Paramedics and other front-line health and social care professionals have responsibilities to safeguard children and protect adults from the exploitations linked with female genital mutilation (FGM). It is estimated that 66 000 women and girls in the UK have been victims of FGM, with up to 24 000 girls under 15 years of age believed to be at risk (Department for Education (DfE), 2014).
It is illegal in the UK to subject a girl or woman to FGM or to assist a non-UK person to carry out FGM overseas. FGM is mutilation of the labia majora, labia minora or the clitoris (Department of Health (DH), 2011). In England, Wales and Northern Ireland the practice is illegal under the Female Genital Mutilation Act 2003 and in Scotland it is illegal under the Prohibition of Genital Mutilation (Scotland) Act 2005.
It is vital that paramedics work with other front-line staff as it is doubtful that any single agency will be able to respond to the multiple needs of a girl or woman affected by FGM. The Government has produced guidelines that set out a multiagency response as well as strategies to encourage agencies to collaborate and work together (DH, 2011). Working with teachers, social care colleagues and the police where necessary can ensure that children are kept safe.
The paramedic as a front-line member of staff is well placed to identify girls and women in need of treatment to deal with the consequences of FGM and to identify and protect those at risk. The practice can occur when the girl is newborn, during childhood or adolescence, at marriage or during the first pregnancy. The DH (2011) suggests that the majority of FGM occurs between the ages of 5 and 6 years. If FGM has taken place the paramedic should be alert to the fact that the girl or woman may find it difficult to walk, stand or sit, she may have longer periods of time off school with menstrual or bladder problems, she may be particularly reluctant to undergo medical examination, and she may also seek help or advice from the paramedic.
The paramedic is encouraged to raise awareness among colleagues regarding FGM, development and understanding of domestic violence, address issues of concern in a sensitive and professional manner and to consider other girls and women in the family who may be at risk of FGM when dealing with a particular case (DH, 2011; DfE, 2014).
Should the paramedic have any concern then they must immediately activate local safeguarding procedures using national or local protocols, and liaise with police and children's social care services.
Acting in the best interests of the child takes precedence over any other interests. The Health and Care Professions Council (2008)Standards of Conduct Performance and Ethics make it clear that paramedics must act in the best interests of service users. Disclosure of concern in law and policy in relation to the public interest is permissible where a criminal act such as FGM has been committed.