Saturday, May 08, 2010

The ritual "nick": AAP statement on female genital mutilation

An article in The New York Times recently reported that the AAP supports legalizing the option of performing a "ritual nick" in order to prevent parents from taking their daughters overseas for more extensive genital cutting. I was curious to read the reasoning behind this position, so I looked up the AAP Policy Statement on Ritual Genital Cutting of Female Minors, recently revised in May 2010. Here is an excerpt concerned with legalizing a small "nick" or pinprick:

Some physicians, including pediatricians who work closely with immigrant populations in which FGC is the norm, have voiced concern about the adverse effects of criminalization of the practice on educational efforts. These physicians emphasize the significance of a ceremonial ritual in the initiation of the girl or adolescent as a community member and advocate only pricking or incising the clitoral skin as sufficient to satisfy cultural requirements. This is no more of an alteration than ear piercing. A legitimate concern is that parents who are denied the cooperation of a physician will send their girls back to their home country for a much more severe and dangerous procedure or use the services of a non–medically trained person in North America. In some countries in which FGC [female genital cutting] is common, some progress toward eradication or amelioration has been made by substituting ritual "nicks" for more severe forms. In contrast, there is also evidence that medicalizing FGC can prolong the custom among middle-class families (eg, in Egypt). Many anti-FGC activists in the West, including women from African countries, strongly oppose any compromise that would legitimize even the most minimal procedure. There is also some evidence (eg, in Scandinavia) that a criminalization of the practice, with the attendant risk of losing custody of one's children, is one of the factors that led to abandonment of this tradition among Somali immigrants. The World Health Organization and other international health organizations are silent on the pros and cons of pricking or minor incisions. The option of offering a "ritual nick" is currently precluded by US federal law, which makes criminal any nonmedical procedure performed on the genitals of a female minor.

The American Academy of Pediatrics policy statement on newborn male circumcision expresses respect for parental decision-making and acknowledges the legitimacy of including cultural, religious, and ethnic traditions when making the choice of whether to surgically alter a male infant's genitals. Of course, parental decision-making is not without limits, and pediatricians must always resist decisions that are likely to cause harm to children. Most forms of FGC are decidedly harmful, and pediatricians should decline to perform them, even in the absence of any legal constraints. However, the ritual nick suggested by some pediatricians is not physically harmful and is much less extensive than routine newborn male genital cutting. 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.

Efforts should be made to use all available educational and counseling resources to dissuade parents from seeking a ritual genital procedure for their daughter. For circumstances in which an infant, child, or adolescent seems to be at risk of FGC, the American Academy of Pediatrics recommends that its members educate and counsel the family about the detrimental health effects of FGC. Parents should be reminded that performing FGC is illegal and constitutes child abuse in the United States.
Thoughts? Is it better to allow a "ritual nick" in order to theoretically prevent more extensive, and more dangerous, genital mutilation? Or is it ethically/morally wrong to support any form of FGM? How might these arguments apply to male genital mutilation (i.e., circumcision)?


  1. I think the double standard is awful, both our boys and our daughters bodies should be protected the same. I don't agree with circumcision at all but as a society it is concerning that we don't protect children the same. Why are our daughters genitals more precious than our boys? I practice reformed Judaism and that affects my belief that parents should be able to make the decision for their children. No matter what the sex of the child. I would choose not to, but that is my choice not my governments.

  2. Girl, you really need to get on facebook LOL This is spreading like wildfire...

    To answer your question, I absolutely believe it is ethically and morally wrong to support mutilation of ANY child's genitals, without exception. I think this is a sick play by the AAP to get more money and lead the way to recommendation of universal infant circumcision (of males at least). I am disgusted that this group who has taken an oath to do no harm would EVER (a) recommend cutting any genitals except in the rare event of true health need; and (b) recommend against the current status of protection of at least half of our children.

    No, I do not believe this would keep US babies from having more severe forms of cutting - quite the contrary. I think girls who would be protected by living here would be subjected to it, as the docs say it's OK. Just like American parents who continue to cut infant boys' genitals because it is currently "accepted" in our society, I think that acceptance would encourage the practice. Outlawing all unnecessary genital mutilation for ANY baby is the ethical and moral responsibility of all who hold authoritarian positions, and especially of those who have sworn to do no harm :(

  3. I think it is wrong to do anything to your children against their consent. In the UK circumcision is practically unheard of (except from medical or religious reasons) I can't imagine it being the norm to put your child through such a painful and unnecessary procedure-it just boggles my mind!

