Sunday, June 2, 2024

Because Two Wrongs Don't Make a Right: Why GALDEF Stands with TERRE DES FEMMES in Urging The Gambia Not to Repeal Its FGC Ban

by David Balashinsky

Female genital cutting (FGC - also known as female genital mutilation, or FGM) has been illegal in The Gambia since 2015.  This past March, however, in response to the convictions of three women for violating The Gambia's anti-FGM law, Member of Parliament, Almaneh Gibba, introduced legislation that would repeal this West African nation's ban on the practice.  If the bill passes, it would be the first instance of an FGC ban being reversed.  Understandably, many human rights activists and organizations - in The Gambia and around the world - have been both outraged and alarmed by this development and have publicly urged the government of the The Gambia not to repeal its law outlawing female genital cutting.  

Recently, the Berlin-based TERRE DES FEMMES, an organization that focuses on girls' and women's rights, also expressed its opposition to repealing the FGC ban in an Open Letter addressed to the president and National Assembly of The Gambia.  When TERRE DES FEMMES (TDF) reached out to the Genital Autonomy Legal Defense & Education Fund (GALDEF) requesting that we add our name in support of this initiative, we agreed to do so. (Intact Denmark and 15Sqaure are also among the more than fifty human-rights organizations that have signed the letter.)

This was not a difficult decision for GALDEF.  As we commented in this space last year on the occasion of the International Day of Zero Tolerance for Female Genital Mutilation (an annual observance that was established by the United Nations General Assembly in 2012), 

GALDEF supports the . . . goal of ending female genital cutting (FGC) worldwide.  We agree that FGC is an inherently harmful practice that violates the fundamental right to bodily integrity of those who are subjected to it.  As our Values Statement makes clear, GALDEF stands in full “solidarity with female and intersex victims of genital cutting. . . .”  Likewise, the United Nations’ goal of eradicating FGC is consistent with GALDEF‘s Vision: “To create a world where the right of everyone to bodily integrity and the freedom to choose what's done to their genitals is legally protected.”

GALDEF does not see any moral ambiguity in the matter of forced genital cutting.  We oppose all forms of non-consensual genital cutting regardless of the sex of the victim.  The right to genital integrity and the right to genital autonomy are among the most basic and important rights that people possess.   However, because we consider these rights universal - belonging, that is, to every human being, regardless of sex - we view sex-exclusive genital-cutting bans as morally problematic.  To be clear, GALDEF does not oppose FGC bans.  But we are opposed to FGC-only bans.  This can put us in a morally ambiguous position when the question is whether to endorse a sex-specific genital-cutting ban or, as in the present case, to lend our name in support of opposition to the repeal of one.  

The obvious and overriding concern is whether or not to support what can only be described as a half measure.  When an organization endorses a female-only genital-cutting ban, that organization is implicitly - or, at the very least, may appear to be - endorsing the genital cutting of everyone else.  The question, then, turns on the inherent tension that often exists between the good and the perfect.  It is further complicated by questions of cultural context, political strategy and the principle of moral consistency.  All of these factors were uppermost in our thoughts as GALDEF weighed TDF's request to sign its letter.  

The purpose of this post is to explain the reasoning behind GALDEF's decision.  Any opportunity to contribute something to the conversation on how to eradicate the genital cutting of all children is welcome, of course.  But, more importantly, as a 501(c)3 tax-exempt organization, GALDEF depends on the financial support of its donors.  Because they (and others, too) have a right to expect transparency of GALDEF, an airing of the philosophical and strategic considerations that informed our deliberations on TDF's request seems warranted.  All the more so as GALDEF is currently soliciting support for an equal protection lawsuit here in the United States that we hope will result in the invalidation, on constitutional grounds, of a statewide ban on genital cutting that protects girls but not boys or intersex children.  This means that, by signing TDF's letter, we are actively opposing the repeal of a sex-specific (female-only) genital-cutting ban in The Gambia while supporting a future effort to have a court strike down a similar law here.  How, some may wonder, do we reconcile these two seemingly contradictory strategies?

The first and most important answer to that arises from the fact that GALDEF and the legislators in The Gambia who support re-legalizing FGC are motivated by and working toward fundamentally different objectives.  The  goal of an equal-protection lawsuit here in the United States is not to deprive girls of legal protection against genital cutting but simply to obtain a judicial decision instructing a state legislature that, in order not to run afoul of that state's constitutional mandate of equal protection on the basis of sex, it must rewrite its anti-genital-cutting statute using sex-neutral language so that the law protects every child - not just those born with vulvas.  The ultimate goal of this strategy is not to "lower the ceiling" for every child so that none is protected from genital cutting but, rather, to "raise the floor" so that every child is protected against genital cutting.  The goal of those behind the repeal of the FGC ban in The Gambia is diametrically opposite to this.  Thus, while these two strategies may, at face value, seem similar, the objectives behind them could not be more dissimilar.

Perhaps equally critical to an understanding of how and why these initiatives differ fundamentally from one another is an appreciation of the radically different cultural contexts of The Gambia and the United States, especially with respect to genital cutting.  In The Gambia, FGC is a "deeply rooted cultural practice" with as many as 73% of girls and women between the ages of 15 and 49 having been subjected to it.  As explained in a comprehensive government-issued report (National Policy for the Elimination of Female Genital Mutilation in The Gambia 2022-2026), 

Communities perform FGM for various reasons.  The retention and preservation of social heritage, family pride, prestige, community acceptance, avoidance of stigma, marriageability, and inclusion are among the main reasons why FGM is still practiced and perpetuated.  Rejecting FGM has cultural, social, economic, and political consequences including stigmatization and discrimination.  FGM is also considered a cultural identifier among the practicing communities distinguishing their daughters from those of communities who do not circumcise their girls and women. 

The National Policy report emphasizes that, 

FGM is a social norm that is deeply entrenched in the cultural, and historical beliefs of certain ethnic groups in The Gambia and has religious connotations.  In many practicing communities, parents practice FGM on their daughters because they believe that it is a religious obligation to do so.  Consequently, parents and traditional and religious leaders continue to promote, perpetuate, and defend the practice.  Statistically, in The Gambia, only about one-third of women (34%) and men (31%) believe that FGM is not a religious requirement.  Less than half of women (46%) and men (42%) believe that female circumcision should not . . . continue [citation omitted].

This report further notes that,

Another reason why [FGC] is practiced is that it is considered a rite of passage into womanhood.  There is a general belief amongst practicing communities that FGM prepares girls for womanhood, for their life ahead as wives, mothers and caregivers.

In contrast to The Gambia, FGC is neither a deeply embedded nor a widespread cultural or religious practice in the United States.  The same cultural forces that make FGC prevalent in The Gambia are what make FGC rare here.  A statutory ban, in other words, is not all that is standing between girls' genital integrity and their being subjected to routine genital cutting in the U.S.   

That is not to say that the U.S. does not have its own shameful history of female genital cutting.  Clitoridectomy was regarded as an appropriate "treatment" for masturbation - a medicalized form of genital cutting that arose in parallel with male genital cutting (MGC) for the same purpose - and was imposed on girls in the U.S. during much of the nineteenth and  twentieth centuries.  (Intersex genital cutting, of course, continues to this day, although it is finally falling out of favor among the medical establishment.)  Even worse (if only because one might hope to expect better of contemporary society), there now appears to be a resurgence of FGC in the United States.  One widely-quoted study estimated that, by 2012, a half million girls were at risk for FGC - a threefold increase over 1990 estimates.  As alarming as these statistics are, however, they also represent the exception that proves the rule.  As the authors of this study concluded, the increase in risk of FGC between 1990 and 2012 "was wholly a result of [the] rapid growth in the number of immigrants from FGM/C practicing countries living in the United States. . . ."  There is no reason to believe, therefore, that a temporary invalidation on equal-protection grounds of an FGC ban would result in open season for FGC in the U.S. or that it would increase the risk to girls of being subjected to FGC beyond girls who already are at risk, ban or no ban.  Again, that is in no way to suggest that girls should not be legally protected against genital cutting.  Of course they should - as all children should.

