Responding to female genital mutilation: multi-agency guidance

4. Good practice response: all practitioners

Approach

The multi-agency approach in this guidance is to encourage engagement with families, to find supportive interventions, and to build trust with individuals and communities. Although in some cases parents may be the source of risk to a child, it is important that communities are not marginalised, and that assumptions are not made about parents’/mothers’ intentions.

Talking about FGM

FGM is a deeply personal issue. How this is discussed is as important as what is said, and can shape all future interactions with a woman or girl. There are some important things to remember when broaching the subject. These are:

Sensitivity

Asking the right questions in a straightforward and sensitive way is vital for establishing the understanding, information exchange and relationship needed to ensure that a girl or woman, and her family members, receive the care and protection they need.

Women often say they felt distressed and humiliated by the reactions of staff when FGM was revealed. They describe horrified expressions, and inappropriate and insulting questions, and say they felt ashamed and ‘abnormal’. If professionals react like this, it can be devastating for women. Word can get back to communities, thus deterring other women from seeking treatment or support and preventing them from getting effective care.

‘Sometimes when circumcised women go to the hospital, the nurses call each other to see the circumcised woman. This is an unhappy experience for many women. The nurses ask a lot of questions and they stare ^[27] .’

There is a video on NHS Choices ^[28] in which women who have undergone FGM discuss how they would like professionals to talk to them about it.

‘It is embarrassing when men or women (except doctors and nurses) from other ethnic groups ask me about FGM and about what happened to me. I prefer speaking to other women like me who know. I hate being exploited and treated like a spectacle - reminds me of the ‘human zoo’ - I bet they won’t appear in any report.’

Ensuring safety

Practitioners may need to devise a safety plan in case someone sees the woman at or near the department, venue or meeting place. This could include, for example, helping her work out another reason for explaining why she is there.

If a woman/girl insists on having someone else with her, for example a teacher or advocate, practitioners should do all that is reasonable ensure that this person understands the importance of maintaining confidentiality, especially from the family.

Women/girls may need an authorised and accredited interpreter in their dialect (see more on interpreting below).

Good practice when raising the subject of FGM

√√ If possible, provide a female practitioner if the girl/woman would prefer this

√√ Understand that the girl/woman may not realise that she has had FGM

√√ Use simple language

√√ Do not make assumptions

√√ Give the girl/woman time to talk

√√ Listen to what she says

√√ Create an opportunity for her to disclose, for example, see her on her own, in private

√√ Be sensitive to the intimate nature of the subject

√√ Understand she may be loyal to her parents or wider family

√√ Explain the limits of confidentiality

√√ Explain that you are asking questions in order to offer support

√√ Ask straightforward questions such as:

• ‘Have you been closed?’
• ‘Were you circumcised?’
• ‘Were you cut?’

√√ Be direct. You are asking her whether it happened and what the effects are on her now. You are not asking her to describe what happened in detail because that could re-traumatise her

√√ If you need to clarify, ask questions such as:

• ‘Does it hurt when you have sex?’
• ‘Does it hurt when you pee?’
• ‘Does it take a long time to pee/does it come out in small amounts?’
• ‘Is it painful when you have your period?’
• ‘Have you had any difficulties in childbirth?’

Good practice when responding

√√ Explain that FGM is illegal and that the law can help a family avoid FGM if/when they have daughters

√√ Explain sensitively the health consequences of FGM

√√ Be non-judgemental (a practitioner should point out the illegality and health risks of FGM, without blaming the girl/woman/her family/community)

√√ Get accurate information about the urgency of the situation if girl/woman is at risk of undergoing FGM, and follow child protection or adult protection procedures

√√ Make and keep a detailed record

√√ If health staff, record FGM in girl/woman’s healthcare record, and details of any conversations with her

√√ Stress that the girl/woman can come back to the service/practitioner at another time if she wishes

√√ Offer support, for example counselling, NHS FGM clinics/services

√√ Give out the Scottish Government leaflet: A statement opposing female genital mutilation ^[29]

Good practice in using interpreters

Practitioners may need to arrange for an interpreter. This should be an accredited female interpreter (or male if preferred by the woman). The interpreter should be able to interpret the girl/woman’s dialect. The interpreter should know that their role is to translate verbatim and not interpret the message or censor or omit any of the information. Ideally, the interpreter should have had FGM-awareness training.

The interpreter should never be a family member, be known to the individual, or be someone with influence in the girl/woman’s community. This is because girls/women may feel embarrassed about discussing sensitive issues. They may be frightened that personal information could be passed on to others in their community and place them in danger. Also, there is a risk that interpreters who are from the family or an individual’s community may deliberately mislead staff and/or encourage and even threaten the individual to drop the complaint and comply with the wishes of the family/community.

√√ Check the girl/woman’s dialect before arranging an interpreter

√√ Meet the interpreter beforehand to brief her/him

√√ Explain the role of the interpreter to the girl/woman at the beginning of the discussion

√√ If the girl/woman insists on being accompanied, check that she understands the nature of the discussion and the implication of having someone else there

√√ Speak separately to the person accompanying to brief them, particularly about the importance of confidentiality and the dangers of breaching it. There may also be the opportunity to debrief them afterwards

Glasgow Violence Against Women Partnership has published good practice guidance on interpreting for women who have experienced gender-based violence ^[30] .

‘I thank you very much for your kind visit to my home today and the encouragement that I should not be ashamed of being a victim of FGM…I very much look forward to baring it all; the shame, the sorrow of depression, the pain of bearing it all without anyone to confide in, the psychological effects of past and present relationships, the list goes on and on. Most importantly, I hold my heart in mouth at the thought of what could be done to my two innocent under-age daughters if I am forced to take them back home. This thought fills me with fear and trepidation, which gives me sleepless nights.
I do hope I get the much desired solutions and support to put a closure to this emotional and psychological torment.’

(from KWISA)