  4. I would think that physicians serving "immigrant populations in which FGC is the norm" would be able to address these concerns in a way that would still be educational without having to try to change the law making FGM illegal, and don't quite understand why they're wanting to make the change. Yeah, I get that they're afraid that people will take their daughters overseas to have them cut worse, but if they can get them to make only a small nick or pinprick in the doctor's office, rather than the full procedure, why can't they talk the families into doing it themselves? If it's such a minor procedure, why does a doctor need to do it? It seems like the doctor should be able to educate the family while still refusing to participate in it.


  5. I would rather see these doctors that are willing to perform this procedure go to the countries that are practicing FGM and teach the villages to safely do the "nick" instead of the extreme and unsanitary practices they are currently doing. It's not the ideal (completely ending the practice), but it's a step in the right direction instead of starting that practice in the U.S., which would be a step backwards.
    I think that culturally speaking, it is easier to get someone to alter their beliefs rather than stop them outright.

  6. NO! It is NOT okay to mutilate ANY child's genitals, even "just a pinprick!" And it IS the government's job to legislate in such a way that PROTECTS CHILDREN against genital mutilation that they did NOT consent to! I believe that even for religious reasons it is inethical for boys to be circumcised, and same for girls. Though to be totally honest I react far more strongly to FGM, not because it is less accepted in my Canadian culture, but because girls and women around the world are so often disrespected, controlled, oppressed and abused, that to allow, sanction, or offer to DO a procedure that mutilates female genitals is mysogenistic, in my opinion. It is a step backwards for women the world over.

    No, no, no. I disagree profoundly with the AAP on this issue.

  7. This is interesting. It seems simliar to the ideas of harm-reduction in addiction treatment and the housing first policies that have been successful in adressing homelessness.

    Harm reduction and housing first on their face may seem counter-intuitve. Harm reduction focuses on just that, reducing the danger to addicts and drunks, i.e. giving out clean needles, encouraging people to choose a safer environment in which to drink. It saves money, lives, and has some great successes in helping to eventually engage people in treatment. Housing drunks and drug addicts without any requirements that they engage in treatment doesn't seem to be common sense, BUT it works. Once people have shelter, privacy, dignity, they are often far more likely to seek and be successful in treatment.

    So it sounds like this might be a successful campaign, that is informed by some pretty sound psychological principles. One school of practice called motivational interviewing, deals mostly with helping people recognize ambivalence to changing and giving them the framework in which to resolve their own ambivalence. There is alot of "coming alongside" of a person. Acknowledging the reasons they might not want to change, and meeting people where they are at in the process. If you pull someone they will inevitably pull the other way. Counter-intuitive to some, but it works. It seems as though there is alot of that in this statemet, and if one can get past the visceral reaction we often have to things like this, it might begin to make sense. or not.... just my 2 cents. =)

  8. i like the comparison to harm reduction. while i don't practice a religion or come from a tradition that would require circumcision of my children in any form, i do have religious objections to other procedures such as blood transfusions. to me, making something that has legitimate religious or cultural value completely illegal walks a very slippery slope. i wouldn't want to be forced by law to do something so i can't see using the force of law to prevent an intervention either....

    however i'm a self identified "intactivist" so i'm torn on this...

  9. Wow. This seems like a complete step backwards for the U.S. How about instead of making it legal to mutilate baby girls' genitals, we make it illegal to mutilate baby boys'? It is so strange and sad to me that adults are in such a position that they get to make HUGE decisions on behalf of babies, who have no voice of their own. "Just a prick" to the genitals of an adult woman--or man--would be considered something akin to rape. Because adults can say "No." Why are our babies (boys and girls) not afforded the same respect?

  10. The article you posted actually did an excellent job exploring the many facets of this issue and the AAP's recommendation.

    What I found most interesting is that this 'nick' is seen as so horrific, when the 'nick' of episiotomy is still so acceptable to so many women in the states-it's just as unnecessary and painful and yet where's the outcry on it? Not to mention the lack of outcry on MALE circumcision.

