Dr. Ahmadu asked me to forward this (she is a member of Gambia-l but for some reason her posts are
rejected). Ylva
---------- Forwarded message ----------
For those of you who are following or have had a chance to glance at the
NY Times debate on female circumcision (see John Tierney or Tierneylab),
which preceded the American Anthropological Association Public Policy
Forum on Female Genital Cutting last Saturday in DC, I am forwarding the
most recent contribution by Rick Shweder, from the University of
Chicago. Many of you expressed concerns about the health implications of
various forms of FGC; Shweder's article is a very important critical
analysis of current research on the medical evidence that few of us
Africans can afford to ignore -- given the exaggerated and
sensationalized claims that are often made in the media. In exposing and
challenging much of the hyperbole, I do not wish to minimize
the experiences and rights of women (and yes, men), however rare these
cases may be, who have been traumatized physically or psychologically by
their experiences of genital cutting - whether in the "bush" or in
clinical settings (as in some cases of male circumcision
gone awry). One of my intentions as an anthropologist as well as an
African from an ethnic group that practices both male and female
initiation is to promote policies that respect both cultural and
individual rights, dignity and autonomy. So, I hope of some of you,
especially women, will weigh in on these very significant discussions on
John Tierney's blog and contribute your own thoughts, ideas, suggestions
or experiences whether for or against, good or bad or none of the above.
I'd also welcome talking to anyone of you either through leonenet
discussions or by direct email ([log in to unmask]) on this topic.
From The TierneyLab (New York Times):
My post about a debate over a female initiation rite in Africa prompted
lots of angry reactions, some quite thoughtful ones, much misinformation
and one entirely reasonable request from Charles:
Having read dozens of passionate comments, are there any
dispassionate factual examinations of the subject addressing
(a) the health risks, (b) the health benefits, and (c) the
actual effect of the procedure on the lives of those subject
to it, all categorizing by the varieties of practice? It
would be nice to have some granular facts rather than summary
conclusions.
I’m not sure it’s possible to find anyone dispassionate on this subject.
The experts, like Lab readers, can’t even even agree on what to call this
procedure. (In my post I used several of the terms: circumcision, female
genital mutilation, female genital cutting, genital modification.) But I
would like to give Lab readers a sense of the research results and range
of expert opinion. I’ve asked several researchers to respond to Charles’
question and to other concerns raised by Lab readers. The first response
(others will follow) is from Richard Shweder, a cultural anthropologist
at the University of Chicago and one of the organizers of Saturday’s
debate on this topic at the American Anthropological Association’s annual
meeting. Here’s Dr. Shweder’s response:
“Female genital mutilation” is an invidious and essentially
debate-subverting label. The preemptive use of that
expression is just as invidious as starting a conversation
about a women’s right to choose by describing abortion as the
“murder of innocent life.” Pro-choice advocates rightly
object to the presumptive disparagement implied by that
label; many African women similarly object to naming a
practice which they describe in local terms as “the
celebration” or the “purification” or the “cleansing” or the
“beautification” as “the mutilation”. Notably in most ethnic
groups where female genital surgeries are customary, male
genital surgeries are customary as well and are named with
the same terms.
Charles calls for a dispassionate factual examination of the
risks and consequences of female genital surgeries. Fact
checking has not been the strong suit of anti-“FGM” advocacy
groups or of the American press. Indeed, the press in general
has served as an effective outlet for the advocacy groups and
has kept itself innocent of available sources of information
that run counter to the received horror arousing story-line
about barbaric or ignorant or victimized Africans who maim,
murder, and disfigure their daughters and deprive them of a
capacity to experience sexual pleasure. With rare exceptions,
the only African women who have been given a direct voice and
allowed to speak for themselves in our media are those who
oppose the practice.
For example, in recent years there have been two major
scientific reviews of the medical literature and an exemplary
Gambia-based research study, which have raised serious doubts
about the supposed effects on mortality, morbidity and
sexuality that are so often attributed to these customary
surgeries; yet, as far as I know, there has been absolutely
no mention of these reviews and studies in any American
newspaper or on NPR, although one might have thought they
were sufficiently eye-opening and significant to warrant
media coverage.
Any reasonably objective assessment of the risks and
consequences of female genital surgeries should begin with
the epidemiologist and medical anthropologist Carla
Obermeyer’s comprehensive and critical reviews of the medical
and demographic evidence on the topic (published in the
journal Medical Anthropology Quarterly). Her first
publication reviews and critiques the available literature on
female genital surgeries through 1996; her second publication
reviews the subsequent literature from 1997-2002. The third
key source is a research report by Linda Morison and her
Medical Research Council team published in 2001 in the
journal Tropical Medicine and International Health. That
research, conducted in the Gambia, is the most systematic,
comprehensive and controlled investigation of the health
consequences of female genital modifications yet to be
conducted.
This is what Carla Obermeyer says in her first comprehensive
review. “On the basis of the vast literature on the harmful
effects of genital surgeries, one might have anticipated
finding a wealth of studies that document considerable
increases in mortality and morbidity. This review could find
no incontrovertible evidence on mortality, and the rate of
medical complications suggest that they are the exception
rather than the rule.” …“In fact, studies that systematically
investigate the sexual feelings of women and men in societies
where genital surgeries are found are rare, and the scant
information that is available calls into question the
assertion that female genital surgeries are fundamentally
antithetical to women’s sexuality and incompatible with
sexual enjoyment.”
