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Friday, May 7, 2010

American Academy of Pediatrics Endorses a Kinder, Gentler Form of Female Genital Mutilation

Posted by on Fri, May 7, 2010 at 3:29 PM

This week the American Academy of Pediatrics softened its decade-plus stance on female genital mutilation as being a human rights violation that results in "life threatening health risks" for girls and women.

The AAP is calling female genital mutilation cutting a "tradition that has existed since antiquity" and only has issue with "all types of female genital cutting that pose risks of physical or psychological harm" to females*. Instead of opposing all forms of female genital mutilation, the organization now recommends that its members "decline to perform any medically unnecessary procedure that alters the genitalia of female infants, girls, and adolescents."

But the WHO and the International Federation of Gynecology and Obstetrics have for years denounced FGM as a "medically unnecessary" procedure that has no health benefits for girls or women.

In 1997, the U.S. Department of Health and Human Services estimated that over 168,000 girls and women living in the U.S. had been or were at risk of being subjected to FGM. Meanwhile, new bipartisan legislation—The Girls Protection Act—introduced last week would make it illegal to transport a minor living in the U.S. out of the country for the purpose of hacking off her clitoris. Now, with the AAP's new policy stance, health experts (who aren't batshit crazy) fear that more girls in the U.S. will be at risk of being mutilated.

To recap, a decade ago the AAP:

1. Opposes all forms of female genital mutilation (FGM).
2. Recommends that its members actively seek to dissuade families from carrying out FGM.
3. Recommends that its members provide patients and their parents with compassionate education about the physical harms and psychological risks of FGM.
4. Recommends that its members decline to perform any medically unnecessary procedure that alters the genitalia of female infants, girls, and adolescents.

Today, the AAP:

1. Opposes all forms of [female genital cutting] FGC that pose risks of physical or psychological harm.
2. Encourages its members to become informed about FGC and its complications and to be able to recognize physical signs of FGC.
3. Recommends that its members actively seek to dissuade families from carrying out harmful forms of FGC.
4. Recommends that its members provide patients and their parents with compassionate education about the physical harms and psychological risks of FGC while remaining sensitive to the cultural and religious reasons that motivate parents to seek this procedure for their daughters.

How is that progress?


*What the fuck? We're talking about mutilating the clitorises of young girls and women. How could that not be physically or psychologically damaging?

 

Comments (36) RSS

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Will in Seattle 1
It's progress because hating sex is what they do.

Unless it's by priests.
Posted by Will in Seattle http://www.facebook.com/WillSeattle on May 7, 2010 at 3:44 PM · Report this
Max Solomon 2
gotta respect those somali traditions! it's all culturally relative!

seriously, i bet they're trying to pitch some symbolic ceremony to the somali grandmas that snips a little labia minora off, but leaves the clitoris.

the fact that they want to keep doing FGM in america means they have no idea what they're missing out on.
Posted by Max Solomon on May 7, 2010 at 3:45 PM · Report this
Vince 3
When they say the same thing about infantile penis mutilation, then we've made progress.
Posted by Vince on May 7, 2010 at 3:48 PM · Report this
4
The penises of infant boys are mutilated every day in this country, and the AAP doesn't have anything to say about that. I don't see why an organization that turns it's cheek to the genital mutilation of roughly half of all little boys born in the U.S. should be expected to make an exception for little girls.
Posted by Lurk on May 7, 2010 at 3:53 PM · Report this
balderdash 5
Cultural relativism, whether it's earnest or just a pretext for prejudice or apathy, makes me want to punch someone in the dick.

If any of you haven't seen it already, you should really check out Sam Harris's TED talk. It's relevant.
Posted by balderdash http://introverse.blogspot.com on May 7, 2010 at 3:59 PM · Report this
6
How is male circumcision and female genital mutilation even comparable? Penile circumcision isn't used as a method of controlling and oppressing men. Its just not the same.
Posted by cardigan weather on May 7, 2010 at 4:00 PM · Report this
7
I'm a pediatrician and just wrote a comment on the AAP site about this policy revision. I recommend others to the same. I'm appalled and ready to cancel my membership. At this rate, AAP is going to wind up like the AMA with only a small percent of membership.
Posted by MM81 on May 7, 2010 at 4:06 PM · Report this
Irena 8
It sounds to me like they're just trying to reframe the issue in a culturally sensitive way. They're not saying go ahead and do it, or alternately, don't do it because it's a savage practice -- they're saying it's time to provide "compassionate education". It's a rhetorical strategy, because the hard line isn't working. They haven't actually changed their stance -- they oppose forms of FGM that pose physical or psychological harm, and as Cienna points out, all forms do. And they still recommend families be dissuaded from it.

