Thursday, 9 February 2017


Department of Health


 10 July 2015

The next few weeks are commonly known amongst anti-FGM campaigners, not without good reason, as the ‘cutting season’. This horrific name marks a time of year when many young girls are taken abroad to have FGM performed, in order that they can ‘heal’ over the long summer holiday period – mainly to avoid detection when they return to school.
Frontline staff are crucial in identifying and protecting against FGM, so the NHS must be even more vigilant in the coming weeks and take every possible action to prevent this abhorrent practice. Some of the signs to look out for are:

·         Young girls attending for inoculations to travel to countries with high FGM prevalence;
·         Young girls talking about travelling home for ‘special’ ceremonies or rituals;
·         Families planning absence from school that would extend the summer holiday period.

I would also like to remind you of the safeguarding requirements on the NHS as there have been a number of recent developments for health professionals around FGM (see Annexes). Please cascade this information amongst your staff and ensure they are fully aware of their responsibility to protect girls from this act, which is illegal in the UK and extends to cover girls taken overseas.
NSPCC helpline staff have now been trained by FGM health experts so that NHS staff can receive support from a 24/7 team of advisors who can discuss the often complex circumstances surrounding cases of FGM. The helpline number is 0800 028 3550. Please ensure that your staff are aware of this important source of information and assistance.
Please also make sure that your organisation has stocks of the ‘Statement Opposing FGM’ leaflet (a wallet-sized document sometimes known as the “health passport”) for families travelling abroad who may be pressured to allow girls to undergo FGM. These are availa-ble to download from or to order from in a wide range of languages.

 JANE ELLISON Parliamentary Under Secretary of State for Public Health ( Signed)

Thank you for your invaluable support in protecting girls.  

FGM e-learning training modules: Raising awareness of female genital mutilation. The five e-learning modules are free of charge to all NHS staff via the ‘e-learning for health’ platform and cover a range of issues in relation to FGM at all stages of a girl or woman’s life including:
- Introduction to FGM;
- Adult women both pregnant and non-pregnant;
- Children and young women;
- Communication skills for staff;
- Legal and safeguarding issues .
These e-learning modules have been developed by Health Education England and are available at:
Safeguarding guidance:
Female genital mutilation risk and safeguarding – guidance for professionals
Published by the Department of Health in March 2015, this provides support to NHS organisations when developing or reviewing safeguarding policies and procedures around female genital mutilation (FGM). It can be used by health professionals from all sectors, particularly designated and named safeguarding leads, and local safeguarding children board members. The guidance is available at:
‘Statement Opposing FGM’:
This wallet-sized leaflet is a preventive tool for families travelling to FGM practising
countries. It can be shown to family members who may be pressuring a girl to undergo FGM. It is signed by a number of government Ministers and clearly states that FGM is
illegal, details the health problems it causes and lists sources of support. Available in
English and ten other languages: and
Patient Information Leaflet:
More information about FGM - This leaflet is to be given to patients identified with FGM. It defines the different types of FGM, explains the health consequences and the help and support available, and provides information on the FGM data being collected in the NHS. Available in English and ten other languages: and 3

Safeguarding duties:
The forthcoming FGM mandatory reporting duty will require a referral to the police every time a confirmed case of FGM is identified in a child under 18 years of age. We will issue guidance and advice on this in due course and assure you that we will work with you to ensure the implementation of the duty across the NHS is as smooth as possible.
In the meantime, safeguarding responsibilities remain as before and as for all other forms of child abuse. This gives us the opportunity to protect girls and prevent FGM before it can take place. All NHS staff must take appropriate safeguarding action every time they identify a child with, or at risk of FGM following local safeguarding arrangements.
Recording FGM data:
Acute Trusts put in significant efforts during the last financial year to comply with the mandatory requirement to record FGM in a patient’s healthcare record and submit monthly returns, which were then published by the Health and Social Care Information Centre. I would like to take this opportunity to thank you all for your support and the work you have done to ensure compliance with this requirement within your Trust. Your engagement to date means we now have a much more informed picture of FGM across the NHS patient population. This is invaluable for commissioning the right services, targeted where they are needed. It also means that the NHS is in a better position to provide the right care for women living with FGM and to protect girls at risk.
On 1 April 2015, we published a new information standard, ‘SCCI 2026 FGM Enhanced Dataset’, which revised what information is collected, and the method and frequency of collection. It is now mandatory for acute Trusts to comply with these updates. The requirement to record FGM data has also been expanded to GP practices and Mental Health Trusts who will be required to submit information under the Enhanced Dataset when treating patients who have FGM, and ensure that they are compliant by October 2015 at the latest. Please ensure that over the summer and beyond this important and valuable information collection continues to develop in your Trust – it is vitally important that you maintain the good work done to date.
To support this we have sent every General Practice an FGM information pack containing a range of resources and materials.

Tuesday, 7 February 2017

Don’t cut your daughter’s body!

What is Female Genital Mutilation (FGM)?

Don’t cut your daughter’s body!

All women and girls have the right to control what
 happens to their bodies and the right to say no to FGM.

