1. Crown Prosecution Service Cheryl Hramiak CPS North West Violence against Women Lead

2. Honour Based Violence - Female Genital Prohibition of Female Circumcision Act 1985 and Female Genital Mutilation Act 2003 as amended by the Serious Crime Act 2015 It is illegal: to practice FGM to take British girls or permanent or habitual residents of the UK abroad for FGM to aid or be involved in any part of the procedure abroad carries a penalty of up to 14 years in prison or a £10,000 fine law protects all British nationals

3. Physical Impact of FGM Common short-term complications include swelling, excessive bleeding, pain, urine retention and healing problems/wound infection. Other short-term complications include fatal bleeding, anaemia, urinary infection, septicaemia, tetanus, gangrene, necrotizing fasciitis (flesh-eating disease) and endometritis.urine retentionwound infection anaemiaurinary infectionsepticaemiatetanusgangrenenecrotizing fasciitisendometritis Late complications vary depending on the type of FGM. They include the formation of scars and keloids that lead to strictures and obstruction, epidermoid cysts that may become infected, and neuroma formation (growth of nerve tissue) involving nerves that supplied the clitoris. [ An infibulated girl may be left with an opening as small as 2–3 mm, which can cause prolonged, drop- by-drop urination, pain while urinating, and a feeling of needing to urinate all the time. Urine may collect underneath the scar, leaving the area under the skin constantly wet, which can lead to infection and the formation of small stones. The opening is larger in women who are sexually active or have given birth by vaginal delivery, but the urethra opening may still be obstructed by scar tissue. Vesicovaginal or rectovaginal fistulae can develop (holes that allow urine or faeces to seep into the vagina). [ This and other damage to the urethra and bladder can lead to infections and incontinence, pain during sexual intercourse and infertility. keloidsstricturesepidermoid cysts neuroma [urinationpain while urinatingurethraVesicovaginalrectovaginal fistulae [pain during sexual intercourseinfertility Painful periods are common because of the obstruction to the menstrual flow, and blood can stagnate in the vagina and uterus. Complete obstruction of the vagina can result in hematocolpos and hematometra (where the vagina and uterus fill with menstrual blood). [ The swelling of the abdomen that results from the collection of fluid, together with the lack of menstruation, can lead to suspicion of pregnancy. Painful periodsmenstrual flowhematocolposhematometra [

4. Mental impact of FGM Several small studies have concluded that women with FGM suffer from anxiety, depression and post-traumatic stress disorder. [65] Feelings of shame and betrayal can develop when women leave the culture that practises FGM and learn that their condition is not the norm, but within the practising culture they may view their FGM with pride, because for them it signifies beauty, respect for tradition, chastity and hygiene. [9]post-traumatic stress disorder [65] [9] Studies on sexual function have also been small. [65] A 2013 meta-analysis of 15 studies involving 12,671 women from seven countries concluded that women with FGM were twice as likely to report no sexual desire and 52 percent more likely to report dyspareunia (painful sexual intercourse). One third reported reduced sexual feelings. [74] [65] meta-analysisdyspareunia [74]

5. Barriers to prosecution Why are victims reluctant to come forward? fears of being disowned loyalty to community/faith/family language mistrust of authorities due to cultural relativism fear of bringing shame on family a taboo never to be discussed age of victim lack of specialist services/awareness

6. Barriers to prosecution 2 Defences- registered practitioner necessary for girl’s physical and mental health-but not custom or ritual Operation connected with labour or the birth Not an offence for girl to carry out FGM on herself Nationality can be relevant- co-operation in getting evidence Expert evidence will be required-wound healing and scar tissue International evidence –passports, flights Reluctant victim Public interest and impact on the victim

7. What action can be taken? Immediate Risk: Female Genital Mutilation Protection order-to protect a girl at risk or protect existing victims. Made to secure the health, safety and well-being. Can apply both inside and outside UK against those responsible for FGM, aiding and abetting, counselling and procuring, encouraging and assisting. For a specified period or until variation or discharge Made by the girl or a relevant third party Made by any other person with leave of the court In deciding whether to grant leave-Look at applicants knowledge of the circumstances of the girl

8. Immediate action Emergency Protection Order -gives local authority parental responsibility for child Prohibited Steps Order-prevents family from removing child from country Police Protection Order-police can remove child to place of safety for up to 72 hours

9. New legislation-FGM 2015 Amendments to 2003 Act from 3 rd May 2015 Permanent changed to habitual resident S3A Offence of failing to protect a girl from risk of FGM-responsible or has frequent contact or has assumed responsibility for caring, even if temporarily staying somewhere else-punishment 7 years on indictment, 12 months summary and or fines S4A Anonymity for victims-punished by fine

10. New legislation 2015 continued S5A-Female Genital Mutilation protection orders come into force 17 th July. Breach punishable on indictment by 5 years and/or fine, summarily 12months and /or fine S5B-Mandatory Duty on professionals (Health Care professionals and teachers) to notify police if discovers FGM appears to have been carried out on a girl under 18-not yet in force

11. HM Government action 22 nd July 2014 Prime minister and UNICEF- Girls Summit- commitments and pledges, strengthen law, improve law enforcement, support professionals, work with communities Department of International Development £36million programme working with 17 countries to end FGM Home Office specialist FGM unit –community awareness HMIC inspection MoJ-protecting FGM victims through amendments to legislation and continuous review of the law Department of Health- £3million FGM prevention programme support, statistics, awareness raising work with mental health needs of victims

12. Government action continued Department of Education-£2million national programme working with Barnardo’s and local government to create teams of skilled social workers and to support teachers Department of Communities. Local Government and Government Equalities Office £270,000 provided for community projects, network of community projects Crown Prosecution Service appointed FGM leads in each area and protocols agreed with police forces setting out arrangements for investigation and prosecution of FGM DPP working with Royal College of Surgeons to build up an expert base

13. Position abroad France has no specific law against FGM Use GBH legislation against cutters and parents In past 34 years 29 trials-100 people convicted 6 trials in Spain 2 in Italy 2 in Sweden, 1 in Denmark and 1 in Netherlands Intensive campaign of education girls systematically examined for signs of FGM during health checks carried out annually

14. Closing Points In summary FGM : is a fundamental violation of Human Rights is a crime causing irreparable damage and harm is a form of child abuse causes irreparable damage and harm is a weapon against female sexuality is a power and control issue not part of any religion IS A SAFEGUARDING ISSUE WHICH OVERRIDES CONSENT