Human Rights

Why Are U.S. Doctors Allowing Female Genital Mutilation?

The American Academy of Pediatrics has issued an outrageous new policy on female genital mutilation, endorsing 'nicking' female genitalia as a cultural compromise.

At the end of last month, the American Academy of Pediatrics (AAP) issued a revised policy statement on female genital mutilation (FGM) called "ritual genital cutting of female minors," suggesting that the federal and state law in the U.S. should permit pediatricians to offer a ritual "nick" of girls' genitalia as a compromise to appease the cultural needs of their immigrant clients. International women's rights organizations from the U.S., Africa, and Europe were quick to respond to this outrageous proposition calling on the AAP to retract its 2010 statement and revert back to its much stronger 1998 statement on the subject. The AAP's response, however, has thus far been underwhelming and they continue to justify this latest position on three grounds:

• "Nicking" is a minor procedure equivalent to a pin prick or ear piercing and has no harmful health consequences.

• Offering the "nick" demonstrates cultural sensitivity in serving immigrant populations.

• The "nick" is a "compromise" that could prevent families from performing more severe forms of FGM on their daughters

FGM, which involves the partial or total removal of the female genitalia, is carried out across Africa, some countries in Asia and the Middle East, and by immigrants of practicing communities living around the world. It is estimated that up to 140 million women and girls around the world are affected by it. The U.S. Department of Health and Human Services estimated in 1997 that over 168,000 girls and women living in the U.S. have either been, or are at risk of being, subjected to FGM.

A comparison of the AAP's 1998 and 2010 statements clearly demonstrates a dilution in the organization's understanding of FGM as a form of sex discrimination and gender-based violence performed to control women's sexuality, ensure virginity until marriage, and guarantee their acceptance into a particular community. A 2008 statement on FGM adopted by 10 prominent UN agencies clearly states that, "the guiding principles for considering genital practices as FGM should be those of human rights, including the right to health, the rights of children and the right to nondiscrimination on the basis of sex."

The AAP's casual comparison of "nicking" of girls' genitalia to ear piercing demonstrates just how far from the international framework the organisation currently stands. "Nicking" cannot be pulled out of context and must be understood within the larger gender politics of controlling women's bodies and sexual rights.

Indigenous grassroots groups and activists, including traditional leaders and ex-circumcisers across Africa, have for decades engaged in transforming their local communities to abandon the practice of all types of FGM and adopted alternative rites of passage instead. The protocol to the African Charter on Human and People's Rights on the Rights of Women in Africa, a widely supported regional human rights treaty that has been ratified by 27 African countries, specifically prohibits "through legislative measures backed by sanctions, all forms of female genital mutilation, including medicalization and para-medicalization of female genital mutilation".

According to a member of the AAP's bioethics committee, the intention behind the revised 2010 policy is to issue a "statement on safety in a culturally sensitive context". The new policy justifies the shift from the 1998 terminology of "female genital mutilation" to "female genital cutting (FGC) or ritual genital cutting, by claiming that the former is "culturally insensitive language". It further validates pediatricians' offer to "nick" girls genitalia to "satisfy cultural requirements". This raises the question of what culture is being talked about and who are the gatekeepers of this culture that are being appeased – and what is the so-called "cultural identity" being preserved. Culture is fluid and evolves over time as practices that are rooted in inequality or injustice are questioned and abandoned. The AAP's current proposition undermines and negates local, national, and regional anti-FGM initiatives in Africa, which are equally a part of the cultural identity of communities where FGM occurs.

The AAP's statement would lead to greater harm to girls in the U.S. by institutionalizing what it sees as less severe forms of FGM. WHO and Unicef have cautioned governments against medicalization of all forms of FGM including pricking and piercing because it "tends to obscure its human rights aspect and could hinder the development of long-term solutions for ending the practice". The statement comes at a time when the US legislature is seeking to close a loophole in its federal anti-FGM legislation, making it illegal for parents to take girls out of the US for FGM and thus preventing more severe forms of FGM.

But most importantly, the statement completely fails to recognize that human rights standards are absolute and not to be compromised upon in the name of possible harm reduction. The principle behind safeguarding human rights is harm elimination. The statement flies in the face of all international and regional deliberations on the issue, which have concluded that any medically unnecessary procedure to alter female genitalia constitutes a human rights violation and therefore must not be tolerated.

"Nicking" constitutes Type IV FGM, and the UN interagency statement clarifies that, "it has been considered important to maintain a broad definition of FGM in order to avoid loopholes that might allow the practice to continue".

The AAP must retract its statement.

Lakshmi Anantnarayan is communications director of Equality Now.
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