Conclusions and Recommendations
Introduction
1. FGM is a severe form of gender-based
violence, and where it is carried out on a girl, it is an extreme
form of child abuse. Everyone who has a responsibility for safeguarding
children must view FGM in this way. (Paragraph 8)
2. Even conservative estimates of
the number of girls at risk of FGM indicate that it could be one
the most prevalent forms of severe physical child abuse in the
UK. In two London boroughs, for example, almost one in ten girls
are born to a woman who has undergone FGM, and are therefore at
risk of being cut themselves. Yet, apart from a small number of
high-level statistical analyses and anecdotal evidence, we have
very little information on the children who are most at risk,
and even the extent to which the cutting is occurring in this
country or by taking girls abroad. Meanwhile, as many as 170,000
women in the UK may already be living with the life-long consequences
of FGM. We welcome efforts by the Government and others to draw
a more accurate picture. However, even in the absence of precise
data, it is clear that the extent of the problem is very significant,
and therefore needs to be matched by a response by all those who
have a responsibility for safeguarding children that is similar
in scale. (Paragraph 14)
3. The failure to respond adequately
to the growing prevalence of FGM in the UK over recent years has
likely resulted in the preventable mutilation of thousands of
girls to whom the state owed a duty of care. This is a national
scandal for which successive governments, politicians, the police,
health, education and social care sectors all share responsibility.
We pay tribute to the efforts of a small number of individuals
and organisations who have worked to raise public awareness of
FGM and the impact it has on those who have undergone the procedure.
Many of those campaigners who have spoken out have had to withstand
criticism and ostracism by those in their own communities who
do not wish to see an end to the practice. We also acknowledge
the work of The Evening Standard, The Guardian, and The Times
in raising public awareness of FGM in the last year. The Government
has started to take action, and we welcome the stated commitment
to end FGM in a generation. It must now implement a comprehensive
and fully-resourced national action plan for tackling FGM. The
plan should provide clear leadership and objectives, setting out
the standards expected of all relevant bodies, and to which they
will be held accountable. It should incorporate a number of interlinked
aspects, including:
a) the achievement of successful
prosecutions for FGM;
b) working with professionals
in the health, education, social care and other sectors to ensure
the safeguarding of at-risk girls;
c) changes to the law on FGM;
d) improved working with communities
to abandon FGM; and
e) better services for women
and girls living with FGM. (Paragraph 19)
4. We consider each of these in the
subsequent chapters of this Report. Finally, we welcome the Prime
Minister's planned summit on FGM and forced marriage. We urge
him to consider the recommendations in this Report. We welcome
the fact that the summit will reflect the international dimension
of the problem, and we hope that the relevant heads of government
of affected states are invited to attend. We believe the Government
should aspire to the UK being a world leader in the policy response
to FGM. (Paragraph 20)
Prosecuting FGM
5. A number of successful prosecutions
would send a clear message to practising communities that FGM
is taken seriously in the UK and will be punished accordingly.
There has rightly been increasing public outrage at the failure
to achieve a prosecution in the 29 years that FGM has been a crime,
with the first prosecutions taking place only this year, after
the Committee commenced its inquiry and only a matter of days
before the DPP appeared before this Committee. This compares starkly
with the approach in France, where a large number of successful
prosecutions has played a key role in discouraging the practice.
One reason behind the UK's poor record is that the police and
Crown Prosecution Service have historically been far too passive
in their approach to FGM by waiting for survivors to come forward
and report. Yet, the nature of FGM means it is unlikely that this
will happen. Often victims do not become aware that FGM is a crime
until some years after it has happened to them. Even then, they
face huge social pressure not to report it. (Paragraph 35)
6. We welcome the more recent proactive
work the CPS has undertaken to secure prosecutions, which we hope
will bear fruit. A key difficulty, though, remains the ability
to gather sufficient evidence on which to base a prosecution.
