Saturday, December 29, 2012

A Vagina is Not a Penis, But Mutilation is Always Mutilation


Those opposing female genital mutilation (FGM) often claim that male circumcision is a completely different thing, and many have no objection to it. To the extent that a vagina is not a penis, FGM and male circumcision are quite different. But they both involve mutilation. It is not the seriousness of the mutilation of a vagina that is objected to. If it was, some forms of FGM would certainly be more objectionable than male circumcision; but some forms would be a lot less objectionable.

FGM is opposed, and rightly so, because it is mutilation, and is generally carried out without consent. It also tends to be carried out in non-sterile conditions and can lead to very serious consequences in later life. But even if it were a mild operation (for example, the American Pediatric Society's 'nick') with no long term consequences whatsoever, carried out in clinical conditions by a trained surgeon, and with parental consent, most people would still object to it.

There have been calls in the UK to make 'home circumcision' (for males) illegal, following several infant deaths as a result of the operation being carried out by unqualified people in unsterile conditions. But why should serious injury or death be required before the legitimacy of male circumcision is questioned? By what reasoning is male circumcision an elective operation that parents can legally choose on behalf of their children, but female genital mutilation an outrage?

The American Academy of Pediatrics is often cited on the subject of infant male circumcision, but they do not suggest that parents should choose circumcision for their children. They say that "the health benefits of newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision" and that "the final decision should still be left to parents to make in the context of their religious, ethical and cultural beliefs". The academy was a bit hesitant about FGM for a while but they later expressed their opposition to all forms of mutilation, even forms that do no permanent damage.

I'm not sure what kind of ethical belief could lead one to choose circumcision for an infant. But why should religious and cultural beliefs be a reason for parents being allowed to choose an unnecessary operation for their children, one that leaves permanent damage? Surely your membership of that religion doesn't depend on your being circumcised as an infant, does it? Does it depend on the operation being carried out against ones will, or can one choose it later in life?

FGM sometimes involves removal of flesh, though it need not do so to be considered mutilation. Male circumcision always involves removal of flesh. Is it really possible that the former is mutilation and the latter is an elective operation just because of the differing gender? And what about the claim that infant male circumcision is 'easier', 'causes less pain', or is in any way preferable to adult circumcision? Is there any basis for the claim, or is it only made to justify the lack of consent involved in infant male circumcision? Would anyone make the same claim about FGM (which is not generally practiced on infants)?

My view of the right to bodily integrity is that it applies equally to males and females, infants and adults, and to people of all religions and cultural groups. FGM constitutes a denial of the right to bodily integrity and ignores the principle of informed consent, but so does male circumcision (excepting cases where there is a medical need). A tolerant society would allow people their religious beliefs, but it would at the same time protect all people from injury. Nobody is being denied their "right to freedom of thought, conscience and religion" as a result of the right of all, male and female, to be protected from bodily harm.

[For more about non-sexual HIV transmission and mass male circumcision, see the Don't Get Stuck With HIV site.]

allvoices

9 comments:

Joseph said...

Thank you for using your blog to address this. Something needs to be done to break people's ignorance on the matter.

The fact of the matter is that all of the alibis and excuses that we use for male circumcision could not ever be used to justify female circumcision.

Saying "female circumcision is worse" is a gross generalization, this ignores the fact that there are actually quite a few kinds of female circumcision, not all of which remove the labia and/or clitoris.

Thank you for bringing up the AAP's "ritual nick." The fact that this endorsement was quickly retracted after a world outcry shows that no one would support the genital cutting of females to any degree.

Notice in your speaking out against this that people bring up the "briefness" and "painlessness" of the procedure, as if this would legitimize female circumcision.

Ask your readers, "Would you be more supportive of FGM, if it could be done in a quick, painless manor? What if it were done at a young age?"

(Simon, are you aware that baby girls are circumcised in South East Asia? Google "sunat your girls" if you don't believe me.)

