Scotland's national action plan to prevent and eradicate FGM: year one report

Monitoring Progress

Through the life of the plan Scottish Government will receive updates from agencies and organisations in relation to their delivery against actions and the outcomes within the plan. The narrative on pages 6 to 14 sets out the main highlights under the themes of the plan. The tables that follow provide updates against objectives and actions and forms part of this year one update.

Overarching:

• Positive gender roles are promoted to ensure that women and girls affected by FGM are empowered to achieve their full potential.
• Women and men have equality of opportunity particularly with regard to access to resources.

These overarching objectives align with Priority 1 and 2 of the Equally Safe delivery plan which was consulted upon over the period 23 March 2017 to 30 June 2017 ^[2] . Responses to that consultation are currently being considered.

Related work includes the development , of Multi Agency Practice Guidance for publication in 2017. The guidance will include best practice for agencies and organisations responding to FGM to ensure access to resources. As part of the Equally Safe Capacity and Capability Workstream the multi-agency Violence Against Women Partnership Guidance that was published by CoSLA and the Scottish Government in August 2016, notes that every local authority area in Scotland is expected to have a multi-agency partnership in place that has strategic responsibility for working to address all forms of VAWG at a local level, including FGM.

The Scottish Government has funded the development and wide scale distribution of a range of training and awareness raising materials in relation to FGM. A range of community based organisations, also funded by the Scottish Government, are carrying out ongoing awareness raising to highlight the impact of FGM on women and girls and to empower community members to challenge the practice.

As part of our work to empower communities to resist the practice of FGM the Scottish Government funds MY Voice, a participatory action research project that is working with communities in Scotland affected by Female Genital Mutilation ( FGM) to ensure their voice is heard in the development of policy and practice. The project empowers communities to challenge and prevent FGM. Engagement with affected communities has been through the use of peer research methods which train young people, women and men affected by FGM as peer researchers and educate and empower them to challenge the continued justification of FGM. Outputs include research reports detailing attitudes, perceptions and experience of FGM among affected communities in Scotland and highlighting recommendations for further action. Alongside this work, the project is reaching out to minority ethnic agencies to gather information about existing support services. This work will inform the development of training resources to ensure effective, culturally sensitive services to communities affected by FGM. The findings from MY Voice are helping to identify key issues and help determine ways in which community participation can be built in to the Scottish response to FGM more effectively.

Kenyan Women in Scotland Association ( KWISA) an African women led organisation, promotes empowerment and advocacy for African women, girls and their families to speak for themselves. KWISA does this by creating spaces, giving a voice and supporting Africans in Scotland particularly in tackling violence against women. KWISA has pioneered engaging with communities and faith leaders in Scotland and works towards restoration of the dignity of women and girls, preventing FGM and other harmful traditional practices ( HTPs) and supporting women and families affected by FGM to protect girls at risk. KWISA addresses all types of FGM because many victims suffer other types which are not addressed by other groups in Scotland and works with women, faith leaders and young people in Scotland and in Africa. KWISA facilitates engagement between service providers and women and girls affected by FGM and other HTPs as a means to improving service delivery.

In the health sector, a review of current activity across Health Boards in Scotland on all forms of GBV is underway. This will provide a national picture of local responses to FGM and will inform the development of future priorities for the NHS in Scotland, including specific actions to progress practice in relation to FGM.

Prevention:

• Women and girls potentially affected by FGM feel safe, respected and equal in our communities.
• People enjoy healthy, positive relationships and understand the damaging effects that FGM has on those relationships
• Individuals and communities recognise the implications and are able to challenge FGM
• Individuals who support FGM change their attitudes and behaviour and are supported to do so

These Objectives and those under Provision and Protection align with Priority 3 and 4 of the Equally Safe Delivery Plan and should be viewed as contributing to work in this area. As previously stated, the multi-agency Violence Against Women Partnership Guidance ,published by CoSLA and the Scottish Government in August 2016, notes that every local authority area in Scotland is expected to have a multi-agency partnership in place that has strategic responsibility for working to address all forms of VAWG at a local level, including FGM.

