Please see UPDATE at end of article!
On April 26,2010, the American Academy of Pediatrics (AAP) issued a new policy statement seen by many as essentially advocating the practice in this country of female genital mutilation (FGM)[sometimes this ‘tradition’ is referred to as female genital cutting (FGC) as well]. In pertinent part, the policy advocates for “federal and state laws [to] enable pediatricians to reach out to families by offering a ‘ritual nick’,” such as pricking or minor incisions of girls’ clitorises.
Yes, I said this was issued by the American Academy of Pediatrics. How, in the world, you ask, could such an august body promote such a misogynistic practice?
For those who may not be familiar with this barbaric (you fill-in the other adjectives – the list is simply too long) ‘ritual,’ a recent online article by PRNewswire sets the chilling background of this controversy.
FGM is a harmful traditional practice that involves the partial or total removal of the female genitalia and is carried out across Africa, some countries in Asia and the Middle East, and by immigrants of practicing communities living around the world, including in Europe and the U.S. It is estimated that up to 140 million women and girls around the world are affected by FGM.
Putting aside my personal opinions regarding the overall chauvinistic cultures of – to name a few – Africa, Asia and the Middle East, what would motivate any culture to engage in such a ritualistic practice?
In an NPR interview of Professor of Law, Cleveland-Marshall College of Law, Cleveland State University, Dena Davis, on May 14, 2010, Professor Davis, a consultant to the AAP and the lead author of the policy statement, the ‘rationale of this ‘tradition’ is explained.
RAEBURN: Do you have a sense I’m just I can’t help but interrupt. Do you have a sense of why in these cultures, there may be different reasons, but why this is done or what is supposed to be the benefit of it?
Ms. DAVIS: Right, it’s a wide array of things. On a positive side, it’s seen as a growing-up ritual, as a celebration of ethnic or national identity. It became politically important as a response to colonization, for example, but it’s also done to remove sexual pleasure from women so that they can be controlled, to guarantee women’s virginity so that they are marriageable and to protect the family’s honor.
So just how did this ‘celebration of ethnic or national identity’ work its way to our shores? How did it conceivably become a part of a policy statement by the AAP?
Professor Davis offers the following explanation:
Ms. DAVIS: Well, I want to start by reiterating what you already said. The statement ends with four recommendations, and none of those mention this compromise. The recommendations are that the American Academy of Pediatrics opposes all forms of female genital cutting that pose risks of physical or psychological harm, encourages its members to educate themselves about the practice, recommends that members actively seek to dissuade families from carrying out harmful forms of FGC and recommends compassionate education of the parents of patients.
Having said that, the controversial part, as you made mention, is a discussion toward the end of the possibility of pediatricians offering what would literally be a nick. And in the statement, we analogize it to ear piercing.
And the idea here was that we knew that some pediatricians in Seattle a number of years ago who had a good relationship with the Somali immigrant community around their hospital had been asked by mothers of girls for this kind of compromise. And they had gone down the road of – they’d had meetings with mothers and so on, and they were about to do that…
RAEBURN: So this was mothers from some of these cultures where this is practiced had suggested that…
Ms. DAVIS: Right, were Somali immigrant mothers.
RAEBURN: Okay, so it was their idea?
Ms. DAVIS: Well, I’m not sure whose idea it was, but they embraced it to the extent that they held off on doing something worse until the doctors could get set up to start offering this. But before that could happen, Congresswoman Pat Schroeder wrote to tell the hospital that it would be criminal under her new law that had recently passed in Congress.
The concern is that we know that in many cases, when pediatricians turn down parents, girls are taken back to Africa for the worst possible procedures done, you know, with no painkilling and no, you know, no infection control and extremely severe forms of these procedures where girls’ labia are scraped away, for example.
