Doctors Seek Compromise On Female Genital Cutting

In a new policy statement, the American Academy of Pediatrics says a "ritual nick" to the genitals of newborn females might "save some girls from undergoing disfiguring and life-threatening procedures in their native countries." Law Professor Dena Davis explains the policy.

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PAUL RAEBURN, host:

This is SCIENCE FRIDAY from NPR. I'm Paul Raeburn, sitting in for Ira Flatow.

Later in the hour, we will be talking about the fascinating and often tragic disorder in which people are unable to ever throw anything away. You've probably heard about this, seen it on cable and lots of other places. And we will be looking at brain scanners that claim to be able to tell whether you're lying.

But first, a rather unusual story on a ritual sometimes called female circumcision but known more properly as female genital cutting. Last week, the American Academy of Pediatrics released a controversial new policy statement on female genital cutting.

For those of you not familiar with the practice, pre-adolescent females in some parts of Africa, the Middle East and Asia are subjected to ritual cutting and alteration of their genitals. The practice has been condemned by some human rights groups, by many human rights groups, and it is illegal in the United States.

The pediatricians issued a statement in which they condemn the practice, and they urge their colleagues to work hard to talk families out of doing this to their daughters. That part's not terribly controversial.

The controversy arises near the end of the statement, where the pediatricians suggest that a slight ritual nick, a ritual nick of the genitals might be a good compromise for some families, saving some girls from the much more harmful and disfiguring and potentially life-threatening genital cutting.

It's an interesting kind of compromise, and joining me to talk more about is my guest, Dena Davis, professor of law at Cleveland State University's Cleveland-Marshall College of Law. She was a consultant to the American Academy of Pediatrics and the lead author of this new statement on cutting. Thanks for taking time to talk with us today.

Ms. DENA DAVIS (Professor of Law, Cleveland-Marshall College of Law, Cleveland State University): Oh, thanks for having me.

RAEBURN: If you would like to get in on the conversation, give us a call. Our number is 1-800-989-8255. That's 1-800-989-TALK. You can tweet us by our tweet our tweet handle is @scifri, S-C-I-F-R-I. If you want more information about what we'll be talking about this hour, go to our website, sciencefriday.com, where you will find links to our topic.

So Dena Davis, thanks again for being with us. Tell us a little bit about the genesis of this statement.

Ms. DAVIS: Well, I want to start by reiterating what you already said. The statement ends with four recommendations, and none of those mention this compromise. The recommendations are that the American Academy of Pediatrics opposes all forms of female genital cutting that pose risks of physical or psychological harm, encourages its members to educate themselves about the practice, recommends that members actively seek to dissuade families from carrying out harmful forms of FGC and recommends compassionate education of the parents of patients.

Having said that, the controversial part, as you made mention, is a discussion toward the end of the possibility of pediatricians offering what would literally be a nick. And in the statement, we analogize it to ear piercing.

And the idea here was that we knew that some pediatricians in Seattle a number of years ago who had a good relationship with the Somali immigrant community around their hospital had been asked by mothers of girls for this kind of compromise. And they had gone down the road of - they'd had meetings with mothers and so on, and they were about to do that...

RAEBURN: So this was mothers from some of these cultures where this is practiced had suggested that...

Ms. DAVIS: Right, were Somali immigrant mothers.

RAEBURN: Okay, so it was their idea?

Ms. DAVIS: Well, I'm not sure whose idea it was, but they embraced it to the extent that they held off on doing something worse until the doctors could get set up to start offering this. But before that could happen, Congresswoman Pat Schroeder wrote to tell the hospital that it would be criminal under her new law that had recently passed in Congress.

The concern is that we know that in many cases, when pediatricians turn down parents, girls are taken back to Africa for the worst possible procedures done, you know, with no painkilling and no, you know, no infection control and extremely severe forms of these procedures where girls' labia are scraped away, for example.

And there's really that's very difficult to stop...

RAEBURN: Do you have a sense I'm just I can't help but interrupt. Do you have a sense of why in these cultures, there may be different reasons, but why this is done or what is supposed to be the benefit of it?

Ms. DAVIS: Right, it's a wide array of things. On a positive side, it's seen as a growing-up ritual, as a celebration of ethnic or national identity. It became politically important as a response to colonization, for example, but it's also done to remove sexual pleasure from women so that they can be controlled, to guarantee women's virginity so that they are marriageable and to protect the family's honor.