To ensure those partnerships, are in place, Scottish Government officials are working closely with the Improvement Service who coordinates the National VAW Network. The network aims to improve the capacity and capability of VAW Partnerships to implement the ambitions set out in Equally Safe at a local level and to support Partnerships to engage effectively with community planning processes.

The Network brings together VAW Partnership Coordinators/Lead Officers across Scotland and other key stakeholders including the Scottish Government and CoSLA to share information, learning and resources and ensure that there is meaningful engagement and a coordinated approach taken on relevant issues.

In recognition of the wide range of women and girls who may be affected by FGM, Police Scotland continues to partner with the Scottish Government and community based organisations to raise awareness of FGM. Their participative strategy seeks to ensure that affected communities are aware of the law and importantly are reassured that the response from Police, to FGM related concerns, will be both sensitive and with the protection of those affected at the heart of that response. Police Scotland has both Child Protection and HBV multi agency working groups in place.

Both of these groups have representation from across the statutory sector and include representatives from affected communities.
Police Scotland has explicit Standard Operating Procedures ( SOPS) for FGM and harmful traditional practices.

In the Education sector in Scotland, schools and early learning centres are supported to evaluate and improve their practice in relation to safeguarding and child protection. Self-evaluation resources such as How good is our school? and How Good is our early learning and childcare? provide schools and centres with guidance on effective safeguarding approaches, including female genital mutilation.

With the inclusion of a specific safeguarding and child protection quality indicator within these national improvement resources, schools are able to identify good practice and areas for development. All school inspections now include an evaluation of safeguarding and child protection approaches and the impact they are having on keeping children and young people safe. Schools and centres are asked to identify how professional learning and development of staff improves their knowledge and understanding of FGM.
Education Scotland is updating information related to FGM on the National Improvement Hub ( NIH). In collaboration with other agencies, we are identifying appropriate resources to support practitioners in schools and early learning centres and will promote relevant information and resources on the NIH.

The Scottish Government continues to fund a range of community based organisations to raise awareness of the harmful effects of FGM and a range of interventions and projects to recognise the important role played by young people and to empower them to challenge the practice.

• Funding to the MY Voice participatory action research project which supports work with FGM affected communities in Scotland has highlighted issues around prevention and relations with both schools and the police. While the overwhelming majority of people who participated in the research stated that they were against FGM, taking action to prevent it in their own community was more challenging

From Phase 1 of the My Voice peer research

• "People feel uncomfortable going to the police directly about any concerns they have if they think friends or family are considering carrying out FGM to a young girl saying 'It is not in our nature to report to the police'. People are however more comfortable discussing possible concerns and how to manage pressure from a family with workers in community organisations who are known to work on the issues related to FGM My Voice has worked to build trust and facilitate communication between the Police and members of affected communities by inviting the police to address the final consultation workshop of the Peer research. Some practical suggestions were made around establishing other routes for reporting that would be easier for communities to access."

• In a second round of peer research which was carried out with women, there were a number of examples of good prevention work being highlighted.

These case studies highlight the experiences of individual women. They show their attitudes to the practice and how they view the approach taken by statutory agencies. The case studies also provide an example of successful multi agency working and good coordination between services to make sure women are protecting their daughters on visits home.

A woman with twin daughters at a nursery in Edinburgh told the nursery staff she was planning to go back to Sudan for an extended visit for a year. The woman, who was aware of the prevalence of FGM in Sudan, sought advice and help to keep her girls safe. She said she was able to get advice from a social worker and from the nursery staff, who talked to her about safety planning. Together they discussed her views on FGM and the woman explained that she was against it. Together they discussed how she planned to protect her daughters and talked this through with her. Social workers gave her a number and said, if you have any problems in your country you can call the number in the UK and they will call the embassy in Sudan and pick up your family and take them back straight away.
They recommended that she did not go for such a long visit this time. She went to Sudan as planned but only stayed for 2 months. She was scared about going and scared about coming back, she was scared that her mother and granny would do something to her kids saying 'you know in my country if I have a girl and I go outside with my husband, my mum will take my girl and she can do anything because she has looked after them. Because of your religion you have to respect your mum, you can't be rude to her. You just cant'.
When she arrived back in Sudan she told her granny and mum 'you are not allowed to do anything to my daughter because there are a lot of laws in Scotland, maybe they are going to put me in detention'. She told the peer researcher 'I don't want to do this to my daughters, it was done to me and it was very bad for me.