The police must do more within practising communities to publicise
the fact that information can be reported anonymously. In addition,
if victims had the protection of press and broadcast anonymity,
this might encourage more to come forward. To allow this, we recommend
the Government bring forward proposals to extend the right to
anonymity under the Sexual Offences (Amendment) Act 1992 to include
victims of FGM. (Paragraph 36)
7. The use of regular examinations
of all children in France has been a key factor in obtaining evidence
that has underpinned a large number of prosecutions. It would
be a disproportionate response to introduce such a universal system
in the UK. However, we do believe there is a case for a system
that empowers medical professionals to make periodic FGM assessments
where a girl is identified as being at high risk. Any such system
would need to form part of a much wider scheme of preventative
and safeguarding work, which we consider in the next two chapters.
(Paragraph 37)
Safeguarding at-risk girls
8. It is deeply concerning that so
many frontline practitioners do not recognise the indicators of
when a girl or young woman is at risk, or has undergone FGM, and,
even when they do recognise the signs, they do not know how to
respond. It is unacceptable that those in a position with the
most access to evidence of these crimes do nothing to help the
victims and those at risk. The record of referrals by healthcare
practitioners and others is extremely poor and a lack of training,
awareness or ethical concerns can no longer prevent positive action
being taken. To remove one of the obstacles to referring, high-quality
training for all professionals, including midwives, GPs, health
visitors, practice nurses, teachers, obstetricians and gynaecologists,
social workers and teaching assistants, is therefore vital both
during education and through continued professional development.
This should form an essential part of all child protection training.
Furthermore, we welcome and support the recommendations of the
Intercollegiate Group, though we believe that this work could
be better communicated. We note with disappointment that the Royal
College of General Practitioners is not a signatory to the report.
GPs have a vital role in responding to FGM, and we hope that the
Royal College will now work with the Intercollegiate Group to
implement its recommendations. (Paragraph 44)
9. The Multi-Agency Practice Guidelines
on FGM have a valuable role to play as a tool for all practitioners.
However, they will only ever be useful if they are read, and that
is more likely to happen if they are mandatory. We recommend the
Government update the Guidelines and place them on a statutory
footing, giving them parity with guidelines for handling cases
of forced marriage. We believe this will provide a much stronger
incentive for agencies responsible for training to ensure the
inclusion of FGM. To support this, the Department of Health should
improve the accessibility of the Guidelines, rather than simply
publishing them online, and provide funding for the development
of e-learning materials for practitioners. The Department of Health
and Department for Education should also ensure arrangements are
in place to monitor compliance and hold to account bodies who
are responsible for training provision. (Paragraph 45)
10. Misplaced concern for cultural
sensitivities over the rights of the child is one of the main
reasons why the UK has failed to tackle FGM to date. A key objective
for a national action plan on FGM must be to overcome practitioners'
own reluctance to address FGM so that they respond to it in the
same way as other forms of child abuse. Practitioners must be
given the confidence to know that they will not suffer any detriment
as a result of raising legitimate concerns about FGM. Again, training
is important for practitioners to have the confidence to talk
about FGM. But it is also about making such conversations routine
so that professionals overcome any awkwardness about having them.
(Paragraph 47)
11. Healthcare professionals have
a vital role in breaking the generational cycle of FGM. When a
woman is identified as having undergone FGM or being from a country
where FGM is practised, then her daughters, future children, younger
sisters and other younger female family members should be considered
at risk, and preventative measures put in place. But at present
there is no consistent approach for identifying at-risk girls
and monitoring them throughout their childhood. This process should
start before the child is even born. We recommend that the FGM
status of the mother and her intentions for the child if it is
a girl be made a compulsory question at the antenatal booking
interview. This would provide an opportunity to discuss the issue
frankly, but sensitively. It would enable better preparation for
the delivery, and where the question is not relevant to the mother,
it will serve to raise awareness of the issue. (Paragraph 56)
12. Where a girl is born to a mother
who has undergone FGM, or where there is perceived to be a risk
to the child, we believe the NHS should, as a matter of policy,
make a referral to children's social care, or the local multi-agency
safeguarding hub, so that an action plan for the safeguarding
of that child can be developed and implemented. We welcome the
pilot in London to implement such an approach, and hope that it
will inform a national roll-out as soon as possible. Furthermore,
we recommend the Royal College of Paediatrics and Child Health
amend the Personal Child Health Record, or Red Book, to include
a specific reference to the risk of FGM to the child, and any
safeguarding steps that have been taken. FGM should also form
part of the standard questioning for women registering for the