Perhaps the most scientifically rigorous and large-scale
study of the medical consequences of female genital surgeries
in Africa is the Morison et al Gambia study. In the Gambia a
customary genital surgery typically involves an excision of
the visible or protruding part of the clitoris and either a
partial or complete excision of the labia minora. (It is
important to note that the visible part of the clitoris,
which many African women view as an unbidden, unwanted, ugly
and vestigial male-like element that should be removed for
the sake of gender appropriate bodily integrity and a sense
of mental well-being, is not the entire tissue structure of
the clitoris and much of that tissue structure, a good deal
of which is not visible and protruding but is rather
subcutaneous, remains even after the surgery, which may
explain why “circumcised” women remain sexual and have
orgasms.)
The Morison et al study systematically compared “circumcised”
with “uncircumcised” women. More than 1,100 women (ages
fifteen to fifty-four) from three ethnic groups (Mandinka,
Wolof, and Fula) were interviewed and also given
gynecological examinations and laboratory tests. This is rare
data in the annals of the literature on the consequences of
female genital surgeries.
Overall, very few differences were discovered in the
reproductive health status of “circumcised” versus
“uncircumcised” women. Forty-three percent of women who were
“uncircumcised” reported menstrual problems compared to 33%
for “circumcised” women but the difference was not
statistically significant. Fifty-six percent of women who
were “uncircumcised” had a damaged perineum compared to 62%
for “circumcised” women, but again the difference was not
statistically significant. There were a small number of
statistically significant differences – for example, more
syphilis (although not a lot of syphilis) among
“uncircumcised” women, and a higher level of herpes and one
particular kind of bacterial infection among women who were
“circumcised.”
But in general, from the point of view of reproductive health
consequences there was not much to write home about. As noted
in the research report, the supposed morbidities (such as
infertility, painful sex, vulval tumors, menstrual problems,
incontinence and most endogenous infections) often cited by
anti-“fgm” advocacy groups as common long-term problems of
“fgm” did not distinguish women who had the surgery from
those who had not. Yes, 10% of circumcised Gambian women in
the study were infertile, but the level of infertility was
exactly the same for the “uncircumcised” Gambian women in the
study. The authors caution anti-“FGM” activists against
exaggerating the morbidity and mortality risks of the
practice. In addition, circumcised Gambian women expressed
high levels of support for the practice; and the authors of
the study write: “When women in our study were asked about
the most recent circumcision operation undergone by a
daughter, none reported any problems.”
My conclusion from reading those three publications is that
the harmful practice claim has been highly exaggerated and
that many of the representations in the advocacy literature
and the popular press are nearly as fanciful as they are
nightmarish. A close and critical reading of the much
publicized 2006 Lancet publication of the “WHO Study Group on
Female Genital Mutilation,” which received widespread,
immediate and sensationalize coverage in the press because of
its purported claims about infant and maternal mortality
during the hospital birth process, suggests to me that again
there is not very much to write home about.
In that WHO study, not a single statistically significant
difference was found between those who had a “type 1” genital
surgery versus no surgery; no statistically significant
differences were found between those who had no genital
surgeries and those who had type 1, 2 or 3 genital surgeries
for the best predictor of infant health, namely birth weight;
the perinatal death rate for the actual women in the sample
who had a “type 3” surgery was in fact lower (193 infant
deaths out of 6595 births) than those who had no surgery at
all (296 deaths out of 7171 births) and only became
statistically significant in a negative direction through
non-transparent statistical manipulation of the data; the
study collected data on women across six nations but never
displayed the within nation results; there was no direct
control for the quality of health care available for
“circumcised” versus “uncircumcised” women; the sample was
unrepresentative of the whole population; and in general any
reported increased risk for genital surgery was astonishingly
small and hardly a mandate for an eradication rather than a
public health program.
The best evidence available at the moment suggests to me that
the anthropologist Robert Edgerton basically had it right
when he wrote about the Kenyan practice in the 1920s and
1930s as a crucible in which it is not just the courage of
males but also the courage of females that gets tested:
“…most girls bore it bravely and few suffered serious
infection or injury as a result. Circumcised women did not
lose their ability to enjoy sexual relations, nor was their
child-bearing capacity diminished. Nevertheless the practice
offended Christian sensibilities”. As Charles put it in his
comment: “Personal revulsion is not a good basis for making
general policy.”
It is noteworthy, perhaps even astonishing, that in the
community of typically liberal, skeptical and critical
readers of the Times there has been such a ready acceptance
of the anti-FGM advocacy groups’ representations of family
and social life in Africa as dark, brutal, primitive,
barbaric, and unquestionably beyond the pale. Many
commentators are confident that when it comes to this topic
no debate is necessary.
One witnesses the ready assumption that any deliberate
modification of the female (and even the male) anatomy is an
example of oppression or torture (as though we should begin
describing the Jewish practice as “male genital mutilation”)
and that these coming-of-age and gender identity or group
identity ceremonies of African mothers should be placed on
the list of absolute evils along with cannibalism and
slavery. At the panel on “Zero Tolerance” policies held on
Saturday at the American Anthropological Association meeting,
one of the participants Zeinab Eyega, who runs an NGO
concerned with the welfare of African immigrants in the USA,
noted that these days in New York “the pain of hearing
yourself described is more painful than being cut.”
The anthropologist Clifford Geertz once wrote: “Rushing to
judgment is more than a mistake, it is a crime.” For those
who are prepared to be slower to judge and learn more about
the topic, have a look at my own first detailed attempt to
come to terms with this type of cultural difference and to
address many of the issues raised by the commentaries– an
essay titled “What About ‘Female Genital Mutilation’: And Why
Understanding Culture Matters in the First Place”, available
here.
Readers can find other scholarly treatments of this topic in “Female
‘Circumcision’
Fuambai Sia Ahmadu
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