FGM in the USA

I've tried not to write about this, but it just won't go away.

Warning: This will not be an easy read.

FGM is 'female genital mutilation'. It's also know as 'cutting' and 'female circumcision'.

The World Health Organization estimates that 100 to 140 million women world wide are currently living with the consequences of FGM.

If you've heard anything about FGM, you've probably associated it with Africa and parts of Asia.

In July, 2003 at its second summit, the African Union adopted the Maputo Protocol promoting women's rights including an end to female genital mutilation.

Having been ratified by fifteen members, it went into force in November, 2005. By December 2008, 25 member countries had ratified and deposited the Maputo Protocol.

And yet, the U.S. State Department estimates that the practice of FGM continues unabated. At the time of the ratification of the Maputo Protocol, a study revealed the prevalence in the following countries:

Egypt: 78 - 90% Type I, II and III

Ethiopia: 69.7%-94.5% Type I, II, III, and IV

Guinea: 98.6% Type I, II and III

Sudan: 91% Type I,II and III

There are more, but these countries are among the worst offenders.

A quick google check did not reveal a more recent study (although, I'm sure there are), but numerous recent articles and films on the subject which I found continue to claim that the laws have had little effect on curbing the incidence, claiming strong, ancient ties to cultural and religious tradition. 

I don't mean to shock you or disturb you - no, wait, I do want to disturb you - but just so we know what we're all talking about here, this is a graphic that shows the three different types of Female Genital Mutilation.

If you choose, you may click on the picture, to see the graphic in greater detail.

Type IV - as practiced in Ethiopia and other parts of Africa - consists of "other mutilation" such as pricking, piercing, incising, ripping, tearing, burning, scraping and cauterization. 

I don't know how anyone can look at this and 'soften' the term by calling it 'cutting'. And, let's not dignify it by calling it 'circumcision', please.

It's mutilation. Full stop.

In the United States, federal law prohibiting FGC was enacted in 1996. 17 states enacted similar laws between 1994 and 2006.

So, we can rest assured that no young girl or young woman is having her genitals mutilated in these United States, right?

Think again.

Just this past May, we came perilously close to allowing a form of FGM called "Nicking".

After suggesting that American doctors should be allowed to “nick” girls’ genitals if it would save them from being sent overseas to have a full female genital cutting procedure done, the American Academy of Pediatrics (AAP) has reversed its decision. Human rights group Equality Now decried the original announcement.

So, we can rest assured that no young girl or young woman is having her genitals mutilated in these United States, right?

Think again.

All we need do is look over to New York City - specifically, New York Presbyterian Hospital, Weill Medical College of Cornell University

Yes, in the heart of the city that is known as "The Capitol of the World," FGM is being conducted in the name of "research".

Can anyone say, "Tuskegee Syphilis Project"?

Alice Dreger and Ellen K. Feder recently (06/16/10) wrote an article in the online Bioethics Forum in which they compare the dehumanizing language of the Tuskegee Syphilis Project with the paper published in the 2007 Journal of Urology, “Nerve Sparing Ventral Clitoroplasty: Analysis of Clitoral Sensitivity and Viability” by Jennifer Yang, Diane Felsen, and Dix P. Poppas.

"Writing in the typically dry, quantifying language of modern medicine, the authors report why they believe Poppas, a pediatric urologist at New York Presbyterian Hospital, Weill Medical College of Cornell University, has left a group of girls still able to have sexual sensation after he has removed parts of the girls’ clitorises. With parental consent, these girls’ clitorises have been cut down in size after the physician deemed these clitorises too big."

As I dug deeper into the story, it seemed that some of these . . . "procedures". . . were being performed on children classified as 'intersex': "a group of conditions where there is a discrepancy between the external genitals and the internal genitals (the testes and ovaries). The older term for this condition is hermaphroditism."

However, the preponderance of evidence suggests that this surgical procedure is being done primarily on girls, some as young as three years old - with full approval of the parents - for "cosmetic" reasons, because of their concern that their clitorises were too large.

As shocking as this is, there is another, shocking post operative aspect to this horrible "medical procedure" - all in the name of "research".

