Wednesday, June 18, 2014

What makes genital mutilation a mutilation?

See this video of a traditional circumcision in Nigeria.

Is it genital mutilation? Is it a medical procedure? Is it a ritual?

The child is forcefully restrained by two adults. If you have seen images of FGM, where teenage girls are restrained by several adults... how is this different? Anesthesia has not been used. The knife is not sterile (and after using it, the circumciser puts it in his mouth). The child is crying, fully aware of what's happening and of his inability to remove himself from the situation.

The knife attacks for the second time. The video shows the abdomen of the child heaving as he cries continuously.

The circumciser now uses a powder to stop the bleeding. Applied with his bare hands.

The child keeps crying after the cutting. His eyes reflect abandonment and betrayal.

The circumciser is dressing the wound. On the top left you can see the string that he will use to tie the bandage... It's on his mouth.

Now the string is being tied to hold the bandage in place. If the string is tied too tight, it could cause necrosis and gangrene and lead to the loss of the penis.

The bandaged wound. There is some dripping of blood noticeable, but the bleeding has been mostly stopped with the powder.

The child is still crying, so now to top it all, the circumciser slaps the child's face.

Is there any doubt that this is abuse of a minor?

What is it that makes this procedure genital mutilation?

Is it the age of the child?
Is it the dirty tools, hands and environment?
Is it the lack of anesthesia?
Is it the forceful restraint?
Is it the loss of tissue from the external genitalia?
Is it the lack of consent?

These are the World Health Organization's key facts on FEMALE genital mutilation:

  • Female genital mutilation (FGM) includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons.
  • The procedure has no health benefits for girls and women.
  • Procedures can cause severe bleeding and problems urinating, and later cysts, infections, infertility as well as complications in childbirth and increased risk of newborn deaths.
  • More than 125 million girls and women alive today have been cut in the 29 countries in Africa and Middle East where FGM is concentrated (1).
  • FGM is mostly carried out on young girls sometime between infancy and age 15.
  • FGM is a violation of the human rights of girls and women. 
My first observation is that these key facts are missing something very important. Violation of consent.

Do these facts apply to what we just saw?

  • Intentionally (yes) altering (yes) and causing injury (yes) to the female (no) genital organs (yes) for non-medical reasons (yes)
  • Health benefits. This is a moot point. While some will argue for the benefits of circumcision, there are also harms (that health organizations refuse to acknowledge) such as the loss of the frenulum, loss of tissue, loss of mobility and long term harm to the glans, and then there are all the risks. Furthermore, in lack of consent, even the benefits are obtained by unethical means.
  • Procedure can cause severe bleeding (yes) and problems urinating (yes - many circumcised boys have meatal stenosis, some develop fistulas, some "medical" methods of circumcision can cause life-threatening urine retention) and later infections or infertility (if there is loss of the penis). (cyst, complications in childbirth do not apply... furthermore complications in childbirth only applies to one type of FGM, infibulation, not all types).
  • More than 125 million girls and women alive today have been cut. Close to 20 to 30% of the male population alive today has been cut.
  • Circumcision is mostly carried out on young boys sometime between infancy and age 15.
  • What are the rights of boys and men? Do boys and men have rights to their physical integrity, to their genital autonomy?
[WHO]: Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.

[We] Circumcision (MGM/MC) involves partial removal of the external male genitalia, for cultural, social, "medical" or "aesthetic" reasons. BTW, at least two studies have found circumcised women to have less prevalence of HIV. If there was a medical "benefit" from cutting females, would the WHO promote it?

[WHO] The practice is mostly carried out by traditional circumcisers, who often play other central roles in communities, such as attending childbirths. However, more than 18% of all FGM is performed by health care providers, and the trend towards medicalization is increasing.

[We] In African, Islamic and Jewish communities, circumcision is mostly carried out by traditional circumcisers. In the U.S. it is often carried out by the doctors attending childbirths (OB/GYN), whose specialty has little or nothing to do with male genitalia.

[WHO] FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person's rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death

[We] MC has not been recognized internationally as a violation of human rights of boys and girls, but the Parliamentary Assembly of the Council of Europe gave a first step in naming non-therapeutic circumcision of underage boys among procedures that violate the children's right to physical integrity. Circumcision reflects inequality between sexes and a form of violence and discrimination against boys. It is nearly always carried out on minors and should be recognized a violation of the rights of children. The practice also violates a person's right to health (externalizing an internal organ, often causing meatal stenosis and loss of erogenous tissue), the right to be free from torture and cruel, inhuman or degrading treatment (see the treatment received by the child in the above pictures) and the right to life when the procedure results in death (deaths after circumcisions are not unheard of, both in traditional procedures -such as South Africa every year-, ritual -such as Israel- or medical -as in the United States).

[WHO] Immediate complications [of FGM] can include severe pain, shock, haemorrhage (bleeding), tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue. 

