The American Academy of Pediatrics (AAP) has issued a revision to its policy statement Ritual Genital Cutting of Female Minors. Almost everything I’ve read about this so far implies that the AAP is promoting female genital cutting (FGC): the custom of ritual cutting and alteration of the genitalia of female children that persists primarily in Africa and among certain communities in the Middle East and Asia.
Initially, I was horrified, and I still am. FGC is surgical misogyny. So I read the original policy statement issued in 1998, and the May 1 update. The AAP states that it opposes “all forms of FGC that pose risks of physical or psychological harm” to children. I don’t think it’s cool to mess with people’s bodies without their consent even when it’s not physically or psychologically threatening. But physicians in some communities are obviously struggling to deal with parents’ requests to perform FGC.
In the United States, federal legislation prohibits FGC and mandates educational programs for physicians about the harmful consequences of the practice. The AAP is advocating for a change in law that would enable pediatricians to offer a ritual “nick” as a compromise when they are asked to perform more extreme procedures. The document presents strong arguments for and against that approach. Here are some key excerpts from the policy statements:
When parents request a ritual genital procedure for their daughter, they believe that it will promote their daughter’s integration into their culture, protect her virginity, and, thereby, guarantee her desirability as a marriage partner. In some societies, failure to ensure a daughter’s marriageable status can realistically be seen as failure to ensure her survival.
The physical burdens and potential psychological harms associated with FGC violate the principle of nonmaleficence (a commitment to avoid doing harm) and disrupt the accepted norms inherent in the patient-physician relationship, such as trust and the promotion of good health. More recently, FGC has been characterized as a practice that violates the right of infants and children to good health and well-being, part of a universal standard of basic human rights.
Protection of the physical and mental health of girls should be the overriding concern of the health care community. Although physicians should understand that most parents who request FGC do so out of good motives, physicians must decline to perform procedures that cause unnecessary pain or that pose dangers to their patients’ well-being.
It goes on to describe, and illustrate, different types of FGC. It explains the situation that gave impetus to the statement:
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. 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. In some countries in which FGC is common, some progress toward eradication or amelioration has been made by substituting ritual “nicks” for more severe forms.
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.
The AAP is supporting a form of ritualistic mutilation on girls in an attempt to prevent potential further harm. But will parents who request FGC be satisfied with–or fooled by–the so-called compromise of a “nick?” I am sympathetic to this complex predicament. However, if doctors suspect that their patients’ parents will sexually mutilate them, they could contact child protective services. What is best for the girls?