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FGM/Honour Based Abuse/Modern Slavery/Forced Marriage

Caldicott Guardian for Primary care is kiran.patel4@nhs.net, (not Dr M Wells)

Definition and Key facts

FGM is when a female’s genitals are deliberately altered or removed for non-medical reasons. It’s also known as ‘female circumcision’ or ‘cutting’ but has many other names.

You might have heard some FGM terms that you’re not familiar with, including:

  • ‘Cutter’

A ‘cutter’ is somebody who carries out FGM. They might use things like knives, scalpels, scissors, glass or razor blades to carry out the procedure.

  • ‘Cutting season’

This refers to the summer months – often July, August and September – when many girls are on break from school. This is often the period when girls have time to undergo FGM. Girls might be flown abroad during this time, so it’s important to be aware of this risk.

The National FGM Centre also has a list of traditional terms (PDF) that you might find helpful.

 

More than 125 million girls and women alive today have been cut in the 29 countries in Africa and the Middle East where FGM is concentrated.

FGM is mostly carried out on young girls sometime between infancy and age 15.

FGM is a violation of the human rights of girls and women and is considered as torture under Article 3 of the European Convention on Human Rights.

FGM is recognised internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.

 

FGM is a form of child abuse. It’s dangerous and a criminal offence in the UK. We know:

  • there are no medical reasons to carry out FGM
  • it’s often performed by someone with no medical training, using instruments such as knives, scalpels, scissors, glass or razor blades
  • children are rarely given anaesthetic or antiseptic treatment and are often forcibly restrained
  • it’s used to control female sexuality and can cause long-lasting damage to physical and emotional health.

FGM can happen at different times in a girl or woman’s life, including:

  • when a baby is new-born
  • during childhood or as a teenager
  • just before marriage
  • during pregnancy.

 

What are the health consequences of FGM?

  • Death       Severe pain and shock       Broken limbs from being held down
  • Injury to adjacent tissues       Urine retention      Increased risk of HIV and AIDS
  • Uterus, vaginal and pelvic infections      Cysts and neuromas
  • Increased risk of fistula     Complications in childbirth
  • Depression and post-natal depression       Psychosexual problems
  • Pregnancy and childbirth    Sexual dysfunction
  • Difficulties in menstruation      Trauma and flashbacks     Infertility

 

Who’s at risk?

Girls living in communities that practise FGM are most at risk. It can happen in the UK or abroad.

In the UK, the Home Office has identified girls and women from certain communities as being more at risk:

  • Somali       Kenyan     Ethiopian    Sierra
  • Leonean    Sudanese    Egyptian    Nigerian
  • Eritrean     Yemeni    Kurdish

Children are also at a higher risk of FGM if it’s already happened to their mother, sister or another member of their family.

 

Female genital mutilation is classified into four major 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.

Type 4: Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

NHS Digital – Female Genital Mutilation Enhanced Dataset

The FGM Enhanced Dataset requires organisations to record collect and return detailed information about FGM within the patient population, as treated by the NHS in England.

You can find out more by visiting their website.

FGM Enhanced Dataset: GP Approach – FGM Prevention Programme

  • explain why the development of the FGM Enhanced dataset took the approach it initially did
  • outline the recommended processes from which GPs can choose which best suits their individual needs and organisation

Multi-Agency Statutory Guidance on FGM – Click Here

Mandatory Reporting Guidance – Click Here

Home Office: The Home Office have now published (February 2020) the updated FGM resource pack, which can be found here

NHS Digital Female Genital Mutilation – Information Sharing You can find out more information by visiting their website.

If you are victim of ‘honour’-based violence or forced marriage please contact:

Freephone 24 Hour National Domestic Abuse Helpline on 0808 2000 247

Forced Marriage Unit on +44 (0) 20 7008 0151 or fmu@fco.gov.uk

What is Honour-Based Abuse?

The concept of ‘honour’ is for some communities deemed to be extremely important. To compromise a family’s ‘honour’ is to bring dishonour and shame and this can have severe consequences. The punishment for bringing dishonour can be emotional abuse, physical abuse, family disownment and in some cases even murder.

In most honour-based abuse cases there are multiple perpetrators from the immediate family, sometimes the extended family and occasionally the community at large. Mothers, sisters, aunties and even grandmothers have been known to be involved in the conspiring of honour crimes.

There is no specific offence of ‘honour’-based violence. Crown Prosecution Service definition:

‘an incident or crime involving violence, threats of violence, intimidation, coercion or abuse (including psychological, physical, sexual, financial or emotional abuse) which has or may have been committed to protect or defend the honour of an individual, family and/or community for alleged or perceived breaches of the family and/or community’s code of behaviour.’

You may recognise ‘honour’ as Izzat, Ghairat, Namus or Sharam.

‘Honour’-based violence includes:

  • Forced marriage
  • Domestic violence (physical, sexual, emotional or financial abuse)
  • Sexual harassment and sexual violence (rape and sexual assault or threat of rape and sexual assault)
  • Threats to kill
  • Social ostracism or rejection and emotional pressure
  • Denial of access to children
  • Pressure to go or move abroad
  • House arrest and excessive restrictions of freedom
  • Denial of access to the telephone, internet, or passport/key documentation
  • Isolation from friends and own family

 

What is the difference between an Arranged and Forced Marriage?

Arranged Marriage: Both participants give their full consent and enter the marriage willingly.

