Female Genital Mutilation

This chapter was added in January 2024.

1. Definition

Female Genital Mutilation is illegal in the Isle of Man and has been since the Prohibition of Female Genital Mutilation Act 2010 was enacted. 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. The exact number of girls and women alive today who have undergone FGM is unknown; however, UNICEF estimates that over 200 million girls and women worldwide have undergone FGM.

FGM has been classified by the World Health Organisation (WHO) into four 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 2 - 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 3 - 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; and
  • Type 4 - Other: all other harmful procedures to the female genitalia for non-medical purposes, for example, pricking, piercing, incising, scraping and cauterising the genital area.

2. What are the Signs that a Child is at Risk?

Signs that a child may be at risk of FGM:

  • A female child is born to a woman who has undergone FGM or whose older sibling or cousin has undergone FGM;
  • The child's father comes from a community known to practise FGM;
  • The family indicate that there are strong levels of influence held by elders and/or elders are involved in bringing up female children;
  • A woman / family believe FGM is integral to cultural or religious identity;
  • A girl / family has limited level of integration within the UK community;
  • The girl talks about a 'special procedure/ceremony' that is going to take place or attending a special occasion to 'become a woman';
  • Parents have limited access to information about FGM and do not know about the harmful effects of FGM or the law on the Isle of Man;
  • A girl talks about a long holiday to her country of origin or another country where the practice is prevalent;
  • Parents state that they or a relative will take the girl out of the country for a prolonged period;
  • A parent or family member expresses concern that FGM may be carried out on the girl;
  • A family is not engaging with professionals (health, education or other);
  • A family is already known to social care in relation to other safeguarding issues;
  • A girl requests help from a teacher or another adult because she is aware or suspects that she is at immediate risk of FGM;
  • A girl talks about FGM in conversation, for example, a girl may tell other children about it - it is important to take into account the context of the discussion;
  • A girl from a practising community is withdrawn from Personal, Social, Health and Economic (PSHE) education or its equivalent;
  • A girl is unexpectedly absent from school;
  • Sections are missing from a girl's red book.

These indicators are not exhaustive; if any of these risk factors are identified, professionals must consider what action should be taken once the practitioners concerns have been discussed with the named designated lead in their organisation. See Section 4, Protection and Action to be Taken.

Signs that FGM may have already taken place:

It is also important to consider whether FGM may have already taken place, for example if:

  • A girl asks for help;
  • A girl confides in a professional that FGM has taken place;
  • A mother/family member discloses that female child has had FGM;
  • A girl has difficulty walking, sitting or standing or looks uncomfortable;
  • A girl finds it hard to sit still for long periods of time, and this was not a problem previously;
  • A girl spends longer than normal in the bathroom or toilet due to difficulties urinating;
  • A girl spends long periods of time away from a classroom during the day with bladder or menstrual problems;
  • A girl has frequent urinary, menstrual or stomach problems;
  • A girl avoids physical exercise or requires to be excused from physical education (PE) lessons without a GP's letter;
  • There are prolonged or repeated absences from school or college;
  • A girl girl displays increased emotional and psychological needs, for example withdrawal or depression, or significant change in behaviour;
  • A girl is reluctant to undergo any medical examinations;
  • A girl asks for help, but is not being explicit about the problem; and/or
  • A girl talks about pain or discomfort between her legs.

Remember: this is not an exhaustive list of indicators and some of the indicators may indicate medical problems and are not necessarily related to FGM.

Where there are concerns that FGM has taken place, the professional should inform their named designated safeguarding lead, prior to a decision being made about what should happen next.

Professionals should not be afraid to ask about FGM, using appropriate and sensitive language. If professionals do not give a girl the opportunity to talk about FGM, it can be very difficult for her to bring this up herself.

3. FGM Mandatory Reporting Duty

‘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.

All agencies on the Isle of Man have a duty according to the Female Genital Mutilation (FGM) Act 2010 to report FGM whether it is planned or has been completed.

4. Protection and Action to be Taken

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.

Where there are concerns that a girl is at risk of FGM:

As soon as a girl is identified as at risk of FGM, information should be shared with the designated named safeguarding lead for the organisation. FGM is child abuse and a form of violence against women and girls and such be treated as such. Wherever a child has suffered significant harm or there is the likelihood of significant harm then a referral should be made to the Initial Response Team, Children and Families Division.

All concerns identified and actions agreed should be noted in the child's record.

Professionals must take into consideration that by alerting the girl's family to any concerns about FGM they may place her at increased risk of harm and professionals should therefore take sufficient steps to minimise this risk.