And there’s really that’s very difficult to stop…
The uproar from this AAP statement advocating a ‘compromise’ – ostensibly premised on the concept of the ‘lesser of two evils’ – comes from virtually every group in this nation. One I quite frankly didn’t anticipate was posted by Jihad Watch: “[T]here are those four words of the Hippocratic oath that the American Academy of Pediatrics seems to have forgotten: First do no harm. And if it is supposed to be harmless, let the AAP doctors line up forthwith for their own “ritualized nick.” The comments to this posting by Jihad Watch, which refers to this practice as being “primarily enforced in Muslim countries, ” are also quite revealing. One person identified as ‘Ccoopen’ had this to say:
I’m not sure why this is listed under dhimmitude, considering that FGM is not Islamic. Sure, it is practiced by Muslims, but it is not a Muslim practice. It is a cultural practice which predates Islam by hundreds, if not thousands of years. In fact, the majority of practitioners in Africa are of the African Tribal religions, not Muslim. While it is a horrific practice, it doesn’t need to be tied to Islam since it has nothing to do with Islam, but with culture.
For those who have dedicated their life’s work to obtaining equality among the sexes, the AAP’s attempt at a ‘neutral’ statement of compromise has been vehemently rebuked:
“Encouraging pediatricians to perform FGM under the notion of ‘cultural sensitivity’ shows a shocking lack of understanding of a girl’s fundamental right to bodily integrity and equality,” says Taina Bien-Aime, executive director of the human rights organization Equality Now. “If foot-binding were still being carried out, would the AAP encourage pediatricians to execute a milder version of this practice?”(See “An End to Female Genital Cutting?”) See our source – Time online article.
In its online posting, Time, a partner of CNN, reports (as do many others) reports a legislative twist to the timing of the AAP’s policy statement:
On the same day the AAP published its new recommendation, the Girls Protection Act, which would make it illegal to take a minor outside the U.S. to seek female circumcision, was introduced in Congress. “I am sure the academy had only good intentions, but what their recommendation has done is only create confusion about whether FGM is acceptable in any form, and it is the wrong step forward on how best to protect young women and girls,” said one of the bill’s sponsors, New York Representative Joseph Crowley, speaking to the New York Times. Davis counters that such a law would be extremely difficult to enforce.
So where do you stand on the issue? Has the AAP done more harm than good? Is the ‘compromise simply dangerous folly or adoption of ‘the lesser evil’ for the safety and well-being of these children? You be the judge. Share with us and our community of readers your reaction.
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UPDATE: in response to my posting this blog on Twitter, one person using the Twitter name kvetchingguru brought to my attention a posting which is a ‘call to action.’ It is entitled “Urgent Alert: Call on the American Academy of Pediatrics to retract their endorsement of Type IV FGM.” A form letter is made available and the names of the Executive Director/CEO of AAP, the Chair of AAP and the President and CEO of the American Board of Medical Specialties are provided.
As I wrote earlier today, this ‘endorsement’ in any fashion – call it ritual snip or piercing – has created a groundswell of reaction.
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UPDATE: May 27, 2010
It appears that the uproar reported in this article has taken its toll.
The American Academy of Pediatrics has retracted its policy statement on female genital cutting after sparking controversy by apparently endorsing the illegal practice of “ritual nicks” to forestall more extensive mutilation.
“The AAP does not endorse the practice of offering a ‘clitoral nick,'” according to a new statement by the organization’s board of directors. “This minimal pinprick is forbidden under federal law, and the AAP does not recommend it to its members.”
The following from the AAP president about says it all:
In a new statement, AAP president Judith Palfrey, MD, of Harvard Medical School, clarified the academy’s position. “Our intention is not to endorse any form of female genital cutting or mutilation,” she said. “We retracted the policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere in the world.”
The source for these quotes: medpagetoday
Tags: AAP, female genital mutilation, Nash & Associates, policy statement
Medical Malpractice and Catastrophic Injury Litigation | Eye Opener: The Nash & Associates Blog 
May 25, 2010 at 9:23 am |
While I believe that this practice should not be tolerated in our country, we all know how difficult it is to alter cultural practices and beliefs. Until such laws are in place to protect young girls/women, these pediatricians, who are on the front lines as it were, are attempting to bridge the gap between this horrible practice and ending it. It seemed that this compromise was recommended only as a last resort. If they can get parents to accept a lesser “procedure”, then maybe, eventually they can talk them out of it completely.
May 30, 2010 at 12:45 pm |
Could you clarify something?
