Anthropology of the Body

1. Anthropology of the Body Sheryl Clark, Naimeh Noori, Alex Barclay, Jennifer Woo, Poonam Mistry and Tara Manky.

2. The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology • Lock and Scheper-Hughes talk about three bodies: • Individual Body: the sense of lived experience and its interaction with the mind, matter, psyche, soul, and self. • Social Body: refers the body’s link with nature, society, and culture. The body and society are seen as influencing each another. • Body Politic: refers to the regulation, surveillance, and control of bodies (individual and collective).

3. René Descartes (1596-1650) • How Real is Real? The Cartesian Legacy. • Argues for classes of body and mind, spirit and matter, and real and unreal. • Cartesian dualismcaused the ‘mind’ to recede into the background and give natural and clinical sciences the opportunity to focus on the physical ‘body’.

4. The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology • Emotion: Mediatrix of the Three Bodies • Often any kind of sickness or illness is the result of the interaction of the three bodies. • Sickness is not just an isolated event, nor an unfortunate event. • It is a form of communication – the language of organs – through which nature, society and culture speak simultaneously.

5. Michel Foucault (1926-1984) • Foucault describes the process through which power over life evolve in two connected forms. • “The first centred on the body as a machine: its disciplining, the optimization of its capabilities, the extortion of its forces, its integration into systems of efficient and economic controls... The second focused on the species body, the body imbued with the mechanics of life and serving as the basis of the biological processes. […]”

6. Michel Foucault (1926-1984) • “[…]Their supervision was effected through an entire series of interventions and regulatory controls: a biopolitics of the population. The disciplines of the body and the regulations of the population constituted the two poles around which the organization of power over life was deployed.” (Foucault 1978: 139) • Foucault, Michel. The History of Sexuality: An Introduction, Volume 1. New York: Vintage Books, 1978.

7. Michel Foucault (1926-1984) • Biopower • A form of power exercised on the body carrying a specifically anatomical and biological aspect. • It is exercised over members of a population so that their sexuality and individuality are constituted in certain ways that are connected with issues of national policy, including the machinery of production. In this way populations can be adjusted in accordance with economic processes.

8. What does the body politicdo to the individual? The example of Female Genital Mutilation

9. Female Genital Mutilation • Female genital mutilation (FGM), often referred to as ‘female circumcision’, comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons. • Bartholin’s glands • Perineum • Anus • Mons veneris • Labia majora • Labia minora • Clitoral hood • Clitoris • Urethra • Vaginal opening • Hymen (source: http://www.who.int/inf-fs/en/fact241.html)

10. Female Genital Mutilation • There are different types of female genital mutilation known to be practiced today. They include: • Type I - excision of the prepuce, with or without excision of part or all of the clitoris • Bartholin’s glands • Perineum • Anus • Mons veneris • Labia majora • Labia minora • Clitoral hood • Clitoris • Urethra • Vaginal opening • Hymen (source: http://www.who.int/inf-fs/en/fact241.html)

11. Female Genital Mutilation • Type II - excision of the clitoris with partial or total excision of the labia minora • Bartholin’s glands • Perineum • Anus • Mons veneris • Labia majora • Labia minora • Clitoral hood • Clitoris • Urethra • Vaginal opening • Hymen (source: http://www.who.int/inf-fs/en/fact241.html)

12. Female Genital Mutilation • Type III - excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation) • Bartholin’s glands • Perineum • Anus • Mons veneris • Labia majora • Labia minora • Clitoral hood • Clitoris • Urethra • Vaginal opening • Hymen (source: http://www.who.int/inf-fs/en/fact241.html)

13. Female Genital Mutilation • Type IV – unclassified: pricking, piercing or incising of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterization by burning of the clitoris and surrounding tissue; scraping of tissue surrounding the vaginal orifice (angurya cuts) or cutting of the vagina (gishiri cuts); introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purpose of tightening or narrowing it; and any other procedure that falls under the definition given above. (source: http://www.who.int/inf-fs/en/fact241.html)

15. FGM Practices Country Prevalence Type Benin 5-50% excision  Burkina Faso up to 70% excision  Cameroon localized clitoridectomy and excision Central Afr. Repub 45-50% clitoridectomy and excision Chad 60% excision and infibulation Comoros very localized excision Côte d'Ivoire up to 60% excision  DRC (Congo) localized excision  Djibouti 98% excision and infibulation  Egypt 85-95% clitoridect., excision and infib. Eritrea 95% clitoridect., excision and infib. Ethiopia 70-90% clitoridect., excision and infib. Gambia 60-90% excision and infibulation  Ghana 15-30% excision Guinea 65-90% clitoridect., excision and infib.

