Global Health Case Study: Female Genital Cutting

1. Global Health Case Study: Female Genital Cutting Bettina Shell-Duncan Department of Anthropology

2. Day 1 Introduction to the Topic

3. Types of “Female Circumcison” • Clitoridectomy (sunna, Type I) • Excision (Type II) • Infibulation (Pharaonic circumcision, Type III) • Intermediate circumcision (matwasat, Type III) • Introcision (hymenectomy, zur-zur cuts, gishiri cuts, Type IV) • “symbolic” circumcision (Type IV)

4. African countries in which FGC has been reported since 1979.

5. Global Campaign to Elimimate FGC • Colonial government and missionary campaigns • Conferences honoring the United Nations Decade for Women (1975-85)

6. Learning Objectives • To understand terminology and classification of types of female circumcision • To understand origins and distribution of the practice • To be familiar with broadly stated reasons for the practice • To understand the political climate fueling international opposition to female circumcision

7. Day 2 Evidence: Female Genital Cutting as a Health Issue What are the Medical Facts?

8. Short-Term Complications • hemorrhage • severe pain • local and systemic infection • shock • keloid scars • urinary retention

9. Long-term Complications • difficulties with menstruation and urination • urinary tract infection • pelvic inflammatory disease • infertility • dermoid cysts • neuroma • diminished sexual pleasure • Higher risk of STDs and HIV/AIDS

10. Obstetrical Complications • Obstructed labor • Hemorrhage • Vesico-vaginal and Recto-vaginal fistulae

11. Learning Objectives • To review findings from survey data, and understand shortcomings of survey approaches to understanding health outcomes of FGC • To review clinic and case studies of FGC, and discuss the limitations of information derived from these studies • To understand how findings on health consequences are interpreted and employed in intervention programs and in arguments used to justify or condemn intervention

12. Day 3 Why Is FGC a Priority?

13. Relative Ranking by Physicians of the Importance of FGC as a Health Problem in Nigeria

14. “Genital mutilation should be treated as a public health problem and recognized as an impediment to development that can be prevented and eradicated much like any disease.” -Fran Hosken, 1978:151

15. Medicalization Approaches • provision clean razors, prophylactic antibiotics, and anti-tetanus injections • training programs for circumcisers and TBAs • have FGC performed by trained medical professionals in clinics or hospitals

16. 1982 Statement from the World Health Organization: “WHO has consistently and unequivocally advised that female circumcision should not be practiced by any health professionals in any setting - including hospitals and other health establishments.” This position has been joined by many other organizations, including: Unicef the International Federation of Gyn. and Obstetrics the American Medical Association

17. Tostan • Public declarations to abandon FGC • First declarations among 10 intermarrying villages in 1997 • Emanated from a basic education program

18. Learning Objectives • To outline arguments for opposing medicalization of FGC, and to critically review evidence supporting or refuting these arguments • To outline principles of harm reduction, and assess how they do or do not fit with efforts to medicalize FGC • To discuss the merits and drawbacks of including FGC in broader “integrated” programs addressing reproductive health and other community needs

19. Day 4 Cultural Meaning and “Insider” Perspectives

20. Reasons for the Practice • Control of female sexuality • Enhance fertility • Female gender identity • Ethnic identity • Religion • Marriageability

21. Western forms of Body Modification • Male circumcision • Breast Enhancement • Female Genital Cosmetic Surgeries “designer vaginas” www.altermd.com

22. Learning Objectives • To discuss insider perspectives on the cultural value and meaning of FGC • To compare FGC to other forms of body modification found in Western societies • To discuss the ethics of condoning procedures such as male circumcision and female genital plastic surgeries, but opposing and outlawing FGC.

23. Day 5 Recasting FGC as a Human Rights Issue: Cultural Imperialism or Protection of Women’s Rights?

24. Who, if anyone, has the moral authority to condemn this practice? • Cultural Relativism: there are no value judgements that are objectively falsifiable independent of specific cultures, and as such, moral judgements and social institutions are exempt from legitimate criticims by outsiders • Universalist Stance: certain individual rights are so fundamental to humankind that they are upheld as universal “human rights”

25. Human Rights Approach • 1) Rights of the child • 2) Rights of women • 3) Freedom from torture • 4) The right to health and bodily integrity

26. Learning Objectives • To understand principles of the universalist/cultural relativist debate, and to discuss how FGC features as a test case in this debate • To understand historical changes in the concept of human rights that have allowed FGC to become classified as a human rights violation • To understand strengths and shortcomings of doctrinist approaches to framing FGC as a human rights violation

27. Day 6 Legislative Approaches and Asylum: National and Transnational Concerns

28. Effects of National Legislation • Deterrence • Backlash • Underground • Enforcability

29. Asylum in the U.S. • Kassindja • Abankwah • 9th Circuit Court of Appeals Ruling

30. Learning Objectives • To understand the context and consequences of enacting legislation that specifically bans FGC • To discuss the role and responsibility of foreign governments in protecting African women from FGC