Are you talking about laws here or laws in their home countries?
May 31, 2010 at 5:04 am
I was referring to that which was reported and referenced in my original post: “…the “Girls Protection Act, which would make it illegal to take a minor outside the U.S. to seek female circumcision, was introduced in Congress. ” According to the report I referenced, this was introduced the same day as the AAP released its statement. Obviously, this is not the law of the land yet. I have no idea if any of the countries in which this practice occurs have laws forbidding such practice. That’s beyond the scope of my article and – quite frankly – beyond my knowledge.
May 29, 2010 at 11:43 am |
I have traveled to one of the parts of Africa where this is practiced. Let me assure you that it is NOT associated with any one of the “official” religious tenets practiced there-Moslem, Judaism, or Orthodox Christianity.
It HAS, however, been incorporated into some of the so-called “hybrid” faiths of some of the tribal cultures–and they can take elements of any one of those three or some combination thereof and add it to the native cultural beliefs. That’s where the problem lies. This isn’t a particular faith’s tenets-it is based on religious customs and cultural beliefs that-for all western thought knows-may have existed for literally thousands of years.
You don’t change such things overnight.
Children are taught from the time that they walk that they will have this done-boys and girls. It is a rite of passage for some-done when they reach puberty. For others, it is done when convenient and the necessary person is available–not often happening in the bush, and the parent has the price.
I’m not defending the practice-far from it. I think it is horrible. But I also understand that when a parent who has had this done to herself, has been taught from childhood that an “intact” woman is “like an animal” and is therefore despicable and completely unworthy of marriage, that a woman who has not had this done will become sexually promiscuous and therefore able to compare her husband with others and poison the marriage relationship, and so on.
You have to remember–these people are out there living with animals such as baboons-where the female DOES copulate with every male possible. It is a reasonable thing for uneducated people to make the logical leap to human females-especially if one has exhibited the same sort of behavior!
I have worked with some of these peoples-they are generally kind, generous, unassuming folk who genuinely love their children. They do things like this because they simply do not know any better-and see no reason to change. That is one reason that I do go there. They do want to learn-and they do care about those kids.
Our outrage blinds us to the people involved. I hate the fact the women and girls suffer. That doesn’t mean I love that land and its peoples any less.
Trust me-if these parents do not “get” something for their girls, they will go home and do it themselves. There was a conviction here in Atlanta just a couple of years ago of an Ethiopian man who performed the infibulation on his daughter because no doctor would help him. He couldn’t afford to get back to Ethiopia to have it done. It will get done-he did it with scissors. The only questions in my mind at this point are-who do you really want doing something? and exactly what do you want done to these girls?
May 29, 2010 at 10:01 pm |
Your comment is very,very much appreciated. You have ‘been there.’ Is there really an answer that’s right? I can see how this ‘endorsement’ came about. People who have to deal w. the real life issues are confronted with a horrible choice (e.g. your man w. scissors in Atlanta). I don’t purport to know the ‘answer.’ Is there an answer? Our public opinion reaction led to the retraction. Will some suffer because of this? No doubt they will.
I suspect that changing a culture is not going to happen in our lifetime; however, it is people like you, who go to these areas and try to make a difference, that will bring about lasting change. Policies are fine for the present. Policies like this were obviously well motivated and designed to protect innocents who will be dragged back ‘home’ in some (hopefully not many) instances for all the reasons you enumerate.When cultures clash – visceral reactions occur. Isn’t that what occurred here.
Keep up the tremendous work. We can only hope and pray that those like you will ultimately make the difference.
May 30, 2010 at 12:42 pm |
I believe that there IS an answer, Brian-it’s called careful education.
My father raised me to believe that only stupidity was permanent-ignorance was curable. These people are ignorant-and guilty only of that. That the practice is cruel and inhumane is beyond question.
However, the education has to be done one individual at a time-and we, of the Western world, cannot march our self-righteous selves in there and just upend their social system and religious beliefs because of our outrage. That accomplishes nothing but raising up more terrorists to fight world-wide. Our sledge-hammer tactics just don’t work in the long run.