16. FGM Practices (continued) Country Prevalence Type Guinea Bissau localized clitoridectomy and excision Kenya 50% clitoridect., excision and infib. Liberia 50% excision  Mali 94% clitoridect., excision and infib. Mauritania 25% clitoridectomy and excision Niger localized excision  Nigeria 60-90% clitoridect., excision, and infib. Senegal 20% excision Sierra Leone 90% excision  Somalia 98% infibulation  Sudan 90% infibulation and excision Tanzania 18% excision, infibulation  Togo 12% excision  Uganda localized clitoridectomy and excision  Based on statistics from Amnesty International and US govt.

18. The Articles Obermeyer, Carla Makhlouf 1999 Female Genital Surgeries: The Known, the Unknown, and the Unknowable. Medical Anthropology Quarterly 13:79-106. Mackie, Gerry 2003 Female Genital Cutting: Harmless Practice? Medical Anthropology Quarterly 17(2):135-158. Obermeyer, Carla Makhlouf 2003 The Health Consequences of Female Circumcision: Science, Advocacy, and Standards of Evidence. Medical Anthropology Quarterly 17(3):394-412.

19. Female Genital Surgeries (Obermeyer 1999) Review of the literature on FGM • Goal is to examine • the prevalence of these practices • the variations and trends • the health implications • its effect on sexuality

20. Female Genital Surgeries (Obermeyer 1999) Problems with classification scheme: • The available evidence is long on advocacy and short on empirically based research. Reflects the presence of an agenda aimed at abolishment rather than understanding (85).

21. Female Genital Surgeries (Obermeyer 1999) Prevalence and its Social Context: • Greatest variations in the prevalence and types of genital surgeries appear to be associated with regional and ethnic differences (88) • Findings call into question the relevance of models that assume linear positive correlations among variables such as “modernization,” education and high “women’s status”

22. Female Genital Surgeries (Obermeyer 1999) Gazing at the ‘Other’ • Genital surgeries remain prevalent in a number of countries in the 1990's, calling into question the idea of "universal" values as a result of modernization (89) • Female genital surgeries uncover the symbolic significance of these practices in their cultural context (89) • "Simplifying views can be part of a process whereby the OTHER is reduced to a physical attribute or social characteristics and create a false sense of knowledge of the OTHER.

23. Female Genital Surgeries (Obermeyer 1999) Gazing at the ‘Other’ • "The mixture of detachment and horror that is thus evoked expresses a profound ambivalence toward and OTHER that is both human and object" (90) “The international chorus of criticism against female circumcision has served as a smoke screen focusing attention and resources on traditions while drawing attention away from disastrous situations of economic exploitation and neglect. The evidence on female genital surgeries is not simply a collection of objective facts. It is part of ongoing political struggles about legitimacy andauthority, at both the local and global levels" (90)

24. Female Genital Surgeries (Obermeyer 1999) Unnecessary and Risky? • Evidence on serious health complications and mortality associated with FGM suggests that they are the exception rather than the rule (92) • Biomedical Model: "From a biomedical point of view, which powerfully shapes the evaluation we make of interventions on the body, no matter what the exact numbers are, any pain and suffering that accompany or follow operations that are not medically prescribed are too high to justify their persistence and even the lowest rates of complications are unacceptable" (93) • Cultural Model: "In societies where they are practiced, female genital surgeries may be considered necessary for reasons that have nothing to do with health, but that are thought to be crucial to the definition of a beautiful feminine body, the marriageability of daughters, the balance of sexual desire or the sense of value and identity that comes from following the traditions of society" (94)

25. Female Genital Surgeries (Obermeyer 1999) Female Genital Surgeries and Sexuality • Removal of the clitoris believed to destroy or impair ability to derive pleasure from sex, though systematic studies are rare • Lightfoot -Klein found that 90% of her respondents experienced orgasm regularly or at some point • “Findings are sufficient to challenge the assumption that capacity for sexual enjoyment is dependent on an intact clitoris, and the orgasm is theprincipal measure of ‘healthy’ sexuality” (96)

26. Postcolonial Critique and FGM • “The feminist writings I analyse here discursively colonize the material and historical heterogeneities of the lives of women in the third world, thereby production/representing a composite, single ‘third world woman” (62). • “[…] This average third-world woman leads an essentially truncated life based on her feminine gender (read: sexually constrained) and being ‘third world’ (read: ignorant, poor, uneducated, tradition-bound, religious, domesticated, family-oriented, victimized, etc.). This, I suggest, is in contrast to the (implicit) self-representation of western women as educated, modern, as having control over their own bodies and sexualities, and the ‘freedom’ to make their own decisions” (65). Mohanty, Chandra, “Under Western Eyes: Feminist Scholarship and Colonial Discourses” In Feminist Review No. 30, Autumn 1988.