  11. "Not to mention the lack of outcry on MALE circumcision."

    I don't agree with male circumcision either, but the consequences of FGM are much worse. It can - and does - permanently destroy a woman's ability to feel pleasure, and it also is one of the things responsible for the high rates of obstructed birth, fistula, and maternal death in communities where this barbaric practice is carried out.

  12. and to follow up from Rebekka, male circumcision does have a medical benefit--lower rates of HIV transmission. There is no benefit to FGM.

  13. Anon--The same can be said with condom use. How about we use condoms to lower the rate of HIV instead of cutting off important body parts.

  14. Rebekka, circumcision of the penis affects men's experience of and pleasure in sexual intercourse. Men have to work much harder to get the stimulation required for that 'high' and their partners (usually women)bear the brunt of that!

    According to breathwork and psychodrama practitioners, the experience of circumcision causes deep resentment in males - their memories of being circumcised are implicit and not available to their conscious minds. Have a look at Jeannine Parvati Baker's article on:

    Jeannine quotes Marilyn Milo, an intactivist, who said "Circumcision is where sex and violence meet for the first time."

  15. Why are Human Males Born with a Foreskin?

    The foreskin plays a role during embryogenesis and development of the distal end of the penis, including the head (glans) and anterior aspect of the urethra [Schoen, 2007e]. Separation of the prepuce from the glans during development is completed in the 5th month of gestation [Diebert, 1933]. The foreskin has no role after birth. Complete absence of a prepuce in a healthy 5 day-old boy has, moreover, been reported [Temiz & Akcora, 2007]. There is no good evidence of any adverse effect of lack of a foreskin and in fact, as has been detailed in this review, we now know that the foreskin poses a risk to the male from various diseases and adverse conditions over his lifetime.

    Circumcision - Benefits Outweigh the Risks

    Dr Tom Wiswell, a respected authority in the USA was a strong opponent, but then switched camps as a result of his own research findings and the findings of others. This is what he has to say: "As a pediatrician and neonatologist, I am a child advocate and try to do what is best for children. For many years I was an outspoken opponent of circumcision ... I have gradually changed my opinion" [Wiswell, 1988; Wiswell, 1992]. This ability to keep an open mind on the issue and to make a sound judgement on the balance of all available information is to his credit ... he did change his mind!

    Wiswell looked at the complication rates of having or not having circumcision performed in a study of 136,000 boys born in US army hospitals between 1980 and 1985. 100,000 were circumcised and 193 (0.19%) had complications, mostly minor, with no deaths, but of the 36,000 who were not circumcised the problems were more than ten-times higher and there were 2 deaths [Wiswell & Hachey, 1993].

    A study by others found that of the 11,000 circumcisions performed at New York's Sloane Hospital in 1989, only 6 led to complications, none of which were fatal [Russell, 1993]. An early survey saw only one death amongst 566,483 baby boys circumcised in New York between 1939 and 1951 [National, 2003].

    There are no deaths today from medical circumcisions in developed countries.

    Very similar to the study by Wiswell above, it was found that of 354,297 infants born in Washington State from 1987-96, only 0.20% had a complication arising from their circumcision, i.e., 1 in every 476 circumcisions [Christakis et al., 2000]. Most of these ‘complications’ were minor and readily treated. It was concluded that 6 urinary tract infections could be prevented for every circumcision complication, and 2 complications can be expected for every penile cancer prevented [Christakis et al., 2000].

    Problems involving the penis are encountered relatively frequently in pediatric practice [Langer & Coplen, 1998]. A retrospective study of boys aged 4 months to 12 years found uncircumcised boys exhibited significantly greater frequency of penile problems (14% vs 6%; P < 0.001) and medical visits for penile problems (10% vs 5%; P < 0.05) compared with those who were circumcised.

  16. You are wrong that "There are no deaths today from medical circumcisions in developed countries." This link has at least one, plus evidence of many others that have been hidden as deaths due to other reasons.


  17. Is FGC mandatory? I thought its a drastic procedure for female. Its painful, why these kinda things included in rituals?

    Viagra Generic


Related Posts Plugin for WordPress, Blogger...