It is also important to bear in mind that, as high as the prevalence of FGC is in The Gambia, the prevalence of MGC in that nation is even higher: 99.2%, according to the 2018 Multiple Indicator Cluster Survey for The Gambia.  As this report explains,

Circumcision in The Gambia is both [a] cultural and religious practice and is observed by all ethnic groups.  In the past, boys were circumcised very late in their life and the practice is seen as a transformation [from] boyhood to manhood.  Furthermore, it was done by traditional circumcisers in overcrowded ritual sites under unhygienic conditions increasing the risk of infection among the children.  Recently trained health professional's [sic] involvement in male circumcision is gaining momentum, however traditional circumcisers still continue to practice in some communities.

The near universal prevalence of genital cutting for religious and cultural reasons across the entire population - male and female - of The Gambia represents another crucial distinction between the proposed legislation repealing the FGC ban there and an equal-protection lawsuit here, and this also explains why GALDEF can oppose the former while supporting the latter.  Unlike the ultimate goal of an equal-protection lawsuit in the U.S. - which, again, is to codify legal protection against genital cutting for all children - the goal of the pending legislation in The Gambia is effectively to deny legal protection against genital cutting for all children.  If The Gambia repeals its anti-FGC law, it won't be because legislators there want to protect boys and intersex children from genital cutting.  Far from it.  With near-universal penile circumcision in The Gambia, an MGC ban isn't even on the table.  The point of the legislation is simply to protect those who practice FGG from prosecution.  That necessarily entails ending legal protection from genital cutting for girls.  That's not a step forward for boys; it's a step backward for girls.  And, just as repealing the anti-FGM law in The Gambia will do nothing to protect boys there, preserving it would do nothing to harm them.  If anything, a repeal of The Gambia's anti-FGC ban will indirectly harm boys by reinforcing the legality and social acceptability of genital cutting in principle.  This will only make it harder to expand protection from genital cutting in the future to boys and intersex children in The Gambia.  It is because of these different cultural contexts, then, that opposing the repeal of an FGC ban in The Gambia while supporting the overturning of a girls-only genital-cutting ban here in the U.S. is logically, strategically, and morally consistent. 

Still another compelling reason to sign on to TDF's letter is simply because they asked us to.  GALDEF recognizes the importance - both on principle and strategically - of making common cause with other organizations that are pursuing similar goals.  Our view is "that all genital autonomy movements stand on the same philosophical foundation."   That means not merely opposing FGC in the abstract - which we do -  but supporting organizations - when we can - that are actively working to end FGC.

Moreover, TDF is not just any girls' and women's rights organization.  TDF has long been a vocal supporter of genital autonomy for boys.  In fact, it might be the only women's rights organization that has had the courage, the moral integrity and the philosophical consistency to publicly articulate its support for the right of all children, regardless of sex, not to be subjected to medically-unnecessary genital cutting.  TDF was a supporter of the Worldwide Day of Genital Autonomy even before there was a Worldwide Day of Genital Autonomy (WWDOGA).  Not long after a district court in Cologne, Germany ruled (on May 7th, 2012) that the circumcision to which a four-year-old had been subjected amounted to an "illegal bodily harm" that violated his right to "physical integrity" (a milestone in the ongoing struggle for human rights that has been commemorated annually ever since as the WWDOGA), Irmingard Schewe-Gerigk, TDF's chairwoman at the time, was interviewed by Choices (an online magazine) and had this to say about penile circumcision and the Cologne ruling:

We welcomed the fact that the Cologne Regional Court made it clear that the physical integrity of children must not be violated using religious arguments. When balancing the interests of two constitutionally protected legal interests, it made it clear: the right to the undisturbed practice of religion and the parental right of parents do not take precedence over the child's right to [bodily] integrity and self-determination.  Furthermore, by ratifying the UN Convention on the Rights of the Child, Germany has committed itself to abolishing customs that are harmful to children. The fact that this irreversible procedure cannot be in the best interests of the child is clearly demonstrated. . . .  [Original in German; this translation via Google Translate.]

To the extent that penile circumcision is comparable to some forms of FGC,  Schewe-Gerigk notes that,

there are definitely parallels. In some regions, only the clitoral [hood] or the inner labia are removed. That's comparable.  I recently looked at circumcision because I, too, imagined it to be more harmless.  After that I can only say: Anyone who trivializes this doesn't know what's happening or doesn't want to know.  My concern is that similar procedures that are prohibited for girls will be permitted for boys.  I fight for equal rights for boys and girls.  [Original in German; this translation via Google Translate.]

In 2016,  the fourth anniversary of the Cologne ruling, Ida Nabaterrega, TDF's former FGM Policy Specialist, issued the following statement in support of that year's WWDOGA commemoration:

TERRE DES FEMMES, as a human rights organization, is fundamentally concerned with the physical integrity of children as a human right that applies equally to all children, regardless of their origin or religion and what gender they are.  Irreversible interventions in the [bodily] integrity of children - with the exception of medically necessary treatments - must not be justified by religion or tradition - not even between girls, boys and intersex children.  [Original in German; this translation via Google Translate.]

TDF's longstanding public opposition to MGC was not solicited by any anti-MGC organization.  Rather, it was an exercise on TDF's part in principled advocacy for an equal right to genital autonomy for all children regardless of sex.  Notwithstanding the fact that GALDEF continues to entertain serious and substantive objections to The Gambia's anti-FGM statute as written, to have rebuffed TDF's request for support in its current anti-FGM initiative would have been a betrayal not just of a longtime and esteemed ally in the cause of universal genital autonomy but, under the present circumstances, of our own values which, as noted above, include "solidarity with female and intersex victims of genital cutting." 

None of this, however, alters our view that The Gambia's current anti-FGM law has major flaws - first and foremost, that it discriminates against boys by failing to include them in its proscription of genital cutting.  Additionally, the law bans not only forced genital cutting of girls but even consensual genital cutting that may be sought by adult women.  In denying women the right to alter their own bodies in conformity with their cultural values and religious beliefs, this law violates their right to bodily autonomy.  In that respect, this law is at odds with GALDEF's core Vision which, to repeat, is "To create a world in which the right of everyone to bodily integrity and the freedom to choose what's done to their genitals is legally protected."

This brings us back to the most basic and important question concerning the ethics of supporting a statute that, by explicitly protecting only one class of persons, denies protection to everyone else.  Under what circumstances is it appropriate to support a measure that is intended to advance a basic human right for some but not others?  Consider, as an analogy, the debate over the 15th amendment to the U.S. constitution that prohibited denying someone the right to vote "on account of race, color, or previous condition of servitude" but not on account of sex.  Faced with a gross injustice to two broad classes of persons - Black men and all women - but presented with an opportunity to rectify that injustice for only one of these classes, what was the more ethical course of action: to hold out for eventual universal suffrage at the cost of near-term suffrage for Black men?  Or to do what one could, given the political and cultural realities of nineteenth-century America, to gain voting rights for Black men and seem, thereby, to implicitly support the continued denial of that right to women?  (This debate actually resulted in a rift in the women's suffrage movement at the time, although it was not shaped exclusively by such noble considerations as utilitarianism, strategy, and idealism but also by less honorable beliefs about who was more "deserving of the vote.")  

Other analogies might be found in the conundrum of "harm reduction."  Harm-reduction strategies are practical approaches that are intended to mitigate rather than eliminate  inherently harmful practices.  Yet the very thing that may make harm reduction effective - being nonjudgmental - strikes critics of this approach as constituting implicit approval of the underlying practice.  Thus, for example, controversy inevitably accompanies proposals to legalize  Supervised Injection Facilities (also known as Safe Injection Sites): locations where people who inject drugs can do so under the supervision of healthcare professionals.  If people are going to inject dangerous drugs, isn't it preferable that they don't die from doing it?  Or is it rather the case that the mere existence of such facilities will "normalize" IV drug use and result in a higher incidence of substance use (and other social ills) with even more fatalities in the long run? 

