Stronger campaign needed to end female genital mutilation
BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7242.1153 (Published 22 April 2000) Cite this as: BMJ 2000;320:1153
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Dear Editor -
The Personal View this week in the BMJ p1153 urged a stronger campaign to
end female circumcision 1. The French authors interviewed 14 African women
who had undergone the procedure and were living in France.
Firstly, this procedure has been outlawed in this country by the 1985
Statute Act. They found that "the 14 women interviewed considered their
daughter's mutilation and their sons' circumcision to be similar". In my
experience as a practitioner of male circumcision including African
requests, there is no similarity considered by the parents of their sons'
circumcision in any way whatsoever to the notion of female circumcision;
parents do not in fact equate the two. As a practitioner, this is not
surprising due to the anatomical differences e.g. clitoridectomy renders
the female anorgasmic and is associated with far more complications. My
issue is with the Editorial Board: I am amazed at the BMJ editorial
decision accepting for publication such poor quality of research.
Dr Martin Harris
B Pharm(Honours) MB BS(London) LRCP(London) MRCS(England) MRCGP
1 Abboud P et al Stronger campaign needed to end female genital
mutilation BMJ 22 April 2000 7242 p1153
Competing interests: No competing interests
Abboud et al have confirmed the continuing existence of
traditional genital surgery for men and women. Targeting the
social and political situation of women at risk in order to
question and eliminate these practices must be a priority.
It implies some insight into traditional ceremonies and
their importance and not, as Abboud et al suggest, simply
the complete prohibition of the whole procedure (1). It also
implies looking at many more problems and human rights
abuses than only female genital mutilation (FGM). However,
as the title and the picture of Abboud’s personal view
demonstrate, this particular aspect of oppression generates
the voyeuristic interest of BMJ readers being a truly gory
and somewhat titillating story. Similar titles of meetings,
documentary films and articles have succeeded in creating an
alien, repulsive image of people living in traditional
societies (2), a bit like the kind of emotions which follow
reports of cannibalism.
This sort of publicity is extremely unhelpful regarding the
women’s situation and often results in ‘Do-gooders’ from
rich countries appearing in Africa behaving once again like
patronising colonialists. An attempt to understand women’s
everyday problems can reveal a surprising amount of
complaints about difficult aspects of their lives, such as
polygamy or poor reproductive health. Such problems appear
somewhat less bizarre and generate much less media attention
- yet cause a great deal of ill health and loss of lives and
are much more readily accepted as real problems by the women
concerned. What about human rights of a teenager who is the
3rd wife of a man the age of her grandfather who will not
allow her to use contraception despite the fact that her
last confinement nearly killed her? Having been
‘circumcised’ is the last thing she is likely to worry
about, so why would she be responding to the educational
efforts of an anti-FGM initiative?
FGM must be seen as one of many harmful practices affecting
women in traditional societies and the planning of
programmes for its abolition must involve the women
concerned and their own perception of well-being and
improvement (3,4). One successful method is the introduction
of ‘initiation without mutilation’ in The Gambia (Bafrow,
personal communication) and similar procedures elsewhere
(5). Women in developing countries are facing a multitude of
suffering - we need a more wholesome approach in order to
reach the ultimate goal of a dignified and healthy life for
all women, everywhere. Sensationalist reports and pictures
are not going to achieve this.
1. Abboud P, Quereux C, Mansour G, Allag F, Zanardi M 2000.
Stronger campaign needed to end female genital mutilation.
BMJ
2. Mills H. The men who will mutilate girls for money. The
Observer, 5 October 1997
3. B Ras-Work (1998); ‘Grassroots Perspective of Traditional
Practices affecting the Health of Women and Children’;
United Nations Commemoration of the International Women’s
Day.
4. Harrison KA. (1997) The importance of the educated
healthy woman in Africa. Lancet; 349: 644-647.
5. Chelala C; (1998) ‘An alternative way to stop femal
Competing interests: No competing interests
The French physicians and midwives should be commended for
understanding, as did their interviewees, that Male Genital Mutilation
(MGM, euphemistically called circumcision) is the same as Female Genital
Mutilation (FGM). The perceived similarity between these two mutilations
is the norm in African societies, in which both these practices are
common. In western societies, on the other hand, especially in those that
mutilate most of their males like the USA and Israel, MGM is considered to
be desirable, and FGM abhorrent.
It is very easy to perceive the actions
of others, who come from less sophisticated cultures as repugnant and
immoral, while perceive your own similar actions as justified. After all
African religions are primitive and lack significance, and their
physicians are only quack doctors, who cannot publish the medical
justifications they have for mutilating both males and females in
respectable medical scientific journals.
French physicians and others should have no moral dilemma when it comes to
mutilating unconsenting and defenseless minors. If they think that
religious demands for genital mutilation are superior to human rights, why
respect Judaism and Islam and not the African religions? If, as they
should, they know that human rights are superior to professing your
religion on the body of others, why are they discriminating against me as
victim of Jewish MGM? Are my human rights, bodily integrity and suffering
less important than those of African girls? The lower morbidity and
mortality of MGM in a hospital setting, as contrasted with the higher
morbidity and mortality in a traditional setting, can also be achieved for
FMG. The French physicians need only convince their government to respect
the cultural and religious norms of all groups and allow FGM in hospitals.
