FGM Awareness Training for Care and Healthcare Staff: Legal Duties and Warning Signs

Female genital mutilation (FGM) is a form of child abuse and a criminal offence in the UK, and every year thousands of women and girls affected by it come into contact with the NHS and social care system. For care and healthcare staff, understanding FGM sits alongside other safeguarding training obligations as a distinct legal duty, with its own reporting requirements that apply directly to regulated health and social care professionals, not just teachers and social workers.

What FGM Is, and Why It Is a Safeguarding Issue

FGM refers to any procedure that intentionally alters or injures the female genital organs for non-medical reasons. UK guidance classifies it into four broad types, ranging from partial removal of the clitoris to narrowing of the vaginal opening. It carries no health benefit, is usually carried out on girls between infancy and age 15, and can cause serious short- and long-term physical and psychological harm, including chronic pain, infection, complications in childbirth, and lasting trauma. NHS England Digital recorded 16,300 attendances where FGM was identified across 104 trusts and 63 GP practices in 2024–25, involving 6,980 individual women and girls — a reminder of how often this issue surfaces in routine health and care settings, not just in specialist safeguarding cases.

FGM is practised in parts of Africa, the Middle East and Asia, and among some diaspora communities in the UK. It is rooted in social convention rather than religion, and families who practise it often believe it is necessary for a daughter's acceptance or marriageability. This context matters for staff because it shapes how a disclosure is likely to happen — rarely as a direct statement of harm, and far more often as something noticed during a routine appointment or home visit.

The UK Legal Framework: FGM Act 2003 and the Serious Crime Act 2015

FGM has been a specific criminal offence in England, Wales and Northern Ireland since the Female Genital Mutilation Act 2003, which replaced earlier 1985 legislation. The Act makes it an offence to perform FGM, to assist a girl in carrying it out on herself, or to assist a non-UK person to perform FGM on a UK national or resident, whether the act takes place in the UK or abroad. These offences carry a maximum sentence of 14 years' imprisonment.

What Changed in 2015

The Serious Crime Act 2015 significantly strengthened the 2003 Act. It introduced a new offence of failing to protect a girl under 16 from a risk of FGM, applying to parents or carers responsible for her, with a maximum sentence of 7 years. It gave FGM victims lifelong anonymity in the media, created civil FGM Protection Orders to protect a girl or her siblings, and — most relevant here — inserted a new duty into the 2003 Act requiring certain regulated professionals to report known cases of FGM in under-18s to the police. That mandatory reporting duty came into force on 31 October 2015.

The Mandatory Reporting Duty Explained

Who It Applies To

The duty applies in England and Wales to regulated health professionals (those registered with bodies such as the GMC, NMC and HCPC), to teachers, and, in Wales, to registered social care workers. In practice this falls personally on doctors, nurses, midwives and many allied health professionals — it is an individual professional obligation, not something a manager or safeguarding lead can decide on your behalf.

What Counts as a "Known Case"

The duty is narrower than general safeguarding suspicion. It is triggered only when a professional either sees physical signs that FGM has been carried out, with no reason to believe this was for a medical or childbirth-related reason, or when a girl under 18 personally discloses to them that FGM has been carried out on her, in whatever words she uses. Guidance is clear that a professional does not need to be completely certain, or to have a clinical diagnosis confirmed, before reporting. A third party telling staff that FGM has occurred, or a case where staff merely suspect a girl is at risk, does not trigger the mandatory duty — those cases should still be escalated through normal safeguarding channels, as a matter of professional judgement rather than an automatic legal requirement.

Reporting Timeframe and What Happens Next

A report to the police should be made as soon as possible, ideally by the close of the next working day, and no later than one month from discovery except in exceptional circumstances. Reports are usually made by calling 101, with 999 reserved for situations where a child is in immediate danger. Once a report is made, police work with children's social care and health colleagues to assess the child's welfare, decide on protective action, and consider whether an FGM Protection Order is appropriate.

Recognising Risk Indicators and Warning Signs

Staff do not need to make a clinical diagnosis, but recognising the signs that FGM may be planned or may already have taken place is central to early intervention.

Signs That FGM May Be About to Happen

• A family talks about a long holiday abroad, or a girl mentions a special occasion or ceremony to "become a woman"
• Relatives, sometimes described by the family as a visiting "cutter", arrive from abroad
• A girl is suddenly withdrawn from school, or her attendance or behaviour changes without explanation

Signs That FGM May Have Already Taken Place

• Difficulty walking, sitting or standing, or spending longer than usual in the bathroom
• Recurrent urinary, menstrual or gynaecological problems
• Withdrawal, anxiety, depression or reluctance to undergo normal medical examinations

Girls from communities where FGM is prevalent — including Somali, Kenyan, Ethiopian, Sudanese, Egyptian, Nigerian, Eritrean, Yemeni, Kurdish and Indonesian communities in the UK — are statistically at higher risk, particularly where an older female relative has herself undergone FGM. Community background alone is never grounds for assumption, but it is a relevant factor alongside behavioural and physical indicators.

Safeguarding Referral Pathways

Every care and healthcare organisation should have a named safeguarding lead and a clear local pathway for both mandatory reports and wider safeguarding concerns. As a minimum, staff should know how to record what they have seen or been told accurately and in the person's own words, how to make an urgent referral to children's social care, how to contact the police to satisfy the mandatory reporting duty, and where to signpost women and girls for specialist support, including NHS FGM clinics. Good documentation matters as much here as in any other safeguarding context; the principles in Learnsignal's guide to incident documentation standards for care providers apply equally to FGM-related records, which may later form part of a police investigation.

Why This Training Matters Beyond Teachers and Social Workers

FGM training is often associated with education and children's social work, but the mandatory reporting duty rests just as heavily on health professionals, and care and domiciliary staff are frequently the ones who first notice something is wrong. A community nurse on a home visit, a GP healthcare assistant taking a family history, or a care worker supporting a young family may encounter warning signs long before a school does. Staff supporting adult women who underwent FGM as girls also have a role: recognising the long-term health impact and responding with sensitivity rather than shock. This is where wider training in trauma-informed care becomes directly relevant, since many women affected by FGM carry lasting psychological trauma.

Frequently Asked Questions

Does the mandatory reporting duty apply to care workers, or only to doctors and nurses?

It applies to regulated health professionals registered with bodies such as the GMC, NMC and HCPC, to teachers, and, in Wales, to registered social care workers. Care staff who are not personally regulated in this way are not bound by the specific legal duty, but they remain bound by their organisation's safeguarding policy and by the general duty of care to report any concern about a child through local safeguarding procedures without delay.

What should I do if I only suspect a girl is at risk of FGM, rather than knowing it has happened?

Suspicion of future risk does not trigger the mandatory reporting duty, which applies only to known cases in under-18s. It should, however, be treated as an urgent safeguarding concern and raised immediately with your organisation's safeguarding lead and, where appropriate, children's social care, following the same seriousness as any other child protection referral.

Is FGM training a one-off requirement, or does it need to be refreshed?

Most care and healthcare employers treat FGM awareness as part of their mandatory or statutory safeguarding training, refreshed periodically (commonly every one to three years, depending on role and local policy) to keep staff current on legal duties, referral pathways and their own organisation's procedures. Specialist advice on handling a disclosure is also available from the NSPCC's dedicated FGM helpline.

FGM awareness is a small but serious part of a much wider safeguarding skill set that every care and healthcare worker needs. Learnsignal's CPD training courses can help your team build that wider safeguarding knowledge in a practical, role-relevant way, so staff feel confident recognising the signs, understanding their legal duties and knowing exactly what to do next.