Closer to home, rather than a blanket ban, should some limited forms of FGC (see, in particular, pp. 506-510), performed under appropriately sterile conditions, be permitted in order not to drive the practice "underground"?  Covert and unregulated, FGC would inevitably result in even greater harm to the victims.  But wouldn't this strategy merely "enable" and perpetuate the practice?  

Then there is the approach that seeks to limit overall harm across a population rather than the degree of harm to any one individual.  Such an approach might incorporate a prohibition of medically unnecessary penile circumcision but with a religious exception.  In the United States alone, this could spare over one million boys every year the trauma and irreversible effects of genital cutting while side-stepping the objection that an MGC ban would violate the free exercise of religion and, therefore, the first amendment.  But don't children who are born into families that practice genital cutting have the same fundamental human rights - and the same constitutional rights - as every other child?  And wouldn't a religious exception have to apply equally to families who sincerely believe FGC to be a religious requirement?  

Finally, what about a genital-cutting ban that protects only girls?  Aren't boys and intersex children born with the same fundamental human rights?

Sometimes, when working toward a particular goal, the quandary consists in there being too many variables to know which course of action is most likely to bring about the desired result.  There are other times when social and political realities simply require us to settle for incremental changes rather than broad, fundamental change all at once.  But there are also times when it is not an expected or even a hoped-for outcome that decides us on what to do but our principles, even though the result is likely to be less than ideal.   With an unprecedented rescinding of an FGC ban looming over the girls of The Gambia and over the broad social movement to end all forms of genital cutting, we believe that this is one of those times.  Whatever The Gambia legislature chooses to do, GALDEF chooses to stand on the right side of history.  Genital cutting of all children will come to an end.  It's not a question of "if" but of "when" and of "how."  Faced with an actual choice rather than a purely theoretical one - the choice between remaining silent or adding our voice to the international chorus urging The Gambia not to repeal its FGC ban - GALDEF can come to only one set of reciprocal conclusions.  For The Gambia, repealing the FGC ban is the wrong thing to do.  For GALDEF, opposing that repeal is the right thing to do.



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Sunday, December 10, 2023

The Importance of Unity

by David Balashinsky

One of the basic questions that every progressive organization has to consider is whether to form strategic alliances with other organizations dedicated to the pursuit of goals that may seem to be entirely different from its own but whose objectives still fall under the rubric of human rights or simply that of making the world better, fairer, healthier, safer and more habitable for everyone.  On a grand scale, this question applies to reform movements themselves.  Should climate activists and environmentalists make common cause with Black Lives Matter?  Should women's rights activists make common cause with those seeking to end poverty and income inequality?  The reality is that strategic alliances such as these are not contrivances or arranged marriages but the opposite.  For example, now that the concept of environmental racism is widely recognized, it's evident that one cannot effectively fight the totality of systemic or structural racism without addressing the problem of industrial pollution.  By the same token, one cannot combat climate change or pollution without recognizing the disparate effect these have on marginalized communities.  Similarly, the fact that more women than men live in poverty means that women's rights and economic justice are not fundamentally different objectives but, rather, fundamentally the same.  

Notwithstanding these root points of intersection, there are those who oppose making common cause with other movements or organizations.  Whether this opposition arises from mistaken notions of ideological purity or whether from overzealous single-mindedness, the result is inevitably a net loss on both sides, if for no other reason than that there is strength in numbers.

This is no less true of the genital autonomy (GA) movement, a worldwide movement that seeks to end all medically unnecessary genital cutting of unconsenting minors.  The GA movement consists of three main branches, each of which is organized around opposition, respectively, to female genital cutting (FGC, known also as female genital mutilation - FGM), male genital cutting (MGC, or nontherapeutic penile circumcision) and intersex genital cutting (IGC, which also includes a variety of surgeries that go beyond "normalizing" genital surgeries).  Like every human rights movement, the GA movement has its share of "purists" who frown on making common cause with other human rights movements and organizations.  Some want nothing to do with organizations not involved in combating genital cutting specifically while some within one or the other of the three branches of the GA movement even regard the other two branches as being beyond the scope of their concern.

At the Genital Autonomy Legal Defense and Education Fund (GALDEF), where I serve as a board member, I am happy to say that we do not share this view.  Although its purpose is to facilitate impact litigation in order to obtain a measure of justice for individual victims of penile circumcision while creating a powerful financial disincentive for the continued imposition of this harmful genital surgery on unconsenting children, GALDEF recognizes that all genital autonomy movements stand on the same philosophical foundation.  Indeed, if one accepts the premise that a medically unnecessary, nonconsensual body modification is a harm in and of itself  because it violates a person's rights to bodily integrity and self determination, it is difficult to see how can one look at FGC, MGC and IGC - practices that are identical in this fundamental respect - and not come to the same moral conclusion about them.  Ultimately, it doesn't matter what the surgery is and it doesn't matter what the sex or the gender of the victim is.  Either there is a fundamental right to bodily self-ownership that applies to everybody, regardless of sex, or there isn't.

It should be a foregone conclusion that, on the most basic level, any one form of genital cutting is morally indistinguishable from another, but the GA movement also shares important characteristics with other reform movements.  For example, there are striking similarities between the way homosexuality and the penile prepuce have been "pathologized" by the medical establishment.  A fact not generally appreciated now is that it was not until 1973 that the American Psychiatric Association (APA) formally dropped its classification of homosexuality as a psychiatric disorder.  Although it's hard to believe that gay women and men were once subjected to electroconvulsive therapy (ECT, or "shock therapy") and other "treatments," for decades the APA viewed homosexuality as a condition that needed to be "cured."  Women and men were not merely stigmatized for being gay; their homosexuality was actually defined as a pathological condition by the medical establishment.  As a result, gay people were subjected to interventions that would now be condemned as medical malpractice.  It took years of advocacy before the APA was finally persuaded to revise its official stance on homosexuality.  (The story of how gay rights activists overcame decades of entrenched thinking within the APA is movingly told in the powerful, heartbreaking yet inspiring documentary, "Cured.")

In parallel to this, during the 19th and 20th centuries, the medical establishment pathologized the penile prepuce, attributing to it a host of ailments and diseases, including that scourge of Victorian-era health and social order, "masturbatory insanity." The "cure" for being born with a normal penis, of course, is circumcision.  

In both cases, what is in fact normal, natural, healthy, good and beautiful was vilified and pathologized.  The result was that, in the case of homosexuality, untold thousands of perfectly healthy people were subjected to "treatments" they neither needed nor (in most cases) desired while, in the case of MGC, untold millions of perfectly healthy people were (and, to this day, continue to be) subjected to a surgery that they neither needed nor desired. 

Thirty years ago, GALDEF president and founder, Tim Hammond, recognized that intactivism (as the movement to end MGC has come to be known) had much in common with the struggle for gay rights.  As someone with extensive experience in both movements, Hammond believed that the LGBT community would be receptive to the idea that, as he put it, "everyone has a right to do with their own genitals what they wish."  For this reason, he argued in favor of building alliances with the gay community by participating in Pride events.  At the time, some intactivists countered that the two movements had nothing in common and, as Hammond recalls, "even warned that it would be political suicide" for the GA movement to align itself with the gay rights movement.  And yet Hammond's prescience has been vindicated.  Intactivists are now fixtures at Pride festivities across the United States.  Last July, for example, GALDEF was honored to hold its first public education and outreach event at Los Angeles Pride.  In September, the producers of "Cured" graciously made their film available to GALDEF for a special screening and fundraising event.  GALDEF was again represented - and represented the GA movement - last September at the Second Annual Riverside Pride Festival.

