Practice nurses ‘uniquely placed’ to identify FGM survivors for referral

Practice nurses are ‘uniquely placed’ to identify and refer cases of Female Genital Mutilation (FGM), a national specialist in gender violence has said.

Rohma Ullah, head of Barnado’s National FGM Centre, told Nursing in Practice that practice nurses are key to ensuring the consistent provision of FGM support services in the UK.

She stressed that referral pathways must be ‘implemented consistently’ across all healthcare settings, with practice nurses central to identifying and referring potential cases of FGM.

‘As trusted first points of contact in primary care, they can provide sensitive, non-judgemental support, helping children and women navigate the system.

‘It is therefore vital practice nurses receive specialist mandatory training, supporting them to provide the best possible care,’ Ms Ullah said.

More referral pathways needed in general practice 

Her comments come as a Women and Equalities Committee (WEC) report, published today, warned that inconsistent referral pathways are preventing many patients from accessing the timely access to care that they need.

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The report says some regional variation in services may be needed to reflect different local rates of FGM, but said practices – regardless of location – must have effective and reliable pathways for referring survivors to specialist services.

This is especially critical in lower-prevalence areas, where dedicated FGM services may not exist locally, the WEC has warned.

The committee is calling for FGM referral protocols to be embedded across all healthcare areas, particularly in general practice, women’s health hubs, sexual health services and other primary care settings.

In the report WEC said: ‘Survivors of female genital mutilation (FGM) experience profound physical, emotional and psychosexual consequences and require specialised care and support to manage these impacts.’

The practice nurse role 

Ruth Bailey, advanced nurse practitioner in sexual health and chair of the Royal College of Nursing (RCN) Women’s Health Forum, described FGM as having ‘devastating health consequence’ for victims, including physical symptoms and psychological trauma.

Ms Bailey, who contributed to the RCN’s updated professional guidance on FGM in 2023, said that GPNs play a ‘pivotal role’ in supporting survivors of FGM when patients attend women’s health screenings and check-ups.

‘GPN’s carrying out consultations for cervical screening, sexual health, contraception and travel appointments have a unique opportunity to ask survivors about their experiences, to listen, support and facilitate onward referral which can result in life enhancing interventions,’ Ms Bailey told Nursing in Practice. 

Immediate complications of FGM can include trauma, severe pain, genital tissue swelling, haemorrhage, infections, fever, urinary problems, and long-term FGM complications include mental health problems, pelvic pain, painful menstruation, and urinary tract infections, urinary difficulties, cysts, abscesses and a range of obstetric complications.

The report highlighted that survivors may not always be aware that health complications they are experiencing is a consequence of FGM, ‘meaning awareness among survivors of the long-term health implications of FGM is vital’.

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How widespread is FGM?

The WEC report notes the lack of data on FGM prevalence in the UK, with the most recent study on FGM numbers being completed by the women’s rights organisation Equality Now in 2015.

It is estimated that that there are 137,000 women and girls living with FGM in England and Wales, and that prevalence varies significantly by region, with London having the highest prevalence rate at 21 per 1,000 population.

Some London boroughs had an even higher FGM prevalence rate. The next highest prevalence rates were in Manchester, Slough, Bristol, Liverpool and Birmingham.

While rates of FGM varied across the country, the report concluded that it is likely there are FGM survivors in every local authority area, but with access to care ‘a postcode lottery’.

Four million girls are estimated to be at risk of FGM globally, and the practice continues within and from the UK.

Types of FGM include clitoridectomy, excision of the clitoris and inner labia, with or without removal of the labia majora, infibulation – narrowing of the vaginal opening – and other procedures such as pricking, piercing, cutting, scraping or burning the area.

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The WEC said in the report that the practice continues in the UK.

‘We are seriously concerned by evidence and data that suggests FGM is taking place in the UK and that UK citizens or residents are being taken abroad to undergo FGM. The Government needs to provide consistent and long-term funding to tackle this gender-based violence.’