Monday, February 3, 2020

On Bodily Self-Ownership: An Open Letter to Cheryl Axelrod, M.D., F.A.C.O.G.

by David Balashinsky

Dear Dr. Axelrod,

You may recall that I wrote you a little over two years ago after I received an email from you and NARAL Pro-Choice America.  I was on NARAL's mailing list because I support abortion rights and have donated to this organization in the past.  When I wrote you, NARAL had recently embarked on a campaign of encouraging women who had had abortions to "come out" and tell their stories.  The point of the campaign was to humanize the reality of abortion, since terminating a pregnancy is among the most significant and personal decisions a woman can make about her health, her body and her life.  If politicians - most of whom are men - have succeeded in passing laws that regulate women's bodies, one of the reasons for their success is that abortion typically is represented as something abstract.  Conversely, abortion is also frequently misrepresented in the most lurid terms, as is happening now * with "late-term abortion" bans and "fetal heartbeat" laws.  In either case, putting a human face to the reality of abortion was one way, as Kate Thomas (digital director of NARAL) wrote in the email, to "de-stigmatize what is a very common medical procedure."  As an OB/GYN and as a woman who had made the difficult choice to terminate a pregnancy, you were in a position of particular moral authority to speak out in support of a woman's right to choose. You did this by sharing your personal story.   I hope you will recall that, when I wrote you, it was partly to express my admiration not just for your courage in sharing it but for your doing so on behalf of such an important cause.

On the other hand, if you prefer not to recall my letter to you in 2017, perhaps it is because my other reason for writing it was to call your attention to what I felt was a glaring double standard with respect to your idea of bodily autonomy.  This is because, in your appeal on behalf of NARAL and in support of abortion rights, you wrote, "It's our body and our decision."  You wrote these words even as in your professional practice  -  perhaps that very day - you were depriving male neonates (and the men that they will become) of the right of bodily autonomy (and of much more, besides) by subjecting them to non-therapeutic penile circumcision, or male genital cutting (MGC).  Frankly, I was stunned by the contradiction between your claim of bodily autonomy for women like yourself and your denial of that same right to men like me.

Before going any further, I should explain why I am under the impression that you perform non-therapeutic circumcisions.

To begin with, when I visited your clinic's website in 2017, under your name was a list of "services performed" and one of these was circumcision.  I use the quotation marks around "services performed" because an individual who has had a major portion of erotogenic tissue cut away from his penis without his consent and in the absence of a medical indication is unlikely to regard himself as having been the recipient of a "service."

Now, to be fair, your website did not specify whether the circumcisions you perform are medically indicated or performed for non-therapeutic reasons, the chief one of which is that MGC has become a deeply entrenched cultural practice in the United States.  However, the reality is that, currently, in the United States, the overwhelming majority of neonatal penile circumcisions are performed without a diagnosis, hence, without a rational or sufficient medical justification for performing them.  (And, of course, 100% of them are performed without consent. Given that circumcision is, in factmedically indicated for between 0.8% and 1.6% of pre-pubescent boys while the incidence of MGG is currently in the neighborhood of 50%, that makes it much more likely than not that most of the penile circumcisions that you have performed (like most circumcisions performed by most medical practitioners) were non-therapeutic.

There are other circumstances that tended to confirm my impression.  First, the fact that the initials "F.A.C.O.G." follow your name.  This means that you are a fellow of The American College of Obstetricians and Gynecologists.  This is an organization that has endorsed the American Academy of Pediatrics' 2012 Technical Report on nonconsensual penile circumcision which, in its own words, "emphasizes the primacy of parental decision-making."  To put that in plain English, the AAP believes that a parent's right to order the removal of normal, healthy erotogenic tissue from a child's penis for religious reasons, for cultural reasons, for cosmetic reasons, for any reason or for no reason outweighs that child's right to live his life with his genitals whole and intact. ACOG happily and profitably endorses this view.  It is not an unreasonable inference on my part, therefore, that, because you are a member of ACOG (like the majority of physicians in your clinic), you support ACOG's pro-male-genital-cutting policy. 

Added to all this is the fact that, at some point after I reached out to you in 2017, the wording on your website was changed.  It now no longer states that you offer "circumcision" but, rather, "surgical procedures."  It is hard to avoid the suspicion that this is a euphemism, the use of which represents your clinic's tacit acknowledgement that routine, non-therapeutic circumcision is a discredited practice that has been rejected by professional medical organizations around the world and that is increasingly being condemned as the human rights violation that it is.  For example, in 2016, the Danish Medical Association issued a statement declaring non-therapeutic circumcision "ethically unacceptable."  Lise Moller, the chairwoman of the DMA, was quoted as follows: "To be circumcised should be an informed, personal choice.  It is most consistent with the individual's right to self-determination that parents not be allowed to make this decision but that it is left up to the individual when he has come of age."