first time at GP practices. To support these recommendations,
the NHS in conjunction with social care agencies must establish
clear referral pathways, which are understood by health professionals
so that they feel confident using them. We do not accept that
patient confidentiality should prevent practitioners from making
a referral where a child is at risk: as with any other form of
child abuse, the law allows for disclosure where it is in the
best interests of the child. (Paragraph 57)
13. Professionals in schools, including
teachers and school nurses, have the most regular and ongoing
interaction with young people outside of their homes. They are
in the best position to detect the warning signs that a girl may
be at risk of FGM, or has already undergone the procedure. It
is vital that school staff have an awareness of these indicators,
and know when to refer the matter to children's social care and
the police. (Paragraph 64)
14. We commend the Secretary of State
for Education's decision to write to every school to highlight
his Department's revised safeguarding guidance, which for the
first time raises FGM. However, it is deeply disappointing that
almost 70 per cent of the recipients of the guidance did not even
look at it in the month after its publication. We recommend that
the Secretary of State for Education resend the guidance to all
head teachers and child protection officers. To ensure that the
guidance has been looked at, the Department for Education should
link the receipt of a proportion of school funding that relates
to social education and child protection to the electronic notification
that the guidance has been viewed. (Paragraph 65)
15. We further recommend that head
teachers and child protection officers, where they have not already
done so, undergo compulsory safeguarding training which specifically
deals with FGM. This training should be disseminated to all teaching
staff through schools dedicating time during the remaining in-service
training days in 2014 to provide guidance on child safeguarding
in respect of FGM and forced marriage. In addition, we recommend
that Ofsted publish a progress report setting out the number and
proportion of its inspections to date that have explicitly asked
about safeguarding against FGM, and the outcome of those inspections.
(Paragraph 66)
16. We note that the large majority
of our witnesses felt that Personal, Social and Health Education
(PSHE) should be made compulsory, with FGM included as part of
a wider curriculum on tackling violence against women and girls.
It is important that teachers and pupils have an opportunity to
discuss issues such as FGM, especially where a proportion of the
school population may come from a practising community. We recommend
that, where Ofsted assesses PSHE provision in schools, it explicitly
examines the school's approach to education on FGM and violence
against women. Empowering children to discuss the issue openly
will increase the likelihood of breaking the inter-generational
cycle of FGM, and will also increase the level of reporting, in
so doing helping to ensure the safeguarding of at-risk girls.
We recommend that PSHE be made compulsory, including teaching
children about FGM in high-prevalence areas. (Paragraph 67)
17. Children's social care has an
essential role in responding to referrals made by healthcare and
education professionals, and others, and in developing an appropriate
response that safeguards the child. It is concerning that many
of those who make FGM-related referrals believe that the threshold
for social care intervention is often too high. We recommend that
the Department for Education investigate this issue with local
safeguarding children boards. We are also concerned that some
children's social care services fail to respond to referrals effectively
either by not responding at all, or by overreacting. All local
safeguarding children boards need to develop clear and consistent
risk assessment protocols so that an appropriate action plan is
put in place for every child referred to social services. This
is particularly the case if efforts to increase the number of
referrals from the health and education sectors are to be successful.
(Paragraph 71)
18. The police have an important
dual role to play in tackling FGM, both by working with children's
social care and other agencies to safeguard at-risk children,
and in investigating where a crime may have taken place. Given
the low level of referrals to the police to date, we welcome the
more proactive approach recently taken by forces such as the Metropolitan
Police Service, particularly its recent operations in airports.
We believe forces need to ensure that officers receive training
to respond appropriately to referrals, and are able to work effectively
with grass-roots organisations to break down barriers with affected
communities. We were extremely disappointed in the role of ACPO
and its lead, who appear to have made little effort to tackle
the problem faced, and have shown a distinct lack of leadership
in this matter. (Paragraph 76)
19. The importance of third sector
organisations in working with other agencies to safeguard at-risk
girls cannot be understated. Their role in raising awareness,
training professionals, and working with affected communities
is vital to tackling FGM in the UK. To date they have achieved
this with very little financial support. The Government must provide
additional funding to increase significantly the capacity of grass-roots
groups, and to encourage the roll-out of best practice from groups
such as Integrate Bristol. We support the NSPCC's FGM helpline,
which has significantly increased the number of police referrals,
though the charity itself believes this is the tip of the iceberg.
