When families come to American doctors seeking the traditional practice of Female Genital Cutting, is it better to offer them a “ritual nick” — a symbolic pinprick — or turn them away and possibly prompt them to find the service under far less safe conditions? The American Academy of Pediatrics caused a stir last month by advocating the ritual nick in a new policy statement written by a team of expert consultants who laid out the case for choosing what they saw as the lesser of evils. Now the AAP has reversed its position, saying in a statement this week: “The AAP reaffirms its strong opposition to FGC and counsels its members not to perform such procedures. As typically practiced, FGC can be life-threatening. Little girls who escape death are still vulnerable to sterility, infection, and psychological trauma. The AAP does not endorse the practice of offering a ‘clitoral nick.’ This minimal pinprick is forbidden under federal law and the AAP does not recommend it to its members.”
Sirens spoke to the lead author of the statement in favor of “nicking,” Dena Davis, a law professor at Cleveland-Marshall College of Law, Cleveland State University, about the reasoning behind their recommendation, the debate over male circumcision, and the similarities between female genital cutting and plastic surgery:
Sirens: Your statement was more of a suggested compromise on following the cultural tradition of FGC by suggesting a ritual “nick” for families that insist on continuing the practice — since many simply go overseas when they find they can’t get it done here. First, can you explain the basic reasoning behind your recommendation?
Dena Davis: Harm reduction. Here, the AAP and I assume most people, are not in favor of any form of FGC–but in a real world, given the very real likelihood that these girls will be taken back to their home countries to have terrible things done to them, a tiny nick seems like a reasonable way to avert this greater harm. A parallel would be needle exchange for drug addicts–we would prefer that no one shot up heroin at all, but given the realities, we think it better to provide them with clean needles and try to protect them from HIV (of course, that’s pretty controversial as well!).
Sirens: How would your original recommendation work under current U.S. law? Or would it be illegal, technically?
DD: Under current federal law (and some state laws) this might very well be illegal, which is why our statement does not advise pediatricians to do this. Congresswoman Pat Schroeder thought that the law–which bears her name–did make this illegal. A close reading of the law does not seem dispositive. In any case, it would be good, in my opinion, if the law were rewritten to allow this loophole. It would still be illegal in states whose laws are more narrowly written–but that’s probably okay. There’s a lot to be said for having something start slowly–like Oregon’s “Death with Dignity” law.
Sirens: How might this relate to the statement on male circumcision that they’re still working on?
DD: I don’t know what’s in the circumcision statement. Our FGC statement came out of the Committee on Bioethics–the circ statement comes out of a different committee. I am sure it will also be faced with a wall of criticism. There are people who believe that all non-medically necessary surgery on children too young to consent is prima facie wrong, as a human rights issue. They are opposed to both male and female genital cutting. Then there are people who cling to the idea that FGC has absolutely no medical advantages, whereas male genital cutting has at least some small advantages. In the last AAP statement on male circ, they used these minor advantages to ground a statement in which they said there was no evidence to recommend routine neonatal circ, but that docs should be respectful of parental choices in this matter. The new statement will, I assume, include the new evidence from Africa that male circ is strongly protective against HIV (I think it reduces the risk by about 60%); I don’t know how they will analogize that to the North American context.
Sirens: Are there other Western practices that we simply accept without thinking that may be judged similarly strange/wrong by other cultures?
DD: In the U.K., and in at least one state law here in the U.S., nonmedical genital cutting of even an adult female is criminalized. That’s really interesting, since females can legally have their breasts added or substracted, have tattoos, nose jobs, etc., etc. There is also the rather strange phenomenon of cosmetic genital surgery–doctors who help women make their genitals look more “attractive.” Would that be criminal also?