Merged Female Genital Mutilation? Naw, it's just a "nick"!

[Tsukasa Buddha]

The American Academy of Pediatrics has suggested a new way to fight female genital mutilation in the United States: Allow doctors to give girls a "nick" down there. In a policy statement titled "Ritual Genital Cutting of Female Minors," the Academy suggests that allowing such a ritual could serve as a way to "build trust" with immigrant families and prevent parents from sending their girls overseas for far more extensive, and potentially life-threatening, procedures. It's a "possible compromise to avoid greater harm," the statement says.

As you might imagine, the Academy's endorsement of a ritualistic "nick" has not gone over well. PZ Myers of Pharyngula mockingly wrote: "We'll just mutilate baby girls a little bit, to make the misogynist patriarchal ******** happy." Taking a similar tack, Shakesville's Melissa McEwan turned up the snark real loud: "Girls get only a little heinous physical and psychological trauma, and their guardians get to practice their violent misogyny, just in a slightly less violent way. Yay for compromise!" I had a similar reaction. I mean, I even disagree with male circumcision (at least when there's a total absence of personal choice in the matter). But the position statement seemed so ambiguous to me that I had to give the Academy a call to ask just what it meant by a "nick." Are we talking about the sort of shallow cut that might result from the slip of a razor or full-on female circumcision, where the clitoral hood is removed? Neither, it turns out.

Linky.

Some advocates against female genital mutilation criticized the policy statement. Rep. Joseph Crowley (D-N.Y.) said, "I am sure the academy had only good intentions, but what their recommendation has done is only create confusion about whether [female genital mutilation] is acceptable in any form, and it is the wrong step forward on how best to protect young women and girls." Crowley recently introduced legislation (HR 5137) to strengthen federal law by making it a crime to bring a girl overseas for circumcision. The AAP statement acknowledges that opponents, "including women from African countries, strongly oppose any compromise that would legitimize even the most minimal procedure."

Linky.

International human rights organization Equality Now is stunned by a new policy statement issued by the American Academy of Pediatrics (AAP), which essentially promotes female genital mutilation (FGM) and advocates for "federal and state laws [to] enable pediatricians to reach out to families by offering a 'ritual nick'," such as pricking or minor incisions of girls' clitorises. The Policy Statement "Ritual Genital Cutting of Female Minors", issued by the AAP on April 26, 2010, is a significant set-back to the Academy's own prior statements on the issue of FGM and is antithetical to decades of noteworthy advancement across Africa and around the world in combating this human rights violation against women and girls. It is ironic that the AAP issued its statement the very same day that Congressman Joseph Crowley (D-NY) and Congresswoman Mary Bono Mack (R-CA) announced the introduction of new bipartisan legislation, The Girls Protection Act (H.R. 5137), to close the loophole in the federal law prohibiting FGM by making it illegal to transport a minor girl living in the U.S. out of the country for the purpose of FGM.

...

FGM is a form of gender-based violence and discrimination that is performed on girls to control their sexuality in womanhood, guarantee their acceptance into a particular community, and safeguard their virginity until marriage. Taina Bien-Aime, Equality Now's Executive Director explains, "Encouraging pediatricians to perform FGM under the notion of 'cultural sensitivity' shows a shocking lack of understanding of a girl's fundamental right to bodily integrity and equality. The AAP should promote awareness-raising within FGM-practicing immigrant communities about the harms of the practice, instead of endorsing an internationally recognized human rights violation against girls and women."

Linky.

What I find particularly troubling is the slow adoption of attitudes toward female genital mutilation that still adhere to male genital mutilation. FGM in its severest forms is far, far worse. But MGM is an indefensible denial of core human integrity and autonomy - and yet its widespread acceptance has helped make "female genital cutting" more acceptable. If men or women wish to mutilate their own genitals as adults, that it their choice. But forcing this onto infants, male and female, even if it is just a cut or a nick, is a form of barbarism.

Linky

God damn.

(Begin MGM derail)

 

[SusanB-M1]

Just to say that I have read your post. I have tried several responses, but have failed to find the right words. I so admire the people who are working to try to stop this terrible practice.

 

[Ivor the Engineer]

On the positive side, at least the AAP have realised their own hypocrisy and are trying to address it.

The argument seems to be that because the parents of these girls would likely seriously physically harm them, it's better for the girls if a physician slightly harms them in a sanitary environment for their parent's pleasure and piece of mind.

 

[Aepervius]

Does this mean they will fight male genital mutilation too ?

 

[Ivor the Engineer]

Does this mean they will fight male genital mutilation too ?

No.

 

[Dancing David]

Does this mean they will fight male genital mutilation too ?

When it involves removal of the scrotum they will. Both parctices are bizzare cultural relics, one is more harmful than the other. They are both wrong.

The APA does not condemn it but they also do not endorse it:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/3/686

 

[pgwenthold]

When it involves removal of the scrotum they will.

