AAP Defends Female Mutilation?

[Eta Carinae]

Advertisement - Members don't see this ad

😱😱





Doctors defend genital "nick" for girls

The American Academy of Pediatrics suggests the ritual to prevent extreme "female genital cutting"

The American Academy of Pediatrics has suggested a new way to fight female genital mutilation in the United States: Allow doctors to give girls a "nick" down there.

In a policy statement titled "Ritual Genital Cutting of Female Minors," the Academy suggests that allowing such a ritual could serve as a way to "build trust" with immigrant families and prevent parents from sending their girls overseas for far more extensive, and potentially life-threatening, procedures. It's a "possible compromise to avoid greater harm," the statement says.

Taking a similar tack, Shakesville's Melissa McEwan turned up the snark real loud: "Girls get only a little heinous physical and psychological trauma, and their guardians get to practice their violent misogyny, just in a slightly less violent way.

Dr. Lainie Friedman Ross, one of the statement's authors, compared it to an ear piercing. It wouldn't involve the removal of skin, instead it would be more like "a pin prick, a drop of blood." As she described it, the "nick" would be ritualistic and symbolic.

"In an ideal world, there would be no female genital cutting," said Ross, but we clearly do not live in an ideal world. "If you just tell people 'no,' they go elsewhere," she explained, adding that a "nick" should be seen as an "option that's not ideal but is better than its alternatives."

Yes?

No?

I find this disturbing on many levels.





.

 

[oldbearprofessor]

Okay, as much as I'm not thrilled by having this topic here, it is a statement by the AAP so as long as the discussion is appropriate and does not stray from the specific topic at hand, it will stay here. Otherwise, off to TIH it will go. I would encourage anyone who wishes to comment to actually read the AAP statement rather than the article about it. No, I won't violate Pediatrics copyright by posting the large sections of the article it would take to appreciate the AAP view.

 

[ForbiddenComma]

The way I understand it is, the AAP is trying to engage in harm reduction by offering parents a "symbolic" FGM that does not actually destroy or mutilate the clitoris.

I sympathize, but I still have major problems with this for two reasons. #1: the old slippery slope. "Ritual nicking" today... what will it be tomorrow? #2: This policy gives aid and comfort to an evil practice based entirely on the hatred of women and of female sexuality. FGM springs from the primal terror that is the primary motivation of many patriarchal types: the fear of female infidelity. What better way to ensure women don't stray than destroying their enjoyment of sex?

Unlike male circumcision, FGM is at its core an entirely malign practice. Male circumcision is based on debatable standards of hygeine (and certainly does not prevent the male's enjoyment of sex)... female circumcision is an act of violence against the child for the crime of being female.

 

[J-Rad]

I'm presuming this is the statement being discussed (AAP usually gives free access to policy statements).

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;125/5/1088

Without having read the above yet (which I will do later) I tend to agree with Comma. Often, but not always, "slippery slope" arguments are dubious. However, wouldn't (one) analog (along the "slope") be: why don't we allow legalized, "symbolic" child marriages so they won't be taken overseas to become a "true" child bride?

There is a reasonable limit to cultural sensitivity and accommodation.

 

[tootsweet]

I agree with the posts above. This is a slippery slope. After reading the paper, it's not clear to me who is supposed to do the nicking..are they supporting pediatricians who perform or oversee the procedure in a safe, controlled environment? If not, how can they be sure that it will be done safely? Moreover, is there any evidence that the nicking would prevent further larger cutting?

I've seen a number (5 or so) of type 2/3's in the somali population I worked with as a medical student. Horrendous and often carried serious implications for the woman, especially at delivery.

 

[Stitch]

I pretty much agree with the above statements. It's disturbing and wrong. It's important to read the whole article, however since the ending recommendations are as follows:

# poses all forms of FGC that pose risks of physical or psychological harm.
# Encourages its members to become informed about FGC and its complications and to be able to recognize physical signs of FGC.
# Recommends that its members actively seek to dissuade families from carrying out harmful forms of FGC.
# Recommends that its members provide patients and their parents with compassionate education about the physical harms and psychological risks of FGC while remaining sensitive to the cultural and religious reasons that motivate parents to seek this procedure for their daughters.

Nonetheless I strongly disagree with the statement that "There is reason to believe that offering such a compromise may build trust between hospitals and immigrant communities, save some girls from undergoing disfiguring and life-threatening procedures in their native countries, and play a role in the eventual eradication of FGC. It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm."

I think the AAP are trying to give the family something to have a ritual around, with the hope to do minimal damage. But we absolutely should not compromise on this. Wrong is wrong, and I personally wouldn't be a party to such a decision. Practically though who exactly would be willing to do these procedures??

 

[Eta Carinae]

While this may seem like a minor, even slightly irreverent topic, it concerns me in a number of ways.

As a medical student, I frequently had the privilege of interfacing with women from different cultures/countries both in the county hospital system and volunteering at a shelter for women and children who have been victims of domestic violence. Women from certain foreign cultures, unfortunately, overwhelmingly constituted the dominant population in such shelters. My personal experience leads me to believe that a subliminal cultural sanction of the unfair treatment of women and girls exists in these populations.

I am taken aback by the fact that a specialty of modern medicine sanctions this practice in any form. If it is ever enacted, and I doubt it will, this may represent the unspoken support, however small, of the culture of subjugation of females, benevolent intentions notwithstanding.

In its defense, the AAP states that and I quote directly from the policy statement itself referenced here:

"However, the ritual nick suggested by some pediatricians is not physically harmful and is much less expensive than routine newborn male (circumcision). There is no reason to believe that offering such a compromise may build trust between hospitals and immigrant communities, save some girls from undergoing disfiguring and life-threatening procedures in their native countries, and play a role in the eventual eradication of Female Genital Circumcision. It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm."


I submit there are many other ways to "build trust between hospitals and immigrant communities"- learning the language where possible, deferring to the system of sole male authority in obtaining consent for the treatment of adult women (as long as there no threats to life/it is a non-emergent issue), or making use of a cultural intermediary, for instance. But acquiescing to a brutal cultural practice such as this (even if the full measure of the practice isn't conducted), seems indefensible to me.

The question then emerges- what other ethnic mores are we (as a body of physicians) going to be willing to concede to gain the "trust" of immigrant populations?


The article goes on to state that,

"The option of offering a "ritual nick" is currently precluded by US federal law, which makes criminal any non-medical procedure performed on the genitals of a female minor."

Bravo for the Federal Law and I hope it stays that way. I also hope that any support for this option quickly dissipates.

 

[J-Rad]

I don't agree with the AAP 100% of the time, but here is a reason why it's still my favorite medical group:
http://www.cnn.com/2010/HEALTH/05/27/AAP.retracts.female.genital.cutting/index.html?hpt=Sbin
👍

 

[Stitch]

I don't agree with the AAP 100% of the time, but here is a reason why it's still my favorite medical group:
http://www.cnn.com/2010/HEALTH/05/27/AAP.retracts.female.genital.cutting/index.html?hpt=Sbin
👍

Nice! They do tend to be rather sensible about things.