{"id":2983,"date":"2016-02-02T19:29:11","date_gmt":"2016-02-02T18:29:11","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=2983"},"modified":"2016-05-06T18:43:26","modified_gmt":"2016-05-06T17:43:26","slug":"controversial-views-on-fgm","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/02\/02\/controversial-views-on-fgm\/","title":{"rendered":"Controversial Views on \u201cFGM\u201d"},"content":{"rendered":"

by Brian D. Earp<\/a>\u00a0\/\u00a0(@briandavidearp<\/a>), with a separate guest post by Matthew Johnson<\/p>\n

Even the term is controversial. Female genital mutilation\/FGM? Many women from societies that practice such traditional initiation rites find the term offensive. Female genital alteration? But that could refer to a wide range of procedures, including some that might be medically advised. Female circumcision? That\u2019s the term used by many practicing communities<\/a>\u2014but others think it trivializes harm. Whatever the term, the set of practices called \u201cFGM\u201d<\/a> by the World Health Organization has\u00a0been in the media of late.<\/p>\n

According to the Guardian<\/em><\/a>, \u201cThe number of women and girls in the United States at risk of female genital mutilation has tripled over the last 25 years, according to a government study released on Thursday<\/a>.\u201d However, \u201cthe increase in women at risk in the US [is] wholly a result of rapid growth in the number immigrants\u201d from countries that practice FGM.<\/p>\n

In other words, there are apparently no firm data on how many (female) individuals have actually been affected<\/a> by non-therapeutic genital altering procedures in the United States in recent years: \u201cbeing at risk\u201d seems to have been defined<\/a> as \u201ccoming from a country where such procedures are known to be performed in some communities.\u201d<\/p>\n

But the type and prevalence of \u201cFGM\u201d procedures can vary widely<\/a> within countries\u2014i.e., they can occur in some communities and\/or families but not others\u2014and as Sara Johnsdotter and Birgitta Ess\u00e9n have recently argued<\/a>, the practice is often relinquished as immigrants begin to acculturate to the so-called West.<\/p>\n

So the headline claim<\/a> that \u201cGenital mutilation risk triples for girls and women in US\u201d should be treated as controversial, in my view\u2014not to mention ripe for being widely misunderstood\u2014pending further, more finely-grained research.<\/p>\n

Another controversial view I should highlight comes from a forthcoming paper in the Journal of Medical Ethics<\/em>, where Kavita S. Arora and Allen J. Jacobs are set to propose that certain \u201cminor\u201d forms of FGM should be tolerated in Western societies. The paper has not yet been published, but my response to it\u2014a piece entitled, \u201cIn Defence of Genital Autonomy for Children\u2014is, for some reason, already available online-first<\/a>. You can read the unabridged version of my paper (with a detailed appendix) by clicking here<\/a>.<\/p>\n

Keep your eyes open for an official announcement from the journal regarding the paper by Arora and Jacobs; I understand that it will be published alongside a commentary from the editors and at least two other dissenting views besides by own.<\/p>\n

Finally, let me turn to an essay by Dr. Matthew Johnson of Lancaster University, which will certainly be regarded as controversial by some, but which I think expresses a valuable perspective worth taking seriously (even if one ultimately disagrees with certain aspects of Dr. Johnson’s\u00a0argument). The essay is published below as a \u201cguest post\u201d on this blog. Please keep in mind that its contents reflect the views of Dr. Johnson, and not necessarily those of the Journal of Medical Ethics,<\/em> its editors, or anyone else.<\/p>\n

Cameron, FGM and Boarding Schools: Empathy and Punishing Parents<\/strong><\/p>\n

by Dr. Matthew Johnson<\/p>\n

David Cameron\u2019s declaration<\/a> that there will be \u2018no more\u2019 passive tolerance of Female Genital Mutilation (FGM) comes against the backdrop of the revelation<\/a> that 1,000 cases of FGM had been recorded in three months this year as part of NHS data collection on the practice. This data collection commenced in April as part of the Government\u2019s eradication drive, and its findings demonstrate the seriousness of the practice. One natural response to the problem is, as Cameron suggests, to call for sterner punishments for practitioners and, indeed, parents who inflict the practice. However, if our concern is to prevent harm, there are many reasons to reject that route and indeed precedents in our treatment of other (different) harmful practices which highlight the deficits in the approach.<\/p>\n