There are two important ways that all this ties together.  By "all this," I mean the right to obtain a timely, safe and legal abortion (on which we both agree), the right not to be subjected to genital cutting (on which apparently we do not agree), and the power of personal narrative.

To take up this last thread first, I want to emphasize that I was not only moved by your abortion story but gratified to see such powerful, first-person advocacy on behalf of the right of women to own and control their own bodies - a right I have long supported.  (I was out in the streets demonstrating in support of a woman's right to choose probably while you were still in elementary school - possibly before you were born.)  Above and beyond all this, your story inspired me.  It brought home to me the power of personal narrative.  Law, social policy, culture itself can be unyielding.  Progress in all of these domains can be glacially slow.  Sometimes, the best way to reach hearts and minds and to effect change is by speaking one's truth not to the ether but directly to one's fellow human beings.

Here  is my truth and I am speaking it to you: Involuntary circumcision deprived me of the right of bodily autonomy.  It deprived me of the right of bodily integrity and the right to experience the full range of my innate human sexuality.  I cannot imagine that I would ever willingly have chosen to have such an important part of my penis cut off but, even if I would have made that choice, the fact that this "choice" was made "for" me, without my consent, means that I was denied my right to choose.

This brings me to the other major thread of this letter: the principle of bodily autonomy or, as I prefer to express it, bodily self-ownership.  In the case of your own abortion, you explain that the fetus you were carrying had developed severe abnormalities and would not have survived past delivery.  This factored crucially in your  decision to terminate the pregnancy.  Equally crucial to the abortion-rights debate is the fact that legislation being passed now by anti-choice legislators would ban abortions during the second trimester, which, as you point out, "often involve medical complications."  Although I acknowledge that abortion is a valid and sometimes necessary medical procedure, my support of abortion rights transcends any specific medical justifications for abortion.  I believe that girls and women have a right to choose abortion because I believe that they own their own bodies.  It's that simple.  The right to obtain an abortion does not need to be justified on the basis of severe developmental abnormalities of the fetus or on the basis of medical necessity for the girl or woman.  It is sufficient that, because it is her body, it is a pregnant person's right to terminate her pregnancy.  It does not follow from this that every abortion is ethical, nor that every reason for abortion is morally valid (such as in the case of sex-selection abortion, which I find morally abhorrent)Yet the right to terminate a pregnancy is as fundamental to basic human rights as any other right that is predicated on the principle of bodily self-ownership. 

That principle - bodily self-ownership - applies no less to males and to male bodies and to intersex bodies than it does to females and to female bodies.  It applies no less to bodies with penises than it does to bodies with uteruses.  And it applies no less to the practice of nonconsensual penile circumcision, which is incompatible with it, than it does to abortion rights, which are supported by it.  As you, yourself, wrote in NARAL's email:  "It's our body and our decision."

One of the goals of personal narrative - coming-out stories, like yours - is to foster constructive and civil dialogue.  I see this personal narrative - this open letter to you - as a way for me to extend a hand in order to help you across what I believe to be the cultural chasm that divides us.  On your side of the chasm, nonconsensual penile circumcision is a normalized, entrenched cultural practice that has been gilded with counterfeit legitimacy through decades of medicalization.  On my side, nonconsensual penile circumcision is a human rights violation.  This is why:  Because it is medically unnecessary.  Because it causes needless pain and trauma.  Because it is a theft from an individual of a body part that he has a fundamental right to keep.  Because it removes densely innervated erogenous tissue, the loss of which necessarily impairs sexual function, sensation, intimacy and  satisfaction.  Above all, because it deprives people with penises of their right to choose.

If you believe, as your clinic's website led me to assume you do, that nonconsensual penile circumcision is a legitimate and ethical practice, you and I remain light years apart on this issue.  If, on the other hand, you believe, as I'm sure you do, that bodily self-ownership is a fundamental human right, you are one small step away from recognizing that the right to obtain an abortion and the right not to be subjected to genital cutting stand on the same moral foundation.  

*Update: Since this open letter was published, the Supreme Court has overturned Roe v. Wade.  See my post on the significance of the Dobbs decision here.

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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 and as Director of Outreach for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), he serves on the board of directors and advisors for Doctors Opposing Circumcision and serves on the leadership team for Bruchim.