Female genital mutilation - advice

This advice provides information regarding female genital mutilation.

Document ID number 2415, version 1, 4 May 2018.

See the female genital mutilation procedure, Intake Policy and Receiving, registering and classifying a report procedure for further information and tasks that must be undertaken when receiving a report, including a report alleging a child or young person is at risk of female genital mutilation.

Introduction

Female genital mutilation (known as FGM) is a practice typically carried out on young girls between the ages of one month and 15 years old. FGM can also occur on adult women but this is less common. It involves a range of procedures to intentionally alter or cause injury to the female genital organs for non-medical reasons.

FGM is the term universally used by health care professionals, however it can also be known as female genital cutting (FMC), as some find the word mutilation offensive.  Previously it was known as female circumcision, however this prompted inaccurate similarities to male circumcision.

FGM is a violation of the human rights of girls and women, and organisations such as WHO and the United Nations International Children’s Emergency Fund (UNICEF) have been campaigning for many years to raise awareness of FGM and educate communities with the ultimate aim to stop all forms of FGM.

Further information on FGM can be found on the WHO website.

Background

The practice of FGM is an ancient cultural tradition pre-dating the Bible and Koran, with scholars debating exactly when and where it originated. FGM is not practiced for religious reasons, although some FGM practitioners may believe this to be true, despite religious leaders condemning FGM.

FGM is estimated to have occurred to over 200 million girls and women alive today, and has been reported in a number of countries, including Africa, the Middle East and Asia. However due to migration, children in Australia may have been subjected to FGM or be at risk of being subjected to the practice, and therefore it is very important to be aware of FGM and the risks it poses to young females.

A study completed by the surveillance unit at The Royal Westmead Children’s Hospital in NSW confirmed FGM has been seen in clinical practices across Australia, and identified a lack of knowledge and cultural awareness by medical practitioners. Despite this study, the prevalence of FGM in Australia is still unknown. Typically this practice is organised privately by families outside the health service and is identified in the context of obstetric or gynecological services and therefore the literature has a focus on women as opposed to children. If a mother has been subjected to FGM this can significantly increase the risk to her daughters.

There have been reports of the ‘medicalisation’ of FGM, which involves the practice being performed in a health setting, or by health professionals, using anesthetic and antibiotics. This has been denounced by WHO and UNICEF, and many countries have laws against the medicalisation of FGM, including Australia.

The World Health Organisation (WHO) have developed a classification system[1] to identify the four distinct practices of FGM, all of which cause harm and have no health benefits. The four major forms of FGM practice are:

  • Type I — Partial or total removal of the clitoris and/or the prepuce (clitoridectomy). When it is important to distinguish between the major variations of Type I mutilation, the following subdivisions are proposed:
    • Type Ia, removal of the clitoral hood or prepuce only;
    • Type Ib, removal of the clitoris with the prepuce.
  • Type II — Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision). When it is important to distinguish between the major variations that have been documented, the following subdivisions are proposed:
    • Type IIa, removal of the labia minora only;
    • Type IIb, partial or total removal of the clitoris and the labia minora;
    • Type IIc, partial or total removal of the clitoris, the labia minora and the labia majora.
  • Type III — Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation). When it is important to distinguish between variations in infibulations, the following subdivisions are proposed:
    • Type IIIa, removal and apposition of the labia minora;
    • Type IIIb, removal and apposition of the labia majora.
  • Type IV — All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization.

Deinfibulation refers to the practice of cutting open the sealed vaginal opening in a woman who has been infibulated, which is often necessary for improving health and well-being as well as to allow intercourse or to facilitate childbirth.

Why do some communities practice FGM?

Some communities across the world support the practice of FGM for a variety of reasons, some of which include:

  • Controlling sexuality – to reduce libido, ensure virginity and fidelity in marriage.
  • Initiation to womanhood - part of the cultural heritage of communities ‘rites of passage’.
  • Myths around female genitalia - such as an uncut clitoris will grow to the size of a penis.
  • Promotion of hygiene and aesthetic appeal - female genitalia being considered dirty and ugly.
  • Pre-requisite for marriage – increasing the ‘marriageability’ of a girl.
  • Financial gain – it is often an income source for FGM practitioners in their community. 
  • Social conventions – pressure to conform to expectations of the community, to avoid rejection.

Consequences of FGM

There are a number of significant short term consequences of FGM including severe pain, excessive bleeding, urinary problems, and wound infection. Long term consequences can include psychological problems, urinary problems, sexual dysfunction, increased risk of HIV and complications during childbirth. In some circumstances, FGM may even lead to death.

The severity of the consequences can vary depending on the general health of the girl or woman, the expertise of the practitioner (who can be a family member), the conditions under which the practice occurred, and the amount of resistance by the individual.

Child protection response

There is no Commonwealth legislation for FGM, however each state and territory have their own respective legislation.

Female genital mutilation is illegal in Victoria and is covered under the Crimes Act 1958, which was amended to make provision with respect to female genital mutilation by the Crimes (Female Genital Mutilation) Act 1996.

Child protection practitioners should be aware of FGM as children are at particular risk of FGM. This risk normally comes from family and within their own communities.

Typically these children may belong to culturally and linguistically diverse communities (CALD) and therefore in addition to associated consequences of FGM, which may include forced marriage, physical, emotional and sexual abuse, workers should also be aware of complexities such as trauma histories as refugees, and english being a second language and requiring interpreters to engage with the family.

See specialist resource Families with multiple and complex needs (pdf, 586.88 KB) for additional information on working with culturally and linguistically diverse (CALD) families.

In Victoria, child protection only becomes aware of an incident or threat of female genital mutilation if a report is received, or it becomes known during the course of an investigation for an unrelated protective concern. It is important to accurately record this information on CRIS, including the areas of concern.

If a report is made regarding FGM, child protection must investigate such a report, see procedure Receiving, registering and classifying a report and if the child is assessed as having suffered or being at risk of harm, the Secretary may seek a court order through the Children’s Court to protect the child. In line with existing practice, a report should also be made to Victoria Police for criminal investigation – see Police and Child Protection protocol.

Considerations for good practice

The World Health Organisation (WHO) are the leading authority on FGM and extensive information can be found on their website, and should be used as a resource when dealing with a report of FGM.

Other organisations such as No FGM Australia, Family Planning Victoria and The Royal Australian and New Zealand College of Obstetricians and Gynecologists also have useful information on their websites which could provide further assistance in understanding FGM.

The Royal Women’s Hospital in Melbourne run a free African Women’s Clinic every second Friday to provide support, education and health procedures, where appropriate, for non-pregnant and pregnant women who have been subjected to FGM. Information in the clinic and FGM can be found on their website.

 

[1] WHO

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