Thursday, May 27, 2010

Female Genital Cutting (FGC) And The American Academy of Pediatrics

Some time ago the American Academy of Pediatrics made a policy statement which suggested that families who want their daughter's genitals cut should be offered a safe ritual alternative in the United States:

Some physicians, including pediatricians who work closely with immigrant populations in which FGC is the norm, have voiced concern about the adverse effects of criminalization of the practice on educational efforts.32 These physicians emphasize the significance of a ceremonial ritual in the initiation of the girl or adolescent as a community member and advocate only pricking or incising the clitoral skin as sufficient to satisfy cultural requirements. This is no more of an alteration than ear piercing. A legitimate concern is that parents who are denied the cooperation of a physician will send their girls back to their home country for a much more severe and dangerous procedure or use the services of a non–medically trained person in North America.33,34

The American Academy of Pediatrics policy statement on newborn male circumcision expresses respect for parental decision-making and acknowledges the legitimacy of including cultural, religious, and ethnic traditions when making the choice of whether to surgically alter a male infant's genitals. Of course, parental decision-making is not without limits, and pediatricians must always resist decisions that are likely to cause harm to children. Most forms of FGC are decidedly harmful, and pediatricians should decline to perform them, even in the absence of any legal constraints. 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 life-threatening 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.

To summarize the quote, a ritual pinprick of the girl's genitals might satisfy the parents without doing any real harm to the child.

Now the American Association of Pediatrics has done an 180-degree turn from this:

The policy statement ignited a storm of criticism from opponents of female genital cutting. Dr. Judith S. Palfrey, president of the academy, said: "We're saying don't do it. Do everything that you can to support that family in this tough time, but don't be pulled into the procedure."

I followed some of the debates on the initial policy statement, but never wrote about it here because I didn't have enough facts.

To see what is needed, go back to the above link and look at the three pictures showing the three different types of FGC. The third one, in particular, has severe health consequences for the woman. These include the need to have her re-cut and re-sewn after every vaginal delivery.

Which of the three types would a family want to have performed on their daughter? If it is the third type, a ritual pinprick will NOT be viewed as an acceptable alternative, and I suspect that it wouldn't serve for the second one, either. But I may be wrong.

Ultimately what one would need to know is the deepest reason for why a girl or a woman would be subjected to FGC. Is it just to do with traditions? Then go with the ritual pinprick. Is it about making a woman into a "good woman", one less likely to take lovers once she is married, by reducing her ability to feel in the genital area? If that is the explanation, a pinprick will do nothing. Or is it about making her vaginal channel narrower, for the sake of the enjoyment of her future husband while also numbing her nerve endings in that area (this would be the third type of FGC) to guarantee fidelity? Once again, a pinprick would not suffice.

I don't know these reasons, but a Sudanese friend I had in college told me that his parents had had his sister cut because without it a woman was regarded "loose" and not someone good men would want to marry.