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Female circumcision: cultural staple, policy nightmare

Female circumcision (also called genital mutilation) is unthinkably inhumane, and it's recognized around the world as a violation of human rights and a form of discrimination against women and children. But in cultures where it persists - including some immigrant populations in North America - the procedure is seen as an important way to prepare girls for adulthood and marriage. Where, then, should it fit in American medical care? Should doctors categorically reject any requests for genital cutting, or should they offer a safer, mostly ceremonial alternative?

That's a question that has stymied the American Academy of Pediatrics (AAP) in recent years, and it's taken up by New York University graduate student Ariel Bleicher in a nice review piece for Bleicher reports that while performing circumcision on a girl has been illegal in the United States since 1996, the AAP in April released a revised policy statement, which discussed the possibility of allowing American doctors to perform "ritual nicks" on young immigrant girls.

While human rights groups fiercely denounced the change, doctors at Seattle's Harborview Medical Center have argued since 2005 that the compromise "would discourage parents from sending their girls back to their native countries for unregulated and unsanitary procedures":

The Harborview doctors proposed that the hospital offer these mothers a “clitoral nick” for their [daughters] - a needle prick, really - in the small hood of tissue that covers the clitoris. “We’re talking about something far less extensive than the removal of foreskin in a male,” a common procedure in the United States, said Dr. Diekema.

Still, the public outcry prevailed. Within a month, the AAP retracted its revised policy:

“What you really have is a disagreement about tactics,” said Dr. Douglas Diekema, a bioethics professor at the University of Washington in Seattle and a physician at Seattle Children’s Hospital, who chaired the AAP’s bioethics committee. “It’s very naive to think that if you suddenly say [female circumcision] is wrong, people will stop doing it.”

Perhaps the debate could be furthered by real data: Few studies have examined how U.S. policies on female circumcision affect immigrant populations, Bleicher says.

Photo courtesy of Ariel Bleicher

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