An uproar has erupted, as NewScientist (27 February 2016) reports, over anti-Female Genital Mutiliation (FGM) strategies:
Two US gynaecologists have proposed legalising some forms of female genital mutilation. They argue this would protect girls from more extreme operations.
Worldwide, around 3 million girls every year undergo FGM. The practice can range from cutting genitals to removing the clitoris and labia then stitching up most of the vagina.
The practice is illegal in the UK and US, but Kavita Shah Arora and Allan Jacobs argue that attempts to clamp down on FGM haven’t succeeded, and can be viewed as racist or culturally insensitive.
Instead, they suggest doctors should perform operations that they think will not affect women’s ability to have children or sexual satisfaction (Journal of Medical Ethics, doi.org/bcqw).
The actual article, written by Kavita Shah Arora and Allan J Jacobs, is here:
Procedures that surgically alter the external genitalia of children are quite common throughout the world, though the distribution varies greatly by geography. The majority of male children in America are circumcised.1 While non-therapeutic female genital alteration (FGA) procedures in children are unusual in the USA, an estimated 80–140 million women throughout Africa, the Middle East, India and South-East Asia have had such procedures.2 ,3 The WHO, American Academy of Pediatrics (AAP), and the American Congress of Obstetricians and Gynecologists (ACOG) have policies in place to support circumcision; however, FGA has been deemed a human rights violation by these same organisations as well as by the United Nations.2–4 In fact, the US government has expressly outlawed any procedure that incises or changes a female child’s external genitalia in the absence of medical indications.5
While years of advocacy and legislation aimed at eliminating non-therapeutic procedures on female external genitalia has resulted in a decline in the prevalence of the practice, the magnitude of this decline has been soberingly small. In Egypt, the percentage of women who had any procedure that altered external genitalia performed on a daughter only fell from 77.8% to 71.6% over 5 years from 2006 to 2011. This relatively small decrease in prevalence was associated with minimal change in attitude towards the procedures.6 In a study in Somalia, the country in the world with the highest prevalence of these procedures, 81% of subjects underwent infibulation and only 3% did not have FGA. Eighty-five per cent had an intention to subject their daughters to an extensive FGA procedure, and 90% supported the continuation of the practice.7 There have been some more encouraging studies, however. In Kenya, for example, prevalence has dropped from 49% in women ages 45–49 years to 15% in girls ages 15–19 years and in Liberia, the prevalence has dropped from 85% to 44%, respectively.8 ,9
With this background:
Immigrants to Western nations may continue to subject their daughters to genital alteration,10–12though the frequency is difficult to assess. While laws enacted in these countries make procedures that alter a female’s external genitalia illegal, they may in some instances worsen health outcomes by driving the practice underground by sending female children to Africa or by inviting circumcisers to the West.11 Making the practice illegal also hampers the ability to study the actual incidence and effects of these procedures, limits an open dialogue regarding changing the practice, and may impede efforts to voluntarily reduce the incidence of these procedures (thereby improving public health).13 ,14 This local culture of silence is due to a distrust of the global eradication campaigns as being ‘sensationalized, ethnocentric, racist, culturally insensitive and simplistic’.15
So they propose permitting harmless forms of FGM (or FGA, for Alteration, as they prefer) “… in recognition of its fulfilment [sic] of cultural and religious obligations …“, as a practical approach to minimizing the harm to children, where harm is a wide ranging term referencing not just physical health, but the consequences of jailing or otherwise penalizing parents responsible for the infliction of FGM on the children.
It’s an fascinating article which raises many interesting points, including the non-equivalent treatment of male circumcision in the West, a re-examination of the several methods of FGM and how they range from barely a nick to severe impairment of function, the impact of penalties on children, the impact of Western campaigns on other countries, how higher portions of women vs men are in favor of FGM as this gives them power over there bodies, and much more.
I have a lot of reactions as I read through the article, starting with the standard Western “ewwww” reaction. For all that Western nations have not treated women equivalently to men throughout history, at least we’ve not inflicted FGM on them.
I can see the point of controlling your own body, and using FGM to symbolize that control, rather than allowing a patriarchy to decide whether or not FGM is appropriate; I do not necessarily agree with the position. I see the equivalence of FGM and male circumcision, and equivalences with cosmetic surgery and FGM.
Enough of boring equivalences. The primary goal of the West has been to stop the practice of FGM; this may be usefully transformed to the confrontational statement “Is FGM a positive or a negative for societies?”, although I suspect anthropologists would wince. In this new light, it would not be improper to suggest that acceptance of the proposal to permit the least damaging FGMs would constitute a victory for the pro-FGM forces in the confrontation over FGM: a major power (the USA) forced to permit FGM is certainly a noteworthy event. This may indeed happen as the authors of the article suggest the primary legal bulwark against FGM in the USA, the Federal Prohibition of Female Genital Mutilation Act, is unconstitutional as it tramples on religious freedoms. (One wonders how Donald Trump would react to a question on this subject in a debate, or indeed any of the GOP candidates.)
As a citizen of one of the more extreme Western countries, I have to be aware that individualist tendencies are a matter of cultural inculcation, so when I state that I have deep concerns about the involuntary infliction of FGM, even in its least damaging forms, on young girls, I need to be aware that I’m not being entirely objective. In this country we have a strong belief that the individual should control what happens to them when they are adults, and that children must be managed responsibly; we occasionally see clashes when the religious sensibilities of parents are not compatible with the laws currently governing the raising of children. A similar problem, with different origins, has been seen recently with respect to the anti-vaccine sentiment that has appeared. In other cultures, the individual’s worth is more deeply discounted, and within that culture the use of FGM, voluntary or not, serves a useful purpose.
But this lets us transition back to the point of the article: the use of FGM in the USA. My position is that the underaged should never be subjected to it, voluntarily or not, because we are an individualistic culture, and individualism requires a degree of mature and responsible thought on the part of the individual, which is not likely to be found in those less than the age of majority (yeah, yeah, even that’s arbitrary, but forcing people to pass a test before they’re considered adults would just result in riots). Once the age of majority is attained, then medical procedures by surgeons may be permissible; I have trouble finding an objection. I do object to a religious figure having any meaningful part in the procedure, on the other hand.
I do recommend the article, not only for the subject matter, but also because it’s a good example of taking apart what appears to be a simple subject and displaying the complications that are its constitutional parts.
A related post on boys is here.
