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Female Genital Mutilation “Endorsed” by American Academy of Pediatrics

Posted by xJane on May 7th, 2010 at 10:49 am · 32 Comments

[Disclaimer: I am an outspoken critic of all forms of genital mutilation (male circumcision, body modification, gender assignment, &c.) unless voluntary, which, in my mind, is predicated upon the mutilatee being an adult at the time of the mutilation.]

Female genital mutilation (“FGM”) is one of the most horrendous forms of enforced female submission. It is practiced in certain cultures on female children girls; often on infants. , all of which should cause your stomach to turn: clitorectomy (yes, that’s complete or partial removal of the clitoris), removal of the clitoral hood (which is “likened” to male circumcision), removal of the labia, and the sewing shut of the external vaginal opening, either with or without prior removal of the labia.

It is done for “cultural or religious reasons” and to ensure that women do not experience pleasure during sex (specifically sex with men they’re not supposed to be having sex with, but if it happens that sex with the legal husband is also unpleasant, well she’s just a woman). In many cases, it also increases pain and complications resulting from childbirth. It is often done by family members or midwifes without anesthesia or sharp tools (this is a consequence, in some areas, of the fact that it is illegal, so professional circumcisers are rare or in hiding). It continues in many areas where it is illegal because there continues to be social cache to having a wife (or daughter, which means potential wife for someone else) who has been mutilated. Otherwise loving parents who perform or seek to have this mutilation performed upon their children are doing it for those reasons. Because of the primitive ways in which it is often performed, it often results in serious consequences (I mean outside the intended consequences), including inability to have children and death.

This barbarism (I refuse to call it a “practice”) has been illegal in the United States since 1996 (which makes me wonder what took us so long), but the American Academy of Pediatrics has recently decided that girls do not suffer enough in our society and has obligingly decided to start performing “a ritual nick” to a child’s genitals “to satisfy cultural requirements”. Which makes me wonder if law enforcement should practice “a ritual beating” “to satisfy cultural requirements” where otherwise a family might carry out an honor killing instead. Yes, it’s not quite as bad, but it’s still perpetuating violence, specifically violence against women, specifically domestic violence against women.

I cannot believe that the AAP is being complicit in the ongoing subjugation of women by mutilating defenseless children—oh, but only at the request of their parents. Do they think this will make home-mutilation more rare? Is “a ritual nick” going to satisfy the parents who think their daughters vagina should be sewn shut? Or are pediatricians going to be pressured into using their sterile equipment to perform more “satisf[actory] cultural” procedures: “You’ll do a ritual nick, but you won’t cut the whole thing off? Why draw that arbitrary line? If you don’t, I’ll just do it at home with a kitchen knife.”

We need to change the culture of violence against women, not pander to it. We no longer abide by the (likely apocryphal) “rule of thumb“—that a woman can be beaten by her husband so long as the rod used is no larger around than his thumb—because that’s barbaric. We do not allow families to murder their daughters because they want a divorce—because that’s barbaric. We used to not allow families to mutilate their own children without reprisals, but now we’re going to sanction it—as long as it’s done by a medical professional. This is a step in the wrong direction.

Take Action

Please write to the American Academy of Pediatrics asking it to retract the portions of the AAP Statement that in effect promote changes in US federal and state laws to enable physicians to “nick” girls’ genitalia. Urge the Academy to abide by the principles of gender equality in its practice and to recognize that human rights are universal and indivisible. TAKE ACTION!

Letters should go to:

Errol R. Alden, M.D. FAAP
Executive Director/CEO, American Academy of Pediatrics
141 Northwest Point Blvd
Elk Grove Village, IL 60007-1019
Phone: +1 847 434 7500
Fax: +1 847 434 8385
Email: ealden@aap.org

Please send copies of your letters to the American Board of Medical Specialties and the American Board of Pediatrics at the addresses listed below:

Kevin B. Weiss, M.D., MPH
President and CEO, American Board of Medical Specialties
222 North LaSalle Street
Chicago, IL 60601
Phone: +1 312 436 2600
Fax: +1 312 436 2700
Email: kweiss@abms.org

Alan R. Cohen, M.D.
Chair, The American Board of Pediatrics
111 Silver Cedar Court
Chapel Hill, NC 27514
Phone: +1 919 929 0461
Fax: +1 919 913 2070
Email: abpeds@abpeds.org

Please also ask your own doctor to take action on this issue.