If, following Referral to the Children and Families Division there is cause to believe that the child has suffered or is likely to suffer Significant Harm, a Section 46 Enquiry will be carried out in conjunction with the Police. A strategy discussion/meeting will be held and this should include relevant health professionals and, if the child is of school age, a school representative.

A Section 46 NARRATES, utilising the Dynamic Risk Analysis tool will be undertaken which will determine what action should be taken next.

It may not always be appropriate to remove the child from an otherwise loving family environment. Parents and carers may genuinely believe that it is in the girl’s best interest to conform to their prevailing custom. Professionals should work in a sensitive manner with families to explain the legal position around FGM on the Isle of Man. The families will need to understand that FGM and re-infibulation (the process of resealing the vagina after childbirth) is illegal on the island.

Interpretation services should be used if English is not spoken or well understood and the interpreter should not be an individual who is known to the family.

If the only risk indicator is that a girl’s mother has undergone FGM, a referral may not be appropriate. Where there is a specific risk, and it is believed that there is the ongoing risk to the child then the case should be referred to the Initial Response Team, Children and Families Division.

When a girl is at imminent risk, legal intervention should be considered and legal advice should be sought. If there is an urgent imminent risk that comes to the attention of the Police or out of hours duty officer then the Isle of Man Constabulary may need to consider the use of a Police Protection Order to avoid a child being removed from the Isle of Man.

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, and look out for changes in relation to any of the known risk factors. For example, if the professional becomes aware of new travel plans or the arrival of extended family members to live with the girl, this information should be shared with appropriate partner agencies without delay.

Children and Families Division, as part of their enquiries 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 may also be commenced.

5. Issues

Prevention Training

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:

  • An overview of FGM (what it is, when and where it is performed);
  • The law on FGM and child protection;
  • The potential consequences of FGM;
  • What to do when FGM is suspected or has been performed; and
  • The role of different professionals and the importance of multi-agency working.

Consequences of FGM

Depending on the degree of mutilation, FGM can have a number of short-term health implications:

  • Severe pain and shock;
  • Wound infections;
  • Urine retention;
  • Injury to adjacent tissues;
  • haemorrhaging;
  • Genital swelling;
  • Death.

Long-term implications can include:

  • Genital scarring;
  • Genital cysts and keloid scar formation;
  • Recurrent urinary tract infections and difficulties in passing urine;
  • Possible increased risk of blood infections such as hepatitis B and HIV;
  • Pain during sex, lack of pleasurable sensation and impaired sexual function;
  • Psychological concerns such as anxiety, flashbacks and post traumatic stress disorder;
  • Difficulties with menstruation (periods);
  • Complications in pregnancy or childbirth (including prolonged labour, bleeding or tears during childbirth, increased risk of caesarean section); and
  • Increased risk of stillbirth and death of child during or just after birth.

In addition to these health consequences there are considerable psycho-sexual, psychological and social consequences of FGM.

Justifications for 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, a form of child abuse, and no explanation or motive can justify it. The justifications given may be based on a belief that, for example, it:

  • Brings status and respect to the girl;
  • Preserves a girl's virginity/chastity;
  • Is part of being a woman;
  • Is a rite of passage;
  • Gives a girl social acceptance, especially for marriage;
  • Upholds the family "honour";
  • Cleanses and purifies the girl;
  • Gives the girl and her family a sense of belonging to the community;
  • Fulfils a religious requirement believed to exist;
  • Perpetuates a custom/tradition;
  • Helps girls and women to be clean and hygienic;
  • Is aesthetically desirable;
  • Makes childbirth safer for the infant; and
  • Rids the family of bad luck or evil spirits.

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.

6. Law on the Isle of Man

FGM has been a criminal offence in the Isle of Man since the Prohibition of Female Genital Mutilation Act 2010. This act came into force in July 2011 and makes it an offence for the first time for Isle of Man Nationals or permanent Isle of Man residents to carry out FGM abroad, or to aid, abet, counsel or procure the carrying out of FGM abroad, even in countries where the practice is legal.

7. NHS (UK) Data Sharing

Female Genital Mutilation Information Sharing (FGM- IS)

FGM-IS is a national IT system in the UK 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.

The above information can be accessed by Manx Care (health professionals only).

Further Information

NSPCC FGM helpline: 0800 028 3550

Multi-Agency Statutory Guidance on Female Genital Mutilation (GOV.UK)

AFRUCA (Child Protection of African Children)

Forward (UK Foundation for Women's Health Research and Development)

Female Genital Mutilation and its Management: Royal College of Obstetricians and Gynaecologists 2015

FGM Act 2010

Female Genital Mutilation Pathway