"What if "research shows" that female circumcision could reduce HIV?" (You ARE aware of Stallings, right?)

Ask them, "Is there a number of benefits that would convince you to circumcise your daughters?"

Dig, and you will quickly find out this is not about "medicine" at all.

Correct me if I'm wrong, but aren't there UN rules and regulations that forbid researchers from trying to medicalize female circumcision in any way?

If I understand correctly, the UN will not tolerate "research" that tries to put female genital cutting in any kind of positive light.

Oh but they have wholly embraced the latest HIV/circumcision trash from Africa, endorsing the wholesale circumcision of African males, young and old.

Is this me, or does the UN have a sexist, two-track system for males and females?

dreamer said...

This is really great. A lot of people are horrified by a (distorted) idea of what's FGM, and are supportive of a (distorted) idea of what's male circumcision.

And yet labiaplasty and hood reduction, two processes under the umbrella of female circumcision, are marketed in the U.S. as sexual enhancement (for adults, obviously) and people don't realize they are speaking of the same procedure.

The issue is consent. Who can provide it and who can't. Who is allowed to refuse and who isn't.

Simon said...

Thank you for your comments. In Kenya it was decided that because HIV prevalence was high among the Luo tribe of Nyanza, this must be because they are generally not circumcised. However, HIV prevalence is very low among the ethnic Somalis of Kenya and it was never claimed that this could be because all the women are genitally mutilated. The Luo don't circumcise women.

Similar apparent correlations can be found in other tribes between female genital mutilation and lower HIV prevalence. But no one would ever suggest that women should be mutilated to reduce HIV transmission (although they do make other arguments for FGM, such as aesthetics, hygiene, custom, etc).

Similarly, access to education and health services are lowest among the Somalis, intergenerational marriage prevalence is highest, gender equality is lowest, poverty rates are highest, etc. But no one would suggest that access to health and education should be reduced, etc, just to reduce HIV transmission.

If it's not the level of harm that makes FGM mutilation, why would anyone compare levels of harm for male and female genital mutilation?

AAP, WHO and the like do not believe in consensus, they believe in issuing edicts and referring to 'experts'. But you don't need to be an expert to see that cutting off a piece of healthy flesh is wrong, that doing it without consent is wrong, that it can wait, etc.

I haven't spent so much time with Asia but I will take a look. However, my main interest is how HIV is used to distort the whole of development. FGM may result in increased sexual transmission of HIV. But if the 'experts' of UNAIDS and other institutions can't see that male circumcision could also result in increased non-sexual transmission, just like FGM, what could bring this to their attention? How could a skin piercing procedure involve a risk of bloodborne HIV transmission to a woman and not to a man?

Not just Stallings, also take a look at Brewer et al:

http://www.icgi.org/Downloads/IAS/Brewer.pdf

I don't know about the UN's rules and regulations on what kind of medical research can and can not be carried out but would be interested to see them.

Joseph said...

Some medical professionals, nongovernmental organizations, government officials and others consider medicalization as a harm-reduction strategy and support the notion that when the procedure is performed by a trained health professional, some of the immediate risks may be reduced (Shell-Duncan,
2001; Christoffersen-Deb, 2005). However, even when carried out by trained professionals, the procedure is not necessarily less severe, or conditions sanitary. Moreover, there is no evidence that medicalization reduces the documented obstetric or other long-term complications associated with female
genital mutilation. Some have argued that medicalization is a useful or necessary first step towards total
abandonment, but there is no documented evidence to support this.

There are serious risks associated with medicalization of female genital mutilation. Its performance by
medical personnel may wrongly legitimize the practice as medically sound or beneficial for girls and
women’s health. It can also further institutionalize the procedure as medical personnel often hold power,
authority, and respect in society (Budiharsana, 2004).

