The new policy on female genital mutilation released by the Royal Australasian College of Physician in April 2012 takes a firm stand in defence of the bodily integrity and human rights of girls and women. According to the policy, FGM is an injury to the external genitals; it is usually performed on girls between infancy and 15 years of age; it causes harm; it violates the human rights of the victims; it is wrong because it is performed on minors without consent; it is illegal in all Australian states; and, although it is a practice authorized and recommended by some cultural and religious minorities, it is unacceptable in Australia. Doctors should vigorously oppose any form of FGM and become advocates for girls who are threatened with it, even against their parents and culture of origin.
These are very fine sentiments, and one wonders why the same principles have not been adopted in the RACP’s policy on circumcision of boys. Every one of the above objections to FGM also applies to male genital mutilation: circumcision is also an injury to the external genitals (usually more severe than mild forms of FGM, such as a nick); it is usually performed between infancy and 15 years of age; it causes harm; it violates the human rights of the victims; and it is performed on minors without consent. But at this point some striking differences emerge: despite injuring the genitals, causing bodily harm and violating a boy’s human rights, circumcision is apparently OK if a boy’s parents prefer him to be circumcised; the practice is not illegal or even regulated anywhere in Australia; and doctors are not urged to oppose the practice and become advocates for the victims.
One can only feels that the RACP is suffering from a certain schizophrenia. If any form of female genital mutilation is a violation of a girl’s human rights, it follows that the right must also apply to boys. A human right is a right that applies to all humans, regardless of gender or age, simply by virtue of their humanity; it has nothing to do with the culture of their parents. For the RACP’s position to be logically consistent there are only two possibilities here: either a girl’s right not to have any part of her genitals injured by FGM is a not a human right at all, but gender-specific right, applicable only to females; or boys are not human. Neither possibility seems very likely, and the shabby truth appears simply to be that the RACP is in the grip of the usual sexist double standard on genital mutilation, whereby the slightest nick to the female genitals is an outrage that must be abhorred and opposed, while the most ruthless and brutal circumcision of a boy is a harmless snip that must be allowed and may be applauded.
The RACP’s full policy on female genital mutilation is reproduced below, preceded by the media release that announced it. We urge readers to add the words and male or and boys or and men whenever they see the word female, girls or women. The result will be a non-discriminatory policy statement that shows equal respect for the bodily integrity and human rights of all children, not merely those fortunate enough to have been born without a penis. Why isn’t circumcision also “a child protection issue”?
Physicians (RACP) today launched the Female Genital Mutilation/Cutting (FGMC) Policy. With increasing numbers of immigrants arriving in Australia and New Zealand, paediatricians may encounter in their practice, girls or women who have undergone FGMC, or are at risk of it, according to Professor David Forbes, Chair of the Policy and Advocacy Committee of the Paediatric and Child Health Division (P&HCD). FGMC is defined as an injury of the external female genitalia undertaken for cultural or non-therapeutic reasons. FGMC is usually carried out on young girls between infancy and 15 years of age. With cultural migration, the practice has moved to Western countries. “FGMC is recognised internationally as a violation of the human rights of girls and women,” Professor Forbes said. “FGMC exposes children and women to significant health risks and has no measurable health benefit. The RACP believes that it is not an acceptable practice.”
The P&CHD, through the launch of the policy, is calling for all paediatricians to be aware of the practice and the associated risks, and to seek opportunities for prevention and child protection. “It is important for paediatricians practising in Australia and New Zealand to understand both the cultural context in which FGMC occurs and the clinical implications for patients who have undergone the procedure. Girls and adolescent women may be exposed to the risk of FGMC either in Australia or New Zealand or on return visits to their country of origin. Girls and adolescent women migrating to Australia and New Zealand may already have undergone FGMC or may be at risk of undergoing FGMC on return visits to their country of origin.”
All forms of FGMC are condemned by leading health professional organisations. It is illegal in Australia and New Zealand for cosmetic genital surgery of any form to be undertaken on minors. FGMC causes significant short and long-term health risks for girls and women, including acute and chronic infection, infertility, childbirth difficulties, sexual relationship difficulties and significant short and long-term psychological trauma. United Nations organisations report that 140,000,000 women have undergone FGMC and 3,000,000 girls are at risk of the procedure every year. “Paediatricians need to develop the skills to be able to recognise families where FGMC may be practiced and girls are at highest risk, and to discuss FGMC with these families,” according to Professor Forbes. Children and adolescent girls who have experienced FGMC may require long-term care that that necessitates the involvement of a range of different services including mental health and gynecological services.