These collaborations amply demonstrate the utility of rights organizations forming strategic partnerships.  They also demonstrate the principle that the objectives of socially conscious movements are not trivialized nor their impact diminished when they unite and make common cause with one another.  Perhaps most importantly, they illustrate the principle that, when distilled down to their essence, most human rights movements embody the same fundamental values.  Thus, it is not their joining forces that is in any way forced or unnatural but their insisting on exclusivity from one another that is.  That is not to suggest that every organization or movement should abandon its individual focus or its specific mission.  I am simply arguing that individual organizations throughout the broad spectrum of progressive organizations should be open to forming strategic alliances in the interests of furthering the aims of all.  Ultimately, by joining forces, the efforts of all socially conscious organizations, whatever their individual goals, can only be enhanced and their collective impact magnified for the benefit of all of humanity.

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David Balashinsky is originally from New York City and now lives near the Finger Lakes region of New York. He is a licensed physical therapist and writes about bodily autonomy and human rights, gender, culture, and politics. 
He currently serves on the board of directors for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), the board of directors and advisors for Doctors Opposing Circumcision and the leadership team for Bruchim.


Thursday, September 14, 2023

No, Farida D., the reason men fear being seen as feminine is not because they fear being treated the way they treat women

by David Balashinsky

Many years ago, when I was in my late 20s or early 30s, I got into a phone conversation with a young woman who had dialed my number by mistake.  She hadn't misdialed: it was a recycled number that formerly belonged to someone she knew.  The phone call began, naturally, with my explaining that the person she was trying to reach did not live at that number.  However, a conversation ensued that seemed for all the world as though there were some flirtatious testing-of-the-waters going on at both ends.  That is the vein in which the call proceeded for several minutes until the young woman abruptly said "You sound like a fag," and hung up.

The recollection of this incident - one of about a half dozen in my life in which my sexual orientation has been mislabeled - either by mistake or intentionally but always as a way of policing my gender - was prompted by a meme that has been making the rounds on social media for several years and that appeared in my Facebook feed yet again last week.  The meme presents a quote from Farida D. and it is item number 214 in "The 2nd List of Shit That Made Me a Feminist."   Here is the quote as it appears on Farida D.'s Instagram wall:

I do not know how Farida D. comes by her special insight into the psychological lives and inmost fears of men - she describes herself simply as "an Arab gender researcher and poet."  But what I do know, as a cisgender, hetero male - what Farida D. refers to as a "cishet" - is that most men in our culture fear being seen as feminine, not just those of us who identify as cisgender or as hetero and certainly not only those men who mistreat women.  This fear is instilled in us beginning in our earliest childhoods, it is reinforced throughout our lives and it is ever-present.  It influences and even controls the choices we make about the clothes we wear, the color of the cars we buy, it determines how we walk, how we talk, how we hold our bodies, how we interact with others and which hobbies and interests - even which careers - we pursue.   For many of us who are gay or trans, it has kept us closeted.  For those of us who are not it has, nonetheless, inhibited us in our relationships with other men.  The fear of being seen as feminine is one of the defining characteristics of masculinity because, as we are taught to be masculine, so we are taught not to be feminine.  In childhood or adolescence, most of us internalize this strict gender code and, having internalized it, actively aspire to be seen as masculine just as we actively fear (dread, really) being seen as feminine.

None of this is news.  On the contrary, it's Feminism 101.  Nor does the concept of gender, obviously, apply only to men.  Women, too, have their own form of gender instilled in them.  They are expected to be feminine in both appearance and behavior; they are expected to be accommodating, indulgent and supportive of men, ingratiating ("Smile, Honey!"), conciliatory, domestic and, above all, they are expected to be fecund.

Just as masculinity is positively reinforced in men because it is rewarded, femininity in women is positively reinforced because it is rewarded - but only up to a point: the rewards that women "earn" for being feminine are not nearly so great as the rewards that men "earn" for being masculine.

And just as masculinity is both negatively and positively punished in women, femininity is both negatively and positively punished in men.  A refresher from Psych. 101: a negative punishment is "a form of operant conditioning that aims to suppress or discourage certain behaviors by taking away something valued or desired by the individual" while a positive punishment entails the delivery of an aversive stimulus in order to discourage certain behaviors.  In my phone call with the young woman, I was on the receiving end of both negative and positive punishments for sounding insufficiently masculine.  The positive punishment was being called "fag" and the negative punishment was the young woman's hanging up on me and withdrawing even the potential of our forming a relationship.  The result was one of those periodic reinforcements of my fear of being seen as feminine.

As I suggested, this is basic stuff.  That is why I was surprised to see Farida D.'s quote mindlessly shared by feminist- and pro-feminist pages and individual Facebook users.  In contrast to mainstream, even orthodox feminist analyses of gender, Farida D. presents a radically different view here.  In this view, the fear of being seen as feminine is not a behavior that is inculcated in most males but is, instead, simply the manifestation of guilt that, by definition, most men feel - since most men fear being seen as feminine - because they mistreat women.

This was news to me.  After all, despite still being prey to the fear of being seen as feminine, I don't fear being treated the way I treat women.  More than this, though, it was because I have experienced the sting of gender policing many times in my life (and not only by being called "fag") and it has always taken the form of an external force or influence (a catcall by a stranger on the street, a sneer, a reproach by a friend) which I have dutifully internalized and which has always tended to reinforce my fear of being seen as feminine.

Another example from my own experience comes to mind.  When I was about 10, some friends and I were "goofing around" (that's what we called it in those days) in the process of which we discovered a freight elevator (this was backstage at the New York State Theater).  The elevator car was huge - we had never seen anything like it - and three of its walls were covered by thick, quilted moving blankets.  Obviously, we had to ride it although we knew we were not supposed to (I think there was a sign that said "Authorized Personnel Only").  The combination of amazement, the sense of our own mischievousness, the fear of getting caught and the sheer fun we were having led to a kind of giddiness.  I think we all felt that.  "We all," I should explain, were three or four girls and me, the sole boy.  In the midst of our cackles, one of the older girls - she must have been about 12 or 13 - suddenly turned to me with a look of concern on her face and said, "David!  Stop it - you're acting like a girl."

I will never forget the impact of that.  It's not that, at that age, I had any conscious sense of being either masculine or feminine.  I was just having fun and my emotions were simply bubbling out of me in the most natural way possible.  In other words - and this is key - my emotions were being expressed in an uninhibited way.  This girl's reproach was the first time I was brought face to face with the societal expectation that an uninhibited display of joyful emotion was inappropriate in a boy and that, unless I wasn't afraid to be seen as feminine, I was not permitted to engage in it.

By no means am I the only man to have experienced gender policing like this nor am I the first person to write about it.  In a 2017 column for the New York Times, ("Talking to Boys the Way We Talk to Girls") Andrew Reiner explores the ways in which how we communicate with boys helps to shape their gender into the masculine ideal.  "Just as women's studies classes have long examined the ways that gendered language undermines women and girls," Reiner writes, "a growing body of research shows that stereotypical messages are similarly damaging to boys."

We tell ourselves we are preparing our sons to fight (literally and figuratively), to compete in a world that's brutish and callous.  The sooner we can groom them for this dystopian future, the better off they'll be.

Among the findings of the studies that Reiner cites are that "mothers interacted vocally more often with their infant daughters than they did their infant sons," that "Spanish mothers were more likely to use emotional words and emotional topics when speaking with their 4-year-old daughters than with their 4-year-old sons," that "fathers . . . sing and smile more to their daughters," and that, "[a]fter visits to the emergency room for accidental injuries . . . parents of both genders talk differently to sons than they do to daughters."

