns that FGM has taken place - professionals should inform their named/designated safeguarding lead, and an immediate Referral should be made to the relevant local authority Children's Social Care department (see Safeguarding Children and Young People and Referring Safeguarding Concerns Procedure).
Remember - Professionals subject to the FGM Mandatory Reporting Duty are also required to report 'known' cases of FGM in girls under 18 to the police.
Children's Social Care will liaise with Paediatric services where it is believed that FGM has already taken place to ensure that a Medical Assessment takes place and the girl receives the care and support she needs. Enquiries will be made about other female family members who may need to be safeguarded from harm. Criminal investigations into the perpetrators can also be commenced (see Section 6, Law in England, Wales and Northern Ireland).
National FGM Support Clinics have been established to offer a range of support services for women over 18 who have undergone FGM. Support for girls under 18 is available from a specialist paediatric service at University College London Hospitals (UCLH). UCLH can be contacted by email at UCLH.paediatricsafeguarding@nhs.net.
Support for children, young people and families is also available from the NSPCC.
Training should be available to enable professionals to discharge their safeguarding duties with regard to FGM, as for any other form of abuse. Training on FGM could include the following:
See also: E-learning for all professionals is available at Virtual College, Female Genital Mutilation: Recognising and Preventing FGM.
Health Education England offer e-learning, free to access by health and social care professionals.
Depending on the degree of mutilation, FGM can have a number of short-term health implications:
Long-term implications can include:
In addition to these health consequences there are considerable psycho-sexual, psychological and social consequences of FGM.
FGM is a complex issue, and individuals and families who support it give a variety of justifications and motivations for this. However, FGM is a crime and child abuse, and no explanation or motive can justify it. The justifications given may be based on a belief that, for example, it:
See the Health Passport - Statement Opposing FGM for an overview of the law on FGM in England, Wales and Northern Ireland. Copies can be downloaded in a range of different languages.
FGM is a traditional practice often carried out by a family who believe it is beneficial and is in a girl or woman's best interests. This may limit a girl's motivation to come forward to raise concerns or talk openly about FGM – reinforcing the need for all professionals to be aware of the issues and risks of FGM and the need to ask questions about FGM when they have concerns. In addition, women and girls who have undergone FGM may not fully understand what FGM is, what the consequences are, or that they themselves have had FGM.
FGM is a complex and sensitive issue that requires professionals to approach the subject carefully. Good communication is essential when talking to individuals who have had FGM, may be at risk of FGM, or who are affected by the practice. When speaking to families, the care of women and girls affected by FGM should be the primary concern, treating them as individuals, listening and respecting their dignity. Sensitive language should be used and the girl's wishes, culture and values are recognised and respected;
An accredited female interpreter may be required. Any interpreter should ideally be appropriately trained in relation to FGM, and should not be a family member, nor someone known to the individual or who has influence in the individual's community.
In England, Wales, and Northern Ireland criminal and civil legislation on FGM contained in the Female Genital Mutilation Act 2003 ('the 2003 Act').
The Act:
(Please note: in Scotland, FGM is illegal under the Prohibition of Female Genital Mutilation (Scotland) Act 2005).
See also: Making an Application for an FGM Protection Order (FGMPO) - Flowchart.
NHS Digital collects data on FGM within in the NHS in England on behalf of the Department for Health and Social Care.
Data on the following is collected from NHS acute trusts, mental health trusts and GP practices:
Aggregate information on the data collected is available online, see NHS Digital website.
Female Genital Mutilation Information Sharing (FGM- IS)
FGM-IS is a national IT system for healthcare professionals and administrative staff to record that a girl has a family history of FGM.
For more information, please see NHS Digital - FGM.
Virginity testing and hymenoplasty can be precursors to child or forced marriage and other forms of family and/or community coercive behaviours, including physical and emotional control. The practices are degrading and intrusive. They can lead to extreme psychological trauma in the victim, and can provoke conditions including anxiety, depression and post-traumatic stress disorder. The practices have been linked to suicide and can be physically harmful.