Forced Marriage:  One or both participants enter the marriage without giving their consent. They go through with the wedding under duress from their families.

Forcing someone into marriage is a criminal offence in the UK.

See The Right to Choose: Multi-agency statutory guidance for dealing with forced marriage and Multi-agency practice guidelines: Handling cases of forced marriage

Arranged or Forced: Grey Area

What starts out as an ‘arranged’ marriage can quickly escalate to a forced marriage. It is not uncommon for one of the participants to change their mind, even on the wedding day only for the families to force them to go through with it.

 

What are the main challenges?

Ensuring everyone in the country understands that culture, religion, and tradition is not an excuse, forced marriage is a criminal offence in the UK.

 

Does culture, religion or tradition justify this abuse?

To our knowledge, there is no scripture in any of the major religions that condone forced marriage. Under British law it is illegal.

 

Which communities does this abuse affect?

Honour crimes are most prevalent within diaspora communities from South Asia, the Middle East, and North and East Africa. Reports come from Muslim, Sikh, Hindu, Orthodox Jewish and occasionally traveller communities. Honour Abuse is not determined by gender; both perpetrators and victims can be male or female.

 

Further services of support

Victim Support

This is a free, safe and secure online space where you can work through interactive guides to help you move forward after crime.

You can find out more by visiting their website.

Southhall Black Sisters

Southall Black Sisters, a not-for-profit, secular and inclusive organisation, was established in 1979 to meet the needs of Black (Asian and African-Caribbean) women.

You can find out more by visiting their website.

IKWRO

A charity providing advice and support in Arabic, Kurdish, Turkish, Dari and Farsi to women, girls and couples living in Britain, in particular helping women facing domestic violence, forced marriage and honour-based violence.

You can find out more by visiting their website.

Karma Nirvana

A national charity supporting victims of honour-based abuse and forced marriage.  They run a national helpline offering direct support and guidance to victims and professionals.

You can find out more by visiting their website.

If you suspect modern slavery, report it to the Modern Slavery Helpline on 08000 121 700 or the police on 101. In an emergency always call 999. Don’t leave it to someone else. Your information could save a life.

Human trafficking and modern slavery are thought to be amongst the most widespread crimes in the world, affecting millions of men, women and children each day.

This is happening in Warwickshire. We all need to be aware of what this is, understand what it involves, be able to spot the signs and know how to respond to and report concerns.

What Is Modern Slavery & Human Trafficking?

Human Trafficking is:

The movement or recruitment by deception or coercion for the purpose of exploitation.

Modern Slavery acts as an umbrella term, which covers a number of human rights issues, of which human trafficking is one, it encompasses:

  • Slavery – including bonded labour, child slavery such as child labour and trafficking, early and forced marriage, forced labour, descent-based slavery and trafficking.
  • Human Trafficking
  • Domestic Servitude – victims are forced to carry out housework and domestic chores in private households for little or no pay.
  • Forced/Compulsory Labour – victims are forced to work against their will, often working very long hours for little or no pay in dire conditions and with verbal and physical threats made to them.
  • Debt bondage – victims are forced to work to pay off debts often accrued by travelling to their place of exploitation with no real prospect of paying off the debt.

Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude, and inhumane treatment.

There are many forms of exploitation into which people can be trafficked and held in slavery.

These crimes are happening in every corner of the world and can include any person, regardless of age, socio-economic background or location. As a result, each case can look very different.

 

Warning Signs To Look Out For

Whilst each case of Modern Slavery can look different, there are signs which are common across multiple forms of exploitation, which may suggest an individual is at risk of, or is a victim of a form of Modern Slavery. These signs include if someone:

  • acts as if instructed by another, as though they are forced or coerced to carry out specific activities
  • demonstrates signs of physical or psychological abuse, such as lacking self esteem, seeming anxious, bruising or untreated medical conditions
  • seems to be bonded by debt; has money deducted from their salary; or has a lack of access to earnings
  • has little or no contact with family or loved ones
  • is distrustful of authorities
  • has threats made against themselves or family members
  • is not in possession of their own legal documents (Passport or documents are held by someone else)

The National Referral Mechanism is a framework for identifying victims of human trafficking or modern slavery and ensuring they receive the appropriate support.

On 29 April 2019 the Home Office assumed responsibility for all areas of the NRM, including referrals, decision making and data collection.

 

Modern Day Slavery Training & Resources

Modern Slavery training – free training resource: Health Education England (HEE) has produced a 30-minute e-learning package that is free to access for all healthcare professionals.

Home Office: Modern Slavery Act 2015

The Modern Slavery Act will give law enforcement the tools to fight modern slavery, ensure perpetrators can receive suitably severe punishments for these appalling crimes and enhance support and protection for victims.

You can find out more by visiting their website.

Home Office: Modern Day Slavery

The pages below provide details about the government’s work to end modern slavery, including details about how to refer victims into the national referral mechanism (NRM).

  1. National referral mechanism
  2. Duty to notify
  3. Transparency in supply chains
  4. Research and publications
  5. Promotional materials
  6. Independent child trafficking advocates
  7. Training

 

National Crime Agency (NCA)

Our efforts against modern slavery and human trafficking are led by our Modern Slavery Human Trafficking Unit (MSHTU).

You can find out more by visiting their website.

 

Warwickshire Safeguarding Board: Modern Slavery and Human Trafficking

Modern Slavery: RCN Guide for Nurses and Midwives