UK Home Office Consultation On Mandatory Reporting Of FGM – My Response

The UK Home Office has been conducting a Consultation on whether and how to introduce a mandatory reporting requirement for female genital mutilation FGM), as proposed in the Home Affairs (Vaz) Report in 2014. I agree absolutely that reporting of FGM should be mandatory for professionals directly involved, but I’d like to see a single, much more integrated and comprehensive approach – eg including all suspected child abuse, plus adult FGM (and forced marriage?) with a national network of trained Abuse Reporting Officers.  This is my submission:

Response to

Introducing mandatory reporting for female genital mutilation: A consultation

(Home Office, December 2014)

 

• Note about the basis of this response

I am author of a textbook, currently in production, on the eradication of female genital mutilation (FGM) in Britain and other ‘western’ nations.  A qualified teacher, I have previously been a Senior Lecturer in Health and Social Care, a Research Associate investigating teenage pregnancy at a medical school, and an Advisor on the integration of health and social care services for Sure Start.  Over the past decade I have become increasingly engaged in the campaign to stop FGM in the UK. The commentary which follows is framed by the belief that we in the UK must examine our own conventional understandings and practices, as well as those of others, if FGM is to be eradicated.

 

• Positioning the proposal to mandate reporting of suspected FGM risk / abuse in minors

There is no doubt that the challenges of FGM eradication in the UK require FGM reporting to become mandatory.  Everything which follows below stems from that position, and from the fundamental belief that FGM and other abuse of women and girls about gender oppression or patriarchy[1] – a matter which the UN Rapporteur brought to the UK’s attention in 2014.

Similarly, it is likely historically that issues around FGM have been confounded by concerns about negative and unfair stereotyping.  It must be noted however that, claims in this Consultation document notwithstanding, there is no clear evidence that the main reason FGM has not been reported in the past is because professionals (in regulated activity[2] – the specific group hereafter considered) themselves were fearful of being thought racist or culturally insensitive.  If convincing evidence for this claim (perhaps the real ‘myth’?) exists, it should be presented.  Consideration of these issues is important because it can help us to see the way forward in regard to FGM mandated reporting.

Concerns to avoid racism were of course one reason; but this was probably not the only, or even main, one which made professionals to hold back on reporting FGM concerns.   Other ‘reasons’ which may have contributed to this reluctance include:

1. the fear by professionals that accusations – in any case very difficult to prove – about FGM might be without foundation but also provoke racism against communities where some practise it;
2. concerns also by professionals (especially men) that their ‘interest’ in little girls would be perceived at best as questionable;
3. a failure to understand the nature and seriousness of FGM (debate about bodily intactivism[3] and male circumcision is also an entirely valid, but routine use until recently of the term ‘female circumcision’ did not help those unfamiliar with the detail to understand what FGM involves);
4. there has been a culture in some organisations of reluctance to report any kind of child abuse – the outcome for those who report, even with the best of intentions, can be difficult;
5. more importantly, evidence for the efficacy of reporting violence against girls and women has not in the past always been forthcoming – domestic violence and sexual abuse have until recently often been down-played or ignored – so professionals have not felt confident that they should report;
6. there has not been (and continues not to be) a clear route for reporting FGM or any other form of child abuse.[4] The Police, Local Safeguarding Children Boards, Social Services and other organisations, even some NGOs, all offer potential ways forward for reporting, whether or not a given professional is attached to an organisation where there is (as required, but not always forthcoming) a named safeguarding officer.

Further, it is unclear from the perspective of preventing or remediating harm why different sorts of child abuse are to be dealt with separately at the level of professional legal intervention.

Identification and community prevention protocols will vary with the specifics of the child abuse, as is true also for many other sorts of crime.  Routes to legal action and intervention (by the Police, Social Services etc) can and will not be identical in all instances.

Legal processes themselves however, once triggered, might be thought for a number of reasons to require similar pathways, whatever the specifics of each act of abuse.  The Home Office FGM reporting consultative document does not however address wider issues around child abuse (except for saying other routes for other types of abuse remain as before); but consideration of these wider contexts is very important, if genuine progress is to be made.