Sample letter

The above was copied and pasted from Equality Now’s Action Alert about this issue.

via Feministing.

Tags: Uncategorized

32 responses so far ↓

  • 1 Meryl // May 7, 2010 at 11:55 am

    Not disagreeing with you at all about the horrors of genital mutilation, but I thought this ruling was aimed at assuaging families so they didn’t look for ways to get their girls properly mutilated either back home or illegally in this country. If I were a doctor and I knew the family was very set on having it done, I might want the option to administer a pinprick in a safe environment…

  • 2 xJane // May 7, 2010 at 12:21 pm

    But will that make a difference? If a family were intent on genitally mutilating their boy (which is legal and socially acceptable here), do you think a “nick” would be sufficient or a “pinprick”? Or would the family demand the entire foreskin? This is a futile attempt at appeasement and only encourages genital mutilation of children in a supposedly civilized country. But then, we’re only starting to disallow parents from withholding medical treatment from their children for religious or cultural reasons. Maybe we’re not so civilized.

  • 3 G // May 7, 2010 at 12:27 pm

    thank you for the list of addresses xjane.

  • 4 Meryl // May 7, 2010 at 12:57 pm

    I’ve not totally decided where I stand on this ruling, but I do think that immigrants typically look for some level of compromise between their former and new cultures. A doctor, as an authority figure associated with good health, might have the power to persuade a family to accept a more symbolic interpretation of the practice. This is especially possible if the extent of the mutilation varies within a culture anyway, and my impression is that this is true.

    I can imagine this ruling providing a safe space for genital mutilation to fade out as immigrants adapt more fully to their new home.

  • 5 Molly // May 7, 2010 at 1:41 pm

    Your comment on law enforcement performing a ritual beating in place of an honour killing was the *first* comparison that sprang to my mind when I heard about this.

    To those who argue that this is a lesser evil and a reasonable accommodation, I say it is a violation of a physician’s solemn oath to Do No Harm. No physician who has taken the Hippocratic Oath could in good conscience perform an unnecessary and harmful procedure on a patient, and any doctor who does should lose their license and go to jail — along with the parents.

  • 6 Craig // May 7, 2010 at 1:47 pm

    I am disgusted, horrified, furious, and aghast at this.

    And while I too oppose circumcision of male infants, children, and anyone not able to give consent, male circumcision is totally in a completely different category from female genital mutilation.

    The AAP has now given credence to the entire idea of genital mutilation as an acceptable cultural practise. By allowing even a ritual nick of the genitals, they’re saying that it’s ok to physically harm children as long as it’s just a little bit.

    @Meryl

    While I understand where you’re coming from, I vehemently disagree. None of the reasons for female genital mutilation could possibly be satisfied by a “ritual nick”. As xJane already pointed out, is a Jewish family going to be satisfied with a pinprick of the foreskin, as satisfying the religious practise of circumcision? Hardly. Do we allow people to splash just a little bit of acid on the face of a woman who refuses to wear a face-covering? Do we allow honour beatings to replace honour killings? Do we bind the feet, just a little bit?

    Symbolic interpretation of violence is still violence. I’m all for multiculturalism and diversity, but not when human rights are infringed upon, especially when it is a child’s human rights, I draw the line. Some cultural practises are just not acceptable, and if that makes me ethnocentric, then so be it.

    This is one of those few either/or situations. It is evil and wrong to mutilate a child, and no reasoning is ever justified.

  • 7 Craig // May 7, 2010 at 1:48 pm

    @Molly

    I too thought this is a clear violation of Do No Harm.

