Committee on Bioethics
Abstract
The traditional custom of ritual cutting and alteration of the genitalia of female infants, girls, and adolescents, referred to as female genital mutilation (FGM), persists primarily in Africa and among certain communities in the Middle East and Asia. Immigrants in the United States from areas where FGM is endemic may have daughters who have undergone a ritual genital procedure or may request that such a procedure be performed by a physician. The American Academy of Pediatrics (AAP) believes that pediatricians and pediatric surgical specialists should be aware that this practice has serious, life-threatening health risks for children and women. The AAP opposes all forms of FGM, counsels its members not to perform such ritual procedures, and encourages the development of community educational programs for immigrant populations.
Ritual cutting and alteration of the genitalia of female infants, girls, and adolescents has been a tradition since antiquity. It persists today primarily in Africa and among small communities in the Middle East and Asia. The spectrum of these genital procedures has been termed female circumcision, or more frequently, female genital mutilation (FGM) as a collective name describing several different traditional rituals that emphasizes the physical disfigurement associated with the practice. It is estimated that at least 100 million women have undergone FGM and that between 4 and 5 million procedures are performed annually in female infants and girls, with the most severe types of FGM carried out in Somalian and Sudanese populations.1,2 Pediatricians, therefore, may encounter patients who have undergone these procedures and pediatric surgeons and pediatric urologists may be requested by patients or by the parents of patients to perform surgery considered a ritual genital operation.
During the past 2 decades several international and national humanitarian and medical organizations have drawn worldwide attention to the physical harms associated with FGM. The World Health Organization and the International Federation of Gynecology and Obstetrics have opposed FGM as a medically unnecessary practice with serious, potentially life-threatening complications. The American College of Obstetricians and Gynecologists and the College of Physicians and Surgeons of Ontario, Canada, also opposed FGM and advised their members not to perform these procedures. In 1995 the Council on Scientific Affairs of the American Medical Association recommended that all physicians in the United States strongly denounce all medically unnecessary procedures to alter female genitalia, as well as promote culturally sensitive education about the physical consequences of FGM.7
FGM is illegal and subject to criminal prosecution in several countries, including Sweden, Norway, Australia, and the United Kingdom.8,9 In 1996 the Congress of the United States enacted legislation to criminalize the performance of FGM by practitioners on female infants and children or adolescents younger than 18 years and to develop educational programs at the community level and for physicians about the harmful consequences of the practice.
The American Academy of Pediatrics (AAP) encourages its members to: 1) become informed about the major types of FGM and their complications; 2) be able to recognize the physical signs of FGM; 3) be aware of the cultural and ethical issues associated with FGM; 4) develop a compassionate educational approach for patients who have undergone or who request such a procedure; and 5) decline performing all medically unnecessary procedures to alter female genitalia.
For further reading
Female Genital Mutilation http://pediatrics.aappublications.org/content/102/1/153.full
Abstract
The traditional custom of ritual cutting and alteration of the genitalia of female infants, girls, and adolescents, referred to as female genital mutilation (FGM), persists primarily in Africa and among certain communities in the Middle East and Asia. Immigrants in the United States from areas where FGM is endemic may have daughters who have undergone a ritual genital procedure or may request that such a procedure be performed by a physician. The American Academy of Pediatrics (AAP) believes that pediatricians and pediatric surgical specialists should be aware that this practice has serious, life-threatening health risks for children and women. The AAP opposes all forms of FGM, counsels its members not to perform such ritual procedures, and encourages the development of community educational programs for immigrant populations.
Ritual cutting and alteration of the genitalia of female infants, girls, and adolescents has been a tradition since antiquity. It persists today primarily in Africa and among small communities in the Middle East and Asia. The spectrum of these genital procedures has been termed female circumcision, or more frequently, female genital mutilation (FGM) as a collective name describing several different traditional rituals that emphasizes the physical disfigurement associated with the practice. It is estimated that at least 100 million women have undergone FGM and that between 4 and 5 million procedures are performed annually in female infants and girls, with the most severe types of FGM carried out in Somalian and Sudanese populations.1,2 Pediatricians, therefore, may encounter patients who have undergone these procedures and pediatric surgeons and pediatric urologists may be requested by patients or by the parents of patients to perform surgery considered a ritual genital operation.
During the past 2 decades several international and national humanitarian and medical organizations have drawn worldwide attention to the physical harms associated with FGM. The World Health Organization and the International Federation of Gynecology and Obstetrics have opposed FGM as a medically unnecessary practice with serious, potentially life-threatening complications. The American College of Obstetricians and Gynecologists and the College of Physicians and Surgeons of Ontario, Canada, also opposed FGM and advised their members not to perform these procedures. In 1995 the Council on Scientific Affairs of the American Medical Association recommended that all physicians in the United States strongly denounce all medically unnecessary procedures to alter female genitalia, as well as promote culturally sensitive education about the physical consequences of FGM.7
FGM is illegal and subject to criminal prosecution in several countries, including Sweden, Norway, Australia, and the United Kingdom.8,9 In 1996 the Congress of the United States enacted legislation to criminalize the performance of FGM by practitioners on female infants and children or adolescents younger than 18 years and to develop educational programs at the community level and for physicians about the harmful consequences of the practice.
The American Academy of Pediatrics (AAP) encourages its members to: 1) become informed about the major types of FGM and their complications; 2) be able to recognize the physical signs of FGM; 3) be aware of the cultural and ethical issues associated with FGM; 4) develop a compassionate educational approach for patients who have undergone or who request such a procedure; and 5) decline performing all medically unnecessary procedures to alter female genitalia.
For further reading
Female Genital Mutilation http://pediatrics.aappublications.org/content/102/1/153.full
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