The ‘cases’ (tragedies) of children such as Baby Peter,[5] Victoria Climbié,[6] Kristy Bamu,[7] some students at Caldicott[8] and Chetham’s[9] Schools and Mirfield Junior Seminary,[10] other reports of church-related child abuse,[11] the grooming and sexual abuses in Oldham, Oxford and elsewhere,[12] the so-called ‘honour’ killing of Shafilea Ahmed [13] and other instances of abuse of minors all demonstrate that procedures for preventing intentional child harm of any kind must be considered together and improved generically in the UK.

FGM must not be viewed in isolation.  It is a crime and a type of child abuse.  Shared protocols at the stage of formal intervention for any such abuse are required, so that teachers, clinicians and others all know clearly what actions they must take.

System complexity, and genuine uncertainty or confusion about what to do on the part of professionals, has probably (more research is required; who will conduct it?) played a significant part in failures to protect against FGM and other child abuse.

These matters are too critical to be left to the awareness and judgements of many thousands of variously prepared (or not) individual professionals.

 

• Tiered strategy and intervention

Many of the questions raised in the Home Office Consultation document on FGM reporting concern uncertainties which have been mentioned above.

The currently proposed ways forward do not however address all these worries directly; rather the Home Office focuses on mandatory reporting only when the evidence suggests strongly that a child has been or will shortly be subject to FGM.

Further, the proposals depend substantially on training many professionals in regulated activity to a level where they will be confident in their judgements about degree of risk.  This dependency is probably unrealistic in the current political and policy climate.

We have already seen for instance that, despite Head Teachers being emailed a letter in April 2014 from Michael Gove, then Secretary of State for Education, which included information about how to address FGM,[14] far from all have actually read it[15].

Emails are an essential part of any package for sharing information and instruction; they are easy and inexpensive for the sender; but they pass the cost in terms of effort and resources onto others, which even with goodwill on everyone’s part may not produce the required outcomes.

Feeling as many do under pressure from all sides, it is almost inevitable that some professionals will miss or even be entirely unaware of similar high-level injunctions about how to make judgements about required mandatory reporting – particularly if the instructions remain different for different types of child abuse.  Child protection measures need to be uniform, easily accessible and effective; but at present they are not.

 

• A way forward?

There is however a way forward which avoids many of the reservations expressed in the FGM reporting consultation:

1. Reporting by professionals of any genuine concerns, whether verifiable or not, should be direct to named and fully trained Officers (perhaps two or three in each local and / or policing authority, to cover 24/7) with specific and dedicated responsibility for addressing child abuse. These Abuse Reporting Officers need not be from the Police or any other specific profession; they would have a senior role in their own right, to ensure the protection of all children from abuse.
2. There must be a uniform protocol for reporting[16], preferably securely on-line, which disallows the possibility of children (or others) ‘slipping through the net’ because – as is often the case in e.g. diaspora communities – people move on to a different area or region.
3. As part of their role, these Officers must keep a confidential record of each report. Where more than one suspicion of harm arises (and of course if a single report is a matter for already serious concern) the Officer must determine the way forward, and how to liaise with, or pass the case on to, the police and other services.
4. Such a system would remove both the anxiety of individual professionals about what to do – every time abuse or a risk is identified, it must be (unless very urgent, confidentially) reported – and would also ensure that only concerns judged significant by trained and experienced Officers are taken forward formally. The Police and others will not be ‘swamped’ with matters of relative insignificance.
5. A clear requirement, such as that here proposed, that professionals report to formally designated, fully trained Officers each time a substantive concern is observed would also be more effective than multiple different routes. (NB We must not assume always that only one abuse factor is at play.) Mounting evidence that something, previously as a single report triggering little alarm, is wrong, can then be acted on urgently by the child abuse officers. In some service provider organisations this is known as the ‘traffic lights’ system. One ‘amber’ report is a warning to watch quietly and carefully; more than that, and it is time for action.
6. Whilst the safety of children must always be paramount, the Abuse Reporting Officers system for mandatory logging of concerns is likely in the longer-term to be more efficient and also more cost-effective, especially if, as it needs to be, the system is co-ordinated nationally.
7. Fewer nominated personnel requiring higher levels of training (with all professionals receiving basic activity-appropriate instruction on mechanisms), and a single reporting system ‘on the ground, offers a mechanism for more well-judged early intervention and for greater professional and public acceptance and understanding.
8. Such a system will also enable better development of child protection policies specifically for FGM as well as other abuse; used alongside the emerging HSCIC data, it can help build a national profile for the prevalence and distribution of children’s vulnerability to harm.