  • 8 Meryl // May 7, 2010 at 2:52 pm

    Good point about the Hippocratic oath.

    I’m fairly puzzled by you guys’ views on what constitutes mutilation. Are we including ear piercing? The cutting of the umbilical cord? I’m pushing because I get the feeling you haven’t thought through where your line is, and I suspect that your issue with the pinprick is more symbolic than actually considering it mutilation.

  • 9 xJane // May 7, 2010 at 2:58 pm

    I’m pretty certain that umbilical cord cutting is required for the health and well being of both mother and child (don’t animals chew through it?). And not “required for the health and well being” in the way that male circumcision is. I am willing to reconsider my position on this if given evidence to the contrary.

    Ear piercing? Absolutely! There is no reason to subject a child to unnecessary pain. Voluntary piercing, tattooing, mutilation, and surgery I’m fine with. Infants cannot act voluntarily to agree to these procedures.

  • 10 Craig // May 7, 2010 at 3:08 pm

    Clearly cutting the umbilical cord is both medically necessary and not harmful. Clearly.

    While I never claimed that a pinprick of the genitals is actual mutilation (nor, I think, did anyone else), I’m not at all convinced that poking the genitals with some sort of needle is the only kind of thing which would fit under “ritual nick”, and I do think that even a slight mutilation could be something which would fit in that description.

    Either way, the point is, it is wrong because it is unnecessary, harmful, unconcenting, and gives credence to the whole idea of genital mutilation.

    No child’s genitals should ever be cut into, pricked or nicked, for any non-medical reason. Cultural/religious rituals and superstitions which in any way harm someone or infringe on human rights should and need to be opposed and abolished, regardless of what they are, who holds them, and how strongly or widely they’re believed/practised.

    I don’t think you should say that we’ve not thought through our arguments. That sort of statement assumes a lot about us that you have no way of knowing.

    And yes, I do also oppose the piercing of children’s ears, as well as all other non-medically necessitated body modifications – because it’s non-consensual.

  • 11 ThankGodI'mAnAetheist // May 7, 2010 at 6:11 pm

    It is very hard to draw a line between respect peoples religious and cultural beliefs by allowing them to freely decide what is right for their own children and governing to protect the rights of children.
    A lot of good arguments here about where the line shold be drawn. I’m not American, so it doesn’t directly affect me yet, but I think you can regulate all ou like, there will always be cowboys prepared to do anything for the right price.
    I think rather than condoning female genital mutilation, it provides an option for Drs where it could mean the difference between a dirty, dangerous mutliation and a relatively risk-free, consequence free ‘ritual nick’. A Dr is only human and has to think about the repurcussions a decision to refuse a ‘ritual nick’ might have ie death of an innocent child.
    That said, I think the ‘ritual nick’ does perpetuate a culture of abuse toward women, and am not thrilled about that (I am a mother of two young girls) and if we could believe no-one would ever peform a female circumcision/mutilation/ritual nick just because it was against the law the decision would be simple. But it’s not.

  • 12 John // May 7, 2010 at 6:57 pm

    I share xJane’s outrage towards the practice of FGM, but as someone who’s studied attempts to eradicate the cultural practice from African regions, I can tell you that the idealistic, principled stand (esp. by white westerners) has done less to reduce the practice than on the ground pragmatic steps taken by people who understand the cultural complexities of the situation. In fact, a principled stand spurred by Western Christians in Kenya actually led to the increase of FGC as a cultural practice as an anti-West reaction. By way of contrast, when local imams issue fatwas condemning the practice, and when mothers work hard in their villages to change the prevailing cultural value that declares a woman with a clitoris unfit for marriage, then you see results. I’m very cynical about the value of general moral outrage without corresponding practical steps taken to reduce the practice.

    I would like to ask this hypothetical question of those of you taking the strong principled stand against the “nick”–if this demonstrably reduced the number of girls who grew up actually mutilated, versus a strong, principled stance which removed complicity by the AAP, but resulted in a wider gap between these populations and American pediatricians and in more girls growing up with a mutilated clitoris (or dying from infection), which would you prefer?

