The BMJ Today: Why does female genital mutilation persist?

rich_hurleyA news story by Clare Dyer and a rapid response from the director of public prosecutions in England and Wales, Alison Saunders, keep The BMJ’s spotlight on female genital mutilation.

For a long time these horrific practices were downplayed as “circumcision” or “cutting.” But female genital mutilation includes, without medical indication, excision of all or part of the clitoris, possibly removal of the labia, and, at its most extreme, closure of the vagina.

And the word “female” in FGM hides the reality that these procedures are often inflicted on very young girls. Thus FGM represents a nadir in societies’ control of women’s sexuality, by physically and irreversibly trying to prevent women ever enjoying vaginal intercourse without pain and other complications.

FGM is rife in parts of Africa and the Middle East, but it also occurs where the traditions have been transplanted to Western settings (see our 2010 editorial). In 1985 the UK government legislated to ban the practices, and in 2003 it extended the law to try to stop UK nationals from taking girls abroad to have them abused this way.

But in three decades, incredibly, not a single prosecution has been brought—that is, until last month, when two men including a doctor were charged under the 2003 act, as Zosia Kmietowicz reported in late March.

In relation to this, Clare Dyer recently reported that some doctors are worried about the potential for being prosecuted if they were to carry out repairs to stop bleeding after giving birth in women who have previously had their genitals mutilated.

In her rapid response posted yesterday, Alison Saunders wrote, “The law is clear that no offence of FGM is committed by an approved person who performs a surgical operation which is necessary for the patient’s physical or mental health, or for the purposes connected with the labour or birth. This was, of course, considered in this case.”

Katrina Erskine, head of obstetrics at Homerton Hospital in London, had reportedly told the Independent newspaper, “I cannot help suspecting this has something to do with the [director of public prosecutions] being up before the home affairs select committee and she needs something to say.” Saunders had appeared before the committee on 25 March.

Saunders slammed such critics, reminding that it is “extremely important that nothing prejudices the upcoming trial.”

Meanwhile, Dyer reports today that a panel of the Medical Practitioners Tribunal Service has found that a general practitioner in London who performed labiaplasty on a 33 year old woman for cosmetic reasons had not intended to perform FGM. Although a “serious clinical failure” on the part of the doctor, there was no evidence of intent as the panel had “not been provided with any cultural or surgical reasons” for the botched surgery.

Let’s leave discussion of the far more common, far less controversial, albeit seemingly far less damaging, non-medically indicated male genital mutilation for another time (we ran a head to head debate on this issue way back in 2007).

Richard Hurley is the deputy magazine editor, The BMJ.