You need to pay attention to the topic of the thread.

 

[Cainkane1]

If I were a judge and this happened in the USA I'd throw the cutter in prison for the rest of his ir her life.

 

[Myriad]

I don't think the suggestion is so outrageous.

It would be outrageous if FGM in far more extreme forms didn't already exist. In the context of existing demand for FGM, it appears extremely unlikely to increase the harm and reasonably likely to decrease it. Especially in conjunction with stronger laws (and stronger enforcement of same) against the real thing. The compromise is reasonable in a less than ideal world, where people sometimes break laws.

Barbaric practices end when (1) all the barbarians get killed, (2) the barbarian culture is destroyed e.g. by enslavement or religious conversion, (3) the practices evolve into less barbaric practices, sometimes step by step, sometimes via relatively peaceful cross-cultural influence. I approve of the latter approach over the first two. How quickly is the current approach of "awareness-raising within FGM-practicing immigrant communities about the harms of the practice" getting the job done?

Compare:

"Graffiti walls in public parks? Hell no, we want to discourage all forms of vandalism, not seem like we're encouraging it!"

"Needle exchanges? Hell no, we want to eliminate all illegal intravenous drug use, not make it easier!"

"Competitive team sports in schools? Hell no, we want to eliminate all activities in which adolescents engage in sacrificial tribal warfare, not make it an official part of the curriculum!"

As far as medical ethics is concerned, there is plenty of precedent for doctors doing harm (e.g. making incisions, sticking needles in people) when not doing the harm would very likely result in greater harm. I believe (I'll have to find sources if this is challenged) that some surgeons have been ethically willing to amputate healthy limbs of patients who have a disorder that makes them feel that the limb is alien and can't be lived with. They do this because the alternative is very likely the patient freezing or otherwise mutilating the limb, to then force an amputation under much less safe circumstances. (Or physically restraining the patient indefinitely to prevent it).

Poke a reluctant, screaming, traumatized girl's clitoris with a sterile lancet? I'm all for it, when the most likely alternative is the same girl getting mutilated permanently.

When all factors are considered, the AAP's suggestion may prove to be wrong, but it is not absurd.

Respectfully,
Myriad

 

[blutoski]

No.

And I think this is relevant to understanding the AAP's position.

Personally, I support it.

They are offering to safely perform genital modification that is strictly aesthetic, because it is probably going to be performed unsafely anyway, and at greater risk to the infant. The purpose is to decrease infants' suffering.

This is the same reason that most pediatricians are willing to do circumcisions.



Please see their actual policy statement (as opposed to polemics from its opponents): [Policy Statement Ritual Genital Cutting of Female Minors]

The poster quoted this:

FGM is a form of gender-based violence and discrimination that is performed on girls to control their sexuality in womanhood, guarantee their acceptance into a particular community, and safeguard their virginity until marriage.

Well, some types of genital mutilation do this. Most are intended to be aesthetic and only affect sexual performance if the procedure is botched and does unexpected damage.

The AAP has explained that their policy is limited to the latter type ("class 4"), and explain how they ultimately came to the conclusion that punishing members who are doing this type of procedure is on the whole inconsistent with the goal of reducing infant suffering in the USA. The nature of moral dilemmas is often that you can only reduce harm through real action, even if your ultimate wish is to eliminate harm through vague idealism.

Here are the contextually relevant passages from the AAP's policy statement itself:

The American Academy of Pediatrics opposes all types of female genital cutting that pose risks of physical or psychological harm, counsels its members not to
perform such procedures, recommends that its members actively
seek to dissuade families from carrying out harmful forms of FGC, and
urges its members to provide patients and their parents with compassionate
education about the harms of FGC while remaining sensitive to
the cultural and religious reasons that motivate parents to seek this
procedure for their daughters. (p1088)

and:

However, the ritual nick suggested by some pediatricians is not physically harmful and is much less extensive than routine newborn male genital cutting. There is reason to believe that offering such a compromise may build trust between hospitals and immigrant communities, save some girls from undergoing disfiguring and lifethreatening procedures in their native countries, and play a role in the eventual eradication of FGC. It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm. (p1092)

 

[Professor Yaffle]

It looks like a pragmatic attempt to reduce the incidence of more severe forms of FGM to me. I prefer pragmatism over black and white principled stances a lot of the time.

 

[pgwenthold]

They are offering to safely perform genital modification that is strictly aesthetic, because it is probably going to be performed unsafely anyway, and at greater risk to the infant. The purpose is to decrease infants' suffering.

This is the same reason that most pediatricians are willing to do circumcisions.

Wait a minute?

Are you suggesting that pediatricians think that if they don't do circumcisions on boys, then there is a good chance that people will do them themselves?

Seriously?