Reiner also highlights the work of the masculine-studies researcher, Michael Kimmel, who "maintains that 'the traditional liberal arts curriculum is seen as feminizing by boys.'"  Reiner's observations during his own 20-plus years of teaching back this up:

Nowhere is this truer than in English classes where . . . boys and young men police each other when other guys display overt interest in literature or creative writing assignments.  Typically, nonfiction reading and writing passes muster because it poses little threat for boys.  But literary fiction, and especially poetry, are mediums to fear.  Why?  They're the language of emotional exposure, purported feminine "weakness" - the very thing our scripting has taught them to avoid at best, suppress, at worst.

Gender policing that reinforces masculinity (and that teaches boys and men to fear being seen as feminine) comes from all sides, not just family or schoolmates.  This continues into adulthood.  Reiner takes up this thread:

Women often say they want men to be emotionally transparent with them.  But as the vulnerability and shame expert BrenĂ© Brown reveals in her book, "Daring Greatly," many grow uneasy or even recoil if men take them up on their offer.

I can attest even to this from my personal experience.  When I was in my mid-20s, I was speaking with my then girlfriend about some very serious problems I was having in my life.  I had become somewhat stuck in a kind of feedback loop of failure, fear, despair and paralysis.  I was so upset, in fact, during this one conversation, that my emotions got the better of me and I began to cry.  This was too much for my girlfriend.  She grew impatient and intolerant and told me to "stop being so mushy."  In other words, "Man up!"

Circling back to how men are expected to communicate verbally as opposed, specifically, to how they are expected to keep their emotions in check (although, of course, the two are closely related), Reiner cites yet another study that

found that college-aged female respondents considered men more attractive if they used shorter words and sentences and spoke less.  This finding seems to jibe with Dr. Brown's research, suggesting that the less men risk emoting verbally, the more appealing they appear.  

- And the less feminine they appear.

A 2018 Harvard Business Review article ("How Men Get Penalized for Straying from Masculine Norms") concluded that "[r]esearch demonstrates that much the same way women face unfair backlash effects for being more masculine or not feminine enough, men similarly face backlash for not adhering to masculine gender stereotypes."  This article cites numerous studies that delved into a half dozen specific categories of behavior including "Showing vulnerability, "Being nicer," "Displaying empathy," "Expressing sadness," Exhibiting modesty" and, of all things, "Being a feminist or feminine."  In every one of these categories it was found that men were penalized in some way (or, in one of the categories, simply not given credit that was given to women) when they exhibited these behaviors.

The upshot of all this is that the reason boys and men fear being seen as feminine is because they are socialized from birth to conform to masculine gender and heteronormativity.  The process of instilling masculinity in boys begins when they are neonates and it continues throughout childhood, adolescence and well into adulthood.  In adolescence and adulthood, the penalties imposed on boys and men, respectively, for being seen as feminine can be severe, ranging from bullying to ostracism to rejection and ridicule to violence and death.  Boys learn at a very early age, therefore, that few things are worse than being seen as feminine.  The fear of being seen as feminine - the heavy psychological baggage that boys and men carry with them throughout much of their lives - is the result of this conditioning and comes from external influences that include both negative and positive punishments.  It does not, as Farida D. suggests, come from their guilty consciences.  The fear of being seen as feminine exists because all men - straight and gay (and transwomen, too, since, in the eyes of their persecutors, transwomen are effeminate men) know how they will be treated by society if they are seen as feminine and not because they fear being treated the way they treat women.

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David Balashinsky is originally from New York City and now lives near the Finger Lakes region of New York. He is a licensed physical therapist and writes about bodily autonomy and human rights, gender, culture, and politics.  He currently serves on the board of directors for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), the board of directors and advisors for Doctors Opposing Circumcision and the leadership team for Bruchim.

Saturday, August 5, 2023

The Bodies That "Every Body" Forgets and the Case for Unanimity Within the Genital Autonomy Movement

by David Balashinsky

In "Every Body," directed by Julie Cohen, the plight of intersex people and the growing success of the intersex rights movement are at last receiving the attention they deserve.  It might not be an exaggeration to say that the intersex rights movement has arrived.  In the last several years, two large hospitals have announced that they will no longer perform certain types of medically unnecessary intersex surgeries.  One of them has even taken the unusual step of apologizing for having performed these surgeries in the past.  The intersex rights movement also recently has begun to achieve success legislatively.  For example, in 2021, Austin's city council passed a resolution condemning "nonconsensual and medically unnecessary surgeries on intersex children."  A half dozen mostly European nations have gone further, banning (most of) these surgeries, outright.  Now, with "Every Body" playing in theaters across the nation,  Cohen is helping to raise the public's awareness of this issue.  These developments - in medical practice, legislatively and socially - are all hallmarks of an idea whose time has come.  For all these reasons and more, "Every Body" is a hugely important film and I urge everyone - every body - to go see (or stream) it.

I have only one criticism of "Every Body" and, while it is only one, this criticism ties in to what I believe to be a serious and ongoing problem within both human rights discourse and the genital autonomy movement broadly.  Because this one flaw in Cohen's film epitomizes this problem, and without intending to detract in any way from this beautifully-made and inspiring documentary itself, I believe that the time is right - and that it's not unreasonable - to call attention to it.

The case that prompted Cohen to make her film in the first place is the tragic story of David Reimer.  Reimer was one of a set of identical twin boys who were both, at the age of seven months, diagnosed with phimosis.  It's important to understand here that, generally throughout childhood, the penile prepuce (the foreskin) remains fused to the glans, a normal condition that is known as physiological phimosis.  In infancy, true, pathological phimosis is extremely rare.  However, partly because of their unfamiliarity with intact penises, physicians frequently mistake physiological phimosis for pathological phimosis.  Consequently, in infancy, "phimosis" is almost always a misdiagnosis of what is, in fact, the natural state of the child's penis.   There is every reason to think then, that the diagnosis of phimosis that both boys received was a case of a physician pathologizing a normal physiological condition.  Not surprisingly, the boys' pediatrician recommended the treatment of choice which, at the time, was circumcision.  This was subsequently carried out by Jean-Marie Huot, a general practitioner, who opted to use, instead of a scalpel, an electrosurgical device (a Bovie cautery machine, to be precise).  In the process, David's entire penis was obliterated - literally burnt to a crisp.  Distraught, his parents turned to one of the world's most prominent sex- and gender researchers, John Money, who had been promoting his theory that gender is "malleable" for the first couple years of a child's life.  Money recommended that David be raised as a girl and that his parents do everything in their power to reinforce their son's gender as female.  The unique circumstances of David's having been born male but raised female while his identical twin brother was raised male made the twins ideal as living experiment-and-control subjectsThus, above and beyond providing a solution to the predicament the family (especially David) was faced with, the experiment would also serve to confirm Money's theory - if it worked.  It didn't.  Thanks to the courageous and diligent efforts of Doctors Milton Diamond and H. Keith Sigmundson, Money's claims, far from being confirmed, were debunked.  As for David, he never felt right living as a girl, he ultimately rejected the gender that had been imposed on him and he lived a short, troubled life that he ended himself with a shotgun blast at the age of 38.

It's also important to keep in mind here that, like physiological phimosis, ambiguous or indeterminate genitals - "intersex" - occur naturally and, in most cases, do not pose a problem for the individual who is born intersex.  Consequently, the surgical modification of the genitals of intersex children that became standard protocol during the 1970s is, like the treatment of physiological phimosis, simply a case of physicians having pathologized and then "treating" what is in fact a natural and benign condition.

The David Reimer case is not merely relevant to the practice of intersex surgery but foundational to it.  Before being discredited and even since, Reimer's putative "successful" transition from male to female through surgery, hormonal treatments and social conditioning was cited as proof of the efficacy of surgical sex- and gender-assignment and used, therefore, to justify the subsequent genital- and body-modifications to which who-knows-how-many intersex children were subjected.  A considerable portion of "Every Body," therefore, is appropriately devoted to the David Reimer case. 