Seems to me they're trying to find a new strategy with which to address it, because FGM is not going away. Then again, I haven't read the article, and it needs to be studied carefully before a strong opinion can be formed.
Posted by Irena on May 7, 2010 at 4:06 PM · Report this
9
If you actually read what they're proposing, it's a realistic attempt to deal with this terrible cultural tradition by using harm reduction. It's analogous to hatafat dam brit, a symbolic act that takes the place of jewish circumcision, where one drop of blood is extracted from the foreskin.

FGM is abhorrent. It is also a significant part of some people's cultures. Telling these folks that they are bad, bad, bad isn't going to keep them from doing this. And is it completely unrealistic to think that just because it's illegal means that we can stop it from happening. But giving folks a way to keep the ritual without mutilating their children seems like a great first step to solving this problem.

Does it address the underlying misogyny and negativity towards sex? No, but those attitudes take a long time to alter. In the meantime, this idea could actually save some young girls from being mutilated.

But outraged knee-jerk liberalism is much more entertaining, of course.
Posted by goreedgo on May 7, 2010 at 4:09 PM · Report this
10
how about we just stop mutilating/"cutting" everyones genitals? everyone wins!
Posted by high and bi on May 7, 2010 at 4:10 PM · Report this
Julie in Eugene 11
@6. They're totally comparable. I mean, FGM involves cutting off little girls' clitorises, and male circumcision involves cutting off little boys' penises. Amirite?
Posted by Julie in Eugene on May 7, 2010 at 4:12 PM · Report this
keshmeshi 12
while remaining sensitive to the cultural and religious reasons


The cultural and religious reasons: those people believing that women ain't shit.
Posted by keshmeshi on May 7, 2010 at 4:15 PM · Report this
Irena 13
Exactly what @9 said.

Looking over the "Education of Patients and Parents" section, I see nothing alarming about this.
Some physicians, including pediatricians, who work closely with immigrant populations in which FGM is endemic, have voiced concern about the adverse effects of criminalization of the practice on educational efforts.24 These physicians emphasize the significance of a ceremonial ritual in the initiation of the girl or adolescent as a community member, and advocate a lesser procedure, such as pricking or incision of the clitoral skin, as often sufficient to satisfy cultural requirements. Pediatricians and pediatric surgical and urologic surgeons who are contemplating performing such a procedure should consider their role in perpetuating this social practice with its cultural implications for the status of women. It is also unclear whether performing such lesser procedures would be exempt from federal criminal laws.

This is a very smart response, and they are being as careful as possible about it. They deserve support for actually trying to find solutions rather than make some big moralistic statement. I think it's a good move.
Posted by Irena on May 7, 2010 at 4:15 PM · Report this
Telsa Grills 14
@3 and @10, well put. Human heredity and adaptation clearly have not found an evolutionary advantage to removal of genital skin, or else it would be happening through some selective advantage via genetic mutation. That goes for whichever sex.

@4: your logic fails, anonymous coward.

@13: And yes, this has long been a very tetchy subject for a long time, so progress is, well, not regression or standing in place.
Posted by Telsa Grills on May 7, 2010 at 4:25 PM · Report this
Telsa Grills 15
p.s., Now if only they would end IGM ("I" for intersex) with stiff sanction from the AAP for any physician who attempts it, then I would call that genuine progress.
Posted by Telsa Grills on May 7, 2010 at 4:28 PM · Report this
ams_ 16
I don't think you read that correctly. It was the old guidelines that opposed "Medically unnecessary" FGM.
From my reading, the problem with the new guidelines is that they oppose FGM "that pose risks of physical or psychological harm." And that they dissuade families from "harmful forms" of FGM. This, of course, assumes that there are forms of FGM that are not harmful.

I really don't know why the guidelines were changed in this way, as there is no elaboration given. If they had only included a guideline for cultural sensitivity, then that would have been fine. Cultural sensitivity is always a good thing, as it allows us to better communicate across barriers.

From the old guidelines:

"Parents are often unaware of the harmful physical consequences of the custom, because the complications of FGM are attributed to other causes and rarely discussed outside of the family. Furthermore, parents may feel obligated to request the procedure because they believe their religion requires female genital alteration."

