Child Welfare Professionals

Different communities and cultures have different reasons for practicing FGC. Social acceptability is the most common reason. Families often feel pressure to have their daughter cut so she is accepted by their community. Other reasons may include: 

• The desire to ensure a woman remains a virgin until marriage. Parents believe FGC is in the child's best interest and therefore is an expression of love.
• Rite of passage. In some countries, FGC is a part of the ritual that a girl goes through to be considered a woman
• Belief that FGC increases sexual pleasure for the man. 
• Hygiene. Some communities believe that the external female genitals that are cut (the clitoris or the labia or both) are unclean.
• Condition of marriage. In some countries, a girl or woman is cut in order to be considered suitable for marriage.
• Religious duty, although no religion’s holy texts require FGC. 

• Procedures are mostly carried out on young girls sometime between infancy and adolescence, and occasionally on adult women. More than 3 million girls are estimated to be at risk for FGC annually.
• More than 200 million girls and women alive today have been cut in 30 countries in Africa, the Middle East and Asia where FGC is concentrated.
• The practice is most common in the western, eastern, and north-eastern regions of Africa, in some countries in the Middle East and Asia, as well as among migrants from these areas.
• Some immigrant families in the U.S. from these countries also practice FGC, or may send their daughters back to their family homeland for FGC. Other immigrant families stop practicing FGC once they are in the United States.                                                                                                    

The World Health Organization (WHO) considers FGC a human rights violation because:

• It violates the rights to health and bodily integrity
• Is a form of violence and torture against women
• Violates the rights of children who undergo the practice without consent.

Because of this many countries have made laws banning the practice of FGC.

Factors that might indicate risk for FGC

• a girl’s or woman’s community or country of origin
• a girl’s mother, sibling or other relatives have undergone FGC
• a girl’s father comes from a community known to practice FGC
• a family believes FGC is important to cultural or religious identity
• elders hold strong influence in child rearing practices
• a girl tells a professional that she is to have a ‘special procedure’ or to attend a special occasion to ‘become a woman’
• a girl talks about a long holiday to a country where the practice is prevalent
• a parent or family member expresses concern that FGC may carried our on the girl
• a girl requests help from a teacher or other adult because she is aware that she is at immediate risk of FGC
• a girl talks about FGC to others, for example, a girl may tell other children about it – it is important to consider the context of the discussion

Indications that a girl or woman has been subjected to FGC

• have difficulty walking, standing or sitting
• spend longer in the bathroom or toilet
• appear withdrawn, anxious or depressed
• have unusual behavior after an absence from school or college
• be particularly reluctant to undergo normal medical examinations
• ask for help but may not be explicit about the problem
• a girl or woman or family member tells a professional that FGC has taken place
• a girl or woman has frequent urinary, menstrual or stomach problems
• a girl avoids physical exercise or asks to be excused from physical education
• there are prolonged or repeated absences from school or college
• a girl talks about pain or discomfort between her legs

The following questions may help when conducting an interview/investigation regarding female genital cutting. Where the term FGC is used please replace with the term the family uses or is familiar with.

Questions for parents/caregivers:

1.  Do you understand what FGC means? What is the term for FGC in your community/family?
2.  I know that some girls and women in your country have been cut. What do you think about this? - Can you please tell me if FGC has affected you or your family? - If yes, do you remember how old you were?
3.  Have you had any complications or problems because of it? Are you aware of health services that can support you? (Give details)
4. Are you aware of the health problems that girls and women can have? - Explain the short term and long term health and psychological problems.
5. Do you feel that cutting is part of your culture or required by religion? If yes: Tell me about this? Highlight FGC is not required by any religion.
6. What are your family’s views on FGC? - Explore location and frequency of contact with extended family members.
7. What are the views of your community in the US on cutting?
8. In your community/country why is cutting practiced? Who usually carries out the cutting in your community? At what age are girls usually cut in your country of origin/in your community?  In certain communities, FGC is closely related to particular milestones a girl reaches, e.g. puberty. Obtaining this information could potentially tell you when a girl is at risk might be cut.
9. If a girl is not cut, what could the consequences be?  Would there be pressure from your family or the community to have your daughter(s) cut?
10. If left in the care of a grandmother, aunt, or other extended family members, would there be a risk to your daughter(s) of FGC?  How do you think you can protect your daughter from being cut? If you felt pressured by your family or community to have your daughter(s) cut, who would you go to for support?
11. Are you aware of the Laws in the US and Michigan on FGC?  Are you aware that it is illegal to take someone out of MI to be cut? Are you aware that FGC is illegal and considered child abuse in the MI?
12. What does your daughter(s) know about FGC? Has your daughter got any friends, siblings or cousins who have been cut? 

