May 6, 2010
By Pam Belluck -The New York Times
In a controversial change to a longstanding policy concerning the practice of female circumcision in some African and Asian cultures, the American Academy of Pediatrics is suggesting that American doctors be given permission to perform a ceremonial pinprick or “nick” on girls from these cultures if it would keep their families from sending them overseas for the full circumcision.
The academy’s committee on bioethics, in a policy statement last week, said some pediatricians had suggested that current federal law, which “makes criminal any nonmedical procedure performed on the genitals” of a girl in the United States, has had the unintended consequence of driving some families to take their daughters to other countries to undergo mutilation.
“It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm,” the group said.
But some opponents of female genital mutilation, or F.G.M., denounced the statement.
“I am sure the academy had only good intentions, but what their recommendation has done is only create confusion about whether F.G.M. is acceptable in any form, and it is the wrong step forward on how best to protect young women and girls,” said Representative Joseph Crowley, Democrat of New York, who recently introduced a bill to toughen federal law by making it a crime to take a girl overseas to be circumcised. “F.G.M. serves no medical purpose, and it is rightfully banned in the U.S.”
Georganne Chapin, executive director of an advocacy group called Intact America, said she was “astonished that a group of intelligent people did not see the utter slippery slope that we put physicians on” with the new policy statement. “How much blood will parents be satisfied with?”
She added: “There are countries in the world that allow wife beating, slavery and child abuse, but we don’t allow people to practice those customs in this country. We don’t let people have slavery a little bit because they’re going to do it anyway, or beat their wives a little bit because they’re going to do it anyway.”
A member of the academy’s bioethics committee, Dr. Lainie Friedman Ross, associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago, said the panel’s intent was to issue a “statement on safety in a culturally sensitive context.”
Dr. Friedman Ross said that the committee members “oppose all types of female genital cutting that impose risks or physical or psychological harm,” and consider the ritual nick “a last resort,” but that the nick is “supposed to be as benign as getting a girl’s ears pierced. It’s taking a pin and creating a drop of blood.”
She said the panel had heard anecdotes from worried doctors.
“If we just told parents, ‘No, this is wrong,’ our concern is they may take their daughters back to their home countries, where the procedure may be more extensive cutting and may even be done without anesthesia, with unsterilized knives or even glass,” she said. “A just-say-no policy may end up alienating these families, who are going to then find an alternative that will do more harm than good.”
Currently, more than 130 million women and girls worldwide have undergone female genital cutting, according to the American Congress of Obstetricians and Gynecologists. It is mostly performed on girls younger than 15 in countries including Ethiopia, Sudan and Somalia. Consequences can include severe complications with pregnancy, childbirth and sexual dysfunction.
The academy’s statement acknowledged that opponents of the procedure, “including women from African countries, strongly oppose any compromise that would legitimize even the most minimal procedure.”
Dr. Friedman Ross said, “If you medicalize it and say it’s permissible, is there a possibility that some people will misunderstand it and go beyond a nick? Yes.”
But she said the risk that people denied the ceremonial procedure, usually on the clitoris, would opt for the more harmful one was much more dangerous.
And the statement said that, “in some countries where FGC is common, some progress toward eradication or amelioration has been made by substituting ritual ‘nicks’ for more severe forms.”