    The more that I think of it, while I do agree that this is a symbol of violence towards women, I don’t equate the ritual nick with full removal of the clitoris, any more than the archaic tradition a father giving away his daughter in a wedding (a tradition I abhor) equates to his daughter actually being his property. If this strange tradition were to move women from real slavery to a much vaguer symbolic one, I would favor the latter. Of course, the issue is way more complex that this, but I think these differences are salient, and that we should allow our outrage to equate the two.

    Those are my few cents. Yes, I’m outraged by the practice. I have mixed feelings about what the AAP is trying to do. But tonight, instead of writing the addresses you listed above, I’m actually going to send a donation to Tostan. They’ve probably saved more girls from FGC than any other group or intiative. I recommend that you all read the page I’ve linked here, about how they go about doing this.

  • 13 John // May 7, 2010 at 6:58 pm

    One more thought: I’m not sure this is a *clear* violation of the Hippocratic oath if the doctors feel they may be saving the girl from greater harm by performing this.

  • 14 ThankGodI'mAnAetheist // May 7, 2010 at 7:02 pm

    I agree- if doctors wee to take the oath to “Do no harm” so literally they cold not perform surgery, even though knowing not doing so would be fatal (imagine burst appendix)

  • 15 xJane // May 7, 2010 at 7:48 pm

    I guess I don’t see this as any kind of lesser evil but as a perpetuation of evil. In the countries where it’s socially acceptable to mutilate children (in fact, where it’s socially required), yes—more good can be done by convincing people this is an incorrect stance than by outlawing the practice. If the Egyptian Academy of Pediatrics had come to this decision, I might see it as progress.

    But this is a step in the wrong direction toward appeasement of people who want to be able to mutilate their children here. And I do not see why we need to appease them. This will do more to normalize infant genital mutilation (and all the misogyny that goes hand in hand with that) in the United States than it will to convince people living in the United States who want to mutilate their children that they should only mutilate them a little bit.

    I also see a gulf of difference between harming someone using surgery to ultimately save their life (or even just make it better) and mutilating their genitals a little bit because we don’t trust their parents not to mutilate them even more.

  • 16 ThankGodI'mAnAetheist // May 7, 2010 at 8:03 pm

    so forget the appendectomy, what about breast augmentation?

    I just don’t see how portraying a dr willing to peform a ‘ritual nick’ as the bad guy helps the situation at all

  • 17 xJane // May 7, 2010 at 8:41 pm

    Breast augmentation is an elective surgery. I have no problem with any adult doing whatever they want to their bodies—including genital mutilation. What distresses me is the mutilation of children by parents and doctors—the very people who should be protecting them.

  • 18 Craig // May 7, 2010 at 9:35 pm

    I agree with xJane here. This is a step towards, not away from, genital mutilation of children.

    @John

    I get that some doctors might think they’re preventing harm by allowing this procedure, but I don’t think we should be condoning medical procedures based on whether someone *thinks* it is keeping someone from harm.

    There needs to be demonstrable clear-cut “greater-harm” for me to condone “lesser-harm”. In this case, if the doctor does nothing, no harm will inevitably directly result. A doctor cannot be making medical decisions based on how a third party might act, in the future.

    Basically I feel that what is being condoned here is blackmail or extortion. A doctor is being told, “Unless you cut into/nick/prick this girl’s clitoris and/or clitoral hood and/or labia, we’re going to do even more damage to her.”

    Should we also say that a doctor can drop a tiny bit of acid on a disobedient girl’s face to satisfy the cultural demands – doing far less harm and pain than if say her face were doused and disfigured. Is a tiny, bitty scar justifiable?

    That’s what it comes back to for me. It just seems inherently wrong to give even the slightest, tiniest bit of credence to such horrific, brutal, misogynistic practises.

    Or seen another way, do we say that as a compromise, gays can have civil unions but not marriage? Do we give even the slightest credence or nod to religious/cultural bigotry in order to bring about the “greater good”?