Questions for girl

Below are examples of questions you might like to consider for girls, bearing in mind their age and understanding.

1. Has anyone ever spoken to you about FGC before? If so, who, and what did they say?
2. Have you learnt anything at home or in school about the body and your body rights? Explain that a child can say no to something which makes them uncomfortable or sad. 
3.  If you are ever worried about something, who would you speak to? 

• Provide accurate and clear information to patients
• Communicate with cultural sensitivity
• Understand your obligations under the law.
• Learn strategies for working with at risk and affected individuals and  communities.    
• Refer to local or national support organizations.  Some national organizations include:
  • AHA Foundation
  • Equality Now
  • Orchid Project
  • Sahiyo
  • Tahirih Justice Center

Physical harm includes:

• Severe pain 

• Difficulty urinating or painful menstrual periods

• Serious bleeding

• Problems during or after childbirth

• Infections and diseases

• Death as a result from some of these problems

Emotional harm includes:

• Anger at the person performing or allowing the procedure                     

• Depression, fear and feelings of helplessness

• Trauma, including nightmares and flashbacks                                                       

• Sexual fears, decreased sexual pleasure

There may be harms that are not listed above.

These health risks can be short-term, long-term or both.

FGC is in the Public Health Code 333.9159, added effective October 9, 2017 The laws:

• Prohibit FGM/C on minors;
• Allow exceptions for necessary medical procedures;
• Apply to parents/guardians who facilitate as well as the individual who performs the procedure;
• Prohibit travel outside the state for the purpose of FGC/M;
• Exclude cultural/ritual reasons and/or consent as a defense;
• Provide a civil cause of action by the victim for physical and emotional damages until the victim reaches age 28;
• Provide for a felony sentence of up to 15 years imprisonment; and
• Provide a basis for termination of parental rights. 

Depending on the facts and evidence in each specific case, FGC may amount to parental child abuse or neglect under the Child Protection Law.

For more information, review:

• 1931 PA 328 (Michigan Penal Code), MCL 750.136 & MCL 750.136a
• 2017 PA 76, MCL 600.5851
• 2017 PA 78, MCL 600.2978
• 2017 PA 77, MCL 333.9159
• 2017 PA 193, MCL 712A.19b
• Child Protection Laws, MCL 722.621

Knowing that a child has been subjected to FCG may establish reasonable cause to suspect child abuse or neglect has occurred. Anyone may contact CPS to make a complaint of suspected child abuse or neglect. 

However, certain individuals are required to make a report to CPS when they suspect child abuse or neglect.  Reports can be called into the CPS Centralized Intake at (855) 444-3911.

CPS Centralized Intake will assess the allegation and assign eligible complaints for investigation, including coordination with law enforcement, when necessary.

The primary goal of CPS is to protect children from abuse and neglect. CPS is also responsible to preserve family. CPS decisions and actions in any case depend on objective analysis of facts and evidence and assessment of risk and safety.

• Identify children at risk of being subjected to FGC and responding appropriately to protect them.
• Identify children who have been subjected to FGC and providing appropriate support for them. 

Organizations

• World Health Organization
• Office of Women’s Health US Department of Health and Human Services

Videos

• The Truth About Female Genital Mutilation
• FGM Among Us
• US Genital Mutilation Victims: It Happens Here
• American Woman Who Underwent Female Genital Mutilation Comes Forward to Help Others 
• How I Survived Female Genital Mutilation

Professional References

• Addressing Female Genital Mutilation/Cutting: A Training Curriculum for Law Enforcement, Educators, and Service Providers
• Social Work Policy Institute. Female Genital Cutting
• The FGM Assessment Tool for Social Workers, National FGM Centre, 2016, licensed under the Open Government License ( http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/) Disclaimer: The FGM Assessment Tool For Social Worker is aimed at social work practitioners in England and Wales. [Appendix 5 could be adapted for US/Michigan use. https://www.healthysuffolk.org.uk/uploads/NFGMC_FGM-Best-Practice-Guidance-for-Social-Workers.pdf
• World Health Organization, Sexual and Reproductive Health