Medical licensing authorities and professional associations have joined the United Nations organizations
in condemning actions to medicalize female genital mutilation. The International Federation of Gynecology and Obstetrics (FIGO) passed a resolution in 1994 at its General Assembly opposing the performance of female genital mutilation by obstetricians and gynaecologists, including a recommendation to
“oppose any attempt to medicalize the procedure or to allow its performance, under any circumstances,
in health establishments or by health professionals” (International Federation of Gynecology and Obstetrics, 1994).

http://www.un.org/womenwatch/daw/csw/csw52/statements_missions/Interagency_Statement_on_Eliminating_FGM.pdf

Joseph said...

Here's an interesting paper. Some of the points may be important for us as well.



http://csde.washington.edu/fogarty/casestudies/shellduncanmaterials/day%203/Shell-Duncan%20Medicalization.pdf

Simon said...

Hi Joseph, thank you for these materials. My understanding is that harm reduction is not the issue, that FGM is wrong regardless of the level of harm. Which is why the AAP's proposed 'nick' is not acceptable to those who oppose FGM.

Not that I would oppose all forms of harm reduction. But I oppose FGM and male circumcision because both deny the right to bodily integrity. The fact that male circumcision is seen to have some possible public health benefit does not justify a mandate to routinely circumcise infants. It would be a different matter if the operation were to be made available for male adults.

Harm reduction for adult intravenous drug users or sex workers does not attract the same objections; some harm reduction measures really do reduce harm. But with FGM and male circumcision, the operation itself, especially when carried out on an infant or minor, is harm. The level of harm involved in carrying out the operation, under any conditions and involving any form of mutilation, is not what I would object to.

The inappropriateness of a harm reduction approach to FGM is agreed to by many already. The problem is that it is not agreed to by many in relation to male circumcision. Many of those objecting to male circumcision list levels of damage and harm among their objections; I do not. The facts that it is an denial of the right to bodily integrity and that it is carried out without consent are enough.

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Joseph said...

May be of interest to the discussion:

Sauce for the goose is sauce for the gander.

"One of the hazards for science is when politically correct results are uncritically welcomed, readily published and repeatedly cited; while politically embarrassing results are ignored or marginalized. Perhaps nowhere is this more obvious than in the study of “female genital mutilation,” where the roles of researchers and political activists often seem to be confused." - To trained exercisers of critical thought, the same is also true of male circumcision.

"We suggest that this silence has to do with prevalent Western ideology concerning 'female genital mutilation' and ongoing political projects. Activists, governmental bodies, funders and even editors of medical journals systematically welcome research results that can be used in preventive work while muting or hesitating to publish results that go against the grain of mainstream thinking regarding this issue. This blurring of the distinction between science and activism is so endemic that researchers often present their 'hard facts' with explicit reference to their political agenda..." (Male circumcision "research" is always coupled with "and so this is why all males need to be circumcised immediately.")

http://tierneylab.blogs.nytimes.com/2008/02/23/the-hazards-of-politically-correct-research/

Simon said...

Thanks Joseph, I just wonder if there needs to be 'scientific research' showing the harm that female genital mutilation (and male circumcision) can do in order to support the conclusion that FEM (and male circumcision) is wrong; for example, because it denies the right to bodily integrity?

Even if FGM and the male equivalents do not do any harm, for me they still deny the right to bodily integrity, and any claimed benefit, even if is thoroughly supported by evidence, can not be used to justify the operation. Your points and those of the author you link to are valid, but they do not lead me to conclude that FGM and male circumcision are wrong; the remaining questions can not be decided by collecting more scientific evidence.

Is there a right to bodily integrity that can not be overridden by possible minor health benefits and the like? If there is such a right, FGM and male circumcision can not be allowed unless there is some immediate health benefit that can not be achieved in any other way. If there is no such right, then my objection to FGM also fails and there is no reason for not carrying out research into the benefits of FGM for reducing HIV transmission, for example. Unless there is no right to bodily integrity, these many arguments based on scientific (and pseudo-scientific) grounds are of little relevance.

I oppose those who would deny the right to bodily integrity, whether it is the right of males or females to bodily integrity. This is not a question about science but rather one about rights.