However another woman who is passionately against FGM reported that she took her two young girls back to visit her family in a high prevalence FGM country and no one made contact with her or her daughters either before she went or when she returned. She felt she should have been checked up on.

• Funding to KWISA to raise awareness about FGM and other HTPs among African women, girls and their families. KWISA also works to improve design and delivery of services by raising awareness of FGM and other HTPs by facilitating engagement between service providers and women and girls affected by these issues. KWISA uses a holistic approach in preventing FGM based on their knowledge and experience that social change happens when the people who are affected by an issue take an active role in tackling the problem with support from policy and laws. It involves all members of the community from youth to faith leaders from different African countries. With the slogan ' FGM is more than cutting, KWISA strongly recommends avoiding personal or single-story approaches and focuses on all types of FGM especially Type 4 which is least known in Scotland. Work includes:
  • engaging women and girls to speak for themselves.
  • This project has built the foundation of work to address the impact of other HTPs such as elongation ^[3] on the sexual and reproductive health of women from communities where such practices are prevalent.
  • Training community champions and volunteers who are taking an active role in the community raising issues related to FGM.
  • Engagement with faith leaders with a view to signing a declaration against FGM.
  • Facilitated joint events between service providers and survivors of FGM and other HTPS.
  • KWISA created spaces for empowering, supporting and engaging women and girls to speak for themselves
  • Supported women and girls affected by FGM and other HTPs.
  • KWISA contributes to FGM working Groups and National strategic groups.
  • Maintained international links with FGM campaigners in the Diaspora and in Africa and continue to monitor global trends on FGM to ensure a coordinated approach.

Provision:

• Women and girls who have been affected and who are potentially affected by FGM have access to relevant, effective and integrated services
• Service providers competently identify FGM, and respond effectively

A range of work is being taken forward to ensure that women and girls have access to services and that service providers are equipped with the skills to respond effectively, as described below:

This includes the Multi Agency Practice Guidance previously referenced due for publication in 2017. Additionally, Police Scotland facilitates quarterly meetings covering both FGM and wider forms of Honour Based Violence ( HBV). Attendance includes Scottish Government, NHS, community based organisations. The National Action Plan Implementation Group facilitates wider discussion and information sharing.

Colleagues in Health Scotland are working with the Scottish Refugee Council and community representatives to develop mechanisms for engagement with local health boards to promote awareness of needs, and accessibility of local healthcare services.

A short life working group within NHS Scotland noted the dependency on clinical staff for the recording of FGM in the correct part of the clinical records e.g. in hospital discharge summaries and GP practice clinical records. Therefore to ensure that health professionals in Scotland are able to respond effectively to FGM a letter from the Chief Medical Officer/Chief Nursing Officer, issued February 2016, requested that health professionals in Scotland implement processes for the recording of FGM within health boards. Details of appropriate codes were provided in- http://www.sehd.scot.nhs.uk/cmo/CMO(2014)19.pdf
Additionally the letter from Chief Medical Officer/Chief Nursing Officer, February 2016, issued guidance on service specification and service standards in relation to FGM. It further advised boards to develop pathways of care for survivors and to raise awareness of health professionals across key service areas. http://www.sehd.scot.nhs.uk/cmo/CMO(2016)05.pdf Officials are working in partnership with NHS Scotland Data Management & Strategic Development to assess and monitor appropriate data capture.

