Indicators of FGM

Pharmacy staff rarely see the physical signs of FGM. Noting psychological, behavioural or contextual indicators during patient contact helps identify risk, improve records and trigger safeguarding referrals when needed.

Behavioural and Psychological Indicators

Patients may show anxiety, distress or changes in behaviour during consultations, medicine requests or other pharmacy interactions. Examples include:

• Severe anxiety, distress or reluctance to attend health appointments, particularly in younger girls or adolescents. ^[1]
• Sudden or unexplained changes such as withdrawal, reduced engagement or avoidance when travel or family plans are mentioned. ^[1]
• Emotional distress or panic responses disproportionate to routine enquiries, for example when asking about pain relief or intimate health products. ^[1]

Consider these reactions alongside clinical and contextual information and be alert to safeguarding implications.

Indicators from Family and Community Context

Watch for family or travel plans that increase risk. Indicators include planned visits to countries with high FGM prevalence, references to a "special cultural ceremony", or requests for medicines before travel for female adolescents or children. ^[1] These observations collected during routine contact can prompt safeguarding action.

Professional Vigilance and Response

If you observe possible indicators, record them clearly, objectively and accurately in patient medication records or incident logs. ^[2]

Immediate referral to the pharmacy's Designated Safeguarding Lead (DSL) or local safeguarding teams ensures an appropriate safeguarding assessment, professional accountability and protection for the patient. ^[2]

Accurate documentation and timely referral are core responsibilities in pharmacy practice.