Royal Australasian College of Physicians, 24 April 2012
The full RACP policy on female genital mutilation follows
Definition
Female genital mutilation/cutting (FGMC) is defined as an injury of the external female genitalia undertaken for cultural or non-therapeutic reasons. The term FGMC is now in use by UNICEF and some other international agencies [1]. FGMC comprises all procedures that involve partial or total removal of the external female genitalia, or other deliberate injury to the female genital organs for non-medical reasons[1]. This includes so-called “nicking” of the external genitalia.
Key Points
Background
FGMC is a cultural, but not religious, practice of groups from Saharan Africa, parts of East Africa, Asia and South America. It is believed to have arisen in Africa and to pre-date Islam. It is not restricted to Islamic populations, is not supported by Islamic doctrine and has been condemned as an unacceptable practice by Islamic groups [1, 14]. United Nations organisations report that 140,000,000 women have undergone FGMC, and 3,000,000 girls are at risk of the procedure every year [1]. Traditionally FGMC was performed to safeguard family honour and social position, and to prevent female promiscuity and rape [3]. FGMC is sustained by the belief that it is in the best interest of the child and that failure to participate may place the child at risk [1, 4], although this justification is no longer considered valid.
FGMC is usually carried out on young girls between infancy and 15 years of age [2]. It is typically carried out by traditional circumcisers, but is now performed by health care providers in some countries. With cultural migration the practice has moved to Western countries and has been documented in North America and a number of European countries [5, 6]. It is not clear that FGMC is practiced in Australia and New Zealand [7], although press and legal reports suggest that it is being undertaken in these countries. [8]
FGMC causes significant short and long-term health risks for girls and women, including acute and chronic infection, infertility, childbirth difficulties, sexual relationship difficulties and significant short and long term psychological trauma. There are higher rates of Caesarean section for women who have undergone FGMC, and increased infant death rates [9], 10]. FGMC is illegal in Australia and New Zealand and in most other western countries. [8] It is also illegal to send girls and young women overseas for the purpose of genital surgery. In some Australian and New Zealand jurisdictions it is a requirement that children who are perceived to be at risk of FGMC or have ever experienced FGMC are to be notified to child protection services.
Western custom and practice appears inconsistent in relation to genital surgery, by tolerating and even facilitating cosmetic genital surgery that includes piercing and labioplasty. Key differences are that genital cosmetic surgery is usually performed on consenting adults, while FGMC is performed without consent on minors.
Paediatricians and FGMC
FGMC is relevant to paediatricians in Australian and New Zealand, and it is important that paediatricians are aware of the practice and the risks associated with it, and the opportunities for prevention and child protection:
Girls may be exposed to the risk of FGMC either in Australia and New Zealand or on return visits to their country of origin.
Girls immigrating to Australia and New Zealand may already have undergone FGMC or may be at risk of undergoing FGMC on return visits to their country of origin.
Paediatricians need to develop the skills to be able to recognise families where FGMC may be practiced and girls are at highest risk, and to discuss FGMC with these families (See Royal College of Nursing educational resource [13]).
The RACP has a role in ensuring trainees and practising paediatricians have access to training regarding cultural awareness and specific aspects of recognition and management of FGMC.
In clinical settings with potential high prevalence of FGMC this should be routinely, but respectfully, inquired about in order to avoid missing girls at risk.
Care must be taken to avoid stigmatizing particular ethnic groups.
Paediatricians working with communities that traditionally practice FGMC should seek opportunities, in conjunction with other health and child protection services to raise awareness that FGMC is not an acceptable practice in Australia, and to educate community leaders regarding healthy attitudes to female sexuality and to the dangers of FGMC.
FGMC is a child protection issue, and paediatricians need to be prepared to advocate for girls and young women with their families and communities, and if necessary with the agencies charged with child protection. Paediatricians may be required to collaborate with other health and non-health professionals to advocate for and protect girls at risk.
Service providers need to be aware that in protecting girls from FGMC they may expose them to risk of becoming ostracized within their families and communities through not participating in cultural rituals, and they may need special intervention to minimise this risk.
Children and adolescent girls who have experienced FGMC are at risk of a range of serious, long-term physical and psychological problems. They will require long-term care that may require the involvement of a range of different services including mental health and gynaecological services.
Royal Australasian College of Physicians, April 2012
References
1. OHCR, et al., Eliminating female genital mutilation: An interagency statement, 2008, World Health Organization: Geneva.