NHS National Education Scotland ( NES) is leading the development of a Knowledge and Skills Framework ^[4] on trauma informed service provision which has been available from May 2017. Implementation of the model, and accompanying training, will be developed subsequently. Police Scotland has been a key partner in the development of multi-agency guidance and has input comprehensively in the development of protocols around information sharing and risk assessment.

The My Voice research has documented extensive trauma among women who have experienced FGM and are now living in Scotland There are also numerous accounts of problems with sexuality including the need for medical treatment. Defibulation is now being offered as part of obstetric care in parts of Scotland and although this is a difficult issue for women to deal with, and physically uncomfortable , a number of the MY Voice participants said it had improved their health and quality of life.

The performance management framework being developed by the Improvement Service will be used to measure the work that is being undertaken locally to address all forms of VAWG, and the impact it is having. While in development, it is intended that it will include indicators to begin to capture data on the numbers of women and children identified as being affected by different forms of VAWG at a local level, including FGM.
The National Adult Protection Coordinator ( NAPC) raised implementation of the FGM Action Plan at the Scottish Adult Support and Protection Conveners Group ( SASPG) on 15th February 2017 and the Social Work Scotland Adult Protection Network (Lead Officers/Coordinators) on 7th February 2017. The NAPC has provided a written list of comments received for consideration the implementation group.

Protection:

• Justice and child protection responses to FGM are robust, swift, consistent and coordinated
• Those who seek to or carry out FGM are identified early and held to account by the criminal justice system

Police Scotland has developed Standard Operating Procedures ( SOPs) to ensure that their response to FGM is consistent, sensitive and meets the needs of individuals and communities affected. They will ensure that where criminality has been identified those who have chosen to perpetrate FGM can be held to account for their actions. The SOP recognises that where a child or young person is involved a Getting it Right For Every Child ( GIRFEC) based approach will be required. Police Scotland has participated across the statutory and third sector fully in the development of the Multi Agency Guidance to ensure that responses on a multi-agency basis are connected, consistent and take into account the need to share information safely and appropriately to keep those at risk or who have been affected safe.

The National Child Protection guidance provides a national framework within which agencies and practitioners at local level -€“ individually and jointly -€“ can understand and agree processes for working together to support, promote and safeguard and the wellbeing of all children. It sets out expectations for strategic planning of services to protect children and young people and highlights key responsibilities for services and organisations, both individual and shared. It also serves as a resource for practitioners on specific areas of practice and key issues in child protection. The revised National Guidance for Child Protection in Scotland, published in May 2014, continues to inform best practice by providing a clear definition of what abuse is. It sets out our expectations for all individuals working with children and young people to identify and act on child protection concerns. The revised guidance contains a strengthened section on FGM and will continue to inform practice in relation to responding effectively as we move forward.

A Multi Agency Writing Group, with membership from the statutory, third sector and community based organisations from FGM affected organisations (or diaspora organisations) has developed for publication in 2017 Multi Agency Guidance for agencies and organisations responding to and supporting those affected by FGM. The guidance is for all services, agencies, organisations and individuals responsible for protecting and promoting the health and welfare of women and girls. This includes local authorities, Police Scotland, the NHS, third sector organisations and crucially FGM affected communities that work with girls and women at risk of or affected by FGM or deal with its consequences.

It will:

• identify whether a girl (including an unborn girl) or young woman may be at risk of FGM;
• how to identify a girl or woman who has undergone FGM; how to protect those at risk and support those already affected;
• how to prevent and end FGM; making clear that statutory bodies and strategic partnerships such as
  • local authorities,
  • health boards,
  • Police Scotland, Community Planning Partnerships and
  • integrated boards
• ensure that their member agencies work together effectively to tackle FGM; support a multi-agency response to support collaborative risk based working between statutory and non-statutory agencies and the affected communities, to meet the often complex needs of women and girls affected by FGM, outlining the issues and presents good practice when dealing with victims.
• set out how agencies, individually and together, can protect girls and young women from FGM, and how they can respond appropriately to survivors.

Next Steps

The Multi Agency FGM National Implementation Group will:

• continue to monitor and oversee progress;
• review existing actions and currency and consider any refinement