Archives Blog Original research

Female genital mutilation in children presenting to a London safeguarding clinic: a case series

Arch Dis Child. 2015 Jul 27. pii: archdischild-2015-308243. doi: 10.1136/archdischild-2015-308243. [Epub ahead of print]

Female genital mutilation in children presenting to a London safeguarding clinic: a case series.

Hodes D, Armitage A, Robinson K, Creighton SM


OBJECTIVE: To describe the presentation and management of children referred with suspected female genital mutilation (FGM) to a UK safeguarding clinic.

DESIGN AND SETTING: Case series of all children under 18 years of age referred with suspected FGM between June 2006 and May 2014.

MAIN OUTCOME MEASURES: These include indication for referral, demographic data, circumstances of FGM, medical symptoms, type of FGM, investigations and short-term outcome.

RESULTS: Of the 47 girls referred, 27 (57%) had confirmed FGM. According to the WHO classification of genital findings, FGM type 1 was found in 2 girls, type 2 in 8 girls and type 4 in 11 girls. No type 3 FGM was seen. The circumstances of FGM were known in 17 cases, of which 12 (71%) were performed by a health professional or in a medical setting (medicalisation). Ten cases were potentially illegal, yet despite police involvement there have been no prosecutions.

CONCLUSIONS: This study is an important snapshot of FGM within the UK paediatric population. The most frequent genital finding was type 4 FGM with no tissue damage or minimal scarring. FGM was performed at a young age, with 15% reported under the age of 1 year. The study also demonstrated significant medicalisation of FGM, which matches recent trends in international data. Type 4 FGM performed in infancy is easily missed on examination and so vigilance in assessing children with suspected FGM is essential.

This article can be accessed in this LINK

Actors Blog Governments Guideline

Guidance. Female genital mutilation: guidelines to protect children and women

UK Home Office, Department for Education, and The Rt Hon Lynne Featherstone MP. 2011

Guidance. Female genital mutilation: guidelines to protect children and women

thumbnail_MultiAgencyPracticeGuidelinesNov14.pdfThese updated guidelines support and assist frontline professionals, such as teachers, health professionals, police officers and social workers, in safeguarding children and protecting adults from the abuses associated with FGM. This guidelines are applied in England and Wales.


This guidelines can be accessed in this LINK


Archives Blog News

UK’s shameful record on female genital mutilation.

BMJ. 2012 Dec 3;345:e8121. doi: 10.1136/bmj.e8121.FREE

UK’s shameful record on female genital mutilation.

Lloyd-Roberts S.

BBC, London, UK.

Comment in BMJ. 2013;346:f29.


Last month the Crown Prosecution Service announced plans to crack down on practitioners of female genital mutilation. Sue Lloyd-Roberts asks why we are lagging behind our European neighbours

Ayanna, a 23 year old mother now living on the 15th floor of a Glasgow tower block, fled Gambia a year ago and applied for asylum in the UK to escape an abusive husband and prevent her 6 month old baby girl from being genitally mutilated. “My husband would have insisted,” she explains. “All the women in my community have been cut.”

She says she feels safe in Scotland but tries to avoid contact with the African community. “They’ll tell me that my daughter should be cut. It’s being done here,” she says, pointing through the window at the other tower blocks which make up the Red Road housing estate. “The older women do it—the grandmothers,” she explains. “They use scissors, razor blades, or sharp knives. I know that just last week one 3 year old and a 2 week old baby were cut.”…

This article can be accessed in this LINK

Archives Blog News

UNICEF Benin FGM/C Country Profile

UNICEF. Benin DHS. 2001.FREE




… While the prevalence of FGM/C among women aged 15-49 varies significantly according to ethnicity, 17% of the women in Benin have undergone some form of FGM/C. This decreases among women in the younger age groups (29 and under).  FGM/C varies significantly across regional and ethnic lines, averaging fewer than 2% in the southern regions of Atlantique, Mono Couffo, Plateau and Oueme, to 58% in Borgou. It is most prevalent among the Peulh (88%), Bariba (77%), and Yoa and Lokpa (72%), and lowest among the Fon (0.3%). FGM/C is not practiced by women of the Adja ethnic group. The prevalence of FGM/C varies significantly according to education as well – 22% of women with no formal schooling have been cut compared to 5% of women with secondary education….

This sheet can be accessed in this LINK

Archives Blog News

The Scottish NHS does not turn a blind eye to female genital mutilation.

BMJ. 2013 Jan 8;346:f29. doi: 10.1136/bmj.f29.FREE

The Scottish NHS does not turn a blind eye to female genital mutilation.

Brown IG.

Comment on BMJ. 2012;345:e8121.


…I am the senior partner in a north Glasgow practice that has more than 3000 patients from an asylum seeking or refugee background. The practice has been involved in the care of this group of patients since 1999. Trained nurses and doctors within the practice are aware of female genital mutilation and its prevention. We regularly examine and report on cases of female genital mutilation for legal purposes. The Medical Foundation in Glasgow also has high levels of awareness and expertise, as do our consultant colleagues at the Princess Royal Maternity Hospital. We do not think routine examination of female children is an abuse of their human rights, we consider it part of our General Medical Services contract…

This letter can be accessed for free in this LINK

Archives Blog Original research

Cultural issues in child maltreatment

J Paediatr Child Health. Jan 2012 48(1): 30–37

Cultural issues in child maltreatment

Raman S, Hodes D


Aims:  Waves of immigration from the latter half of the 20th century have changed the cultural and ethnic mix of major regions of the world. Dynamic multicultural societies now are a reality across the Western world. The relationship and influence of these diverse cultures to the understanding and identification of child abuse and neglect is challenging and complex. Health professionals working with children from culturally and linguistically diverse groups often find themselves with the challenge of exploring and resolving the tension between definitions of harm in child protection practice and various cultural and child-rearing practices. In this paper, we set out ways of thinking about the influence of culture when approaching and dealing with the suspicion of child maltreatment.