"An educational program about FGM requires, above all, sensitivity to the cultural background of the patient and her parents and an appreciation of the significance of this custom in their tradition. Objective information should include a detailed explanation of female genital anatomy and function, as well as a thorough review of the lifelong physical harms and psychological suffering associated with FGM. It should be emphasized that many countries in Africa have supported efforts to educate the public about the serious negative health effects of FGM, and that prominent physicians from Africa are advocates for the elimination of these practices because of their adverse consequences. "

This sounds like an opportunity for education to me, backed up with guidelines that say "No, we do not do this".
More...
Posted by ams_ on May 7, 2010 at 4:29 PM · Report this
17
I'm #4, and I think that FGM is an ABHORRENT practice. Don't get me wrong, please, on that regard. I have children, none of whom have had their genitals compromised by unnecessary medical procedures. I was trying to make the same point as #3 and #10! That every cutting the genitals of children, boy or girl, is wrong!

I was simply stating that the AAP turns its backs on little boys every day. I am not shocked that they're making such appalling steps in regards to protecting the genitals of little girls.
Posted by #4 on May 7, 2010 at 4:32 PM · Report this
OuterCow 18
"...while remaining sensitive to the cultural and religious reasons that motivate parents to seek this procedure for their daughters."

How do you remain sensitive to ideas that you know are factually wrong, medically unsafe and psychologically damaging, and why the fuck should you? That part they did not answer.
Posted by OuterCow on May 7, 2010 at 4:48 PM · Report this
ams_ 19
@18- Because if you're a doctor, you're going to get shit-all done if you take that "You're wrong. I'm right. fuck you" attitude. It's simple pragmatism.

What would you say to a parent who comes to you about FGM? Would you tell them to leave, and miss maybe the only opportunity a health practitioner will ever have to educate/dissuade them? That wouldn't be very productive.
Posted by ams_ on May 7, 2010 at 4:58 PM · Report this
20
General Napier had an excellent method for dealing with cultural differences of this type and put it to good use in India when he dealt with sati.

People from Somali have the excuse that they were raised in that culture, the people on this blog, @18, 13 & 9 for instance, must simply have been born without a soul.
Posted by MikeB on May 7, 2010 at 5:16 PM · Report this
keshmeshi 21
@20,

And what's your excuse for not getting those comment numbers right?

Sue me for caring that a significant percentage of the population (both men and women) treat women like chattel.
Posted by keshmeshi on May 7, 2010 at 5:58 PM · Report this
22
Easy rule, folks: Don't cut other people's junk without their informed, adult consent. Boys or girls.

All you trogs out there slicing off boy's foreskins? You are fucking sick too, m'kay? But it is all okay, because it is commonly done, right?

And no, I don't care that some desert nomads called Jews did it a long time ago, and some still want to follow this "tradition".

Leave people's junk alone unless they give you consent; kids cannot consent.
Posted by mimi is the pass code... on May 7, 2010 at 6:48 PM · Report this
lark 23
Cienna,
This is absolute bullshit. This is mutilation plain and simple. The AAP is caving in to sexist and "cultural" pressure. This is most dissappointing.
Posted by lark on May 7, 2010 at 9:32 PM · Report this
Catalina Vel-DuRay 24
Why is it that a discussion about something like Female Genital Mutilation cannot occur without the anti-circumcision crowd intruding on it with their usual bleating and blaming?

A circumcision, whatever you think of it, cannot be compared to a cliterectomy. Anyone who would make that comparison has a problem not in their penis, but in their brain.
Posted by Catalina Vel-DuRay http://www.danlangdon.com on May 7, 2010 at 10:03 PM · Report this
kk in seattle 25
Reading this makes me wonder if parents should be allowed to mutilate their children's earlobes by stuffing metal trinkets in them.
Posted by kk in seattle on May 7, 2010 at 10:08 PM · Report this
26
Catalina @24 - I'm seeing a lot in this thread about them both being wrong and/or mutilation but nothing about them being equal in severity. As much as I love a good bitch-out of anonymous "crowds," straw-manning much? Calling a fender-bender an "accident" doesn't mean you're "comparing" (equating?) it to the Hindenburg.
Posted by Bainbridger on May 7, 2010 at 10:34 PM · Report this
27
I mean, FGM involves cutting off little girls' clitorises, and male circumcision involves cutting off little boys' penises. Amirite?
Well actually, yes, you are "rite." Part of the penis--a part with a very high density of nerve endings--is in fact being "cut off." It usually doesn't cause outright sexual dysfunction, but it's still mutilation. Or do you propose we set some limit as to exactly how much of someone's genitals is it OK to hack off before it officially becomes "mutilation?" 10%? 20%?
Penile circumcision isn't used as a method of controlling and oppressing men.
Circumcision can cause permanent loss of sensation, disfigurement, and even chronic pain. It also makes it more difficult to masturbate, something I'm sure the various oppressive religious groups (both Christian and Jewish) who push it on helpless infants would consider a "benefit."
Posted by Furcifer on May 7, 2010 at 10:40 PM · Report this
passionate_jus 28
My god this sucks. There are some traditions that need to be wiped off the face of the planet and female genital mutilation is one of them.

