The Cruelest Cut: A Cultural Rite Misunderstood

Last fall when physicians at Harborview announced they were considering performing female genital cutting, the outcry rained down swift and certain. "I was horrified to think that Harborview Medical Center would even entertain thoughts of performing any type of medically unnecessary procedure, especially one designed to further oppress women," fumed one reader in a letter to The Seattle Times. Carol Leppa, a UW nursing professor who teaches health care ethics and cross-cultural variations in health care, became interested enough in the flap that she made female circumcision the subject of her remarks at the Third World Congress on Bioethics, held in San Francisco in November. "One person called me several times in advance of my speech, upset that I was even going to talk about the practice," Leppa says. As Leppa told a gathering of the Human Rights Action Group at the UW's Bothell campus last month, she could understand the outrage. "Female genital mutilation," the human-rights community's label for the spectrum of procedures ritually performed upon a girl's genitals in certain African cultures, is frequently described in its most horrific variant. A recent AP story, which begins with a 6-year-old girl's screams for mercy, is typical of the coverage. It describes "infibulation," in which the clitoris, inner labia, and soft flesh of the labia majora are cut and scraped away. "The two sides of the vulva are then fastened with acacia thorns, catgut, silk, or a glue made from a tree gum or eggs," the article read. Reading about rituals like these, it's not difficult to see why the US Immigration Court broke new ground last June in declaring female genital mutilation persecution justifying asylum. "A lot of people read the articles about Harborview considering this practice, saw the words 'genital mutilation,' and went into a tizzy," explains the Harborview community relations director who fielded the protest calls, Tina Mankowski. But a few who had studied female circumcision, like Leppa, had a more measured reaction. "I wondered which form of female circumcision Harborview was actually considering," Leppa said. According to Leppa's research, a spectrum of female genital cutting procedures exists throughout the world, some 20 percent of which are the grisliest sort known as pharonic circumcision or infibulation, as vividly documented above. Though little is known about the particulars of the other 80 percent of procedures -- excision, circumcision, clitoridectomy, and sunna -- many of them are less drastic than the two extreme genital cutting methods which Leppa found were given almost exclusive description in the press. As it turned out, the method Harborview doctors were considering was similar to the sunna purification ritual performed in certain Bedouin cultures. "What we proposed was not a removal of tissue, but a small cut, a bloodletting, in the prepuce area," explains Mankowski, referring to the fold of skin over the clitoris. Doctors at Harborview told Leppa they see body piercings more radical. "It was a modified technique that wouldn't have satisfied everyone," Mankowski says. "But it would have satisfied a number of people, and it was something our doctors and nurses could perform safely." Indeed, in Harborview literature the procedure was termed "an alternative to genital mutilation," and was initially proposed by doctors concerned that withholding the ritual from the growing number of refugees seeking it would compel those individuals to engage in dangerous "back-alley" surgeries. For those whose tribal traditions mandate ritual genital cutting -- an ancient practice with deep cultural significance for many African Moslems and animists -- not having it performed on their young girls would be unthinkable. As unthinkable as a proscription against male circumcision for a practicing Jew. Or, for that matter, a proscription against male circumcision for the great majority of late 20th-century secular Americans. "Male circumcision is accepted as a part of American culture -- it's standard procedure for most infants," says Dr. Leslie Miller, one of the Harborview physicians who argued in favor of the compromise procedure. "The hypocrisy of turning away those desiring female circumcision just because they come from another culture is odd." It is indeed difficult, as Leppa suggested to the Human Rights Action Group, to miss the specter of cultural imperialism in the Harborview flap. On what conceivable basis is male circumcision excusable if female ritual cutting of the sort Harborview proposed is not? How can the American Medical Association decry female genital cutting as unnecessary surgery on healthy tissue and at the same time condone, say, nose jobs? Even the arguments defending the rights of the child -- used almost exclusively in this country to protest the cutting of girl genitals -- presume the decidedly Western value of liberal individualism. It's the air we breathe in this country and therefore like heresy to question, but are individual rights of a higher value than tribal rights? Is that a universal moral value, or is it just our moral value? That is a question human rights advocates have learned to be cynical about. "Many abusers take refuge in the 'it's culturally relative' argument," declared Bruce Kochis, convener of the Human Rights Action Group meeting at which Leppa spoke. It's been partly in response to that argument that human rights crusaders have honed their famous absolutism, basing their entire crusade on the ethic that certain human rights -- freedom from torture among them -- are inalienable, never culturally relative, beyond the purview of debate. One consequence of such uncompromising zeal has been the innumerable triumphs human rights crusaders have won on behalf of humanity. But in response to Leppa's sensitive analysis, Kochis and his group were compelled to acknowledge a rather more unintended consequence. The human rights movements' absolutist stance tends to render any moderate view unacceptable. "It's so ingrained in human rights work that these rights are absolute, many advocates feel they can't appear to condone any sort of genital cutting procedure at all," Kochis admitted. "This is an issue caught in the history of the discourse about human rights. It's become almost like a religious crusade." That such well-intentioned zeal sometimes works against the best interests of the cultures in question is precisely the point Leppa had come to this forum to make. "It's a knee-jerk reaction," sighs Leppa. "The human-rights groups get on the bandwagon, the feminists get on the bandwagon, the doctors get on the bandwagon -- everyone gets so upset." Add in the news media's overwhelming fascination with acacia thorns and tree gum, and before long all forms of female genital cutting are reviled as torture. That is what seems to have happened in the case of Harborview. After the doctors came forth with their proposal and the public weighed in (and in, and in) with their opposition, the medical center brought the contentious matter before the Attorney General for counsel. In December came the memo in which Harborview made public its decision. "Harborview Medical Center will not consider performing the alternative procedure reviewed," the statement read, in a tone somewhat more elegiac than one typically sees in press releases. "Harborview's role in considering the need for a culturally sensitive, safe alternative to the practices of female circumcision or female genital mutilation has now been concluded."

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