Here's what Dreger and Feder report:

"At annual visits after the surgery, while a parent watches, Poppas touches the daughter’s surgically shortened clitoris with a cotton-tip applicator and/or with a “vibratory device,” and the girl is asked to report to Poppas how strongly she feels him touching her clitoris. Using the vibrator, he also touches her on her inner thigh, her labia minora, and the introitus of her vagina, asking her to report, on a scale of 0 (no sensation) to 5 (maximum), how strongly she feels the touch. Yang, Felsen, and Poppas also report a “capillary perfusion testing,” which means a physician or nurse pushes a finger nail on the girl’s clitoris to see if the blood goes away and comes back, a sign of healthy tissue. Poppas has indicated in this article and elsewhere that ideally he seeks to conduct annual exams with these girls. He intends to chart the development of their sexual sensation over time."

While there are obviously many, many problems with this, one of the Very Big problems has to do with institutional oversight in the form of an IRB or Institutional Review Board, which approves and monitors all research done at the facility.

Dreger and Feder reveal that:

"Yang, Felsen, and Poppas report IRB approval for retrospective chart review (Are you kidding me????), but apparently have no IRB approval for the post-op “sensory testing.”

I don't know about you, but this makes me sick to my stomach. It boggles my mind that, in the year of our Lord, 2010, well-educated men and women who have taken an oath to "do no harm" could entertain such an idea, much less look the other way while human rights violations are happening in the name of 'research'.

I am a fervent supporter of cultural diversity. I have learned so much from my sisters and brothers around the world which has opened my Western mind to different perspectives of the human enterprise. I am an avid supporter of many Eastern medicine practices and find many of the medicinal, herbal practices in the Global South to be nothing short of genius. I continue to be in awe of the resilience of the human body.

I am, however, sick unto death of the accommodation of cultural and religious differences which violate the rights of women and children.

Polygamy in the Global South, sadly understood and tolerated as a way to counter the effects of poverty on women.

Foot binding in China as an "intensely erotic" experience for men.

Breast Ironing in Cameroon as a way for mothers to protect their pre-pubescent daughters from rape.

My worst fear is that these "good doctors" are operating out of an ethic of doing "less harm" to these girls who, I suspect, are the children of parents from countries where FGM is widely practiced.

Like "nicking", I suspect these "good doctors" believe that they are sparing these young children from a return to their home countries to be mutilated in a village hut by women for whom this is their only source of income.

Or, perhaps it is all a part of our insane obsession with plastic surgery to 'perfect' what God has created.

Someone is saying, "Hang on! We circumcise infant boys all the time in the name of cultural and religious diversity. Isn't that wrong, as well?"

You will get absolutely no argument from me on that issue.

A quick check into google reveals that "The American Medical Association report of 1999, which was "…confined to circumcisions that are not performed for ritualistic or religious purposes," states that

"Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."

And yet, the World Health Organization estimates the prevalence of male circumcision in the United States and Canada at 75% and 30%, respectively. Prevalence in Africa varies from less than 20% in some southern African countries to near universal in North and West Africa.

Clearly, there is much work to be done - in this country and around the world.

As for me, I'm starting across the Hudson.

I have written a letter to New York Presbyterian Hospital, Weill Medical College of Cornell University at 525 East 68th Street New York, NY 10065 (their telephone number is (212) 746-5454), expressing my outrage at these blatant violations of human rights..

I encourage you to do the same thing.

The best way to fight poverty, prejudice, bigotry, oppression, cruel abuse and extremism is to educate and empower girls and women, who will teach and equip the next generations of women and men to live fully into the enterprise of being full, whole, complete human beings.

The horrors of FGM and other human rights abuses to women will not go away just because we don't want - or refuse - to think about them.

"Women," the old Chinese saying goes, "hold up half the sky."

May that become our passionate and persuasive cry to end the sexism and misogyny which results in the mutilation and oppression of some of God's most beautiful creatures.

Lest half the sky fall.

UPDATE:  Sign the petition to stop FGM at Cornell.