FGM Safeguarding: Concerned Relative

Clinical Scenario

Fatima Hassan, 32, a British-born Somali woman, attends requesting contraception but becomes tearful during the consultation. She discloses she is worried about her 7-year-old niece, Amira, who is being taken to Somalia next month by her grandmother for a 'coming of age ceremony.' Fatima herself underwent FGM aged 8 during a similar trip and suffers ongoing complications. She loves her sister (Amira's mother) but believes the mother is complicit. She is terrified of family rejection if she reports her concerns and asks you to promise confidentiality.

What This Case Tests

Understanding mandatory FGM reporting duties under the Serious Crime Act 2015; managing a third-party safeguarding disclosure sensitively; supporting a patient who is herself a survivor of FGM; navigating cultural sensitivity without cultural relativism; explaining the limits of confidentiality clearly; coordinating with safeguarding leads and social services

Common Mistakes Trainees Make

The three most common mistakes are: promising confidentiality when you cannot — FGM risk in a child under 18 triggers mandatory safeguarding duties and you have a legal obligation to act, so promising silence would be both unethical and illegal; being so culturally cautious that you fail to name FGM clearly and take decisive safeguarding action — cultural sensitivity does not override child protection; and focusing entirely on the safeguarding process without supporting Fatima herself, who is a trauma survivor disclosing her own FGM experience and needs care in her own right.

The Consultation Challenge

This consultation has two layers: Fatima is a patient with her own FGM trauma, and she is also disclosing a safeguarding risk to a child. You need to address both.

When Fatima becomes tearful, slow down. Don't rush past the emotion to get to the facts. 'I can see this is really distressing. Take your time — I'm listening.' When she discloses her concern about Amira, let her explain fully before responding.

When she asks you to promise confidentiality, be honest immediately. Do not promise what you cannot deliver. 'Fatima, I can hear how frightened you are about your family finding out. I want to be completely honest with you — when there's a risk of FGM to a child, I have a legal duty to report it to safeguarding services. I can't promise to keep this confidential. But I can promise that I will support you through this, and that the priority is keeping Amira safe.'

Explain the process clearly: you will contact the practice safeguarding lead today, who will make a referral to children's social services. Social services will assess the risk and may involve the police if the child is at imminent risk of being taken abroad. Fatima does not need to make the report herself — you are doing it. Reassure her that the referral can be made without immediately identifying her as the source.

Then turn to Fatima herself. She has disclosed her own FGM. This needs acknowledgement: 'Fatima, what happened to you as a child was not OK, and I'm sorry you went through that. You mentioned ongoing complications — would you like to talk about those today, or would you prefer to come back for a separate appointment?' Offer referral to a specialist FGM clinic for her own health needs.

Ask about her safety: could there be repercussions from her family if they discover she raised concerns? Does she have a safe place to go? This is a domestic safety assessment.

Document everything meticulously — date, time, exact words used, your assessment of risk, and actions taken.

Time check: Minutes 1-3 on allowing the disclosure and responding with empathy. Minutes 3-6 on explaining your safeguarding duty and the reporting process. Minutes 6-9 on supporting Fatima — her own FGM, ongoing complications, safety assessment. Final 3 minutes on immediate actions, documentation, and follow-up plan.

How Examiners Mark This Case

Data Gathering and Diagnosis: Examiners assess whether you gather sufficient detail about the risk — the planned trip, the 'ceremony,' the grandmother's role, the timeline (next month creates urgency). They look for whether you assess Fatima's own FGM history and ongoing health needs, and whether you conduct a safety assessment for Fatima herself. Asking about Amira's awareness and current wellbeing shows thoroughness.

Clinical Management and Medical Complexity: Examiners evaluate your knowledge of mandatory FGM reporting duties, the safeguarding referral pathway, and the urgency created by an imminent trip abroad. Contacting the practice safeguarding lead the same day, understanding that social services may apply for a court order to prevent travel, and offering Fatima her own FGM clinic referral demonstrate layered management. Documenting the disclosure accurately is essential.