27. Postcolonial Critique and FGM • “Today, newspaper descriptions of female genital mutilation (FGM) performed on African Women, actual film footage of an FGM operation in progress playing throughout the day on CNN television network, and medical reports of the brutalities of ‘Islamic’ and Asian states towards women reinforce the notion of a barbaric South and, by contrast, a civilized North. In these scripts, a more generalized narrative of Western superiority, the media version of which Edward Said detailed in his book Covering Islam, meets up with a Western feminist script just as it did in the case of English feminists a century ago. If African and Asian women are victims of their cultures, Western women can rush in to save them and, in so doing, can affirm their own positional superiority.” Razack, Sherene, “Looking White People in the Eye: Gender, Race and Culture in Courtrooms and Classrooms.” Toronto: University of Toronto Press, 1999.

29. Female Genital Cutting (Mackie 2003) • Obermeyer claims that FGM is a relatively harmless practice – Mackie denies this • According to Mackie international consensus and mobilization to end FGM is based on • the general absence of meaningful consent to the irreversible act of FGM • Complications that are non-trivial

30. Female Genital Cutting (Mackie 2003) • Mackie believes that FGM is a social practice rather that a pathogen or toxin. It is more important to investigate the sociology of the practice. • FGM compared to foot-binding • She claims that the practice is carried on by people, even those who oppose it due the question of marriageability. • There is discrepancy between behaviours and attitudes about FGM among women.

31. Female Genital Cutting (Mackie 2003) • Mackie claims that the article has limitations due to • Inconsistent standards • Survey research • Harms and Benefits • Sexual Limitations

32. Female Genital Cutting (Mackie 2003) Conclusion • According to Mackie the article shifts standards of evidence without justification, its hypothesis are falsified by evidence from source. Its central conclusions dissolve with linguistic analysis. The conclusive proof it seeks of complications is not possible in any empirical investigation and is not appropriate for evaluation of a health and human-rights issue such as FGM. • She ends by saying that international consensus and mobilization to which the article objects is based primarily on irreversible limitation of a human capacity carried out in the absence of meaningful consent. The complications are non-trivial.

34. The Health Consequences of Female Circumcision (Obermeyer 2003) Two parts to the article • Response to the critique of the 1999 article: • The role of research and advocacy in discussions of harmful effects • The sorts of evidence that is appropriate for measuring health effects • The way in which different disciplines –demography, epidemiology and anthropology are brought together to analyze data on health consequences • Review published sources and provide an update on their results. It shows that few studies are appropriately designed to measure health effects

35. The Health Consequences of Female Circumcision (Obermeyer 2003) Part One • Denies Mackie’s claim that the 1999 article is an attack against “advocates” and is based on selective readings and quotes. • Mackie’s claims about the integrity of the review are unfounded • Indicates that despite his efforts to find fault with the quality of the review, he offers no credible evidence of any additional studies that disprove her review (395) • Multidisciplinary Still Requires Specific Standards or Evidence • Obermeyer does not approve of Mackie’s analogy with reference to female circumcision. She states, “Mackie compares female circumcision to domestic violence in order to show the futility of research that would investigate the harm caused by the phenomenon” (398) • Obermeyer clarifies that this analogy is deceptive, where it equates it to an aggressive practice

36. The Health Consequences of Female Circumcision (Obermeyer 2003) Part Two • Fundamental problems associated with female circumcision studies (401) • Studies indicate that the pain and seriousness of the surgery is culturally dependent (402) • In order to study female circumcision: • Either individual reports or medical examinations are necessary • Funding individual reports are most frequently utilized (403)

37. The Health Consequences of Female Circumcision (Obermeyer 2003) In general • Studies indicate that circumcision is associated with significantly higher risks of complications • Available evidence does not show significant differences between uncircumcised and circumcised (403) • To have a more effective study comparisons are necessary • Most research conducted on female circumcision is from Burkina, Central African Republic, Cote d’Ivoire, Egypt, Gambia, Kenya, Mali and Tanzania (403)

38. The Health Consequences of Female Circumcision (Obermeyer 2003) Conclusion • Despite the accumulation of information on health effects, large gaps remain in present understandings of female circumcision (408)

40. Jones, Heidi, Nafissatou Diop, Ian Askew, and Inoussa Kabore 1999 Female Genital Cutting Practices in Burkina Faso and Mali and Their Negative Health Outcomes. Studies in Family Planning 30(3):219-230. • Observations done at 21 clinics in rural Burkina Faso (BF) and 4 rural and 4 urban clinics in Mali. • Complications – immediately after cutting - haemorrhage, severe pain, shock, damage to surrounding organs and urinary retention and infections. Long term complications – keloids (scar formation), bleeding, dermoid cysts (resulting from embedding a skin fold in the scar or blocking), clitoral neuroma (painful tumour affecting neural tissue) and stenosis or narrowing of the vagina or urethra; openings resulting in scar formation. • Gynaecological Complications • Obstetric Complications • Genital Infection