[We] Immediate complications of circumcision can include severe pain, shock, haemorrhage (bleeding), sepsis (life threatening), urine retention, injury to nearby genital tissue (the glans, the shaft).

[WHO] Where FGM is a social convention, the social pressure to conform to what others do and have been doing is a strong motivation to perpetuate the practice.

[We] "he will thank you later", "he will be made fun of in the locker room", "girls won't like him if he is not cut", "all males in my family have been traditionally circumcised", "all American boys are circumcised", "baby must match daddy"... Yup, social pressure. “The desire to conform is an important motivation for circumcision in places where the majority of boys are circumcised,” Dr Catherine Hankins.

[WHO] FGM is often considered a necessary part of raising a girl properly, and a way to prepare her for adulthood and marriage.

[We]  According to the AAP: "In the pluralistic society of the United States, where parents are afforded wide authority for determining what constitutes appropriate child-rearing and child welfare, it is legitimate for the parents to take into account their own cultural, religious, and ethnic traditions, in addition to medical factors, when making this choice."

[WHO] FGM is often motivated by beliefs about what is considered proper sexual behaviour, linking procedures to premarital virginity and marital fidelity. FGM is in many communities believed to reduce a woman's libido and therefore believed to help her resist "illicit" sexual acts. When a vaginal opening is covered or narrowed (type 3 above), the fear of the pain of opening it, and the fear that this will be found out, is expected to further discourage "illicit" sexual intercourse among women with this type of FGM.

[We] It is necessary to remember that the original motivation behind medical circumcision in the United States was to prevent and cure masturbation. Male infibulation (sewing the foreskin with a silver thread) was also done at the time to prevent erections. Doctors today deny that there is any sexual harm, but they were circumcised at birth themselves so they don't have a personal experience of intact sex.

[WHO] FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are “clean” and "beautiful" after removal of body parts that are considered "male" or "unclean".

[We] Circumcision and masculinity: “Circumcision is also associated with factors such as masculinity, social cohesion with boys of the same age who become circumcised at the same time, self-identity and spirituality,” Dr Catherine Hankins. From the same article: "In some settings where circumcision is the norm, there is discrimination against non-circumcised men. For the Lunda and Luvale tribes in Zambia, or the Bagisu in Uganda, it is unacceptable to remain uncircumcised, to the extent that forced circumcisions of older boys are not uncommon. Among the Xhosa in South Africa, men who have not been circumcised can suffer extreme forms of punishment, including bullying and beatings."

Circumcision and cleanliness: (from the same article) "In a study of US newborns in 1983, mothers cited hygiene as the most important determinant of choosing to circumcise their sons, and in Ghana, male circumcision is seen as cleansing the boy after birth. Improved hygiene was also cited by 23% of 110 boys circumcised in the Philippines"

Circumcision and female parts: (from the same article): "certain ethnic groups including the Dogon and Dowayo of West Africa, and the Xhosa of South Africa view the foreskin as the feminine element of the penis, the removal of which (along with passing certain tests) makes a man of the child."

[WHO] Though no religious scripts prescribe the practice, practitioners often believe the practice has religious support.

[We] The Quran does not mention male circumcision. The New Testament dismisses the old covenant of circumcision. Yet Muslims and American Christians would affirm that circumcision is part of their religions.

[WHO] Religious leaders take varying positions with regard to FGM: some promote it, some consider it irrelevant to religion, and others contribute to its elimination

[We] ---

[WHO] Local structures of power and authority, such as community leaders, religious leaders, circumcisers, and even some medical personnel can contribute to upholding the practice.

[We] Male circumcision was made massive in the United States by the Army and the American medical community. The AAP, the WHO, UNAIDS, Unicef, the CDC are contributors to the perpetuation of male circumcision.

[WHO] In most societies, FGM is considered a cultural tradition, which is often used as an argument for its continuation.

[We] AAP says "it is legitimate for the parents to take into account their own cultural, religious, and ethnic traditions, in addition to medical factors, when making this choice."

[WHO] In some societies, recent adoption of the practice is linked to copying the traditions of neighbouring groups. Sometimes it has started as part of a wider religious or traditional revival movement.

[We] (Again, from the UNAIDS article) "With advances in surgery in the 19th century, and increased mobility in the 20th century, the procedure was introduced into some previously non-circumcising cultures for both health-related and social reasons."

[WHO] In some societies, FGM is practised by new groups when they move into areas where the local population practice FGM.

[We] (Again, from the UNAIDS article): "The desire to ‘belong’ is also likely to be the main factor behind the high rate of adult male circumcisions among immigrants to Israel from non-circumcising countries (predominantly the former Soviet Union)."

After reviewing all these parallels, we call the propaganda of the WHO and Catherine Hankins:

"Monitoring and minimising potential negative gender-related impacts of male circumcision programmes, such as conflation of male circumcision with female genital mutilation (FGM), unsafe sex and sexual violence" - Catherine Hankins

Please help stop male genital mutilation. You can make it stop.