<\/p>\n

The acquittal<\/a> of Dr. Dhanuson Dharmasena in the first prosecution of someone alleged to have conducted FGM since its criminalization in 1985 serves to highlight the dangers of evaluating attempts to eradicate the practice through the courts. As Jeremy Laurence notes<\/a>, this politically motivated trial undermined those efforts and points to the need for a much more holistic<\/a> approach to dealing with FGM. While education and understanding the extent of the practice is surely important, the continuing association of the eradication drive with prosecution efforts is problematic, particularly with regard to its potential role in enacting David Cameron\u2019s threat<\/a> to imprison parents who fail to prevent FGM being performed on their daughters. What better way to prevent harm than to identify cut girls and send their parents to prison? Well, there may be many. The most constructive of these, in my view, involve, among other things, empathizing with the people who are associated with and affected by the practice.<\/p>\n

To be clear, I am not a cultural relativist<\/a>. Indeed, I believe that culture \u2013 the shared understandings which enable us to exist collectively \u2013 should be evaluated according to the extent to which it promotes wellbeing in any given circumstance. All other things being equal, a world without non-therapeutic genital cutting, whether in girls or boys<\/a>, would seem to be better. The problem is that all other things are not equal and that sending parents to prison serves, in most cases, to undermine, rather than promote, the wellbeing of children.<\/p>\n

What is lost in the often shrill coverage of the topic of FGM, is that parents generally love their children and believe<\/a> that they are acting in their children\u2019s best interests when having them cut. They believe<\/a> that being cut will ensure that their children are socially accepted, that their health will be improved and that they will live better lives than if they were left intact. Of course, there is good reason to view these decisions as “adaptive preferences<\/a>,” in which parents pursue courses of action they would not otherwise pursue were the preconditions and nature of acceptance–and social status–not shaped by erroneous, deleterious and\/or perverse belief(s).<\/p>\n

While some<\/a> have argued that the physical harms of FGM (which actually encompasses a wide range<\/a> of practices of varying degrees of severity) are exaggerated by Western commentators, it seems reasonable<\/a> to suggest that, as in the case of male circumcision, having an uncut body leaves greater potential physically for sexual satisfaction<\/a> and fewer risks of complications. The harms that parents who cut wish to avoid are social ones \u2013 the stigma of not being recognized as a woman capable of fulfilling a series of adult roles. Ultimately, parents feel compelled socially to do something they would otherwise likely\u00a0avoid were the cultural underpinnings different.<\/p>\n

The more general point, however, is that under imperfect conditions, many if not most parents–in believing that they are acting in their children\u2019s best interests–run the risk of making regrettable decisions. This is true with respect to a wide range of decisions that apply to practices very different from FGM. Nevertheless, while those decisions concern a range of\u00a0practices, with potentially very different forms of harm, the decisions themselves often do lead to harm and this raises a quandary. The quandary is how the state should respond to the consequences of parents (all parents) having to make socially-informed decisions which have the potential to lead to harm in their children. There are different cases closer to home which may give us cause for concern about imprisoning parents in the case of FGM.<\/p>\n

Alex Renton<\/a> has highlighted a tide of reflection and revelation<\/a> among former pupils of independent boarding schools. Renton<\/a> has talked of the potentially profound psychological effects of \u201cprivileged abandonment\u201d (a term coined<\/a> by Nick Duffell; for his more recent work see here<\/a>), whether occurring directly by that abandonment, by the perverse sense of stoicism promoted in those environments, or by the social, sexual and physical abuse meted out in many of the institutions. As the partner of a former pupil has noted<\/a>, \u201cboarding school has had a particularly powerful effect \u2013 it has made an elite that is not empathetic, that believes hardship is good for you. That finds situations that should inspire sympathy deeply uncomfortable.\u201d<\/p>\n

While the harms of abusive\u00a0boarding schools are very different, along a number of dimensions, to FGM, they can be significant, debilitating, and caused by the adaptive preferences of parents. There are no calls for the prosecution of parents who handed their children over to public school child molesters or who ignored the suffering of their children at these institutions or who even willfully wished for their children to be transformed into stoic individuals lacking in empathy.<\/p>\n

After all, they only wished the best for their children. Many parents felt deeply uncomfortable as they left their children at these institutions, helpless in the knowledge, perpetuated by their privileged communities, that abandonment was an integral means of shaping their offspring into respectable citizens. Despite all the evidence of harm among some former pupils, there has hardly been a wave of calls for parents to be penalized for their actions.<\/p>\n

