Medicalization of FGC in Africa --and in the United States?

1. Medicalization of FGC in Africa --and in the United States? Wednesday, November 8, 2000

2. Please remember…. • To pick up your reading guide on the Navajo at the end of class • To hand in your third segment paper on Monday

3. Also please remember... • Power Point presentations are on the Website • So no need to copy down all the quotations

4. Medicalization of FGC in Africa • Should medicalization be encouraged and promoted?

5. What is medicalization? (1) • Making FGC safer for traditional excisers • girls brought to clinics day before ritual • receive anti-tetanus injections & antibiotics • parents given sterile razor blade

6. What is medicalization? (2) • Clinicalization • in-clinic (antiseptic environment) • trained health personnel • use of anesthesia • cutting decreased

7. What is medicalization? (3) • Use of physicians widespread already (20% in urban Sudan; up to 45-55% in urban Egypt) • Should governments regulate and render these practitioners more secure (training, open discussion, insurance)?

8. The health value of medicalization • In Kenya study, 1997-1998: families that received anti-tetanus, antibiotics, and sterile razors had 70% lower risk of infection and complications • clinics and doctors’ offices: even higher reductions of risk

9. Grassroots criticism of medicalization • Anesthesia detracts from ritual • Kenya: “I think it is good to give us antibiotics. But we should not perform the ritual in a clinic, where they inject the child with anasthesia. This is very much against the value of the rite.” • Clinicalization undermines ritual • “If girls go into the clinic to do it, what is the meaning of it? They must have it together, in the group, where they are being initiated!” • Excisers fear loss of authority • “I do not agree with nurses doing it. They have not learned the meaning of these things – they do it like they are giving a shot. Then no one will respect it – no one will respect it!”

10. Criticism by medical profession and international organizations • Since 1982: WHO’s statement: it is unethical for FGC to be performed by “any health officials in any setting” • Since 1994: resolution by International Federation of Gynecology and Obstetrics: “health care personnel should refuse to perform any such surgery” • Since mid-1990s: UNICEF on board against medicalization; many ministries of health in Africa

11. Reason 1: Medically unethical • WHO 1982 statement: “The argument that female genital mutilation performed under medically controlled conditions is a lesser evil compared to the greater risk of severe complications is not acceptable, since the cause of the risk is human behavior, which can be changed, and not an uncontrollable pathology. It is therefore unethical for a health professional to damage a healthy body in order to prevent more destructive human behavior.”

12. Reason 2: Perpetuates FGC • UNICEF statement: “It is sometimes claimed that medicalization is part of a policy of eradication. We, however, believe that in fact medicalization institutionalizes and perpetuates FGM.” • Some evidence from Egypt: • 1970s: anecdotal evidence of decline in urban Egypt; • 1996 survey found same high rates in both urban and rural areas • 1996 survey found increase in use of clinics in last 10 -15 years (17% of urban women over 30 had FGC in clinics; 55% of their 15-20 year old daughters had done so)

13. Reason 3: Legitimates “offensive” practice • International Federation of Gynecology and Obstetrics: • “Medicalizing FGM legitimates a practice that is offensive to the dignity of women. Surgeons who are contemplating performing such a procedure should consider their role in endorsing this social practice with its implications for the status of women.”

14. Medicalization of FGC in the US? • African immigration to the US • Currently: 150,000 women from Africa living in the US either are cut or face possibility of being cut (acc. to CDC) • 7000 more every year • about 30,000 from infibulating societies (Somalia, Sudan, etc.), due in part to wars of 1990s

15. Harborview case • Issue faces hospitals across the country • 3500 Somalis in Seattle by 1996 • Proposal for nick to clitoris of girls (8-10 years old): no tissue excised, local anesthetic, on children “old enough to give consent”

16. Parents said they would get girls cut by one of 3 local midwives; or would return for operation to Somalia Operation would help process of eradication: older versus younger women: operation becoming less invasive The two justifications

17. Opinion of State Attorney General • Stated that the proposal, if enacted, would violate Illegal Immigration Reform and Immigrant Responsibility Act (September 24, 1996) • Whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years shall be fined under this title or imprisoned not more than 5 years, or both.

18. Harborview invoked clause 2: “[An exception is given when ] the operation is necessary to the health of the person on whom it is performed” Attorney General invoked clause 3: “In applying this exception, no account shall be taken of the effect of any belief that the operation is required as a matter of custom or ritual.” Response, counter-response

19. The torrent of letters • 100s from Seattle residents • Some were supportive (as in editorial assigned to you): • “Who are we to impose our values on them? This is a cultural practice that must be respected.”

20. But most of the letters went the other way... • “Even talking about cutting female genitals legitimizes a barbaric practice, one that disempowers women and serves to keep them out of the American mainstream.” • Pat Schroeder (D-Colo) wrote a letter like this...

21. Letter from a social worker • “I have heard Somali women say ‘We were taught that this was a way of ensuring a girl's good behavior. Women should be meek, simple and quiet, not aggressive and outgoing. This is something we just accept.’ How can we help support a practice that has this effect? Shouldn’t these women be encouraged to move toward the American mainstream?”

22. Letter from an Ethiopian woman • “How dare it even cross their minds? What immigrants like me need is an education, not ‘sensitivity’ to culture. . . When Americans are ‘sensitive’ to culture, they keep us locked into tradition, which of course Americans like, because it is exotic… I’ll bet that most of the Somali women don’t want this, but the few who do are getting all the attention! They must be brought into the 20th century!”

23. Letter from a Somali woman • “I am happy to be in this country, where cutting is against the law. I am young and I do not want to continue this custom. . . Here we do not have to do it. Please do not turn back the clock with this. Now I can say: ‘I will not cut my daughter, because we are in a country that disapproves of this.’ What will I say if the plan goes through?”

24. How it ended... • Plan dropped • Since then, no other hospital in US has tried this • Cutting continues… but hard to document • So: did Harborview do the right or wrong thing?