Women and girls may themselves present to agencies requesting the procedures in an attempt to protect themselves from further harm and abuse, including shaming, disownment, physical abuse and possible honour-killings. Family and/or community members who are unaware of the change in law may also try to contact agencies seeking the procedures for their daughters and female relatives.
See Virginity Testing and Hymenoplasty: Multi-agency Guidance (DHSC) for good practice guidance and indicators that a woman or girl is at risk of or has been subjected to a virginity test and/or hymenoplasty.
It is important to find out if the woman or girl is in immediate danger. In an emergency, the police should be contacted without delay. If it is not an emergency but there is a concern that the individual is at risk, the organisation’s safeguarding procedures and any professional duties should be followed. This may involve a referral to social care services and/or the police should be made.
Virginity testing and hymenoplasty are forms of so called ‘honour-based’ abuse and violence against women and girls. Like forced marriage and female genital mutilation (FGM), the victims of these abuses are at risk of being subjected to further harm, whether that be psychological or physical. The same sensitivity and precautions apply as for other types of so called ‘honour’ based abuse.
Organisations should not involve families and community members in cases involving virginity testing and hymenoplasty, including trying to mediate with family or using a community member as an interpreter. Engaging with families and community members may increase risk of harm to the victim. The victim may be punished for seeking help and arrangements for procedures may be expedited.
The Health and Care Act 2022 has made it illegal to carry out, offer or aid and abet virginity testing or hymenoplasty in any part of the UK. It is also illegal for UK nationals and residents to do these things outside the UK.
In England and Wales and Northern Ireland, the offences will each carry a maximum penalty of a 5-year custodial sentence and/or an unlimited fine. There is a risk that women and girls may be taken abroad and subjected to virginity testing and hymenoplasty (as is often seen with so called ‘honour-based’ abuse offences, such as female genital mutilation or forced marriage). The offences, therefore, carry extra-territorial jurisdiction. This means that UK nationals and residents who carry out a virginity test or hymenoplasty outside the UK also commit an offence in the UK.
Breast flattening which is the painful and harmful practice of bringing a girl's breasts into contact with hard or heated objects (which may vary in nature but may include stones, belts, pestles and heated implements) to suppress or reverse the growth of breasts by destroying the tissue.
Breast flattening is often performed at first signs of puberty, usually by female family members professing to make a teenage girl look less womanly to avoid sexual interest, prevent pregnancy and rape, deter from sexual relationships outside marriage and dishonouring the family/community. Due to the type of instruments, force and lack of aftercare, there are significant physical and psychological consequences and risks related to this practice.
Breast flattening is a form of child abuse. See the CPS legal guidance on So-Called Honour-Based Abuse.
Multi-Agency Statutory Guidance on Female Genital Mutilation (GOV.UK)
Female Genital Mutilation Resource Pack (Home Office) - including links to local organisations
FGM Protection Orders: Factsheet Mandatory Reporting of Female Genital Mutilation – procedural information
Safeguarding Women and Girls at Risk of FGM – Guidance for Professionals (DHSC) – includes Pathway and Risk Assessment tools
Virginity Testing and Hymenoplasty: Multi-agency Guidance (DHSC)
Female Genital Mutilation CPS Guidelines
NSPCC FGM helpline: 0800 028 3550
FGM Assessment Tool for Social Workers (National FGM Centre). It has two elements; Best Practice Guidance and an Online FGM Assessment Tool to help guide the assessment of cases where FGM is a concern.
Female Genital Mutilation and its Management: Royal College of Obstetricians and Gynaecologists 2015
National FGM Centre provides a range of guidance for all agencies including schools, health and social care
AFRUCA (Child Protection of African Children)
Forward (Foundation for Women's Health Research and Development)
NHS - FGM (including information on where to get support)
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