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US researchers argue for 'minimalist' forms of FGM

26 February 2016


Tribesman-campaigner: a member of the Maasai Cricket Warriors runs onto the field during a charity cricket match against former rugby players, in Sydney, earlier this month. The Maasai Cricket Warriors travel the world to campaign against female genital mutilation and substance abuse, while promoting conservation in their African homeland

Tribesman-campaigner: a member of the Maasai Cricket Warriors runs onto the field during a charity cricket match against former rugby players, i...

A SMALL surgical “nick”, or minimalist procedure to change the look of female genitalia, without causing harm or permanent damage, should be “legally permitted” as a compromise to the issue of female genital mutilation (FGM), two gynaecologists have argued.

Writing in the Journal of Medical Ethics, one of 50 specialist titles published in the British Medical Journal (BMJ), this week, two doctors in the United States argued that a “nuanced and balanced solution” to FGM could be achieved.

FGM was made illegal in the UK in 1985, but campaigners say that it remains prevalent because of its perception as a religious requirement. The procedure, which can cause severe long-term physical and mental damage, is still common in many African countries, despite more than 30 years of campaigning.

Today, 137,000 women and teenagers in the UK are affected, a figure that is down from 170,000 in 2014, when the Prime Minister announced that he would make it mandatory for teachers, doctors, and social workers to report FGM fears (News, 25 July 2014).

In the paper published on Monday, the authors, Dr Kavita Shah Arora of the MetroHealth Medical Center in Cleveland, Ohio, and Dr Allan J. Jacobs of Stony Brook University, New York, wrote: “We are not arguing that any procedure on the female genitalia is desirable. . . Rather, we only argue that certain procedures ought to be tolerated by liberal societies.”

They suggest that the term FGM should be replaced with “female genital alteration (FGA)” to reflect the different types of procedure and their associated risks, and to avoid “demonising” long-established cultural practices.

There are four types of female genital cutting, the majority of which are equivalent to, or less extensive than, orthodontics, breast implants or labiaplasty (virginal sculpting) “for which affluent women pay thousands of dollars”, the authors say.

A new system of categorisation should be introduced, based on the “effects of the procedure, rather than the process”. This would distinguish between those that have “no long-term harm” on the appearance or function of the genitalia — such as a “small nick in the vulvar skin”, comparable to male circumcision — and those that maim and impair sexual fulfilment, pregnancy, and childbirth. The latter, they write, should be banned.

Laws prohibiting all female genital cutting are, however, “culturally insensitive and supremacist, and discriminatory towards women”, and encourage more severe forms of the procedure, the authors argue.

In a commentary to the paper, Professor Ruth Macklin of Albert Einstein College of Medicine, New York, said that FGM could not be compared to male circumcision. “There is no doubt that, in whatever form, FGA [FGM] has its origin and purpose in controlling women,” she wrote. “A cultural tradition designed to control women — even in its least harmful form — is best abandoned.”

In another commentary, Brian D. Earp, a visiting scholar at the Hastings Center,a bioethics research institute in New York, said that permitting “minimalist” FGM would lead to “a fiasco” of legal, regulatory, medical, and sexual issues.

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