    Is even the least bit of misogyny ok? Homophobia? Racism? Do the ends justify the means?

    I’m writing these as rhetorical questions, but they are applicable. I see a very strong parallel between these situations and the AAP allowing this practise.

    Certainly the goal of this is very laudable and desirable, but the means make me very uncomfortable. As much as I loath black & white thinking, I can’t help but feel that this is such a situation where wrong is just plain wrong (to me).

  • 19 Elaine // May 9, 2010 at 1:19 am

    Yeah. This move by the AAP makes me really uncomfortable. Yes, they might think they’re doing a lesser harm. Yes, their intentions might be noble. But it also weakens the stand that the act of female genital mutilation, which is illegal in the United States, is just plain wrong.

    Which statement, I suppose shows that I’m not a very good anthropologist, since there are things that I am not willing to give a pass just because they are “cultural”. You don’t cut a girl’s clitoris off. You don’t force a widow onto her husband’s funeral pyre, which is illegal now in India, but still happens sometimes. You don’t try to gas a whole school for girls, or burn it down, because you don’t believe women should be educated. The Taliban has done or tried to do this on a number of occasions. You don’t kill a daughter because she’s been raped and that dishonors your family. I think it’s interesting that I’ve never heard of anyone killing a son because he dishonored his family by raping someone. It might go on, but I doubt it.

    Now, having said all this…when the subject is FGM in other countries, I have to echo something John wrote. I worked for a time with a young woman who came from a nation in Africa where FGM is practiced. She said that while the women in her country appreciate that we care here about the issue of FGM, they generally wish that we would keep out of it, that they are doing there all that possibly can be done to stop that practice and our injection into the debate does not help, and sometimes hurts their cause.

    But…when the subject is the practice of even symbolic FGM here in the States, I think it is completely legitimate to stand up to the AAP with a great big, “Oh, no you don’t.”

    I hope this all makes some kind of sense, considering that it’s nearly 2:30 a.m. and I’m only still up because I was working on some writing for an organization I belong to that is due in the next day or two.

    Elaine

  • 20 Sunday in Outer Blogness: Happy Mothers’ Day Edition! | Main Street Plaza // May 9, 2010 at 7:27 am

    [...] — as an answer to the cultural practice of female genital mutilation. Folks didn’t mince words when explaining what’s wrong with that. Holly has discovered some interesting [...]

  • 21 John White // May 9, 2010 at 4:00 pm

    ThankGodI’mAnAetheist:
    > so forget the appendectomy, what about breast augmentation?

    I’m against breast augmentation for infant girls too.

  • 22 ThankGodI'mAnAetheist // May 9, 2010 at 5:38 pm

    OK. The breast augmentation comment was just in response to claims that a Dr performing surgery is against the hippocratic oath. That’s all. Saying a Dr performing a ritual nick is against the hippocratic oath is ridiculous. Sometimes you have to see the bigger picture- like, how will not doing it affect the patients mental and emotional health? I think people who are not i the situation directly are quick to draw a line, that’s all. In life there is grey area, which is what this is all about.

  • 23 Craig // May 9, 2010 at 5:53 pm

    I agree that life is a grey area in as much as right/wrong always depends on the situation. Morality/ethics are relative.

    What some of us are arguing is that in the US, the AAP has made a mistake. I can conceive of myself supporting or at least acquiescing to a temporary similar “ritual nick” policy in Ethopia or Somalia or a place where it is an ingrained cultural practise and is a clear step away from massive harm to women and girls with the end result of ending even the “ritual nick” as soon as possible.

    But this is not the case in the US where not only is the “ritual nick” illegal, but female genital mutilation isn’t a cultural practise, and there is evidence that in secular, western countries making the practise completely illegal and having harsh penalties for parents who allow the mutilation is extremely effective in getting immigrants to abandon the practise.

    I think we all here see the “bigger picture” and are all very concerned about preventing as much harm as possible.