The Moslem invaders of long ago found out the same thing in that area. They’d ride in, demand adherence to their faith and customs, and those that didn’t comply had either their hamstrings or achilles tendons cut with scimitars and marched away as slaves. Effective? yes. Efficient? Oh, yes. Long-lasting? No so very. The area is about 50-50 Moslem-Christian. If they’d succeeded like they thought they did then, it would be completely Moslem.
(Don’t entirely get down on the Moslem slave traders-if they hadn’t been there, you wouldn’t be sitting there drinking coffee!)
This is going to be one person-then one family-then one village at a time. It will be slow. But it will happen. Just send those of us working as volunteers some crumbs–we need it!
May 31, 2010 at 6:13 am |
Ellen
Isn’t that what led in large part to the furor over the AAP statement – ‘careful education’? Those opposed to any compromise position by AAP ostensibly believe that because the practice is so repulsive and inhumane that any acknowledgement of it being at any time ‘acceptable’ in order to avoid a worse fate for these children was simply a bad idea and should not be permitted in THIS country.
On the issue of the age-old problem of ‘ugly-Americanism’ tactics – shoving our beliefs down the cultural throats of foreign peoples, this is a philosophical and political debate well beyond the scope of this conversation. We could engage in a lengthy discussion about (a) the spread of democracy for the greater good; (b) what led to the Crusades from the 11th to the 13th Centuries; or a host of other issues of a similar nature.
I agree with your observation – “the education has to be done one individual at a time.” You also say, “This is going to be one person-then one family-then one village at a time. It will be slow. But it will happen.”
If I can apply those same principles of individualized education done by those such as you – who deserve more than ‘crumbs’ for your incredible work – isn’t that precisely what the debate was all about when it came to the AAP issue? These were American physicians, on American soil, faced with the same ‘ignorance’ in one-on-one settings with their patients. When the AAP seemed to ‘approve’ a lesser alternative but still one repugnant to OUR culture, wasn’t the outcry in America – No, this is NOT acceptable! Start your education process now – do NOT give any indication of approval that in the US FGC/FGM is even remotely acceptable.
That’s what I think the debate was about. Our principles on our soil.
What I was alluding to in terms of “is there an answer?” is this – I am pragmatic enough to respect the unenviable task facing a pediatrician who in the real world is faced with a family culturally mired in the practice of FGM/FGC. That doctor is not caught-up in a philosophical debate of which is the correct way to deal with this. He/She is facing the not-remote possibility if some ‘compromise’ is not used, this child, sitting in the doctor’s office with the parents, will be taken home (wherever that may be in some foreign land) for ‘proper’ handling – FGM. In order to deal with this nightmare, the physician opts to provide an alternative/compromise. That’s what has been going on – that’s what the AAP was addressing.
Just a societies have always spoken their historical will on such public pronouncements, that’s what has occurred here. We, as a people of this country, said NO to a society invested with the well-being and care of children.
While one can argue whether our efforts to spread democracy throughout the world are ill-conceived or not, I don’t see a whole lot of room for debate about whether we as a nation should condone – as a policy statement – FGM/FGC in any form or fashion. That being said, however, I still can understand and empathize with a physician, faced with this nightmare, with his/her patients sitting there. This isn’t philosophy or politics – this is a child about to be mutilated. A small cut, a symbolic piercing? – rather than God-knows-what mutilation w a non-sterile instrument in some room (Atlanta) or village hut in some foreign land? That’s the picture I was envisioning when I asked – “is there an answer?”
Keep up the phenomenal work you do. Some day, through efforts by people such as yourself, this debate/discussion and the horrible, despicable practices that led to it will be an historical footnote never to be seen again anywhere on this planet.
Thank you again, Ellen, for adding so much to this discussion.
May 31, 2010 at 6:38 am |
For those who are interested, the full text of the legislation known as “Girls Protection Act of 2010” – H.R. 5137 – and the ability to track that legislation – it can be found at http://www.govtrack.us/congress/bill.xpd?bill=h111-5137. Another online location for the official text of the house bill where you can also provide your comments is found at http://www.opencongress.org/bill/111-h5137/text.
This legislation was introduced by NY Democratic Representative Joseph Crowley on April 26, 2010. According to the government website, the house bill has 133 sponsors.
