New Guidance Advises Clinicians on Tackling FGM
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This story was first published by the Nursing Times in the U.K.  We run the stories from the U.K. to help educate the U.S. public on FGM, since the U.K. has made great strides toward ending the practice of FGM.  Clinicians must know the difference between recording and reporting female genital mutilation, according to new UK guidance on the issue.

The guidelines also state that pregnancy provides a major opportunity for health professionals to identify FGM and all hospitals should have a named midwife responsible for caring for women that have suffered the procedure.

They noted that the clinical management of women with FGM requires high quality care that is “accessible, sensitive and informed”.

“This guideline, drawing on the latest scientific evidence and expert opinion, provides further clarity on how healthcare professionals should manage FGM”

The guidance – titled Female Genital Mutilation and its Management – was published today by the Royal College of Obstetricians and Gynecologists and is an updated version of guidance from 2009.

It stated that pregnancy “presents a key opportunity” for healthcare professionals to identify women with FGM and, therefore, to provide information and advice, address healthcare needs and assess the risk to the unborn child or other female family members.

The guideline also provides evidence-based advice on the clinical care of women with FGM before, during and after pregnancy – including legal and regulatory responsibilities.

It said that clinicians must be aware of the short- and long-term complications of FGM, including scarring, urinary infections, menstrual difficulties, impaired sexual function, painful sexual intercourse, obstetric complications and psychological trauma.

In addition, the guidance emphasizes that all healthcare professionals must be aware of the Female Genital Mutilation Act 2003 in England, Wales and Northern Ireland, and the Prohibition of Female Genital Mutilation Act 2005 in Scotland (see box below).

  • FGM is illegal unless it is a surgical operation on a girl or woman which is necessary for her physical or mental health or for purposes connected with labor or childbirth
  • It is illegal to arrange, or assist in arranging for a UK national or UK resident to be taken overseas for the purpose of FGM
  • It is an offence to fail to protect a girl from risk of FGM, including those who have parental responsibility
  • If FGM is confirmed in a girl less than 18 years of age, reporting to the police is mandatory

The guidance notes that the Department of Health has implemented the FGM Enhanced Dataset in England in order to ensure a consistent approach to data monitoring.

It requires all acute trusts, general practices and mental health trusts to record data about women with FGM on a monthly basis.

The guidance stated that healthcare professionals “must understand the difference” between recording FGM for the dataset and reporting FGM to the police or social services.

There should be a lead consultant or midwife responsible for the care of women with FGM in all hospitals, it also said.

Meanwhile, the guideline addresses treatment via de-infibulation and clitoral reconstruction.

Women who are likely to benefit from de-infibulation should be counseled and offered the procedure before pregnancy and ideally before first sexual intercourse, it said.

“Midwives have a pivotal role to play in identifying and supporting women who have undergone FGM”

Clitoral reconstruction should not be performed because current evidence suggests that there are associated complication rates without conclusive evidence of benefit, it added.

Dr. Manish Gupta, co-chair of the RCOG Guidelines Committee, said: “This guideline, drawing on the latest scientific evidence and expert opinion, provides further clarity on how healthcare professionals should manage FGM, as well as the organization of services for women with FGM.

“The guideline is intended for use alongside established training programs and we urge all healthcare professionals caring for women and girls to undertake Health Education England’s FGM e-learning program,” he said.

Dr. Gupta added: “Trusts have a responsibility to ensure that all women with FGM can access specialist FGM services, and that their staff has received appropriate training.”

The Royal College of Midwives welcomed the updated guidance and said it provided good information for health professionals working in maternity services.

Janet Fyle, the RCM’s professional policy advisor, said: “Midwives have a pivotal role to play in identifying and supporting women who have undergone FGM.

“Meeting a midwife is often the first time that many of these women will engage with health services,” she said. “Consequently we must ensure that midwives have the training, time and knowledge of the services needed to support women.”

“We’re here to support them with any of the complex questions or concerns they may have about FGM”

Kam Thandi called on trusts and other employers to ensure their staff had the appropriate training on FGM, with clear national guidelines and pathways in place, and mechanisms for monitoring effectiveness.

The initiative comprises a dedicated 24/7 team of advisors who have recently received additional training from FGM specialist midwives in order to provide an enhanced service for NHS staff.

Kam Thandi, head of the NSPCC FGM helpline, said: “We understand the pressure that health professionals face in extremely fast-paced and busy environments and we’re here to support them with any of the complex questions or concerns they may have about FGM.

“Our team of practitioners, trained by specialist FGM midwives, can help NHS staff assess the situation and discuss what to do next, including signposting to other services which may be able to help.”

Vanessa Lodge, NHS England’s director of nursing for North, Central and East London and chair of the national FGM steering group, said: “By calling the helpline, doctors and nurses can talk through their concerns, clarify risks and seek advice on taking appropriate action to protect the women and girls at risk.”

She described FGM as a “terrible scourge” and said the helpline was a “great step forward in protecting women at risk” from it.