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Launch of the the RCOG Green-top Guideline on FGM

Blog 15 July 2015

RCOG President, Dr David Richmond writes...

I am very pleased to announce the publication of the revised RCOG Green-top Guideline Female Genital Mutilation and its Management (no. 53) last Friday. It has been around two years in the making and I would like to acknowledge the hard work of our guideline authors and contributors.

This new guideline provides clear advice on the clinical care of women with female genital mutilation (FGM) before, during and after pregnancy. It also includes advice on the legal and regulatory responsibilities of doctors caring for women with FGM.

The RCOG’s position on FGM has always been unequivocal – it is child abuse and a severe form of violence against women and girls. There is no medical benefit. As a College, we are committed to eradicating it from the UK but it is also essential for us to understand the myriad cultural and social explanations why FGM occurs. Regardless of these reasons, there is no justification for FGM and we must work closely with the communities, parents and women and girls themselves to ensure that attitudinal and behavioural change occur.

An estimated 137,000 women and girls in England and Wales have undergone the practice which often affects those from hard to reach communities with complex healthcare needs. In meeting these needs, healthcare professionals must deliver safe and high quality care that is accessible, sensitive and informed, whilst at the same time safeguarding girls at risk. It is this duty of care that was foremost in our minds when we began to review the guideline.

As a Royal Medical College, we must ensure that all doctors and trainees are aware of the perimeters of the law contents and work within these. This guideline focuses primarily on the care of the pregnant woman but because we are very aware of the way in which FGM currently affects women across the ages, we have also included new advice on managing FGM in gynaecological care and for those using the guideline to be sensitive to the woman’s emotional needs following FGM. In drafting this guideline, we have listened to the views of our international members and worked very closely with our midwifery, GP, paediatrician colleagues so this has been a truly multidisciplinary effort.

What else is new in the guideline and how does it reflect recent changes to legislation? In order to ensure a consistent approach to data monitoring, the Department of Health implemented the FGM Enhanced Dataset in England earlier this year, which requires all acute trusts, general practices and mental health trusts to record data about women with FGM on a monthly basis. Healthcare professionals must understand the difference between recording  and reporting FGM in the NHS and their responsibilities with respect to each of these. We should also be aware of supporting materials produced by the Department of Health such as the risk assessment and safeguarding guide

The guideline addresses de-infibulation and clitoral reconstruction. Women who are likely to benefit from de-infibulation should be counselled and offered the procedure before pregnancy and ideally before first sexual intercourse. Clitoral reconstruction should not be performed because current evidence suggests associated complication rates without conclusive evidence of benefit. And on the topic of re-infibulation, this is illegal by law.

As well as this revised Green-top Guideline, Health Education England’s FGM e-learning programme launched in March this year provides an excellent platform for doctors and other healthcare professionals to update their knowledge about FGM, along with advice on the communication skills needed in dealing with women who present with FGM.

Much progress has been made over recent years to mainstream FGM into existing prevention strategies and the government has done a lot to ensure that the different agencies and professionals work together to close the gaps in identification, monitoring and the sharing of information. As healthcare professionals dedicated to improving women’s health, we must all be aware of our pivotal roles and responsibilities in caring, supporting and protecting women and girls with or at risk of FGM. Globally, this includes the move to end the medicalisation of FGM. I encourage all our international members to familiarise themselves with the principles to end medicalisation in countries where it still occurs.