Kluge, EH. Journal of Obstetrics and Gynecology; 16, 2; 71-77.
Summary
This paper explores the ethical implications of female genital mutilation. It argues that irrespective of cultural reasons underlying the practice, it is ethically indefensible. It suggests that the medical profession has a particular obligation in this regard neither to participate in nor to facilitate the practice, and to take a public stand opposing it. The fact that some women may agree to their own genital mutilation does not change this. Such agreement is ethically invalid because it either lacks voluntariness or is based on an inadequate understanding of the true nature of the situation.
For further reading
'FEMALE GENITAL MUTILATION, CULTURAL VALUES AND ETHICS'
http://chpe.creighton.edu/events/roundtables/2009-2010/pdf/Kluge.pdf
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_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 readingFemale Genital Mutilation http://pediatrics.aappublications.org/content/102/1/153.full
International Family Planning Perspectives Volume 23, Number 3, September 1997 SPECIAL REPORT By Frances A. Althaus Female circumcision, the partial or total cutting away of the external female genitalia, has been practiced for centuries in parts of Africa, generally as one element of a rite of passage preparing young girls for womanhood and marriage. Often performed without anesthetic under septic conditions by lay practitioners with little or no knowledge of human anatomy or medicine, female circumcision can cause death or permanent health problems as well as severe pain. Despite these grave risks, its practitioners look on it as an integral part of their cultural and ethnic identity, and some perceive it as a religious obligation.Opponents of female genital cutting, however, emphasize that the practice is detrimental to women's health and well-being. Some consider female circumcision a ritualized form of child abuse and violence against women, a violation of human rights.The debate over female circumcision is relatively recent. The practice was rarely spoken of in Africa and little known in the West until the second half of this century. In the 1950s and 1960s, however, African activists and medical practitioners brought the health consequences of female circumcision to the attention of international organizations such as the United Nations and the World Health Organization (WHO). Still, it was not until 1979 that any formal policy statement was made: A seminar organized by WHO in Khartoum to address traditional practices affecting the health of women and children issued recommendations that governments work to eliminate the practice.During the following decade, the widespread silence surrounding female circumcision was broken. After African women's organizations met in Dakar, Senegal, in 1984 to discuss female circumcision and other detrimental cultural practices, the Inter African Committee Against Harmful Traditional Practices (IAC) was formed. With national committees in more than 20 countries, the IAC has been important in bringing the harmful effects of female circumcision to the attention of African governments. In addition, other African women's networks and organizations that had focused primarily on such issues as reproductive health, women's rights and legal justice became involved in working against the practice. Such groups as Mandalaeo Ya Wanawake in Kenya, NOW in Nigeria and New Woman in Egypt now include the elimination of female circumcision among their goals.In part because these groups brought fresh perspectives to the issue, the emphasis in discussions of female circumcision shifted to encompass women's human and reproductive rights as well as their health. International consensus statements and treaties such as the Convention to Eliminate All Forms of Discrimination Against Women, the Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child began to include language applicable to female circumcision. These documents, however, did not directly mention the practice, focusing instead on broad categories such as detrimental practices, violence and rights violations.With shifts in emphasis came new language: Although activists and clinicians continued to refer to female circumcision when working directly with women in the community, policy statements and other documents began to use the term "female genital mutilation." That term was used in the first international document to specifically address the practice, the Programme of Action adopted by the International Conference on Population and Development in Cairo in 1994.3 The Program refers to female genital mutilation as a "basic rights violation" and urges governments to "prohibit and urgently stop the practice...wherever it exists." For further readingFemale Circumcision: Rite of Passage Or Violation of Rights? http://www.guttmacher.org/pubs/journals/2313097.html fOR
The New England Journal of Medicine Nahid ToubiaN Engl J Med 1994; 331:712-716 September 15, 1994In many civilizations, certain surgical procedures have profound cultural and social meanings. Male circumcision, for example, has deep importance as a symbol of religious and ethnic identity and has played a major part in the political and social history of many peoples1. Female circumcision has particularly strong cultural meaning because it is closely linked to women's sexuality and their reproductive role in society. Female circumcision is practiced today in 26 African countries, with prevalence rates ranging from 5 percent to 99 percent. It is rarely practiced in Asia. It is estimated that at least 100 million women are circumcised. The practice is known across socioeconomic classes and among different ethnic and cultural groups, including Christians, Muslims, Jews, and followers of indigenous African religions2. From the perspective of public health, female circumcision is much more damaging than male circumcision. The mildest form, clitoridectomy, is anatomically equivalent to amputation of the penis. Under the conditions in which most procedures take place, female circumcision constitutes a health hazard with short- and long-term physical complications and psychological effects. The influx of refugees and immigrants from different parts of Africa to North America, Europe, and Australia in the past decade requires that physicians and other health professionals familiarize themselves with the practice and its ramifications for their patients. This article reviews the common types of circumcision, their complications, and the challenges in giving appropriate care to circumcised women. In counseling families who believe in the practice, it is important to understand the depth of cultural meaning it carries. Finally, a brief review of legal and ethical issues will include consideration of existing and expected pieces of legislation and what they mean to the medical profession.For Further Reading Female Circumcision as a Public Health Issuehttp://www.nejm.org/doi/full/10.1056/nejm199409153311106
_East African Medical Journal Vol. 77 No. 5 May 2000
CURRENT GLOBAL STATUS OF FEMALE GENITAL MUTILATION: A REVIEW
G.A.O. Magoha, MBBS, FWACS, FICS, FMCS(Urol), Department of Surgery College of Health Sciences, University of Nairobi
ABSTRACT
Objective: To provide an overview of the current global status of female genital mutilation
(FGM) or female circumcision practised in various countries.
Data source: Major published series of peer reviewed journals writing about female genital mutilation (FGM) over the last two decades were reviewed using the index medicus and medline search. A few earlier publications related to the FGM ritual as practised earlier were also reviewed including the various techniques and tools used, the “surgeons or perpetrators” of the FGM ritual and the myriad of medical and sexual complications resulting from the procedure. Global efforts to abolish the ritual and why such efforts including legislation has resulted in little or no success were also critically reviewed.
Conclusion: FGM remains prevalent in many countries including African countries where over 136 million women have been ‘circumcised’ despite persistent and consistent efforts by various governments, WHO and other bodies to eradicate the ritual by the year 2000 AD.This is as a result of deep rooted cultures, traditions and religions. Although FGM should be abolished globally, it must involve gradual persuasion which should include sensitisation and adequate community-based educational and medical awareness campaign. Mere repression through legislation has not been successful, and women need to be provided with other avenues for their expression of social status approval and respectability other than through FGM.
For further reading...
http://www.ajol.info/index.php/eamj/article/viewFile/46631/33026
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