With such a system in place the issue of who must report what is much clearer and so, therefore, will become that of when sanctions must be brought to bear on professionals who do not report. Placing mandatory reporting of FGM within a protocol for all children at risk names FGM very clearly as criminal child abuse.  It is not ‘different’ legally from any other form of harm to children. Also, because this system requires overt action only when important evidence for concern is judged by trained Officers to arise, the confidentiality of individuals is not needlessly broken, nor Police and welfare professionals distracted by multiple unnecessary enquiries – thereby also removing other current obstacles to making reports of FGM (and similar abuse) mandatory.

 

• Reporting FGM in adults

Under the system proposed above matters become simpler.  Professionals engaged in regulated activity[17] (mostly clinicians, sometimes teachers and social workers etc) and other professionals as identified in the current Consultation with direct responsibility for care would report their concerns confidentially as above – and as in some contexts sometimes already happens – and the decision to take action, or just to keep watching brief would lie with an Officer at remove from the client, patient etc., thereby removing the decision from the professional close to the person concerned.

In effect this suggestion takes further the current HSCIC recording of FGM[18], but at the level where individuals can be named under carefully moderated conditions if the specialist Abuse Reporting Officer decides the evidence requires further action, eg if there is evidence that a child may become at risk, or perhaps if clusters of reports suggest the identity or location of a cutter.  (NB There are also other medical conditions which clinicians must already report.[19] This is not a new idea.)

It is unrealistic to leave decisions of this nature with many thousands of individual professionals, significant numbers of whom will have little training or mentoring in how to make decisions of this sort.  In the model above responsibility for action is, or can be, taken elsewhere at the next level, and confidentiality is not unnecessarily breached, nor communities unnecessarily labelled as promoting FGM.

 

• Multi-Agency Guidelines

The development of Officers with a clear duty to monitor FGM and other abuse also removes some of the current difficulties in regard to the Multi-Agency Guidelines; they are in some aspects instructions about what to do which are weak on the actual, practical methodologies for taking action.

This is especially so in situations such as at present, where different agencies all seek support from the reduced funding resources; multi-agency cannot be presumed to be genuinely cross-disciplinary in the ‘sharing’ sense of willing collaboration if resources are hugely over-stretched.

 

• Footnote

1. It is not made clear in the Consultation document why small girls should not routinely be fully examined at least superficially by clinicians. In fact, many are; and that was also the practice in years past.  There is obvious benefit to be had from kindly, careful and thorough medical examination at sensible intervals of all young children.

This check-up occurs routinely in France, with the consent of parents.[20] [21] The UK health visitor role should include this service for all boys and girls, and the part which school nurses[22] (more are needed[23]) can also play must be considered very carefully.  Between these two roles there is much scope for preventative work re FGM and other child protection.

2. Infancy and early childhood are times when children are known to be at particularly high risk of various sorts of abuse;[24] and the risk specifically to very young girls of FGM seems also to be increasing.[25] There are also specific high risks of various forms of abuse later on in childhood.

The collation of national data (cf the anonymised acute hospital SCIC model for recording FGM) via mandated reporting of concerns about FGM would add considerable to the scope for evidence-based further policies to be developed.

An effective national child protection system must be instituted, and then calibrated as information becomes available, to identify in more detail the risks of abuse to all children, and of FGM and other violence against women and girls, and other vulnerable adults.  On this basis a more effective system of protection can be developed, replacing the distressingly haphazard and ineffective provision which has enabled the abuses catalogued above (p.1) to occur.

3. Most importantly, regardless of how it is implemented in the short term, mandatory reporting of FGM must be made law as a matter of urgency. If that law can be composed so as to permit further development (cf above) as more is learnt about what is required and most effective procedures, that will be better still.

