{"id":38216,"date":"2017-01-20T18:00:10","date_gmt":"2017-01-20T17:00:10","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=38216"},"modified":"2017-03-10T14:37:30","modified_gmt":"2017-03-10T13:37:30","slug":"aarefa-johari-why-doctors-need-to-speak-out-against-female-genital-cutting-in-india","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/01\/20\/aarefa-johari-why-doctors-need-to-speak-out-against-female-genital-cutting-in-india\/","title":{"rendered":"Aarefa Johari: Why doctors need to speak out against female genital cutting in India"},"content":{"rendered":"

\"\"Female circumcision, known around the world as female genital mutilation or cutting (FGM or FGC), is recognised as a human rights violation by the World Health Organisation. It involves cutting or altering parts of the female genitalia for non-medical reasons. It is not much talked about in India and is known so far to be limited to a single community\u2014the Dawoodi Bohra community. Although more severe types of FGC are practiced by several African communities, the kind that Bohras practice\u2014cutting all or part of the clitoral hood\u2014falls within WHO\u2019s definition of Type 1 FGC. The practice is illegal in at least 40 countries, because there are no medical benefits to cutting any part of the female genitalia. In fact, even the mildest form of FGC can have harmful health consequences, including bleeding, swelling, painful urination, infection and reduced sexual sensitivity.<\/p>\n

And yet, there are instances where it is taking place and is being performed by licensed gynaecologists who at times administer general anaesthesia on the child so that she has no memory of the procedure happening without her consent.<\/p>\n

If most doctors and medical associations in India are unaware of such incidents, I wouldn\u2019t be surprised. Until a few years ago, almost no one had heard of FGC\u00a0being practised in India. Even international campaigns against FGM\/C focused mainly on Africa. But in India, Bohras have been secretly circumcising their daughters for centuries. Like so many seven-year-old Bohra girls, I was cut as a child too.<\/p>\n

We are not a large community\u2014barely two million in number\u2014but those familiar with Dawoodi Bohras know us as a close-knit, well-educated, wealthy business community with a reputation for being progressive towards women. But the Bohras are the only group known to practise FGC in India so far. Other Indian Muslim sects don\u2019t even consider the ritual Islamic, because there is no mention of it in the Quran.<\/p>\n

Bohra families, depending on who you speak to, give a variety of different reasons for practising female khatna<\/em>. \u201cIt is in the religion,\u201d \u201cit curbs sexual desire,\u201d and \u201cit prevents pre-marital and extra-marital affairs\u201d are the most common justifications. Other reasons include hygiene and health, specifically the prevention of urinary tract infections and other diseases. Medically, of course, there is no proof of such claims.<\/p>\n

More recently, some Bohras have begun rationalising khatna<\/em> with the strangest argument: they claim it is the same as \u201cclitoral unhooding,\u201d a surgical procedure that a number of doctors in Western countries perform on adult women to enhance sexual pleasure. It is claimed that by removing the hood covering the clitoral glans, the clitoris is more exposed and thus experiences more stimulation and pleasure.<\/p>\n

Now that there is a growing movement against FGC within the community, many khatna<\/em> supporters are trying to promote clitoral unhooding as a \u201cscientific\u201d justification for cutting all seven-year-old girls without consent. If this isn\u2019t enough to mislead parents, we are also witnessing another disturbing trend: the medicalisation of khatna<\/em>.<\/p>\n

Medicalisation refers to the process by which the cultural, non-medical practice of FGC is treated as a medical condition, and performed by a trained medical practitioner instead of an untrained traditional cutter. For several years now, Bohras in bigger cities like Mumbai have been getting their daughters cut by doctors (though not necessarily gynaecologists) in Bohra hospitals or clinics. They have come to realise that untrained cutters are not only unhygienic, but are also more likely to cut more than intended\u2014particularly if the child is kicking or resisting the cut. The trend is now also spreading to smaller cities and towns.<\/p>\n

Undoubtedly, a doctor will perform khatna<\/em> in a safer manner than a neighbourhood aunty with a blade. But medicalisation also promotes the entirely false idea that FGC, even in its mildest form, is medically beneficial and acceptable. Not all Bohras are affected by khatna<\/em> in a uniform manner, and many say they have faced no negative consequences. But in the past five years, with the silence around this tradition gradually breaking, we have heard numerous\u00a0stories of women who have been physically, psychologically, and sexually scarred by their circumcisions in a variety of ways.<\/p>\n

What is a doctor\u2019s responsibility, then, in the face of such a ritual? Two of the most basic pillars of medical ethics are to do no harm and to act in the best interests of a patient. Female circumcision has no health benefits and can potentially harm girls and women. For a patient, it serves no scientific or medical interest. In fact, since khatna<\/em> is not a medical procedure at all, girls being brought to get cut can hardly be called patients. Besides, a seven-year-old is not capable of giving informed consent to the procedure.<\/p>\n

Some doctors I know are already discouraging parents from getting their daughters circumcised. But others carry out khatna<\/em> on little girls even if they are aware that it has no medical standing.<\/p>\n

Now that the practice of FGC among Bohras is no longer a secret, perhaps it is time for medical bodies and doctors\u2019 associations to take an official stand on the subject. There are already scores of activists working to end khatna<\/em> by spreading awareness within the community. In a few years, India might even have a law against the practice. But strong medical opinion is just as important.<\/p>\n

If the medical fraternity publicly and vocally condemns this practice, many more girls could be saved from the blade.<\/p>\n

Aarefa Johari<\/strong> is a journalist with Scroll.in and the co-founder of Sahiyo, an NGO working to end Female Genital Cuttin<\/em>g in the Bohra community.<\/em><\/p>\n

The author will be at\u00a0the Difficult Dialogues UCL Summit<\/a>\u00a0in Goa on 10 – 12 February 2017.<\/p>\n

Competing interests:<\/strong> None declared.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Female circumcision, known around the world as female genital mutilation or cutting (FGM or FGC), is recognised as a human rights violation by the World Health Organisation. It involves cutting […]<\/p>\n

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