What is FGM?
Female Genital Mutilation (FGM) is a procedure where the female genital organs are deliberately cut or injured, but where there is no medical reason for this to be done. The procedure has no health benefits for girls and women and can cause severe bleeding and problems urinating, and later, potential childbirth complications and newborn deaths. It's also known as "female circumcision" or "cutting", and by other terms such as sunna, gudniin, halalays, tahur, megrez and khitan, among others.
FGM is performed on women and girls at different ages, depending on the community or ethnic group that carries it out, though it is mostly carried out on girls between the ages for 5 and 8 years old. FGM is usually carried out on young girls between infancy and the age of 15, most commonly before puberty starts. It is illegal in the UK and is child abuse.
It is very painful and dangerous and can seriously harm women and girls’ health. Some girls die from blood loss or infection as a direct result of the procedure.

Many clients who experience FGM may have associated problems with health, including mental health problems (e.g. post-traumatic stress disorder), difficulties in giving birth, problems with or painful menstruation, repeated infections, difficult and painful intercourse, inability to conceive, problems during pregnancy and in a surprising number of cases, infant mortality.

An estimated 10% of victims die from short-term effects and 25% from recurrent problems.  There are different types of FGM and all of them are extremely harmful with many short and long term health implications including:

Short term health consequences of the practice can include infections, severe pain, emotional and psychological shock.

Longer term consequences for women can be severe and wide ranging, including, chronic infections, renal impairment, complications during pregnancy and childbirth, psychological issues, including depression and post stress-traumatic stress disorder, increased risk of sexually transmitted infections.

Types of FGM:
There are four main types of FGM:
  • Type 1: (clitoridectomy) – removing part or the entire clitoris.
  • Type 2: (excision) – removing part or all of the clitoris and the inner labia (lips that surround the vagina), with or without removal of the labia majora (larger outer lips).
  • Type 3:  (infibulation) – narrowing of the vaginal opening by creating a seal, formed by cutting and repositioning the labia.
  • Other harmful procedures to the female genitals, including pricking, piercing, cutting, scraping or burning the area.
Health risks of female genital mutilation (FGM)
1.    Severe and constant pain: Cutting the nerve ends and sensitive genital tissue causes extreme pain. Proper anaesthesia is rarely used and, when used, is not always effective. The healing period is also painful.
2.    Death: can be caused by infections including tetanus and haemorrhage including.  Death of mother and child during childbirth
3.    Excessive bleeding: (haemorrhage) can result if the clitoral artery or other blood vessel is cut during the procedure.
4.    Shock: can be caused by pain, infection and/or haemorrhage.
5.    Problems during labour and childbirth, which can be life-threatening for mother and baby
6.    Child birth complications: severe difficulties during pregnancy and increased risk of child’s poor health or death and high risk of infertility.
7.    Genital and urination problems: genital swelling, urinary retention and urinary tract infection, pain in passing urine.
8.    Psychological and psychosexual consequences: caused by the pain, shock and the use of physical force by those performing the procedure. Other effects include  mental health and psychosexual problems such as low libido, depression, anxiety and sexual dysfunction; flashbacks during pregnancy and childbirth;
9.    Menstrual problems: painful and irregular periods caused by the obstruction of the vaginal opening..
10. Trauma:  causes severe long term emotional and mental health issues.
11. Wound infections risk of HIV and other sexually transmitted infections caused by the use of unsterilized instrument such as razor blades, broken glass, knifes and scissors.
12. Injury to adjacent organs:  as a result of the forced use during the cutting process
13. Pain during sexual intercourse, reduction in pleasurable sexual sensation; reduced desire and arousal; reduced frequency of orgasm or anorgasmia, decreased lubrication and poorer sexual satisfaction, increased sexual phobia.
14. Female Genital Mutilation Can Be Treated: There are procedures which can, to some extent, repair or reverse the physical damage caused by FGM.

FGM is illegal

      FGM is a criminal offence. It is an unacceptable practice for which there is no justification. It is child abuse and a form of violence against women and girls.
      FGM is illegal in the UK and it is illegal to prepare, send or take a child to another country.
      Child abuse: violation of the rights of young girls and linked to other harmful practise e.g. domestic abuse and forced marriage.

Help and support

If you have any concerns that you have been affected by FGM then please speak to a trusted health professionals such as your GP for advice and treatment. Talk to your GP or another healthcare professional if you have sexual problems that you feel may be due to FGM, as they can refer you to a special therapist who can help.

If you are worried that this may happen to you or someone you know, you can speak in confidence to a teacher, doctor, school nurse, social worker, police officer or any health, educational or social care professional. They will be able to help, support, protect you and keep confidential your problems and FGM status.

If you are worried that a child or young person may be at risk of FGM, you can contact us confidentially on the contact details below.

Please feel free to contact us for confidential advice, guidance and information about  FGM:

Diversity Living Services, 57 The Market Square, Edmonton Green, London, N9 0TZ. Tel: 02088036161; email:

Charity No: 1098916; Company No: 4459816
Diversity Living Services is accredited to UN in Special Consultative Status with Economic and Social Council (ECOSOC).