Hilary Burrage                         

10 January 2015

 

 

[1] https://hilaryburrage.com/2014/04/15/un-rapporteur-rashida-manjoo-visits-uk-my-briefing-note-on-violence-against-women-and-girls/ (Prof Manjoo’s initial report on her UK visit is expected in early 2015.)

[2]https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/377519/DBS_referrals_guide_summary_of_regulated_activity_with_children_v2.2.pdf

[3] To give one example: http://www.circumstitions.com/

[4] https://hilaryburrage.com/2014/07/26/schools-must-safeguard-girls-from-fgm-but-how/

[5] http://www.bbc.co.uk/news/uk-11626806

[6] http://www.crimeandinvestigation.co.uk/crime-files/victoria-climbie

[7] http://www.bbc.co.uk/news/uk-29531396

[8] http://www.bbc.co.uk/news/uk-england-26073155

[9] http://www.bbc.co.uk/news/uk-england-manchester-27594822

[10] http://www.secularism.org.uk/news/2014/11/victims-of-historic-child-sex-abuse-speak-out-after-catholic-church-refuses-to-accept-liability-for-the-crimes-of-their-priests

[11] http://www.independent.co.uk/news/uk/crime/church-of-england-embroiled-in-another-alleged-child-abuse-scandal-9650278.html

[12] http://www.bbc.co.uk/news/uk-28953549

[13] http://www.bbc.co.uk/news/uk-england-19068490

[14] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/309593/KCSiE_letter.pdf

[15] http://www.standard.co.uk/news/uk/more-than-half-of-school-heads-fail-to-read-official-fgm-guidance-9416201.html

[16] https://hilaryburrage.com/2014/04/07/lets-drop-the-cliches-mandatory-reporting-and-simple-protocols-are-essential-to-prevent-fgm-and-other-child-abuse/

[17] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216900/Regulated-Activity-Adults-Dec-2012.pdf

[18] http://www.hscic.gov.uk/fgm

[19] http://www.patient.co.uk/doctor/Notifiable-Diseases.htm

[20] I am informed by Linda Weil-Curiel, the French attorney who has led legal moves against FGM in her country, that no French parent has been known to refuse this positive health intervention.  She reported that:

Dr Emmanuelle Piet also said that never has she seen a family refuse medical examination for their child. They trust doctors regarding their children’s health. But also they must be informed that if something is wrong, if there is evidence of abuse, the facts will be reported.
One mother being told that the excision discovered would be reported said to the doctor, “You are doing your job. I did mine.”

[21] https://hilaryburrage.com/2012/11/28/the-uk-can-learn-from-france-on-fgm-prosecutions/

[22] http://www.rcn.org.uk/__data/assets/pdf_file/0012/201630/003223.pdf

[23] See e.g. http://www.asend.co.uk/managing-medical-needs-schools/

[24] http://www.standard.co.uk/news/london/fgm-training-for-london-nurseries-amid-fears-victims-are-getting-younger-9784091.html

[25] http://www.standard.co.uk/news/london/fgm-training-for-london-nurseries-amid-fears-victims-are-getting-younger-9784091.html

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FURTHER INFORMATION AND ACTION

Readers are invited to support these two FGM e-petitions:

UK Government: Enforce the UK law which forbids FGM (Female Genital so-called ‘Cutting’)    ..

and FGM abolitionists internationally: Support the Feminist Statement on Female Genital Mutilation

[See also HM Government e-petition, No. 35313, to STOP Female Genital Mutilation (FGM / ‘cutting’) in Britain  (for UK citizens and residents – now closed).]

There is a free FGM hotline for anyone in the UK: 0800 028 3550, or email:fgmhelp@nspcc.org.uk

The #NoFGM Daily News carries reports of all items shared on Twitter that day about FGM – brings many organisations and developments into focus.

Also available to follow is daily news from NoFGM_USA.

For more on FGM please see here.

Twitter accounts: @NoFGM1  @NoFGMBookUK  @FGMStatement  @NoFGM_USA   [tag for all: #NoFGM]

Facebook page: #NoFGM – a crime against humanity

More info on FGM in the UK here. Email contact: NoFGM email

** Hilary Burrage is currently writing a book, Eradicating Female Genital Mutilation: A UK Perspective