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Key Takeaways

• Female Genital Mutilation (FGM) means any non-medical injury to or removal of external female genitalia. It is a human rights abuse with serious medical, psychological and social consequences.
• WHO classifies FGM as Type 1 (Clitoridectomy), Type 2 (Excision), Type 3 (Infibulation), and Type 4 (Other harmful procedures).
• Pharmacy staff have safeguarding duties: recognise behavioural and circumstantial indicators, record objective findings, and refer concerns without delay.
• Mandatory reporting under the Serious Crime Act 2015 requires contacting the police on 101 within one working day when a girl under 18 discloses FGM or shows physical signs.
• The Designated Safeguarding Lead (DSL) coordinates reporting to the police, local authority MASH teams and specialist FGM services.
• Use clear, culturally competent communication, keep accurate records and follow confidentiality and GDPR when sharing information.

Overview & Definitions

• FGM: Partial or total removal of external female genitalia without medical justification.
• WHO Types:

• Type 1: Removal of the clitoral glans and/or prepuce.
• Type 2: Removal of the clitoral glans and labia minora, with or without labia majora.
• Type 3: Infibulation - narrowing of the vaginal opening by stitching or sealing the labia.
• Type 4: Other harmful procedures such as piercing, cutting, scraping or cauterising.

Prevalence & UK Context

• About 200 million women and girls have experienced FGM worldwide; prevalence reaches 80-98% in some countries such as Somalia, Guinea, Egypt and Sudan.
• In the UK, an estimated 137,000 women and girls live with the consequences of FGM. Community pharmacies serve diverse populations and may encounter people at risk.

Cultural Competence & Communication

• Drivers: Practices persist for reasons including perceived purity, modesty, marriage prospects and social acceptance; there is no required religious basis.
• Speak without judgement, use professional interpreters when needed and explain safeguarding duties clearly.
• Work with community advocates and use culturally adapted materials to support affected families and prevention efforts.

Indicators & Scenarios

• Behavioural/Psychological: Severe anxiety, withdrawal or panic when travel or intimate health is mentioned.
• Circumstantial: Planned travel to a high-risk country for a "special ceremony" or requests for medication intended for overseas use.
• Scenario Responses:

1. Distressed child at the counter - reassure briefly, record objective observations and refer to the DSL.
2. Adolescent discloses FGM in consultation - acknowledge the disclosure, explain the duty to report, record the exact words used, call police on 101 and notify the DSL.
3. Parent asks about pain relief for a ceremony - clarify the reason for the request, record the interaction and refer the concern to the DSL.

Legal & Ethical Obligations

• Serious Crime Act 2015: Mandatory reporting to police for disclosures or observed physical signs in those under 18.
• GPhC/RPS: Professional standards require prioritising welfare, keeping accurate records and maintaining competency through training.
• Documentation: Record date and time, verbatim statements, observed signs, police reference numbers and communications with the DSL.

Safeguarding Process & Role of DSL

1. Identify indicators or receive a disclosure.
2. Document objective findings in patient records or the incident log.
3. Engage the DSL immediately and provide factual information.
4. Mandatory Reporting: Call police on 101 for under-18 disclosures or physical findings suggestive of FGM.
5. Referral Pathways: Make referrals to local authority MASH, specialist NHS FGM clinics and other multi-agency partners as appropriate.
6. Follow-up: Record outcomes, coordinate any required care and observe confidentiality limits when sharing information.

Confidentiality & Data Protection

• Limits: Confidentiality must be breached when mandatory reporting or safeguarding referrals are required.
• GDPR: Share the minimum necessary information, record the legal basis and recipients, and document what was disclosed.
• Storage: Keep records accessible only to authorised staff and protected in line with data protection requirements.