42. Larsen, Ulla., and Sharon Yan 2000 Does Female Circumcision Affect Infertility and Fertility? A Study of the Central African Republic, Cote d' Ivoire, and Tanzania. Demograp 37(3):313-21. • "Main findings of this analysis are that female circumcision is not associated with increased infertility nor with reduced fertility in the Central African Republic, Cote d'Ivoire and Tanzania. • The relative odds of infertility and the relative odds of having a child do not differ between uncircumcised and circumcised women, regardless of their age at circumcision, when confounding effects of socioeconomic, demographic and cultural characteristics are taken into account" (319)

43. Larsen, Ulla., and Sharon Yan 2000 Does Female Circumcision Affect Infertility and Fertility? A Study of the Central African Republic, Cote d' Ivoire, and Tanzania. Demograp 37(3):313-21. • Possible that only the more severe forms of cutting and infibulation affect women's ability to have a live birth • Obermeyer and Reynolds have documented in the same detail that the practice of female circumcision, deeply rooted in tradition, is unlikely to be changed or reduced by a simple health argument (321)

45. The widespread prevalence of FGM in so many countries makes outright condemnation more difficult: if the practise is so dangerous and undesirable why do so many societies continue to practise it? FGM is intricately linked to cultural understandings of sexuality, gender and health, making the practise not simply an isolated operation that can be removed without profound changes in key cultural concepts The enthusiastic condemnation of FGM within the West can be linked to ethnocentric and colonialist views of the victimised and oppressed “third world woman” Arguments in Support of FGM

46. Each society is distinct and the causes, consequences and processes of FGM must be understood within specific cultural contexts rather than broadly condemned as abominable. Links between FGM and decreased sexual enjoyment are brought into question by studies reporting very high rates of orgasm (up to 90%) among women who have undergone FGM. These numbers are considerably higher than rates in the West, which have been estimated as low as 60%. Plastic surgeries in the West can be compared to FGM for their non-medical necessity and aesthetic motivations. While we may criticize plastic surgery in many ways, would we accept its outright condemnation by outside activists? Arguments in Support of FGM

47. Localized Beliefs A girl who is not circumcised is considered "unclean" by local villagers and therefore unmarriageable. A girl who does not have her clitoris removed is considered a great danger and ultimately fatal to a man if her clitoris touches his penis. One of the most common explanations of FGC is local custom. Family honor, cleanliness, protection against spells, insurance of virginity and faithfulness to the husband, or simply terrorizing women out of sex are sometimes used as explanations for the practice of FGC. Arguments in Support of FGM

48. Circumcision as it is typically regarded among some African peoples like the Dogon, Bambara, and Lobi of Mali (northwest Africa): Among these peoples the fundamental law of creation is twinship. At birth, each infant is "twin," - doubled, equipped with twin souls of different sex. In the girl the masculine soul resides in the clitoris, which is considered her male organ. In the male, removal of the prepuce, in which the female soul resides, confirms the boy in the sex for which he was destined. Excision, which ablates the clitoris, rids the girl of the male element. However, as Pierre Erny, writes in his book, Childhood and Cosmos: Even after these operations have been imposed by social life, duality remains the fundamental law of beings. The soul of the opposite sex, diminished in the body, remains present in the double. The person will find his twinned unity again only at the time of marriage. Through the union of husband and wife, the doubles join like bodies in the act which actualizes the ideal union of twins. After circumcision it is the man's duty to go after his lost femininity and find it again in his wife. And the woman who was freed from her masculinity at the time of excision finds it again in the person of her husband. Arguments in Support of FGM

49. There is much else to be reported on these enlightening and important views of these peoples which, however they may vary elsewhere in the world, are representative of a system of beliefs that stands at the very core of their lives. It is an intricate system of beliefs of so sacred a nature, and so profoundly a part of their being, that it is difficult to imagine their ever living free of them. It is, therefore, unrealistic to refer to such beliefs as barbaric or cruel, for that is not what they are conceived to be by the peoples whose lives they govern and to which they willingly conform. Arguments in Support of FGM

50. Beyond the obvious initial pains of the operations, FGC has long-term physiological, sexual, and psychological effects. Complications following procedure include hemorrhage, severe pain, shock, damage to surrounding organs, urinary retention and infections-Hepatitis B and HIV infection are possible outcomes due to non-sterile instruments used to perform procedure among large numbers of girls at same time Arguments Against FGM