Anyone who does this or allows this to happen to a young girl should spend the rest of their lives in jail. No exceptions.

I don't give a fuck if this is part of your religion or your culture or your belief system. Too fucking bad.
Posted by passionate_jus on May 7, 2010 at 11:46 PM · Report this
ADoodle 29
@24 Because it's hypocritical, that's why. Because we (rightfully so) condemn severe genital mutilation of females without their consent nor medical supervision and then turn around and exclaim "of course little Davy will be circumcised, Doctor, we wouldn't want him to look different down there", nevermind that little Davy doesn't get a chance to weigh the pros and cons for himself about whether to have a piece of his penis lopped off. So while it seems a bit over the top to play the game of "my genital mutilation is worse than yours", yes we can indeed compare one human rights violation with a similar one. //

I was pretty shocked about the AAP's position when I heard about it this morning, but I can see now that pediatricians are in a tough spot about this. (Dare I compare this to the outlawing of abortions? Being refused or sternly lectured might simply make the parents turn to "back alley" genital mutilations.) It's definitely easier for us to rant and condemn the AAP than to face the harsh reality of how difficult it is to change a world-wide culturally-ingrained practice...
Posted by ADoodle on May 8, 2010 at 12:15 AM · Report this
30
Why is it that a discussion about something like Female Genital Mutilation cannot occur without the anti-circumcision crowd intruding on it with their usual bleating and blaming?

A circumcision, whatever you think of it, cannot be compared to a cliterectomy. Anyone who would make that comparison has a problem not in their penis, but in their brain.

----------------------------------------------------------

Genital mutilation is not an issue of severity, it’s one of sovereignty. If eradication of FGM were based solely on the notion that it harms health, one would expect people to support a reduced form of female cutting (clitoral hood), comparable to male foreskin amputation, under hygienic and anesthetized medical conditions. That they are virtually unanimous in their opposition to even a "nicking" of the female foreskin indicates that the issue goes beyond severity and is one of sovereignty. Genital cutting of healthy unconsenting individuals fundamentally violates individual autonomy. In both forms of circumcision, adults usurp the child's right of choice before the child has any knowledge or ability to exercise sovereignty over her/his reproductive organs.

Those who dismiss the importance of the prepuce (foreskin) are unaware that male and female genitals evolve from the same embryologic tissue and share more anatomical similarities than differences. The prepuce is the most densely nerve-laden part of the penis with specialized anatomical structure and functions that serve a male throughout his life. The prepuce, while small in a baby, accounts for about 50% of an adult male’s penile skin, approximately 15 square inches of erogenous tissue.

It’s perverse to excuse one cruelty by invoking a worse one. The genitals of both sexes should be left intact without encouraging a "dreadfulness competition" between assaults on little girls or boys.
More...
Posted by Tonga on May 8, 2010 at 5:05 AM · Report this
Catalina Vel-DuRay 31
As a male who has been "mutilated", I understand the difference between my circumcision (which has not impeded my sex life or my enjoyment of sex*) and the practice of essentially making sure a woman will never enjoy having sex, and opens her up to a variety of ailments, including (according the the WHO) Bladder infections, cycsts, infertility, Increased risk of childbirth complications and - get this - the need to have the whole thing undone so that she can do things like lose her virginity and have children. Once those rather mundane things are over, it's usually REDONE! As in, after each child! Can you imagine the toll that takes on a woman, particularly in a culture that has little access to birth control, and has a high infant mortality rate?

Oh, and it's usually first done at the age of twelve or thirteen, compared to a circumcision, which is usually done to babies. And the girl is told that it's being done for her own good, so she won't be a slut.

I'm all for everyone leaving everyone's "junk" alone. But the magnitude of cruelty of Female Genital Mutilation is just mind-boggling. To compare the two processes is just - in my opinion - typical boorish male behavior. It's like a guy worrying about an infected hangnail while his wife is having an emergency Caesarian.