People also have often these are people who have never seen normal female genitals in their lives because in Somalia, for example, it's almost 100 percent of women are cut. So people have, you know, fairly strange ideas about what would happen if girls weren't cut, for example that their clitoris would grow to the size of a penis.

RAEBURN: Well, that's an unusual idea. You're right there. Let's take a call from a listener, Mary(ph) in Louisville. Are you with us?

MARY (Caller): Yes, I am.

RAEBURN: Welcome to SCIENCE FRIDAY. What would you like to ask?

MARY: I would just like to make a comment that I think that if the doctors do agree to nick the little girls, we are still in the same spot in that really the Somalian culture, and I believe it actually is also part of a Muslim practice, need to be educated that none of it is okay, and that is my comment.

Ms. DAVIS: Thanks.

RAEBURN: Well, that's a thought that I had, too. Yeah, what about that? Go ahead.

Ms. DAVIS: Two responses. First of all, it's not necessarily Muslim. It certainly is done in many Muslim countries, but for example, Saudi Arabia, one of the most conservative Muslim countries, has no incidence of this at all. And there are other non-Muslim countries that do it.

RAEBURN: But what about the idea that nicking itself is already across some line, that whether you do that or not, there's a big education issue here and that if you do that, you either medicalize it or somehow legitimize the process, even if not the specific procedure.

Ms. DAVIS: I know, and obviously that is a serious concern. I think one way to think about this and one reason why it is so controversial is in terms of other kinds of harm reductions that have also been controversial.

For example, we'd like to eradicate heroin addiction entirely, but we can't at the present time, and we give clean needles instead to protect people from HIV, for example. So we hope to reduce harm, and of course, the critique is: Aren't we just condoning, you know, people shooting up?

You know, we tell young teenagers how to protect themselves from pregnancy and STDs, when of course what we'd really like is for them not to be having sex at all.

RAEBURN: Well, so I take I mean, I take the point that things in an ideal situation are different from things in a public health context, where it gets tricky sometimes to try to figure out what to do. But a part of this discussion I think should be whether or not there's evidence that the, you know, the ritual nick would in fact displace the other procedure, would satisfy the families and improve the situation. Do we have any evidence that that's the case?

Ms. DAVIS: We have a little bit of evidence. It's not a lot because it was not legal for that to happen in the U.S. So of course, you know, we're not suggesting that pediatricians break the law. We do have the evidence...

RAEBURN: Good, that's good.

(Soundbite of laughter)

Ms. DAVIS: Right, right. We do have the evidence, you know, of this immigrant community in Seattle that was actively working with the doctors to make this happen. That's, you know, one small example.

There are a few examples around the world where, over time, very minimal procedures, like a prick with a thorn, for example, in Indonesia, have in fact displaced the horrifying procedures. So that would be a reason to see if it works.

What we know is that, you know, girls are being taken to Canada or being, you know, operated on in unsterile conditions on kitchen tables. That we know.

RAEBURN: I'm curious how you got involved in this issue yourself.

Ms. DAVIS: I've always been interested in human rights issues, having to do with bodies, for example. I've also been interested in the way in which people can be quite horrified at even this notion of a slight nick and be comfortable with routine male circumcision, which of course is more extensive.

So I've always been interested in those ideas. I'm also interested in how, sort of how the public perceives religion and some of the very I wanted to try and change some of the very condescending ways in which religion was talked about in this context by people who opposed female genital cutting.

For example, it's common to hear people say oh, they think, you know, the religion calls for it, but they're wrong, as if, you know, somebody in Philadelphia can tell, you know, an entire population of Egypt what their religion calls for.

RAEBURN: Well, thanks for taking the time to be with us to talk about this very interesting and complicated issue. My guest has been Dena Davis, professor of law at Cleveland State University's Cleveland-Marshall College of Law. She was a consultant to the American Academy of Pediatrics on the statement on genital cutting. Thanks for taking time talk with us today.

Ms. DAVIS: Thank you, bye.

RAEBURN: And we'll be right back after a very short break.

(Soundbite of music)

RAEBURN: This is SCIENCE FRIDAY from NPR.

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