The non-debate on FGC

by zunguzungu

There’s something just a bit off about calling Female Circumcision or Female Genital Mutilation a “controversial topic.” After all, everyone is against it, right? Or, rather, everyone whose opinion counts. If you’re “for” it, in any sense, you’re hardly someone who can be reasoned with, hardly someone whose opinion matters. All reasonable people agree, etc.

For example, take a look at the “debate” that erupted when the American Academy of Pediatrics rewrote their policy on female genital mutilation. This was the response from Equality Now, a press release immediately parroted, point by point, by Katy Kelleher at Jezebel and PZ at Pharyngula, and seconded by Andrew Sullivan:

International human rights organization Equality Now is stunned by a new policy statement issued by the American Academy of Pediatrics (AAP), which essentially promotes female genital mutilation (FGM) and advocates for “federal and state laws [to] enable pediatricians to reach out to families by offering a ‘ritual nick’,” such as pricking or minor incisions of girls’ clitorises. The Policy Statement “Ritual Genital Cutting of Female Minors“, issued by the AAP on April 26, 2010, is a significant set-back to the Academy’s own prior statements on the issue of FGM and is antithetical to decades of noteworthy advancement across Africa and around the world in combating this human rights violation against women and girls.

Among other things, the AAP now use the phrase “female genital cutting” or “ritual genital cutting” instead of “female genital mutilation,” the term preferred by advocacy groups like Equality Now. In the words of the AAP:

…”mutilation” is an inflammatory term that tends to foreclose communication and that fails to respect the experience of the many women who have had their genitals altered and who do not perceive themselves as “mutilated.” It is paradoxical to recommend “culturally sensitive counseling” while using culturally insensitive language. “Female genital cutting” is a neutral, descriptive term.

Pharyngula calls this a “bizarre bit of pandering” and voices the doctors in question thusly “We’ll just mutilate baby girls a little bit, to make the misogynist patriarchal assholes happy.” Melissa McEwen at Shakesville adopts the same sarcasm soaked rhetoric: “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. Yay for compromise!”

Now, on the issue itself, I don’t particularly disagree with Andrew Sullivan’s statement that “forcing this onto infants, male and female, even if it is just a cut or a nick, is a form of barbarism” (though I find the word “barbarism” pretty unhelpful), nor do I think McEwen is wrong to say that “There is no reason to tolerate even this proposed alternative version of the procedure in a culture with an ostensible belief in gender equality.” If you frame it as a “would you allow your daughter” problem, my reaction is going to be the same as theirs. Of course not.

But it’s not your daughter, is it? And all the super-heated rhetoric on this issue, all the delightfully gratifying sarcasm launched at straw-misogynists whose arguments and beliefs you are thereby enabled to never actually know about helpfully snarks out of existence the incredibly thorny problem that the AAP is trying to find the least bad solution to, the problem of juggling culturally specific notions of rights and justice, and the rights people have to choose what is best for their children, with the belief by liberal minded people that their notions of justice are right.

Now, again, on the issue of FGC, I pretty much agree with all of the people I’ve just linked to. My views on this issue are pretty conventional liberal morality; I believe in gender equality and I find this practice to be some fucked up repugnant shit. But the problem that the AAP are taking seriously doesn’t stop being a problem just because you’re right and they’re wrong. It’s an even more difficult problem, especially then, because the important question of how and where one intervenes, at what point you start forcing people to adopt your moral compass, is never a simple one. And by the way, I do believe there might be a point where you start using the power at your disposal to force less powerful people to share your values. I may even think so in this case; again, cutting babies is pretty close to what I would be willing to entertain as a universal Thou Shalt Not.

But here’s the thing, white people: when it comes to forcing non-white people to act in ways that you decide are civilized, you better tread light as fuck, and proceed with some caution and humility. There is nothing obvious about the right answer, in that situation; there is, in fact, only a choice between bad solutions, on of which you might, perhaps, decide is the least bad of the two.