But before there was intersex surgery there was penile circumcision.  And before David Reimer's sex, gender and identity were tampered with, his penis was.  It bears repeating here that the botched circumcision in this case was prompted, in all likelihood, not by a pathological condition but by a physician's having pathologized a normal one.  The problem, then, was not that Reimer's attempted circumcision was botched but that it was attempted in the first place.  The circumcision itself that was imposed on David Reimer, therefore, was the prime mover: the first in a concatenation of events that led, through diverging paths, to the disastrous outcomes in David's own life, to numerous unwanted and unnecessary intersex surgeries on other children, to the rise of the intersex rights movement, even to the making of Cohen's film.  I take it as axiomatic that, when connecting dots, the first dot is the most important and yet it is this dot that Cohen fails to connect to all the others.  It's not that Cohen fails to mention Reimer's circumcision - it would be impossible not to.  But Cohen seems to regard the original attempted surgical modification of David's penis as incidental: relevant to her subject only because its untoward and catastrophic results led to his being raised as a girl and because his allegedly successful sexual reassignment was then used to justify subsequent intersex surgeries on other children.  Thus, Cohen treats David's circumcision as something that stands apart, conceptually, from the equally unnecessary intersex surgeries that her film documents (and implicitly condemns).  As a result, this can leave the viewer with the impression that the problems that David faced in his life and that so many other intersex people would face in theirs did not begin at the moment the decision was made to subject David to circumcision but only after the decision had been made to subject him to sex- and gender-reassignment.  That is the one conceptual flaw in Cohen's film.

I want to be clear that I fully respect the right of a filmmaker to focus on whatever topic she chooses and, in presenting that topic to her viewers, to circumscribe her camera's field of view as narrowly as she deems appropriate.  Viewed strictly as a documentary about intersex people, intersex surgery and the intersex rights movement, it might seem unfair to criticize "Every Body" for not going far enough and to criticize Cohen for not connecting all the dots.

But "Every Body" is about much more than chromosomes and gonads.  To view it superficially, as though that were all there is to it, would be to miss its larger point.  The deeper message of "Every Body" - its fundamental truth - is that every body has an inherent right to exist as nature made them.  This is the guiding principle against which every norm, every injustice and every harm documented in the film stands in opposition, from what was done to David Reimer, to the imposition on intersex children of a socially-constructed and strict binary view of human sexuality (two absolute and mutually exclusive sexes, with nothing in between), to the imposition on transgender individuals of a parallel and equally rigid view of gender, to "bathroom bills" - and, especially - to physicians surgically "fixing" bodies that they themselves have needlessly pathologized.  More than anything, then, "Every Body" is an unequivocal condemnation of the practice of pathologizing naturally-occurring but harmless anatomical features - especially genitals - of human bodies and surgically altering them without consent in order to make them conform to socially-constructed standards of appropriateness or normalcy.  Nota bene: that is not just a description of intersex surgery - it is the very essence of routine penile circumcision. That is why Cohen's failure at least to acknowledge as much in her film is disappointing.

Again, I'm not faulting Cohen for failing to make a movie about circumcision. There are already several important films - "Whose Body, Whose Rights?""Cut - Slicing Through the Myths of Circumcision" and "American Circumcision" - that have attempted to do for people with penises what Cohen has now attempted to do for people with intersex traits. But it's impossible to view intersex surgery accurately, both in theory and in practice, without contextualizing it within medicine's long history of pathologizing natural and harmless conditions (homosexuality and the penile prepuce are prime examples) and within its long-established practice of using these contrived pathologies as a justification for administering treatments that are neither needed nor desired and, especially, as a justification for performing medically unnecessary surgeries on the genitals of unconsenting children.  By the time surgical modification of the genitals of intersex children became standard protocol, medical professionals in the United States already had been performing surgical modifications to the normal genitals of infant males for decades.  In fact, at that point, most fully and normally developed infant penises were being operated on.  With a precedent like that, what chance might the anomalous genitals of the 0.5 to 1.7 percent of the population that is intersex stand?

Viewed this way, David Reimer's circumcision is neither extraneous nor even incidental to the story that, in "Every Body," Cohen seeks to tell.  That fact that his circumcision, in all probability, and like the vast majority of the million-plus infant circumcisions that are still performed every year in the United States, occurred for no other reason than that Reimer's penis had been patholgized, and because the surgery was therefore both medically unnecessary and imposed on Reimer without his consent makes it, in every way that matters, not just similar in its particulars but morally indistinguishable from the intersex surgeries that are the main focus of Cohen's film.

It is not only in large ways - that is, in principle - but in small ones, too, that nontherapeutic penile circumcision is identical to at least a major portion of intersex surgeries.  I do not know what the statistics are - intersex surgeries run the gamut from clitoral reduction to the removal of internal testes - but these would be those surgeries that are intended to "normalize" the external genitalia of intersex children in order to make them appear more stereotypically "male" or "female."  As a report by Human Rights Watch explains, 

"Intersex," sometimes called "Disorders or Differences of Sex Development (DSD) in medical literature and by practitioners, encompasses around 30 different health conditions that affect chromosomes, gonads, and internal and external genitalia.  In many cases, a significant factor motivating surgical intervention - and often the primary rationale for it [my emphasis] -  is the fact that these conditions cause children's genitalia to differ from what is socially expected of men's [again, my emphasis] and women's bodies.

Similarly and in parallel, social acceptability and meeting cultural expectations about the appearance of a child's genitals are also often the primary rationales for surgically altering a child's penis from an intact one to a circumcised one ("so he won't be made fun of in the locker room," "so his future sex partners won't be turned off").  By the same token, conformity with culturally-determined anatomical standards is embodied in that other stand-by justification for nontherapeutic penile circumcision: "so he will look like his father."

The more sinister aspect of cultural expectations, of course, is the body shaming by which they are enforced.  Alicia Roth Weigel, one of the intersex activists profiled in "Every Body," makes this point

We are told by doctors from the moment that we are born that our bodies are shameful and that they are a problem and need to be fixed and oftentimes we undergo nonconsensual surgeries. . . .  We all have different physical traits or . . . sex traits that maybe some people aren't accustomed to but we are fighting for the message that diversity is a beautiful thing. . . .

What I would tell Weigel, if I had the opportunity, is that there are millions of people with penises in this country who can relate, to one degree or another, with this statement.  The harsh truth is that it is not only intersex people - those with visibly atypical genitalia - whose genitals have been pathologized by the medical establishment.  The medicalization and normalization of penile circumcision have created a culture in which the penile prepuce has been utterly stigmatized.  Body-shaming of people with intact penises continues to be rampant and socially acceptable.  As a result, every person with a penis - whether circumcised or intact - grows up with the perception that they were born with a congenital "deformity" of their penis that either was "corrected" through circumcision or, if it wasn't, ought to have been.  And every time a physician performs a medically unnecessary circumcision, that physician contributes to this body-shaming culture.

Yet another similarity between intersex surgeries and penile circumcision is that both have been and continue to be rationalized on the basis of their putative benefits and prophylactic value.  But, in both cases, the evidence to support these claims is scant and, even when present, the anticipated health benefits - which may not be realized for years or even decades to come, if ever - do not justify depriving people of their right to make such personal medical decisions for themselves.  This is a point that is argued forcefully by Weigel.   In an interview with Terry Gross on Fresh Air (NPR), Weigel explains how the internal testes with which she was born came to be surgically removed when she was less than one year old:

Doctors . . . told my parents that I had internal testes . . .  and that my internal testes could become cancerous one day and so they recommended removing them as soon as possible.  And here's the kicker: anyone who is born with testes could get cancer one day; that is true.   What we now know . . . is my risk of getting cancer is only somewhere between one and five percent and much later in life; that cancer never happens in childhood for people born like me, or very rarely if it ever does.  And so because of a somewhere between one and five percent risk of cancer they decided to remove my hormone-producing organs without asking me. . . .  Essentially, by trying to fix something that wasn't even broken, they created problems. . . .  By trying to fix me, they broke me.