Relating to Others: This domain is critical. Examiners look for immediate honesty about confidentiality limits — not promising and then backtracking. They assess whether you acknowledge Fatima's courage in disclosing, validate her trauma as a survivor, and reassure her that you will protect her identity as far as possible. Navigating the tension between her fear of family rejection and the child's safety with genuine empathy is the hallmark of an excellent consultation.

Example Opening

When the disclosure begins: "Fatima, I can see something is really worrying you. Whatever it is, this is a safe space to talk. Take your time."

When addressing confidentiality: "I need to be honest with you before you go any further. If what you're about to tell me involves a risk to a child, there are limits to what I can keep confidential — I have a legal duty to act. But that doesn't mean I won't support you. Whatever you tell me, we'll work through it together."

Avoid: "Don't worry, everything you say is between us" — this is a promise you cannot keep in a safeguarding context, and breaking it later destroys trust irreparably.

How This Appears in the SCA

FGM safeguarding tests your knowledge of mandatory reporting duties, your ability to manage cultural sensitivity alongside child protection, and your communication skills in a high-stakes disclosure. Examiners assess whether you are clear about confidentiality limits while remaining compassionate toward the disclosing relative.

Key Statistic

An estimated 137,000 women and girls in England and Wales are living with the consequences of FGM. The mandatory reporting duty requires regulated professionals to report known cases of FGM in under-18s to the police within one month.

Relevant Guidelines

• FGM mandatory reporting duty under the Serious Crime Act 2015
• NICE CG89: Child maltreatment — recognition and response
• RCGP FGM safeguarding toolkit
• NHS England FGM prevention programme
• Multi-agency statutory guidance on FGM (Home Office).

Frequently Asked Questions

What is the mandatory FGM reporting duty and when does it apply?

Under Section 5B of the Female Genital Mutilation Act 2003 (as amended by the Serious Crime Act 2015), regulated professionals in England and Wales must report to the police when they discover that FGM has been carried out on a girl under 18, or when they have reasonable grounds to suspect a girl under 18 is at risk. The report must be made within one month. Failure to report is not currently a criminal offence but may result in professional disciplinary action. In this case, the imminent trip abroad for a 'ceremony' constitutes reasonable grounds for concern.

How do I balance cultural sensitivity with safeguarding duties?

Cultural sensitivity means understanding the context — FGM is practised across certain communities and families may genuinely believe it is beneficial. But cultural sensitivity does not override child protection. The law is clear: FGM is illegal in the UK and arranging for it to be performed abroad is also illegal. You can be respectful of Fatima's cultural background while being unequivocal that Amira must be protected. Avoid framing FGM as a 'cultural practice' — it is classified as child abuse under UK law.

What happens after I make a safeguarding referral for FGM risk?

Your immediate step is contacting the practice safeguarding lead, who will refer to children's social services and the police. Social services will conduct a strategy discussion, potentially involving the police, education, and health. If there is an imminent risk of the child being taken abroad, the court can issue a Female Genital Mutilation Protection Order (FGMPO) preventing travel. The child's passport can be surrendered. Fatima's identity as the referrer is protected as far as possible, though complete anonymity cannot be guaranteed.

How should I support Fatima as a survivor of FGM?

Acknowledge her experience directly: 'What happened to you was wrong, and I'm sorry.' Offer referral to a specialist FGM clinic — there are 8 NHS specialist clinics in England offering deinfibulation, psychological support, and management of complications including chronic pain, urinary problems, and sexual dysfunction. Offer practice-based counselling in the interim. Ask about her safety within the family — if she is at risk of repercussions for raising concerns, this becomes a separate safeguarding issue for an adult at risk.

Can I make the referral without Fatima's consent?

Yes. Where there is risk of significant harm to a child, you can and should share information with safeguarding services without the consent of the person disclosing. You should inform Fatima that you are making the referral and explain why, but her consent is not required. Document clearly that you informed her of your duty, the reasons for the referral, and her response. If she withdraws her account or denies the concern, you must still refer based on the information already disclosed.