The higher health toll associated with traditional FGM can thus be
eliminated.
They suggest that MGM be tolerated because it is widespread,
but should crimes be tolerated, because there are many perpetrators? If we
go along with their logic we should aim to eliminate FGM only in western
societies, where it is rare and not in the African countries, in which it
is widespread. At the end of their point of view, they say that MGM is
doing less harm, but this (if you can at all quantify the harm of one
mutilated body in comparison to another, and assuming that the mutilation
did not cause any "undesirable" effects and complications.) is only true,
if you compare MGM with excision or infibulation. If you compare it with
the most common form of FGM, the Sunni circumcision, the harm is the same
as only the prepuce of the clitoris is removed. Indeed, unlike MGM, which
is much more "publicly" verifiable, "FGM" in many occasions is only a
symbolic procedure with no physical mutilation at all, as found in studies
among Bedouins and Ethiopian Jewish women in Israel.
Avshalom Zoossmann-Diskin, PhD,
Executive Director,
The Israeli
Association Against Genital Mutilation. POB 56178, Tel-Aviv 61561, Israel.
e-mail: zoossmann@hotmail.com
Competing interests: No competing interests
Abboud and colleagues are to be congratulated for recognising that
male circumcision is also a form of genital mutilation and that it will be
difficult to persuade mothers that they should not mutilate their
daughters while they continue to have their sons circumcised. It is not
clear however why male circumcision should be tolerated as doing less
harm.
The prepuce is a specialized, specific erogenous tissue in both males
and females. Therefore, surgical excision should be restricted to lesions
that are unresponsive to medical therapy.[1] The male prepuce contains
specialised sensory mucosa which may have a role in the afferent limb of
the ejaculatory reflex.[2] Male circumcision has an adverse effect on
penile health of boys leaving them more likely to develop balanitis,
meatitis, coronal adhesions, and meatal stenosis.[3] It gives rise to
many complications and risks.[4] The Netherlands Institute of Human
Rights has considered male circumcision as a violation of human rights.
Perhaps the solution to this dilemma is to avoid discriminatory
language by removing the word “female” and simply campaigning to end
genital mutilation? Human rights should be conferred without predjudice
to race, religion or gender.
1. Cold CJ, Taylor JR. The prepuce. BJU International 1999;83 Suppl.
1:34-44.
2. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa and
its loss to circumcision. British Journal of Urology 1996;77(2):291-295.
3. Van Howe RS. Variability in penile appearance and penile findings: a
prospective study. British Journal of Urology 1997;80:776-782.
4. Williams N, Kapila L. Complications of circumcision. Br J Surg 1993;
80:1231-1236.
5. Jacqueline Smith. Male Circumcision and the Rights of the Child. In:
Mielle Bulterman, Aart Hendriks and Jacqueline Smith (eds.), To Bear in
Our Minds: Essays in Human Rights from the Heart of the Netherlands.
Netherlands Institute of Human Rights, University of Utrecht, Utrecht,
Netherlands, 1998.
Competing interests: No competing interests
I agree with the paper published by Abboud and Quereux, but il also
important to know that these mutilations can be cured by adequate surgery.
Of course, prevention of mutilation is better than the surgical treatment
of so awfull consequences.
Competing interests: No competing interests
Genital Mutilation, women fighting Aids in Africa taking up this issue
Dear Editor
Further to Caroline Sherfs letter regarding genital mutilation in Africa I
would
like to make an appeal to the BMJ readers. Whilst visiting Nairobi in
August
I met a network of Kenyan women organising themselves around the theme of
AIDS.
Their group, WOFAK (Women Fighting Aids in Kenya) provides counselling,
education,
drugs to treat opportunistic infections and (occasionally) drugs to fight
HIV,
when they can get hold of some. Not surprisingly gathering together on one
issue
has opened up a much wider discussion amongst the women on themes such as
domestic
violence and genital mutilation. They are looking for their own solutions
but
asked me to make an appeal on their behalf:
they need about £800 to bring a shipment of medicines for reproductive
health
and treatment of opportunistic infections from Mombassa to Nairobi in the
next
month or two They would also like to ask the British population not to
dispose
of drugs for the treatment of HIV when the prescription changes or when
drugs
are getting close to the expire date but to recycle them according to
schemes
that already exist in other parts of the world. Hence this letter.
Sometimes questioning deeply entrenched traditional practices is difficult
but
the opportunity may arise out of overriding needs. Genital mutilation (in
women
and in men) spreads AIDS, so they are dealing with it initially on those
bases.
I would welcome any help or suggestions on how to support their
project.
Silvia Bercu , Consultant Forensic Psychiatrist, EHF Trust, Uxbridge Rd,
Mddx
UB1 3EU.
sabercu@doctors.net.uk
Competing interests: No competing interests