    And yes, I do indeed think that in the US, Canada, Europe a doctor would be in breach of medical ethics to perform “ritual nicks”. I’m not arguing it’s morally bad, always, in every place, forever. Rather in the situation the AAP is advocating, I find it a breach of the Hippocratic oath because it does harm and perpetuates a supremely misogynistic practise and mindset.

  • 24 ThankGodI'mAnAetheist // May 9, 2010 at 6:54 pm

    Fair enough.

    I think I’m just of the mindset that if this new ‘rule’ will prevent even one baby girl from a backyard mutilation, then it has merit.

    But I don’t live in America and I’m not a Doctor.

    Also, why is it still ok to circumcise little boys? I have 3 friends as far as I know that have had their baby boys (a total of 7) circumcised, not because of religious views, but purely and simply “So they look like their Daddy”. This to me is disgusting and child abuse. It my not perpetuate a culture of women being the inferior sex BUT when will it stop???

  • 25 Craig // May 9, 2010 at 7:26 pm

    Also, why is it still ok to circumcise little boys?

    I don’t believe it is.

    I guess it’s more socially accepted because of the misinformation surrounding the practise, and because it’s far less harmful than FGM. I’m guessing it’ll be a while before it dies out in the US.

    I’m curious as to where you live.

  • 26 ThankGodI'mAnAetheist // May 9, 2010 at 8:07 pm

    I am Australian. And before I had my children years ago, I was (somewhat naively) under the impression that the practice of male circumcision was almost obsolete, limited to only those with strong religious convictions.
    But my friends that I talk about have no such convictions and are not under the impression that its more hygienic or anything- none of the old misconceptions. They simply put their infant boys through it so they match their Daddy’s??? Do fathers and sons spend a lot of time comparing penises???
    I have an american friend (yes she had her 3 sons all circmcised at only a few days old) who found it incredulous that it was difficult to to find a Dr who would do it before the age of 6 weeks, yet looked at me in disgust when I dared breastfeed my infant daughter in public!!!
    I didn’t realise the world was still so backward.

    On Female Genital Mutilation, the world is changing, and probably too slowly, but frwards is forwards. I definately do not condone the ritual nick by the way, but I do condone options!

  • 27 ThankGodI'mAnAetheist // May 9, 2010 at 8:08 pm

    *I had my children only 6 years agoapologies for ommission

  • 28 Craig // May 9, 2010 at 8:27 pm

    It’s a practise that is unfortunately still quite common in the US. I’m from Canada where it’s less common, but still more common than in most of Europe.

    According to wikipedia, in the US and Australia the rate of circumcised males is about 60% (the younger, the lower the rate), in Canada 30%.

  • 29 xJane // May 14, 2010 at 12:05 pm

    The title says it all: “We’ll just mutilate baby girls a little bit, to make the misogynist patriarchal assholes happy.” at Feminist Law Profs.

  • 30 Craig // May 27, 2010 at 9:18 pm

    The AAP has just rescinded their policy! (Due, I’m certain, mainly to the outrage they rightfully garnered.)

    Yay!

  • 31 xJane // May 30, 2010 at 7:55 pm

    YAY!

    …although, did they really need the outrage to realize that they needed to rescind their policy?

  • 32 Mack // May 31, 2010 at 3:57 pm

    I understand supressing an imagrent’s culture being a tuchy subject. But they chose to move HERE. They went through all the crap of imagration to become americans, but they don’t want to go by our rules? In Muslum countries our women have to cover their hair or risk jail or worse. Why do they expect to be able to continue a custom we have deemed inapropreate? I’m sorry this sounds anti imagration but when it comes to children I have a “you hurt them, we kill you” adatude. I have a son and was pro cercomsision (thinking he would be imbarised in the locker room if he looked funny.) but then I saw an artical about the screams of pain that made a nurse drop out of medical school. I couldn’t do that to him. The baby’s mother was, most likely, also mutalated. For not just the father who may not fully understand, but the MOTHER to be willing to do this to their baby girls they must feel very stroungly about it. If you give a mouse a cookie, in this situation, he’ll take her whole clitoris.

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