2. World Health Organisation, Female Genital Mutilation: Fact Sheet, 2012, World Health Organisation: Geneva.
3. Shell-Duncan, B., et al., Dynamics of change in the practice of female genital cutting in Senegambia: Testing predictions of social convention theory. Social Science & Medicine, 2011. 73: p. 1275-83.
4. Alo, O.A. and B. Gbadebo, Intergenerational Attitude Change Regarding Female Genital Cutting in a Yoruba-Speaking Ethnic Group of Southwest Nigeria. J Womens Health (Larchmt), 2011. 20: p. 1655-61.
5. Davis, D.S., Ritual genital cutting of female minors. Pediatrics, 2010. 125(5): p. 1088-93.
6. Jaeger, F., M. Caflisch, and P. Hohlfeld, Female genital mutilation and its prevention: a challenge for paediatricians. Eur J Pediatr, 2009. 168(1): p. 27-33.
7. Grover, S., Female genital mutilation. J Paediatr Child Health, 2009. 45(10): p. 614-5.
8. Matthews, B., Female genital mutilation: Australian law policy and practice challenges for doctors. Med J Aust, 2011. 194: p. 139-41.
9. Chibber, R., E. El-Saleh, and J. El Harmi, Female circumcision: obstetrical and psychological sequelae continues unabated in the 21st century. J Matern Fetal Neonatal Med, 2011. 24(6): p. 833-6.
10. Merritt, D.F., Genital trauma in children and adolescents. Clin Obstet Gynecol, 2008. 51(2): p. 237-48.
11. American Academy of Pediatrics, Policy Statement- Ritual cutting of female minors. Pediatrics, 2010.
12. Royal College of Obstetricians and Gynaecologists Joint RCOG/RCPCH statement on the AAP policy statement on FGM. 2010.
13. Royal College of Nursing, Female genital mutilation. An RCN educational resource for nursing and midwifery staff, 2006, Royal College of Nursing,: London.
14. WISE Muslim Women’s Shura Council, Female Genital Cutting: Harmful and Un-Islamic. 2010. Accessed 5 March 2012: http://www.wisemuslimwomen.org/images/uploads/WISE_Shura_Council_FGC_DigestStatement.pdf_.pdf
The United States federal law criminalising any form of female genital cutting was passed by Congress as an addition to the U.S. Cade Title 18, Crimes and Criminal Procedures, and listed in Part I, Chapter 7, “Assault”. In other words, it categorises female genital cutting as an assault. The most relevant paragraph reads: "(a) Except as provided in subsection (b), whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years shall be fined under this title or imprisoned not more than 5 years, or both." Sub-section (b) allows the operation to be performed if it is “necessary to the health of the person on whom it is performed, and is performed by a person licensed in the place of its performance as a medical practitioner”.
Source: 18 U.S.C.A. § 116. Female genital mutilation
Congressional Findings
Justifying the passage of the law, Congress advanced the following arguments:
The Congress finds that:
Section 645(a) of Div. C of Pub.L. 104-208
Why these observations would not apply just as strongly to circumcision of a boy is not obvious.
Female circumcision page on this site
Male circumcision is a feminist issue
Brian Earp, Female genital mutilation (FGM) and male circumcision: Time to confront the double standard. Practical Ethics (Oxford), 18 February 2014.
Robert Darby and J. Steven Svoboda, A rose by any other name: Rethinking the differences/similarities between male and female genital cutting, Medical Anthropology Quarterly, Vol. 21, September 2007. Full text available as PDF here.
Robert Darby and J. Steven Svoboda, “A rose by any other name: Symmetry and asymmetry in male and female genital cutting”, in Chantal Zabus (ed.), Fearful Symmetries: Essays and Testimonies around Excision and Circumcision (Amsterdam and New York: Rodopi, 2009). Full text available as PDF here: RoseByAnyOther%20Name-Zabus
Robert Darby and Laurence Cox, “Objections of a sentimental character: The subjective dimension of foreskin loss”, in Chantal Zabus (ed.), Fearful Symmetries: Essays and Testimonies around Excision and Circumcision (Amsterdam and New York: Rodopi, 2009). Full text available as PDF here: ObjectionsSentimental-Zabus
Wim Dekkers, Cor Hoffer and Jean-Pierre Wils, Bodily integrity and male and female circumcision, Medicine, Health Care and Philosophy (2005) Vol. 8: 179–191.