It’s striking to me, therefore, that most of the red-hot rhetoricians opining on the issue seem to have little or no awareness of what the AAP actually wrote, or why; it seems telling that the Jezebel piece didn’t even link to the AAP report, just the press release hyperbolically denouncing it (until, of course, a thoughtful comment thread pointed out how poorly she had mischaracterized their position). In fact, while and Pharyngula declared that “[t]heir whole policy is designed to avoid confronting misogynistic bigots with the horrendous consequences of their traditions,” the AAP framed the issue as a problem of how to educate immigrant communities not to perform FGC, which they repeatedly and graphically warn is dangerous at best and of no medical value. Their (very tentative) argument is simply that compromise and education might be able achieve what criminalization will fail to do:

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 is common, some progress toward eradication or amelioration has been made by substituting ritual “nicks” for more severe forms.

Unlike the angry writers I first linked to, the AAP has footnotes and (limited) data that they see as supporting their position. But, more importantly, there are two points that none of the writers I linked to seem cognizant of:

1. This is all academic. As the AAP puts it, “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.” And since the AAP is completely clear that this “ritual nick” is not a medical procedure (and is illegal anyway), what they’re actually advocating for is simply opening the door to rendering some form of compromise legal. As they put it:  

…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.

But the take-home message is that FGC is, currently, always illegal; the last line of the “education” section is that “Parents should be reminded that performing FGC is illegal and constitutes child abuse in the United States.” There are no death panels in this bill, people. 

2. Parents actually have rights to make important decisions about their children, and the fact that they have a different cultural sense of what is best than you doesn’t change that. The AAP decision is incomprehensible except from the standpoint of that problem, which is, I think, why none of the bloggers seem to understand it (though I suspect they also haven‘t read it very carefully). This would be an important place to start:

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.

Now Sullivan’s position is against both male and female circumcision, full stop, which is a consistent position for a political advocate to hold. But the AAP has to find a consistent position from a different perspective, that of medical practitioners. And their point is that, right now, doctors are performing male circumcisions whose illegality is not in question, and which are much more “extensive” than the ritual nick they’re advocating. In other words, if you accept that male circumcision is not harmful (as legal and medical practice do), then they argue that the “ritual nick” (but not all the other forms of FGC) can’t be seen as harmful either. And since, as they put it, “Efforts should be made to use all available educational and counseling resources to dissuade parents from seeking a ritual genital procedure for their daughter,” they are opening the door to using the “ritual nick” as a way of doing so.

Now, I have real questions about the entire “ritual nick” idea. I don’t think that it will work, in short, because I doubt that a doctor-performed “ritual nick” will ever fill the function that the various “traditional” demands for it prescribe. But that’s a slightly different issue. For now, the point I want to underscore is that all the commentary I’ve read on this issue hyperbolically simplifies the issue in ways that enable their own moral posturing at the cost of moving farther and farther from the real issues at stake. The AAP represent doctors trying to serve patients, so they’re obliged to deal with the profoundly difficult shades of grey that this problem represents. The various pundits who rail against the very idea of thinking about compromise are not; they have, in fact, a direct interest in ignoring all those shades of grey, because it makes it more difficult to make their own position seem obvious and righteous.

After all, those doctors need to respect their patients for all sorts of reasons, but above all — as the flow of their logic demonstrates — they need access to these populations if they are to do any good at all. And exactly how far do you think they would get if, as Pharyngula demands, they spent all their time “confronting misogynistic bigots with the horrendous consequences of their traditions”? How many mothers will die in childbirth because they didn’t get medical attention because they knew physicians would not allow them to do what they wanted with their children, for example? I don’t know the answer to that question, but neither does anyone. And the AAP have the advantage in this debate of at least realizing it’s a debate. Calling people “misogynistic bigots,” on the other hand, betrays your complete lack of interest in why people would actually do this sort of thing. High on your moralistic high horse, you don’t care. And by painting lurid pictures of “misogynist patriarchal assholes…waving scalpels about in the genitals of children,” you can pretend that it’s an open and shut case, that no reasonable people would ever, all without even knowing what peoples reasons are.