The Government therefore needs to do much more to promote awareness
of the helpline's existence among frontline practitioners and
practising communities. (Paragraph 79)
20. Overall, the safeguarding of
girls and young women at risk of FGM requires the development
of a multi-agency approach with co-operation between all those
who come into contact with children—health, education,
social care, the police and others. FGM is child abuse and needs
to be treated accordingly through existing child protection and
safeguarding system. This requires a much greater emphasis on
the collection and sharing of information, and the development
of clear referral pathways that are well-understood and used by
front-line practitioners. (Paragraph 80)
21. There is a clear case for a national
FGM awareness campaign, on the same scale as historic public health
campaigns on domestic violence and HIV/AIDS. For too long it has
been left to grassroots campaigners and the national media to
do this work. And whilst we welcome the €300,000 of EU funding
for awareness-raising, it is not sufficient. We recommend the
Government provide funding to implement a national campaign that
targets frontline professionals, practising communities, including
at-risk girls, as well as the wider general public. The campaign
should carry the unambiguous message that FGM is a serious crime
and child abuse. It should also signpost practitioners who are
unsure as to how to make a referral, and women who have undergone
FGM and are seeking support. (Paragraph 84)
Changing the law
22. We believe there is a strong
case for strengthening the law on FGM, principally to ensure the
safeguarding of at-risk girls, but also to increase the likelihood
of achieving successful prosecutions. We welcome the Government's
plans to broaden the scope of the 2003 Act so that it covers girls
who are habitually resident in the UK. The state has a duty of
care to all those who live within its borders, regardless of their
immigration status. We also recommend that the Government amend
the 2003 Act to include reinfibulation. We further recommend that
the Government examine the extent to which there is a double standard
in the current treatment of female genital cosmetic surgery and
FGM under the law, and whether there is a case for prohibiting
all such surgery on girls under the age of 18, except where it
is clinically indicated. We also support the introduction of FGM
protection orders, and look forward to seeing proposals from the
Ministry of Justice in this respect. (Paragraph 97)
23. We note the Government's reluctance
to strengthen the statutory reporting requirements for child abuse.
It is clear, however, that many professionals still fail to view
FGM as child abuse and respond accordingly. This is why the level
of referrals has been much lower than the likely prevalence of
FGM in the UK. New initiatives such as the pilot for automatic
referral to children's social care of newborn girls to mothers
with FGM, should help to address this issue, as would a fully-funded
national awareness campaign. However, if in a year's time the
level of reporting has not reached the level that would be expected,
we recommend the Government should take steps to make the failure
to report child abuse a criminal offence. (Paragraph 98)
Working with communities
24. FGM will continue to be a problem
in the UK until communities themselves choose to abandon the practice.
The Government has a crucial role to play in enabling community-based
initiatives that seek to break down the powerful social norms
that underpin FGM. We welcome the £100,000 of funding from
the Home Office to support greater engagement work by voluntary
organisations. But it is not enough. To support a full-scale national
action plan that is commensurate with the extent of the problem,
the Government needs to provide long-term funding that is an order
of magnitude greater than that which it has committed to date.
(Paragraph 104)
25. There is too little provision
of clinical and mental health support services for the many thousands
of women and girls in the UK who have undergone FGM. The NHS and
commissioning groups need to ensure that the provision of services
better reflects the prevalence of FGM. The services available
should specifically include the provision, through NGOs or local
authorities, of dedicated FGM shelters to enable women and girls
to remove themselves from a position of danger. These will also
provide the pastoral, medical and psychological support needed
to enable those at risk to break the cycle of abuse. Overall,
services should be widely publicised, sustainable, and tailored
to cater to different age groups. Frontline health professionals
need better training to ensure women and girls who have undergone
FGM are referred appropriately and sensitively to these services.
Not only would much greater investment in such services improve
the lives of a great many women and girls, it would also contribute
significantly to breaking the cycle of violence, so protecting
future generations. (Paragraph 110)
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