This is how many circumcision survivors feel.  (I'm sure it's how David Reimer felt, too.)  And, by way of comparison, the risks of developing any of the diseases its boosters claim that neonatal circumcision can help prevent are also comparably low.  As Frisch et al. point out

. . . [about] 1% of boys will develop a UTI [urinary tract infection] within the first years of life.  There are no randomized controlled trials (RCTs) linking UTIs to circumcision status.  The evidence for clinically significant protection is weak, and with easy access to health care, deaths or long-term negative medical consequences of UTIs are rare.  [Morever,] UTI incidence does not seem to be lower in the United States, with high circumcision rates compared with Europe with low circumcision rates. . . . Using reasonable estimates . . . for every 100 circumcisions, one case of UTI may be prevented [but] at the cost of two cases of hemorrhage, infection or, in rare instances, more severe outcomes or even death.

So with penile cancer ("one of the rarest forms of cancer in the Western world"), STIs, HIV & AIDS:

. . . only one of the . . . arguments has some theoretical relevance in relation to infant male circumcision; namely, the questionable argument of UTI prevention in infant boys.  The other claimed  health benefits are also questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves. . . .

The importance of allowing individuals to exercise informed consent - to decide for themselves which parts of their bodies they are permitted to keep - that Frisch et al. are asserting here with respect to penile circumcision is mirrored exactly in the sentiments expressed by intersex rights activists.  Here's Weigel, again: 

[A]n analogous example I like to give  . . . [is] the BRCA gene. . . .  The BRCA gene is a genetic variant that confers with it a high risk of breast cancer and ovarian cancer and the risk of cancer if someone is born with the BRCA gene is much, much, much, much, much higher than my one-to-five-percent risk of testicular cancer ever would have been.  But you don't see them force-removing little girls' ovaries who are born with the BRCA gene because they could get cancer one day.  They wait until the girl is a certain age where she is able to make an informed decision with her consent. . . .  
We have suffered these nonconsensual and medically-unnecessary surgeries that everyone from the United Nations to the World Health Organization condemn as torture - they call it genital mutilation - and entire countries have banned these practices. . . . Unfortunately, they happen every day in accredited hospitals in the United States. 

I do not know how often an intersex child is subjected to a medically unnecessary surgery in the United States but even once per day is once per day too often.  At the same time, it's worth remembering that medically unnecessary penile circumcisions occur more than three thousand times every day in accredited hospitals in the United States.

If one accepts the premise of "Every Body" that intersex surgery is a medically unnecessary, nonconsensual body modification that is unethical in and of itself because it violates a person's rights to bodily integrity and self determination, it is difficult to see how can one look at the practice of nontherapeutic penile circumcision (let alone at what happened to David Reimer) and not come to the same conclusion about it, not form the same moral judgement about it, and not be as outraged by it. 

My own view is that, as an abstract principle, any medically unnecessary surgery (that is, a surgery not urgently necessary to save life or limb) that is imposed on someone without that person's consent is unethical.

Keeping that principle in mind, it doesn't matter what the surgery is and it doesn't matter what the sex or the gender of the victim is.

Keeping all of this in mind, all of the particulars of David Reimer's case - not just some of them - matter and are therefore inseparable from the premise of "Every Body."  A more appropriate way to have presented David Reimer, then, would be not merely as an unfortunate victim of happenstance or of medical incompetence who subsequently became a victim of medical malpractice but, rather, as the man whose very life (and, likely, death) represents the nexus between medically unnecessary penile circumcision and medically unnecessary intersex surgery.  

For this very reason, the most appropriate way to honor David Reimer's memory is to take from his case the lesson that the campaigns to end all medically unnecessary, nonconsensual genital (and other, non-genital) surgeries are, fundamentally, one and the same.  It is high time that the movements to end nontherapeutic penile circumcision, medically unnecessary intersex surgeries and female genital cutting (FGC) made common cause with one another and formed the strategic alliances that moral consistency and common sense demand.  The failure of these three pillars of the genital autonomy movement to unite on the basis of their shared logical, philosophical and ethical foundations is the ongoing problem within the genital autonomy movement, and within human rights discourse, more broadly, of which "Every Body" is, I began by observing, a good, if unwitting, illustration.  

I am not suggesting that it is somehow wrong for intersex rights activists to focus primarily on banning medically unnecessary intersex surgeries, for anti-FGC activists to focus primarily on banning FGC, or for anti-MGC (male genital cutting) activists to focus primarily on banning MGC, just as I am not suggesting that it was wrong for Cohen to make the intersex rights movement the primary focus of her film.  But I do think that it would be beneficial to all of these groups to present a united front to the world and to support one another by at least acknowledging their shared values and objectives and by treating one another as respected and valued allies.  Similarly, organizations concerned with promoting human rights more generally and with promoting the common good should be morally consistent and adopt a position of inclusion when condemning harmful practices that violate the rights of children.  Too often, however, the opposite has been the case.

Sometimes this is a failure of omission but sometimes, one of commission.   Equality Now, for example, used to have a "fact sheet" (and I use the quotation marks advisedly) on female genital mutilation (FGM) in which the author or authors went out of their way to differentiate FGM from nontherapeutic penile circumcision, representing the former as abhorrent and never justifiable and the latter as benign. This fact sheet included the eye-popping statement that "circumcision is the removal of foreskin and does not affect the male sex organ itself."  (The male foreskin, or prepuce, is, of course, an integral part of the penis - as integral to the penis, in fact, as any part of the external genitalia, including the female foreskin, is to the vulva.)   In contrast, the statement continued, "FGM damages the sex organs, inhibiting pleasure and causing severe pain and complications for women's sexual and reproductive health." It's a small but encouraging sign that Equality Now has since scrubbed from its site language denying the critical erogenous function of the penile foreskin and dismissing the human rights violation that necessarily occurs when it is surgically removed without consent.

But Equality Now is not the only organization that has gone out of its way to distinguish female genital cutting from male genital cutting.  The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS have gone even further, explicitly promoting male genital cutting while, at the same time, condemning female genital cutting.  

The reluctance by these organizations and others within the anti-FGC movement to recognize the similarities between FGC and MGC is hard to fathom.  Likewise, their apparent aversion to accepting the banning of nontherapeutic penile circumcision as a valid human rights concern.  Both campaigns to end genital cutting (that is, of penises and vulvas), like the intersex rights movement, rest on the same ethical and philosophical foundation: the right of every individual to bodily self-ownership - the right to control one's own body.  Yet, paradoxically, there appears to be a notion among some within the anti-FGC movement that the movement risks becoming trivialized or diluted by making common cause with the anti-MGC movement.  The thinking seems to be that, because FGC is so much worse, MGC can't be all that bad.  Or perhaps there is an apprehension by some that the true horrors of FGC can only adequately be characterized by distinguishing it from MGC.  But, even allowing that, in certain cases (but by no means all) FGC is more harmful than MGC, that is like reasoning that it's okay to cut off a boy's hand simply because cutting off a girl's arm is so much worse.  Both are wrong and it is morally inconsistent and ultimately counterproductive for opponents of FGC to view opponents of MGC as competitors in a zero-sum game.

An example of the failure of some to acknowledge others within the genital autonomy movement through an act of omission (although someone who is pessimistic about human nature might also view this as an act of commission) would be the post by Organisation Intersex International Europe last year in which it made a point of linking FGM and IGM (intersex genital mutilation) conceptually and strategically while conspicuously omitting male genital mutilation (MGM).  The meme, which was posted on Twitter, depicts a flower suspended between two hands, each coming from opposite ends of the image.  Next to one hand is the caption "#EndFGM" and, next to the other, the caption "#StopIGM."