References: NSCCP, NHS and WHO.


A  WHO report states, “For many girls genital mutilation is a major experience of fear, submission, inhibition, and suppression of feelings and thinking. This experience becomes a vivid landmark in their mental development, the memory of which persists throughout life….for some, nothing they have subsequently gone through, including pain and stress in pregnancy….has come close to the painful experience of genital mutilation…their tension and tears reflect the magnitude of emotional pain they silently endure at all times…the resulting loss of confidence and trust in family and friends can affect the child/parent relationship and has implications for future intimate relationships between the adult and their own children.”



Saturday, 4 February 2017

Resources about FGM

FGM: ‘My daughter will never be cut. It stops with me’

England had 5,700 recorded cases of FGM in 2015-16, figures show

FGM is banned but very much alive in the UK

Female genital mutilation (FGM) real story

Female circumcision, FGM, and cutting

My quarrel with a proud FGM cutter

Communities Tackling Female Genital Mutilation in the UK

Female genital mutilation and obstetric outcome

Muslim Council of Britain (MCB)

The Cut Conference: Exploring the Reality of FGM

Growing Global Movement To End FGM

Female genital mutilation: abuse unchecked

WHO collaborative prospective study in six African countries

Razor's Edge - The Controversy of Female Genital Mutilation

‘I used a razor blade and often cut ten girls a day’

FGM: What is female genital mutilation? Debunking the myths


London FGM clinic to close after funding cut

Our Vision and Services

Our vision is of a society where no one should experience discrimination on the grounds of their mental health.

Mental health problems are extremely common across society, with one in four of us experiencing them in any year. Despite being so common, people from all communities will still experience discriminatory attitudes and behaviours that can prevent people from speaking out, seeking support and playing full and active roles in our communities. The impact of mental health stigma and discrimination will vary between communities as mental health has a cultural context that affects the way communities talk about the subject and engage with people who have mental health problems. In some cultures depression, for example, doesn't exist and in others an experience of a mental health problem can be attached to a sense of shame.

For the African and Caribbean communities a key issue is the overrepresentation of young African and Caribbean men in mental health services. Misconceptions and stereotypes have led to a perception that this group is more likely to pose a risk of violent behaviour and, as a result, they are more likely to be treated as inpatients and sectioned when compared to other groups. It is well documented that this has led to a fear of talking about mental health issues more openly and a fear of using mental health services. Research by the Race Equality Foundation (2011) also highlighted fears that discrimination against Black & Minority Ethnic (BME) communities and migrant service users will increase in the austerity climate and whilst commissioning arrangements change.

Our Services

· Provide information, advice, advocacy

· Represent diversity communities in Health Care services, policies and strategies

· Organise training in health and social care in collaboration with local colleges

· Provide human resources ( including interpreters) who are suitable to the diversity communities especially to break language and cultural barriers

· Provides domiciliary care and support

· Provide services such specialised support for people with mental health needs, including people who suffer from short-term memory problems, Dementia and Alzheimer’s Disease.

· Provide visits to elderly people and help them with outings and home services

· Participate in local authority and NHS consultations , research events and programmes to voice the needs of diversity communities.

· Increase access to services and rights for disadvantaged people and the most vulnerable of our society

· Help and support unemployed people to look for work, including training and job preparation

· Provide legal advice in a range of issues from on Immigration and Asylum , welfare benefits, housing, health, education, community care, and training, employment, etc.

· Provide advice and guidance, information and practical help so that our service users can access opportunities they are entitled to

· Organise training and other community learning opportunities that provide new skills, increase confidence and motivation

· Support our service users to overcome barriers to learning, employment and training

· Provide support for young people with their education, training, confidence building, employment and social needs.

Objectives of our Diversity Living Programme:

· To promote the inclusion and participation of diversity communities* in integrated care.

· To inform policy, locally and nationally, and assisting in the formulation of effective policies, strategies and good practices in integrated care in order to contribute to improved health outcomes for the people from the diversity communities (e.g. Black and minority ethnic communities) and to ensure health services are able to meet their specific needs.

· To improve the quality of life for diversity people with disability, mental health problems and their families and carers through integrated care by providing inclusive advocacy and information.

· To provide service that enable diversity groups and individuals with disability /elderly and their carers to make the right choice for themselves and have an influence on decisions made about their future.

· To promote the rights of diversity people with disability, their families and carers and make sure their rights are safe and protected.

· To promoting access to information regarding healthcare issues and to raise awareness of the needs of diversity disabled children, young people, older people and their families.

· To promote the rights of older and disabled diversity people, helping them overcome and enable them to participate in decisions about their future

· To provide support and information to those suffering the isolation and loneliness that can be associated with disability and old age

· To fight against mental health stigma in refugee, black and minority ethnic communities and ensure no one should experience discrimination on the grounds of their mental health or disability.

*Diversity communities are older people, disabled people, Black, Asian, refugees, migrants, asylum seekers and other ethnic minorities.