In what way would sending such parents to prison help their damaged children? In my view, it would compound harm and fail to demonstrate empathy with the victims. The state\u2019s present approach runs the risk of making such a mistake with victims of FGM.<\/p>\n

With regard to FGM, the College of Policing\u2019s consultation<\/a> recognizes that \u201cVictims may also be unwilling to assist as in most cases it will require giving evidence against their own family and\/or parents.\u00a0If the victim is a child, they may fear that they or their siblings could be put into care, especially if the prosecution is successful and results in imprisonment of a parent, or family breakup. They may also have no memory of the act if the FGM took place at a young age, or they may not know who was responsible.\u201d\u00a0The fact that the child may not feel harmed and may feel that prosecution of family members is against their own interests appears tragically to be glossed over.<\/p>\n

It is unfortunate, then, that a government led by people from boarding schools should be committed to inflicting separation between children and their parents by sending the latter to prison \u2013 whether the former believe they have been harmed or not. Like the gradual shift in privileged families away from boarding school in light of the harms that experience engendered, the only way that FGM or male circumcision will disappear is by people in practicing communities gradually rejecting it collectively themselves.<\/p>\n

A more beneficial approach than prison may<\/a> be to bring practices like FGM and potentially harmful ritual forms of male circumcision into the open, ensure that they are sanitized as fully as possible and make particular figures who promote practices personally liable for damages in the instance of children feeling harmed and parents feeling misled.<\/p>\n

Most importantly, we must, in accordance with that approach, uphold freedom of speech to subject such harmful practices to public criticism<\/a> irrespective of religious sensitivities. Not only might this highlight the people behind the practices, it might give the people subject to the practices the ability to challenge them directly without police compulsion, thereby achieving change in a safer manner. At present, if girls are aware, for example, that their seeking medical attention may contribute to their parents being imprisoned, it may be the case that their immediate as well as long-term health is threatened as they avoid seeking such attention at all.<\/p>\n

Biography\u00a0<\/strong><\/p>\n

Matthew Johnson is a Lecturer in Politics at Lancaster University. His research focuses on the relationship between culture, public policy and wellbeing, often examining genital cutting to illustrate this topic. He is editor of the journal Global Discourse<\/em>, and author of Evaluating Culture: Well-being, Institutions and Circumstance<\/em> (Palgrave MacMillan), which seeks to identify objective means of cross-cultural critique. He is currently organizing a participatory project entitled \u201cA Cross Cultural Working Group on \u2018Good Culture\u2019 and Precariousness,\u201d which involves a cross-cultural exchange between community co-researchers from an Aboriginal Australian community in South East Queensland and Ashington in the North East of England.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

by Brian D. Earp\u00a0\/\u00a0(@briandavidearp), with a separate guest post by Matthew Johnson Even the term is controversial. Female genital mutilation\/FGM? Many women from societies that practice such traditional initiation rites find the term offensive. Female genital alteration? But that could refer to a wide range of procedures, including some that might be medically advised. Female […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7933,2153,443],"tags":[395,7965,2611,2343,698,137,7964,7925,615,7937,787],"class_list":["post-2983","post","type-post","status-publish","format-standard","hentry","category-brian-earps-posts","category-guest-post","category-jme","tag-bioethics","tag-boarding-schools","tag-circumcision","tag-david-cameron","tag-distributive-justice-in-health-care","tag-ethics","tag-female-genital-mutilation","tag-journal-of-medical-ethics","tag-medical-ethics","tag-sex","tag-sex-education"],"yoast_head":"\nControversial Views on \u201cFGM\u201d - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/02\/02\/controversial-views-on-fgm\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Controversial Views on \u201cFGM\u201d - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"by Brian D. Earp\u00a0\/\u00a0(@briandavidearp), with a separate guest post by Matthew Johnson Even the term is controversial. Female genital mutilation\/FGM? Many women from societies that practice such traditional initiation rites find the term offensive. Female genital alteration? But that could refer to a wide range of procedures, including some that might be medically advised. 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Earp\u00a0\/\u00a0(@briandavidearp), with a separate guest post by Matthew Johnson Even the term is controversial. Female genital mutilation\/FGM? Many women from societies that practice such traditional initiation rites find the term offensive. Female genital alteration? But that could refer to a wide range of procedures, including some that might be medically advised. 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