(* For those who will come back with the argument "You'd enjoy your penis a lot more if you were uncircumcised!": I might enjoy being taller, or having blue eyes, or being able play the accordion. But I don't have any of those things, so I don't know what I'm missing. All I know is I use the damn thing all the time, It's given me literally thousands of hours of fun, clean-up's a breeze, and I never have any trouble with it. Best of all, I don't have to have my circumcision redone each time I use my penis.)
More...
Posted by Catalina Vel-DuRay http://www.danlangdon.com on May 8, 2010 at 8:06 AM · Report this
translinguistic other 32
So, I'm as squeamish about the idea of FGM as the next person, and as a privileged western white woman, I can certainly identify with the desire to impose my idea of how women ought to be treated on other people in the world. But I'm neither a doctor nor an anthropologist, and so in all honesty I don't actually know much about the ethics of the proposed procedure. So, for what it's worth, I asked my sister, who is very smart, liberal, and about to graduate from medical school and begin a pediatric residency. She is also no expert on FGM, but at least her opinion is informed by hearing ethics lectures directly from doctors who have done humanitarian work in Africa and seen FGM from both sides of the cultural coin.

She says, "It is easy for us to say female genital mutilation is wrong, but native people in many countries struggle with issues of cultural heritage that are not issues for us. I think the AAP's new statement sounds more culturally sensitive. [...] I think the AAP's ethicists are weighing the ethical principles of benficence and nonmaleficence thinking that a ceremonial procedure done in a doctor's office might replace some horrific scarring done while visiting family in some village in Africa. I agree though that there is a valid argument in that these girls are not of a consenting age (the same reason I am opposed to routine male infant circumcision)."

She also referred me to a blog post about the proposed procedure from someone who also appears to know more about the topic than either of us do: http://bigthink.com/ideas/20004
Posted by translinguistic other on May 8, 2010 at 11:27 AM · Report this
33
@31: You forgot fistulas.

Because it's always great for a woman when she has the chance to develop horrible, painful holes down there, which may destroy her ability to control her bladder and/or may allow her urine and feces to come out of the same spot together.

Seriously, reading the stories of women who have had this done to them makes me feel like vomiting. At least circumcision is done with clean, sterilized instruments, by a doctor (and I agree with you in general about male circumcision, anyway, Catalina). Often not the case for girls.

And the intent between male and female circumcision *is* different. I don't know if I buy the hygiene idea for men, but, at worst, it's so a man's junk looks the same as other men. For women, the intent of circumcision is to eliminate sexual pleasure. And it can often involve the vagina being STITCHED CLOSED afterward to protect her virginity. And give her extra chances for nasty infection and fistulas.
Posted by Alexandrine on May 10, 2010 at 7:53 AM · Report this
Fenrox 34
@Catalina, Shut the fuck up. Its bad for everyone except when it's not. We need to change when a person can be cut up for fun, science or profit. All genital cutting should occur when an adult has signed consent away to do it to himself.

And the AAP needs to shut the fuck up too.

Male circumcision is terrible and the argument is: NOBODY CARES that its so terrible.

Female circumcision is terrible and the argument is: Continue to despise and outlaw this.

Awesome.
Posted by Fenrox on May 10, 2010 at 10:41 AM · Report this
35
Female circumcision does NOT normally involve cutting off the clitoris. That particular form of FGM is very rare indeed. We should not be exaggerating the issue. What happens is bad enough. When we exaggerate it makes the actual practice seem mild in comparison.

The AAP presumably made the endorsement as a way of protecting male circumcision, which has come under attack in recent years. There is a double standard in the AAP regarding genital mutilation. It's fine for boys, but not for girls. In order to allow MGM to be accepted they have to make FGM acceptable. The only alternative is to renounce both, and the AAP is not going to be willing to alienate the thousands of pediatricians in the US who see circumcision as a nice easy way to make a few extra bucks.
Posted by Ian Brett Cooper on June 1, 2010 at 5:02 AM · Report this
36
As for male genital mutilation, anyone who circumcises a boy is either an idiot or a psychopath. No part of the genitals is disposable. In order for them to work properly, they need to be complete. A circumcised man is deformed and dysfunctional, dirty and unhealthy (because the foreskin is not just extra skin - it is a complex structure which aids in sexual function and protects the glans, keeping it clean, healthy and free from disease). The idea that men who have been circumcised have no adverse effects is nonsense. The fact that circumcised guys don't know what they're missing is only proof that guys either don't pay much attention to their genitals, or they were mutilated before they could give their genitals much thought.
Posted by Ian Brett Cooper on June 1, 2010 at 5:09 AM · Report this

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