May 31, 2010 at 9:56 am |
Brian,
I am well aware of the responsibilities of the pediatrician/surgeons in their offices. I worked in a large multi-specialty clinic that brought me into regular intimate contact with their daily duties and responsibilities. My job was to help them meet those needs. I was, and am, a background player. My function was to make the doctor look competent and in control to his patients and patients’ families.
I know-from experience-some of the heart-wrenching things that a peds doc faces. Things people in this country think don’t happen, but do. I’ve been in the room-and in one case, notified the office-of victims of extreme child abuse. (I learned a long time ago to love hearing children cry, scream, and laugh. Sound crazy? It’s not. When I came towards them with a needle to draw blood and a child is stoic-devoid of any reaction at all-it’s a dead giveaway to extreme abuse. Another marker is the child who suddenly attacks-usually with fingernails AND TEETH. ) The child I found was covered in cigarette burns-from his step-dad. He was near death. He was brought in for a high fever and sore throat.
You have to be one very tough cookie to be a peds doc. They see so much of the ugliest side of life. So I know that philosophically, yes, they would be adamantly opposed to FMG or any variant therefore. But I also know that these people also tend to be very realistic–they know-first hand-what they can ask of people who come from foreign countries with all their cultural baggage. They are consummately aware, too, of their protection of freedom of religious expression-and this is sometimes part of that.
I know I just invoked the Constitution and Bill of Rights. The thing is-they ARE protected. Whether we like this or not-it IS their belief system.
Okay-now that we’ve gotten the discussion into some very deep waters-and no reasonable end is in sight (though quite a few people wish somebody would/could come up with something), I’ll close.
May 31, 2010 at 10:35 am |
Ellen
“Very deep water’ about says it all. ‘No reasonable end in sight’ may have been intended to bring to a natural close this dialog we’ve been having. I hope not – at least in terms of ‘others’ who might decide to read our conversation and join in. Your comments have been not only inspiring but also have given some reality and balance to this issue. Again – they are most appreciated and welcomed.
When I first posted this piece, I did so at the urging of my wife. More on this connection to the ‘story’ in a moment.
If you go back to the original blog and even the headline I used to broadcast it through Facebook and Twitter, you’ll note that I attempted to present it as more of a question – “Is AAP’s ‘endorsement’ of compromise for female genital mutilation dangerous foley or a necessity. http://bit.ly/cXfHcE.” Note the word ‘necessity.’
I was a bit surprised when my followers on Facebook were universal in their condemnation of the AAP’s ‘endorsement.’ I have purposely used quotation marks around the word ‘endorsement’ because I believe that’s an overstatement of what the organization says – but that’s how the media presented it. I also used the term “Female Genital Cutting” rather than mutilation only since there is no way the AAP was in any way suggesting the barbaric mutilation techniques unfortunately practiced in some places across the globe.
Then came your comment(s) and the one from Tracy Klima that preceded yours. Finally, someone was taking somewhat – and I emphasize that word – a different perspective on the issue. You have been there. This isn’t theoretical or an esoteric discussion. This is real life ‘stuff’ happening to real life people – including the healthcare providers faced with these patients and how to handle such situations. Which brings me to the issue of my wife.
She is a lawyer now as well. However, she devoted many years of her professional life to pathology. She is not a physician. She has an advanced degree in pathology. She has done not only surgical pathology but also autopsies. One of the reasons she left her previously chosen field to which she devoted years of education and practice was the fact that she had done way too many autopsies on children who were the victims of child abuse. That’s also real life ‘stuff’ by any stretch of the imagination.
A ‘tough cookie to be a peds doc’? I can’t even imagine. My sister worked as a nurse in the pediatric oncology unit of NIH years ago. Her tales of the last days of life for these children stricken with cancer are gut-wrenching.
So,I do get it somewhat. I’ve not had to deal with these clinical trials and tribulations. You’ve seen it up front and personal, which is why I so appreciate your becoming part of this discussion. Some have said – there is NO other side to this discussion. Well – maybe there is….but then again, that leads us back to ‘deep waters’ doesn’t it?