{"id":765,"date":"2013-01-03T14:12:56","date_gmt":"2013-01-03T14:12:56","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=765"},"modified":"2013-01-03T14:14:20","modified_gmt":"2013-01-03T14:14:20","slug":"female-circumcision-using-facts-to-moderate-the-message","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2013\/01\/03\/female-circumcision-using-facts-to-moderate-the-message\/","title":{"rendered":"Female circumcision: using facts to moderate the message"},"content":{"rendered":"<p>In a contemporary Western context female circumcision is hardly an issue that divides opinion.\u00a0 A \u00a0WHO study, published in <em>The Lancet<\/em> (2006), and receiving considerable media coverage, appeared to corroborate widespread concerns as to its implications for the health of \u201ccut\u201d women and their babies\u00a0\u00a0 (<a href=\"http:\/\/www.thelancet.com\/search\/results?searchTerm=WHO+Study+Group+on+Female+Genital+Mutilation&amp;fieldName=AllFields&amp;journalFromWhichSearchStarted=lancet\">http:\/\/www.thelancet.com\/search\/results?searchTerm=WHO+Study+Group+on+Female+Genital+Mutilation&amp;fieldName=AllFields&amp;journalFromWhichSearchStarted=lancet<\/a>).<\/p>\n<p>However, a paper in the latest <em>Hastings Center Report<\/em> (HCR) \u2013 by the Public Policy Advisory Network on Female Genital Surgery in Africa (PPAN) \u2013 takes issue with recent coverage of the issue for being sensationalist, and excessively influenced by advocacy literature; it calls for a less partisan discussion based on evidence and informed by a full range of bio-ethical and anthropological debate (<a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hast.81\/full#hast81-bib-0015\">http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hast.81\/full#hast81-bib-0015<\/a>).\u00a0 An added interest is the inclusion in this issue of responses to the PPAN paper; that of Nawal M. Nour, in particular, is sympathetic, yet critical (<a href=\"http:\/\/www.thehastingscenter.org\/Publications\/HCR\/Detail.aspx?id=6062\">http:\/\/www.thehastingscenter.org\/Publications\/HCR\/Detail.aspx?id=6062<\/a>).\u00a0 Overall, this discussion offers a fascinating insight into a complex ethical issue.<\/p>\n<p>The PPAN are anxious to dispel a certain idea of circumcision (or \u201cgenital surgery\u201d) as imposed on women by repressive and patriarchal attitudes.\u00a0\u00a0 They point out that the practice is generally managed by women for women, and tends to be regarded as an aesthetic enhancement \u2013 like a breast implant.\u00a0 On the sensationalist claims of the campaigning literature \u2013 and the unfortunate tendency of the medical literature to echo such claims \u2013 there seems to be a measure of agreement among contributors to the Report.<\/p>\n<p>Disagreement arises in relation to the evaluation of the medical consequences of female circumcision.\u00a0 The PPAN are content to contest the claim that circumcision causes increased maternal mortality (as was suggested by media coverage of the 2006 WHO report); Nour, who agrees on this point, nevertheless also draws attention to significantly increased levels established by the WHO report for caesarean section.\u00a0 Risks include\u00a0 post-partum haemorrhage, extended hospital stay, and infants needing resuscitation in circumcised women (RR for cases of circumcision involving excision of external clitoris and labia minora, but not infibulation, respectively: 1.29; 1.21; 1.51; 1.32).\u00a0 As for reduced sexual responsiveness, this is evidently difficult to assess; but, in response to the PPAN who dismiss the idea, Nour cites the evidence of a recent systematic review (Berg &amp; Denison: <a href=\"http:\/\/link.springer.com.libproxy.ucl.ac.uk\/article\/10.1007\/s13178-011-0048-z\/fulltext.html\">http:\/\/link.springer.com.libproxy.ucl.ac.uk\/article\/10.1007\/s13178-011-0048-z\/fulltext.html<\/a>) for increased levels of dyspareunia \u00a0and failure to experience sexual desire (respectively: 1.15; 2.15 in the case of circumcision without infibulation).<\/p>\n<p>In the stand-off between the PPAN and the advocates of anti-circumcision, we have an object lesson in the way that advocacy positions on one side or another can bias the presentation of data \u2013 as becomes admirably clear from Nour\u2019s response to the PPAN position.\u00a0 Claims, on one side, that \u201cfemale genital cutting raises by 50% the likelihood that mothers or their newborns will die\u201d are met by assertions that may be less extreme but would be hard to substantiate by data \u2013 such as that \u201ca high percentage of women who have had genital surgery have rich sexual lives\u201d, or \u201cmedical complications associated with female genital surgeries in Africa are infrequent events and represent the exception rather than the rule\u201d.\u00a0 Nour, on the other hand, points us to data, such as those cited above, that are not sensationalist but suggest some level of negative consequences.\u00a0 On the whole, there seems much to recommend her policy of &#8220;using facts to moderate the message\u201d.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In a contemporary Western context female circumcision is hardly an issue that divides opinion.\u00a0 A \u00a0WHO study, published in The Lancet (2006), and receiving considerable media coverage, appeared to corroborate widespread concerns as to its implications for the health of \u201ccut\u201d women and their babies\u00a0\u00a0 (http:\/\/www.thelancet.com\/search\/results?searchTerm=WHO+Study+Group+on+Female+Genital+Mutilation&amp;fieldName=AllFields&amp;journalFromWhichSearchStarted=lancet). However, a paper in the latest Hastings Center Report [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2013\/01\/03\/female-circumcision-using-facts-to-moderate-the-message\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2787],"tags":[],"class_list":["post-765","post","type-post","status-publish","format-standard","hentry","category-female-circumcision"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Female circumcision: using facts to moderate the message - Sexually Transmitted Infections<\/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\/sti\/2013\/01\/03\/female-circumcision-using-facts-to-moderate-the-message\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Female circumcision: using facts to moderate the message - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"In a contemporary Western context female circumcision is hardly an issue that divides opinion.\u00a0 A \u00a0WHO study, published in The Lancet (2006), and receiving considerable media coverage, appeared to corroborate widespread concerns as to its implications for the health of \u201ccut\u201d women and their babies\u00a0\u00a0 (http:\/\/www.thelancet.com\/search\/results?searchTerm=WHO+Study+Group+on+Female+Genital+Mutilation&amp;fieldName=AllFields&amp;journalFromWhichSearchStarted=lancet). 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