FGM and MGM

by David Balashinsky

FGM has been in the news lately.  This is on account of the arrest and indictment last month of two Michigan physicians (as well as the wife of one of them) for allegedly performing genital-alteration surgery on two 7-year-old girls.  One of the physicians, Dr. Fakhruddin Attar, practices internal medicine and the other, Jumana Nagarwala, is an emergency-department physician.  They, along with Attar's wife, Farida Attar (who is Attar's office manager) have all been charged with the commission of female genital mutilation, conspiracy to commit female genital mutilation, and conspiracy to obstruct an official proceeding.  In addition, the two physicians have also been charged (somewhat perplexingly) with conspiracy to transport a minor with intent to engage in criminal sexual activity. 

Although this story has exploded throughout the media and been the subject of widespread commentary, it is an interview with the anthropologist Fuambai Ahmadu, conducted by Tucker Carlson for Fox "News," that I believe provides a particularly compelling foundation for a brief discussion of the extent to which FGM (female genital mutilation) and MGM (male genital mutilation) are fundamentally the same.  This is, in part, because Dr. Ahmadu touches upon the ethnocentrism, so prevalent here in the United States, that constitutes the conceptual foundation for the double standard that many here maintain with respect to these two practices.  At the same time, Carlson, himself, as he reveals in his comments throughout the interview, perfectly epitomizes that very ethnocentrism, hence, that double standard.

There is actually little or nothing that can be said about FGM that cannot be said with equal validity about MGM.  Both practices are rooted in deeply entrenched cultural beliefs and attitudes about anatomy, sex, sexuality, and gender.  The double standard to which  many Americans  tenaciously cling demonstrates their cultural arrogance.  What they are as much as saying is  "It's okay when we do it but when they do it it's mutilation."

Carlson's refusal to acknowledge the ethical and sociological argument that FGM and MGM are fundamentally the same results largely from the fact that, like many Americans, he views MGM through the distorting lens of his own cultural experience: an experience in which MGM has been normalized while FGM remains alien. But, as Ahmadu notes, in those cultures that practice FGM, it is not viewed as "mutilation." They reject that nomenclature just as vehemently as supporters of MGM here reject the term "mutilation" to refer to what is euphemistically known as "circumcision."

Carlson's inability to bridge the cultural divide also rests in part on a false assumption regarding the facts and in part on faulty reasoning.  First, he states, erroneously, that FGM is only illegal when it removes "an entire portion of the sex organ." That is not true. Even a slight ceremonial nick to any part of the vulva is treated as a felony. Contrast that with the radical prepucectomy to which over 3,000 infant boys are subjected daily in our own genital-cutting culture here in the United States of America.  In fact, The World Health Organization defines and categorizes FGM into four types.  The inclusion of amputation of the prepuce within a subcategory of one of these types means that this particular form of FGM is identical to infant male circumcision.

Carlson's faulty reasoning comes into play when he states that there are no studies that demonstrate any health benefits of FGM in contrast to those that purport to demonstrate the health benefits of MGM.  This is, indeed, one of the most commonly cited alleged distinctions between FGM and MGM.  But absence of proof isn't proof of absence.  As the Oxford bioethicist Brian D. Earp has noted^*, the fact that studies do not support the "benefits" of FGM is due largely to the fact that such studies do not exist. As Earp has pointed out,

any scientist who tried to . . . [conduct such a study] would be arrested under anti-FGM laws (and would never get approval from an ethics review board). . .   As a consequence of this, every time one sees the claim that 'FGM has no health benefits' - a claim that has become something of a mantra for the WHO - one should read this as saying, 'we actually don't know if certain minor, sterilized forms of FGM have health benefits, because it is unethical - and would be illegal - to find out.

Such potential benefits might include a decreased incidence of UTIs, STDs, and vulvar cancer.

In contrast, there remains in the United States a widespread notion that it is perfectly ethical to experiment on baby boys by permanently amputating a major, normal, sensitive, and functional part of their genitals in order to conduct, as Earp writes, "study after well-funded study" in search of the elusive benefits that may result from this amputation. The double standard here occurs because our society approaches both FGM and MGM with a set of a priori assumptions that the former is intrinsically harmful and always performed for malevolent reasons while the latter is intrinsically benign at the very least or positively beneficial. But this set of assumptions is not borne out by the facts and certainly not by controlled, side-by-side scientific studies of the procedures performed under "appropriate" (meaning aseptic) conditions. And in all probability they never will be.  That says much more about our cultural assumptions than it does about scientific hypothesizing.  As Earp writes, "Imagine a report by the CDC referring to the benefits of removing the labia of infant girls, where the only morally relevant drawback to such a procedure was described as the ‘risk of surgical complications.'"

Of course, any amputation of a body part has potential benefits. If you amputate an infant's hand, her chances of getting it crushed in a car door later on in life are reduced to zero. But what about that child's right to grow up with her hand in place? What about her right to decide for herself that the benefits of having her hand - it is hers, after all - outweigh the risks of keeping it, or vice versa?

There is no rational or ethical basis for treating the male prepuce any differently from a hand or - more to the point - from a female prepuce. A prepuce is a prepuce. But there is a difference in how male and female prepuces are treated and this is due entirely, as Earp (and others) have observed, to a culturally determined valuation of the male prepuce as essentially vestigial and worthless, even a noxious and harmful structure. The putative innocuousness and even salubriousness of male "circumcision" in the United States therefore rests entirely on the completely arbitrary social construct of the male prepuce, in contrast to the female prepuce, as serving no purpose, having no function, having no value and, therefore, having no legitimacy.  But that is not how the majority of intact men feel about it.  And it is certainly not how many victims of MGM feel about it.

No one - female, male, or intersex - should ever be deprived of the right to own and control her, his, or their body and to decide, for herself, himself, or theirself, which parts he, she, or they get to keep and which parts get cut off.
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* See, in particular, Brian D. Earp: "Boys and girls alike," in Aeon, 13 January 2015, or the longer essay from which it was was adapted, Earp, B. D. (2014). "Female genital mutilation (FGM) and male circumcision: Should there be a separate ethical discourse?"
Practical Ethics. University of Oxford. Available at:
https://www.academia.edu/…/Female_genital_mutilation_FGM_an…. DOI: 10.13140/2.1.3530.4967.

Here is a link to one of many YouTube videos of the interview:

https://www.youtube.com/watch?v=SZdsSYQ3Mik

Here are links to some other worthwhile commentaries:

http://www.arclaw.org/resources/articles/is-circumcision-legal-peter-w-adler

https://mosaicscience.com/story/troubled-history-foreskin

http://www.huffingtonpost.com/entry/americas-infuriating-double-standard-on-cutting-childrens_us_5908fef7e4b03b105b44bd0e

http://www.huffingtonpost.com/morten-frisch/time-for-us-parents-to-reconsider-the-acceptability-of-infant-male-circumcision_b_7031972.html?utm_hp_ref=science