Other notable examples can be found outside the genital autonomy movement.  The WHO, the United Nations and several other important human-rights- and physicians' organizations, including Physicians for Human Rights, the American Academy of Family Physicians, Human Rights Watch and Amnesty International, "have condemned medically unnecessary surgeries on intersex youth" while remaining silent on equally unnecessary genital surgeries on children with penises.

Still another example of this failure has been the subject of much of this essay: Julie Cohen's film, "Every Body," in which the original pathologizing and medical mismanagement of David Reimer's genitals are passed over and implicitly treated as being fundamentally distinct from the pathologizing and medical mismanagement of the genitals of intersex people.

In contrast to these exclusionary approaches to genital autonomy is the work of bioethicist Brian D. Earp and others who argue for a unified, ethical approach to solving the problem of genital cutting in all its various forms.  On the question, "Female Genital Mutilation (FGM) and male circumcision: Should there be a separate ethical discourse?," Earp concludes,

It is . . . to be welcomed that ethicists, activists and other stakeholders have been campaigning to protect the rights of girls to be free from non-therapeutic, nonconsensual cutting into their genital organs.  I cannot state enough that I am in support of such efforts. . . .  My argument has been that they should not be stopping there.  Female, male and intersex genital cutting . . . should be done exclusively with a medical indication or with the informed consent of the individual.  Children of whatever gender should not have healthy parts of their most intimate sexual organs removed before such a time as they can understand what is at stake in such a surgery and agree to it themselves.

A model of promoting unity and emphasizing the shared objectives of the three branches of the genital autonomy movement is the Worldwide Day of Genital Autonomy (WWDOGA).  Although WWDOGA commemorates a judicial ruling vindicating the rights of a victim of male, or penile, genital cutting, the creators and organizers of this annual event have taken pains to deliver a message of universality on behalf of all victims and potential victims of genital cutting.  WWDOGA calls for "protection for all children from non-therapeutic genital interventions" and "Genital self-determination regardless of sex traits, gender, religion, tradition or where you come from."  Additionally, WWDOGA endorses The 2012 Helsinki Declaration of the Right to Genital Autonomy which states, in part,

Whereas it is the fundamental and inherent right of each human being to security without regard to age, sex, gender, ethnicity or religion as articulated in the Universal Declaration of Human Rights, the International Covenant on Civil and Political Rights, and the Convention on the Rights of the Child[,]

Now we declare the existence of a fundamental right of each human being a Right of Genital Autonomy, that is the right to:

* personal control of their own genital and reproductive organs; and

* protection from medically unnecessary genital modification and other irreversible reproductive interventions. 

Another modest but nonetheless important example of inclusiveness and support for its sibling movements by an organization created primarily to eradicate nontherapeutic, nonconsensual penile circumcision can be found in the Values Statement of the Genital Autonomy Legal Defense and Education Fund (GALDEF) which begins with these words: 

GALDEF promotes solidarity with female and intersex victims of genital cutting and we recognize that some transgender people have also been harmed by penile circumcision. 

(Full disclosure: I serve on the board of directors of GALDEF.)  Most recently, GALDEF has issued a public statement in support of the International Day of Zero Tolerance for Female Genital Mutilation.

There are several reasons why the three pillars of the genital autonomy movement should view and honor one another as allies, and these include not just philosophical reasons but strategic and practical ones as well.  Above all, it's the right thing to do.

A good illustration - and a good example of making common cause - is, again, provided by Alicia Weigel, herself.  (If I have given an unfair amount of space here to Weigel, it's because she is featured prominently in "Every Body" and is a prominent spokesperson for the intersex rights movement.  Additionally, it is because her comments, not surprisingly, are so relevant to the cause of banning nontherapeutic penile circumcision.  Beyond all this, she also happens to be tremendously quotable.)  Weigel, who also serves as a Human Rights Commissioner for the City of Austin, was asked by Terry Gross (in the Fresh Air interview, linked above) what she thought are the strengths and potential drawbacks of intersex people being included with the other communities represented respectively by the initials "LGBTQIA," with the "I," of course, standing for "intersex."  As Weigel explained,

We share so many common experiences.  Just like people who grow up gay, grow up often feeling ashamed  simply for existing, or might have undergone conversion therapy whereas intersex kids also undergo conversion therapy just using surgeons and scalpels, instead of electric shocks.  We also hold a lot in common with the trans community in that we often have had surgeries that change our bodies' gender presentation. . . .  So there's so much natural overlap and allyship between our experience that I think it makes total sense to include us in that community.  Just like there are some gay people who are closeted and not out, there are some intersex people who I think also don't consider themselves part of the LGBTQI+ community - and maybe it's because they're straight in terms of their sexuality; or the choice of their gender was not wrong.  But, for me, including us as part of that community helps all the other letters of the acronym feel compelled to stand up for us; just like the gay community was so vital in the trans folks finally getting a platform to stand up for their needs, we are now asking on all of our brothers, sisters and comrades in the broader queer and trans community to now fight for us, too.  Because, just like I showed up to help kill the bathroom bill, even though it wouldn't necessarily have affected me - it already says "female" on my birth certificate and I pee in the women's room - I was there to really help my trans friends that day, we really hope our gay and queer and trans friends will stick up for us as well, understanding that all of our liberation is intricately bound up in one another's progress [my emphasis].

The intersectionality expressed in this statement can, of course, be expanded even further.  There are literally millions of people with penises who have the exact same anger and resentment about what was done to their bodies that intersex people have about what was done to theirs.  I hope, for this reason, that Weigel may come to look upon these people with these bodies too as her natural allies and that they, in turn, will view and support Cohen's film and embrace Weigel, the other courageous stars of "Every Body," Sean Saifa Wall and River Gallo, and the entire intersex rights movement as allies. 

Another prominent intersex rights advocate, and one who has publicly made the connection between the movements to ban all forms of genital cutting (and other forms of medically unnecessary intersex surgeries), is Mx. Anunnaki Ray Marquez.  Marquez (who is also tremendously quotable: my favorite is "When you've met one intersex person, you've met one intersex person.") is the first person in the state of Colorado to receive (retroactively, and after fifteen months of fighting for it) an intersex birth certificate.  Marquez truly embodies the spirit of intersectionality and of making common cause with all movements to ban genital cutting.

Ultimately, the right to bodily integrity and the right to genital autonomy rest on the foundation of bodily self-ownership, no matter whose body we're talking about.  Either there is a fundamental right to bodily self-ownership that applies to every body, regardless of sex, or there isn't.  And, if there is, that means that that right is not just fundamental but universal.

This ties in to the underlying concept of Cohen's film just as it does to Weigel's comments about inclusion.  Importantly, the demands for justice and equality by any one group within the abbreviation "LGBTQIA" are not trivialized or diminished by the inclusion of any other group within that assemblage.  The cause of advancing gay rights, for example, is not undermined by linking it conceptually and strategically to the cause of advancing intersex rights.  By the same token, the right of intersex people and people with vulvas to autonomous control over their bodies (especially their genitals and reproductive organs) is not diminished, trivialized or threatened by acknowledging that that same right belongs no less to people who happen to have been born with penises.  On the contrary: that right can only be strengthened by recognizing its universality.  It's self-evident that a morally consistent principle is more powerful than one with a carve-out that omits 50% of the population.  Hence, the campaigns to end female genital cutting and medically-unnecessary intersex surgeries can only be strengthened by joining forces with the campaign to end male genital cutting.  Establishing the right to be free from nonconsensual genital surgery on a universal right of bodily self-ownership rather than on a right narrowly tailored to protect only people with vulvas or only people with intersex traits will help secure and guarantee this right for Every Body.


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David Balashinsky is originally from New York City and now lives near the Finger Lakes region of New York. He is a licensed physical therapist and writes about bodily autonomy and human rights, gender, culture, and politics.  He currently serves on the board of directors for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), the board of directors and advisors for Doctors Opposing Circumcision and the leadership team for Bruchim.