Monday, May 17, 2010

Medical Group addresses Ritual Genital "Cutting" For Females

Click on the post title to read the recent New York Times article about the American Academy of Pediatrics' statement on Female Genital Mutilation (FGM).  According to an AAP Bioethics Committee member in this article, ritual nicking is supposed to be like "getting your ears pierced" and losing only "a pin drop of blood."   Seems they were thinking that this milder form of "cutting" might be more acceptable to families, thus preventing them from sending their daughters overseas for the more drastic form.  Fortunately this attitude did NOT prevail in the AAP's final recommendations, but the fact that it entered the discussion at all is quite disturbing.

Click on this link to read the entire policy statement from the American Academy of Pediatrics Committee on Bioethics concerning Ritual Genital Cutting of Female Minors:    http://pediatrics.aappublications.org/cgi/content/abstract/125/5/1088  The final recommendations read as follows:  "The AAP opposes all forms of FGM, counsels its members not to perform such ritual procedures, and encourages the development of community educational programs for immigrant populations."  The statement also includes an excellent explanation of the cultural reasons for cutting as well as pictures and descriptions of the various types of FGM.  While I am thankful that the final recommendations come out against FGM, I still have many concerns about this issue.

First of all the debate certainly reflects the issues providers face when working with immigrant populations, and the AAP is wise to meet it head on.  I can see how ritual nicking could be sold as a much better choice since it has a lot less side effects than the more extreme form.  The danger is in allowing ourselves, in the name of political correctness and cultural sensitivity, to become more accepting of the milder procedure just because it doesn't seem to do as much physical damage.  We may not be on the slippery slope yet but we certainly are approaching the edge.

Secondly, there is no way that we as providers should put ritual nicking in the same league as ear piercing and other forms of body art.  The difference here is ornamentation and choice.  In most cultures, body art is considered ornamentation.  In our culture, we choose whether or not we want our ears pierced, etc.  Not so with ritual nicking and FGM.  In this situation young girls are expected at best, forced at worst, to undergo a medically unnecessary procedure purely to make themselves a more attractive marriage and sexual partner!

Although it is important that we as medical professionals advocate for our patients, it is even more important to stand up and speak out against procedures that do more harm than good.  We need to stop being politically correct and call this procedure what it is--mutilation and the complete subjugation of one group's sexuality to another.  There are groups that are successfully fighting against RGMworldwide.  If the American medical profession shows tacit approval of FGM by condoning milder forms, it will completely undermine the progress these groups have made in this struggle.

It would behoove all of us to study the different forms of FGM as outlined in the AAP statement and reflect upon whether or not we can in good conscience recommend them to our patients.   Perhaps we should ask ourselves whether or not we would recommend them for ourselves and our  families and friends.  Because if we are not willing to recommend them for ourselves and our daughters we have no right to recommend them to anyone else.

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