You really think that most parents who want to do a circumcision are so adamant on doing it that they would do it themselves if they had to? Most of the parents I have heard talk about it are completely non-committal, and "We didn't have a reason to, we just did it" is not uncommon. Yes, there are the occasional examples of that happening, but the vast majority of male circumcisions in the US are non-committal cultural procedures, not due to hardcore religious beliefs.

In contrast, the ONLY FGM demands are from hardcore religious zealots, the types that would "do it themselves" if it came to that.

 

[blutoski]

Wait a minute?

Are you suggesting that pediatricians think that if they don't do circumcisions on boys, then there is a good chance that people will do them themselves?

No, I'm saying that it was the reason that it is historically OK. Pediatricians have been doing this pretty much from day one.

In regions where MDs were prohibited, parents rarely did it themselves - they'd hire some hack with a scalpel.

In contrast, the ONLY FGM demands are from hardcore religious zealots, the types that would "do it themselves" if it came to that.

I don't think that's a good assessment of the population involved.

My impression is that this type of modification (aesthetic) is a largely secular cultural phenomenon.

The reason is that I observe it followed by some of my female friends from Africa regardless of their parents' religious convictions (including nonreligious). I grew up in North Vancouver, which has a huge population of East African (Uganda, Kenya) refugees who had to flee because they weren't religous zealots.

They have genital modifications, plus other aesthetic modifications such as piercings, tattoos, and patterned scarring.

 

[blutoski]

It looks like a pragmatic attempt to reduce the incidence of more severe forms of FGM to me. I prefer pragmatism over black and white principled stances a lot of the time.

Yeah, sometimes you just have to make the best of a bad situation.

Do what you can to minimize the damage.

 

[Dancing David]

You need to pay attention to the topic of the thread.

I was responding to the comments about MGM, removal of the scrotum is the biological equivalent of the removal of the labia minora.

 

[Dancing David]

It looks like a pragmatic attempt to reduce the incidence of more severe forms of FGM to me. I prefer pragmatism over black and white principled stances a lot of the time.

I agree.

 

[pgwenthold]

No, I'm saying that it was the reason that it is historically OK. Pediatricians have been doing this pretty much from day one.

Completely disagree. Pediatricians in the US historically have agreed to do it because it was considered good medical practice. It was even advocated by the AAP for a while as a means to prevent UTIs and stuff. That has ultimately been abandoned, but it was never recommended by the AAP because it was safer than doing it at home.

In regions where MDs were prohibited, parents rarely did it themselves - they'd hire some hack with a scalpel.

No, they'd hire the rabbi. They still do, to an extent.

I don't think that's a good assessment of the population involved.

My impression is that this type of modification (aesthetic) is a largely secular cultural phenomenon.

The reason is that I observe it followed by some of my female friends from Africa regardless of their parents' religious convictions (including nonreligious). I grew up in North Vancouver, which has a huge population of East African (Uganda, Kenya) refugees who had to flee because they weren't religous zealots.

They have genital modifications, plus other aesthetic modifications such as piercings, tattoos, and patterned scarring.

They do that on infants?

 

[blutoski]

No, they'd hire the rabbi. They still do, to an extent.

You probably mean a Mohel? Some are Rabbis, of course. Interesting enough, all the Mohels I know are pediatricians.

I think it's reasonable to assume that only Jewish parents would hire a Mohel.

The other 99% of parents who obtain circumcision for aesthetic cultural reasons are not Jewish, and I think it's fair to assume that the usual 10% of the population are not religious at all.

In any case, the point is that the objective is to participate positively, rather than risk increasing suffering.

They do that on infants?

Sure. The rationale is that infant amnesia reduces the trauma compared to doing it on, say, a child older than 2 years.

 

[pgwenthold]

You probably mean a Mohel? Some are Rabbis, of course. Interesting enough, all the Mohels I know are pediatricians.

I think it's reasonable to assume that only Jewish parents would hire a Mohel.

The other 99% of parents who obtain circumcision for aesthetic cultural reasons are not Jewish, and I think it's fair to assume that the usual 10% of the population are not religious at all.

Right

And for those people, they don't care enough about circumcision to the point where if the doctor says, "There's no reason to do it," they aren't going to go out and find someone in a back alley. It's no big deal to them, they only do it because that's the way things are done, or so they thought. If the doctor tells them, don't bother, they won't.

That's basically my point. 90% of the population doing male circumcision don't think about it in the first place, and 90% of those that do think about it aren't so committed to it that they will go out of their way to get it done. Maybe 1% of those who are doing it are so intent that they will go out and find someone to do it.

In contrast, the only ones who are doing FGM are majorly committed to the issue. You won't hear them saying, "Well, it doesn't matter either way, so we just went ahead and did it" (which IS a very common attitude for male circumcision)

 

[blutoski]

In contrast, the only ones who are doing FGM are majorly committed to the issue. You won't hear them saying, "Well, it doesn't matter either way, so we just went ahead and did it" (which IS a very common attitude for male circumcision)

Perhaps. I think this supports the AAP's reasoning.