Doctors Face Difficult Dilemma Over Female Genital Cutting

Filed under: In The News




Is it OK to inflict a little bit of harm in order to avert serious physical damage? That's a question pediatricians in America are grappling with, and the answer is far from clear cut.

At issue is the practice of female genital cutting (FGC), a procedure sometimes referred to colloquially as female circumcision, which ranges from the partial removal of a girl's external labia to the complete removal of the clitoris and all labia. In the most extreme cases, the vagina will be sewn shut. The practice dates back to the Pharaohs in Egypt and is widely practiced in parts of Africa and of Asia. It is not associated with any particular religious belief.

The World Health Organization and other groups have been working for years to abolish FGC, which was banned in the United States in 1996. The practice is seen as such an essential rite of passage by many parents, though, that they ask their doctors here to cut their daughters anyway. Those who cannot find someone to perform the procedure in the United States often send their daughters abroad to have it done -- often in unsterile environments without any anesthesia. The WHO estimates that between 100 and 140 million women worldwide have been subjected to a cutting procedure.

All this leaves doctors in a moral quandary: They know that by declining the parents' requests, they could be ultimately subjecting the girls to far more harm. To counter that, the American Academy of Pediatrics recently revised its guidelines to allow for "a ritual nick" that "would not cause physical harm." The thought was that by inflicting a small, symbolic cut -- much less severe than male circumcision -- doctors in the United States could prevent more drastic damage.

"When you're dealing with religious or cultural beliefs, saying no is sometimes not sufficient for people, and it will not necessarily eliminate the practice," Dr. Doug Diekema, a pediatrician at Seattle Children's Hospital and a member of the AAP's ethics committee who advocated for the new guideline, tells ABC News. "The cut itself would be tiny, really just like a poke with a needle, so there might be a drop of blood."

Well-intentioned though the changes may have been, women's rights groups, victims of FGC and other organizations were swift and strident in their opposition.

"The reality is that what (that) statement does is perpetuate female genital mutilation," Taine Bien-Aime, president of Equality Now, tells ABC News. "There is no other way around it."

After the onslaught of outraged opposition, the AAP withdrew the policy modification, saying it had caused too much confusion.

"The AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere else in the world," AAP President Dr. Judith Palfrey says in a statement. "One good thing to emerge is that this discussion has shone a bright light on this issue and raised the world's awareness about this harm to young women."

Related: Cameroon Moms Iron Daughters' Breasts in Little-Known Mutilation Practice

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Start by teaching him that it is safe to do so.