Executive Summary
The Women’s Hope (FGM) Community Clinic is a specialised maternity service provided by Nottingham University Hospitals NHS Trust (NUH) for women and birthing people affected by Female Genital Mutilation (FGM). In line with national guidance and the NHS Long Term Plan, the service transitioned from a hospital-based clinic model to a community-based service model in 2024.
Analysis of service activity to date indicates a notable reduction in Did Not Attend (DNA) rates, whilst clinical activity levels have remained stable. Early evidence demonstrates that the community model has significantly enhanced engagement whilst maintaining safe specialist clinical oversight.
The service supports early identification, safeguarding, specialist antenatal review, birth planning, and continuity of care for women affected by FGM within a trauma-informed and culturally sensitive care framework.
Background and Clinical Context
Female Genital Mutilation (FGM) is recognised internationally as a significant public health and safeguarding issue. Women affected by FGM may experience physical, psychological, sexual, and obstetric complications, alongside barriers to accessing maternity care. Trauma-informed and culturally sensitive models of care are therefore essential to improving engagement and outcomes.
National guidance from the World Health Organisation (WHO, 2018), the Royal College of Obstetricians and Gynaecologists (RCOG, 2015), and the National Institute for Health and Care Excellence (NICE, 2021) recommends:
- Antenatal identification and referral to specialist services
- Review during every pregnancy
- Planned discussion of deinfibulation (surgical opening of infibulated scar tissue) where clinically indicated
- Clear safeguarding documentation and multi-agency communication
Historically, hospital-based specialist FGM clinics have been associated with DNA rates exceeding 40%, creating barriers to continuity of care, safeguarding oversight, and birth planning opportunities. The Women’s Hope Clinic was therefore redesigned to improve accessibility, engagement, and person-centred care.
Current Service Model
The Women’s Hope Clinic operates as a weekly community-based specialist service delivered across two NUH-aligned community locations:
- Sneinton Health Centre
- Mary Potter Health Centre
The community clinic model was introduced in 2024 following review of persistently high DNA rates within the previous hospital-based service. Clinics currently provide a combined capacity of approximately [insert number] appointment slots per month.
Appointments alternate between face-to-face and telephone clinics, with face-to-face capacity prioritised for:
- Initial assessment
- Physical examination
- Safeguarding review
- Birth and deinfibulation planning
Telephone appointments are offered primarily to women who have previously given birth at NUH and require review only, whilst maintaining flexibility for face-to-face review where clinically indicated.
Referrals are made electronically via the BadgerNet FGM referral template at the time of maternity booking.
Accessibility has been improved through:
- Delivery within trusted community settings
- Flexible appointment formats
- Clearer appointment information
- Enhanced communication at antenatal booking
- Verbal and written information regarding specialist FGM support pathways
Informal service-user feedback has demonstrated that women value receiving care within familiar community settings and report feeling more comfortable discussing sensitive health concerns within the specialist clinic environment.
The service also contributes to workforce education and safeguarding awareness through multidisciplinary teaching sessions and awareness events coordinated alongside migration services and Nottinghamshire Police during International Day of Zero Tolerance for FGM awareness activities.
The reduction in DNA rates compares favourably with previously published reports of specialist FGM clinic non-attendance rates exceeding 40% within traditional hospital-based models.
To download and read the full report, including engagement and activity data, Clinical Implications and workforce development and sustainability findings click HERE