December 24, 2018
We Care About The Children, Really We Do
By Michael D. Shaw
According to the World Health Organization, Female Genital Mutilation (FGM) includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. Indeed, it is well established that the procedure has no health benefits for girls and women.
There are four major types of FGM:
Type 1—Often referred to as clitoridectomy, this is the partial or total removal of the clitoris, and in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).
Type 2—Often referred to as excision, this is the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva), with or without excision of the labia majora.
Type 3—Often referred to as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoris.
Type 4—This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping, and cauterizing the genital area.
Reasons for performing FGM involve regional social norms, and various beliefs about how a woman should be more suitable as marriage material. According to UNICEF, the practice of FGM is mostly limited to central Africa. It is not common in Algeria, Iran, Jordan, Libya, Morocco, Oman, Saudi Arabia, or Syria. FGM is concentrated in a small swath of states in western Africa and another swath of states along the Red Sea. Except for a handful of countries, only a small percentage of women who undergo FGM believe the practice is required by religion.
While usually identified with Islam, participation by members of Christian religions in these countries is nearly as high. FGM is also practiced by an Ethiopian-based group of Jews, known as the Falashas.
A host of health conditions are associated with FGM, including menstrual, vaginal, sexual, and urinary problems, along with increased risks of complications in childbirth and psychological issues. There are also immediate risks during the procedure itself, including excessive bleeding, infection, shock, and even death.
Some try to compare FGM to male circumcision, but this is a fool’s errand. The advantages of circumcision are well-documented, and include decreased risk of penile cancer, decreased risk of sexually transmitted infections, decreased risk of urinary tract infections, easier hygiene, and prevention of penile problems. There may even be derivative benefits—with respect to lower rates of STD infection to the partners of circumcised men.
As to the practice of FGM in the United States, it had been illegal since 1996, in accordance with 18 U.S. Code § 116. There are anti-FGM laws in several states, as well. And, Michigan is on this list, but its law was enacted in June, 2017.
Which brings us to the celebrated recent case of US v. Jumana Nagarwala, et al. In April, 2017, Dr. Jumana Nagarwala of Northville, MI was arrested and accused of heading a conspiracy that lasted twelve years, involved seven other people and led to mutilating the genitalia of nine girls. (The prosecution held that Nagarwala may have performed the procedure on up to 100 girls.) The defendants were said to be in violation of the federal law prohibiting FGM.
However, in a November 20, 2018 ruling that can only be called bizarre, US District Judge Bernard Friedman (a Reagan appointee) dismissed all charges under the federal anti-FGM law, but did leave intact the conspiracy and obstruction charges. Even though several of the affected children were transported from other states to receive FGM, Friedman held that the law did not involve interstate commerce. And, he declared the law unconstitutional.
Of course, missing in all of this was the basic rationalization of Roe v. Wade. In that case, women should not have to travel out-of-state to receive their abortion. Thus, the 14th amendment’s equal protection clause would apply, and the procedure should be legal in all states. The same reasoning was used to legalize gay marriage in all states. As such, protection from FGM should be upheld in all states.
The Societies for Pediatric Urology issued this statement, in reaction to the ruling:
“While respecting the federal judge’s ruling, the Societies for Pediatric Urology (SPU) repudiates the ruling that deemed the federal genital mutilation law as unconstitutional. The procedure of female circumcision, for which there is no medical justification, is traumatic both physically and emotionally, and serves only to make sexual relations for women unpleasurable. The medical community is well aware of the significant risks inherent to this procedure which are potentially permanent, and life altering.”
“It should be noted that pediatric urologists were among the first doctors to call attention to this tragic practice when the girls of Middle Eastern and African origin began arriving in the United States as a form of child abuse. It is our responsibility as doctors who care for the genitourinary system in children to ensure their safety.”
As you can imagine, most of the reaction to the decision was negative, typified by this tweet. Oh yes, we live in interesting times.