Methods:  We will explore how culture shapes the experiences of childhood, child-rearing practices, and identify common barriers in working with children and families from culturally diverse backgrounds when presenting with child maltreatment. We will use case examples from Europe and Australia to illustrate the real life challenges of working in the area of child maltreatment across cultures. We will review the scientific literature exploring the nexus between culture and child maltreatment, identifying the gaps in the literature and highlight areas for future research.

Results:  We suggest a model for dealing with cultural issues in child maltreatment that is culturally competent and respectful.

Conclusions:  The model for cultural competency in child health and child protective services incorporates four domains for advocacy and action – individual, professional, organisational and systemic.

This article can be purchased in this LINK

Archives Blog Original research

Prevalence of female genital cutting in Upper Egypt: 6 years after enforcement of prohibition law

Reprod Biomed Online. 2008 16 (1): 27-31

Prevalence of female genital cutting in Upper Egypt: 6 years after enforcement of prohibition law

Hassanin I, Saleh R, Bedaiwy AA, Peterson RS Bedaiwy MA


The objective of this study was to evaluate the prevalence of female genital cutting (FGC) in Upper Egypt, after 6 years of putting prohibition law into action. A total number of 3730 girls between the ages of 10–14 years were recruited to participate in this study. They were mainly preparatory school students (three urban and three rural areas). Social workers interviewed them as to whether they had undergone circumcision within the last 6 years or not. Subsequently, a questionnaire was sent to parents of girls who were positive for circumcision as to the circumstances surrounding the procedure. The prohibition law of FGC seems not to have altered the prevalence of this procedure. The majority of girls (84.9%) had had circumcision within the last 6 years with high prevalence in rural areas (92.5%). Circumcision was done for a combination of reasons, according to parents, with high rates of non-medical personnel participation (64.15%). This study’s results indicate that the practice of FGC in Upper Egypt remains high despite enforcement of law. Extensive efforts are needed both to revise public awareness and to change attitudes regarding FGC.

This article can be purchased in this LINK.

Original research

Issues in Islamic Biomedical Ethics: A Primer for the Pediatrician

Pediatrics. Oct 1, 2001 (108)4, 965 -971 (doi: 10.1542/peds.108.4.965)

Issues in Islamic Biomedical Ethics: A Primer for the Pediatrician

Kamyar M. Hedayat and Roya Pirzadeh


The United States is becoming increasingly pluralistic. Pediatricians must become familiar with the factors that affect the emotional, physical, and spiritual health of their patients that are outside the ken of the traditionally dominant value system. Although many articles have addressed the cultural and ethnic factors, very few have considered the impact of religion. Islam, as the largest and fastest-growing religion in the world, has adherents throughout the world, including the United States, with 50% of US Muslims being indigenous converts. Islam presents a complete moral, ethical, and medical framework that, while it sometimes concurs, at times diverges or even conflicts with the US secular ethical framework. This article introduces the pediatrician to the Islamic principles of ethics within the field of pediatric care and child-rearing. It demonstrates how these principles may impact outpatient and inpatient care. Special attention is also given to adolescent and end-of-life issues.

This article can be purchased in this LINK

Archives Blog News

[Is genital examination of preschool girls offensive?] [Article in Norwegian]

Tidsskr Nor Laegeforen. 2007 Sep 20;127(18):2402-4.

[Is genital examination of preschool girls offensive?]. [Article in Norwegian]

Gulla K, Myhre AK, Bratlid D

Barne- og ungdomsklinikken, St. Olavs Hospital, 7006 Trondheim.

Diskusjonen omkring rutineundersøkelse av barns underliv er ikke av ny dato. Blant annet gikk den høyt i 1990-årene, den gang i kjølvannet av flere store overgrepssaker. Debatten har nå fått ny aktualitet – denne gang på grunn av en gryende bevissthet om at også jenter bosatt i Norge utsettes for kjønnslemlestelse. Etter vår mening er tiden nå moden for å vurdere saken i hele sin bredde, både ut fra de mange og dels nye utfordringer innen barnehelse og ikke minst i lys av ny kunnskap på området…

This article can be accessed in this LINK

Archives Blog Review

[Genital mutilation of children is an offence. Do health services have a sufficient knowledge to see the problem?]

Lakartidningen. 2005 May 23-29;102(21):1637-8, 1640, 1642-3.

[Genital mutilation of children is an offence. Do health services have a sufficient knowledge to see the problem?]. [Article in Swedish]

Holmgren H, Almroth L, Berggren V, Bergström S.

Barn- och ungdomskliniken, Centralsjukhuset, Kristianstad.


There are contradicting opinions whether female genital cutting (FGC) takes place in Sweden. The results from several studies indicate, however, that FGC is practiced on girls residing in Sweden. Almost no research has been done on girls on how they are affected by FGC. Thus there is no scientifically based knowledge on signs and symptoms in girls related to the practice, which can lead to cases passing unnoticed. Many health professionals feel they have poor knowledge about FGC. It is important to teach about FGC at medical and nursing schools and to make guidelines based on paediatric aspects of FGC.

There is no LINk to view this article online.