At least as important is the fact that doctors are not all-powerful fiat wielding enforcers of liberal ethics. The rhetoric of “should we tolerate” presumes that they are, that deciding what the principle will magically translate into practice. Kelleher’s assertion that “no type of female genital cutting should be tolerated no matter the degree” is a nice abstract statement of principles. But the entire AAP statement is based on the fact that doctors are faced with the public health issue of immigrant populations to whom they have little access and over whom they  have little power. As a member of the AAP’s bioethics committee, Dr. Lainie Friedman Ross, pointed out, for example:

“If we just told parents, ‘No, this is wrong,’ our concern is they may take their daughters back to their home countries, where the procedure may be more extensive cutting and may even be done without anesthesia, with unsterilized knives or even glass,” she said. “A just-say-no policy may end up alienating these families, who are going to then find an alternative that will do more harm than good.”

In the rhetorical world of “should we tolerate,” the question can be yes or no. But doctors live in the real world, where “no” is an option they may not have the power to put into practice. And who do you think has a better sense of that reality, Dr. Lainie Friedman Ross or a bunch of fire-breathing bloggers who haven’t bothered to understand her argument (much less address it)? It’s the AAP, after all, that actually have data backing up their assertion that “in some countries where FGC is common, some progress toward eradication or amelioration has been made by substituting ritual ‘nicks’ for more severe forms.”

* * *

Now, my sense of FGC is that it’s overwhelmingly practiced on adolescent girls, not on infants. And so, this entire discussion has very little to do with the most common versions of the practice. Moreover, I don’t think most of the bloggers who have opined on this issue have thought particularly hard about the difference; because they’re trying to be as hyperbolic as possible, they tend to emphasize an image of FGC in which powerful men are cutting helpless females, for which infant FGC is the most powerfully polemic site. But compare that to Fuambai Ahmadu’s description of what female circumcision is like in Sierra Leone, where she is from:

…the institution itself is synonymous with women’s power, their political, economic, reproductive and ritual spheres of influence. Excision, or removal of the external clitoral glans and labia minora, in initiation is a symbolic representation of matriarchal power. How can this be so? Removal of the external glans and hood is said to activate women’s ‘penis’ within the vagina (the clitoral ‘shaft’ and ‘g-spot’ that are subcutaneous). During vaginal intercourse, women say they dominate the male procrea­tive tool (penis) and substance (semen) for sexual pleasure and reproductive purpose, but in ritual they claim to pos­sess the phallus autonomously. Excision also symbolizes the ‘separation’ of mother and son or of matriarchy and patriarchy (in Mande mythology matriarchy is portrayed as prior to and giving birth to patriarchy). Female elders say that initiation and the act of excision is a potent emo­tional and psychological reminder to men that it is women who give birth to them and mothers who, after God, are the natural origins or raw elements from which all human creation, culture and society are derived. This concept of a primordial, supreme and all-powerful Mother is at the core of Mande creation mythology and ritual practices that are prevalent even today.

This has been a very long post, and I need to stop. But if you’d read this far and are actually interested in this issue, the thing to do now is read Fuambai Ahmadu. If you think you know anything about this “debate,” and yet you’ve read only pundits and advocates who speak in hyperbole and polemic about the barbaric practices of non-white people, and yet you’ve not read or heard from a single woman of color who underwent some variant of the practice and can explain why she doesn‘t regret it, then you are not taking the question  seriously. And there is no better way than casual unexamined racism to allow yourself to not notice, for example, that this entire debate gets framed by white people calling non-white people “barbaric” without ever hearing a single one of the barbarians speak up for their side. You have Africans who speak against FGM, of course, but you don’t ever hear from Africans speaking for it. Why should you? They’re barbarians.

By contrast, there’s a moment in Bondo: A journey into Kono womanhood (Sunju Ahmadu‘s documentary) in which an anti-FGM activist asserts that African women think sexual intercourse is only for reproduction and a young circumcised Kono woman relies confidently that she can experience complete (and even greater sexual fulfilment) than her unexcised friend. Unless that voice is part of the debate, it’s not a debate. And as Ahmadu puts it,

Is it that African women are masochistic and disturb­ingly enjoy their own sexual subjugation? Or might this suggest that some Westerners and feminists have it wrong about the nature of African marriages, social systems and male-female interactions and intimacies? If the experi­ences of these Sudanese women are anything like my own and those of the community of women I was raised among, then I doubt very much that they are somehow sexually deviant masochists who are ignorant of and enjoy their own oppression.