First, let me explain: since reading about female genital mutilation in class, I was interested to learn more. While doing this, I ran across some very interesting comparisons and arguments made by people from the US. They argued (on comments sections for articles vilifying FGM (female genital mutilation)) that it is hypocritical for US writers to complain about FGM when they themselves (presumably they are male) were subject to a procedure of male genital mutilation without their consent. This is where my question originates from.
Personally, before even considering the ethics, I wanted to understand the risks and benefits of both male circumcision and FGM. The best place to find this information has been WHO, of course. Looking at their factsheet on FGM (WHO, 2013) they discuss a variety of negative side effects which can include:
- severe pain
- shock
- urine retention
- cysts
- infertility
- increased risk of child birth complications and newborn deaths
This list in not exhaustive but it highlights some of the potential dangers. Compare this with male circumcision (WHO & UNAIDS, 2007) and you see that male circumcision has complications in infants from .2-.4% and complications can include bleeding or excess skin.
It becomes seemingly harder to compare the two when looking at the potential health benefits. WHO cites no known health benefits from FGM (WHO, 2013) and they (WHO & UNAIDS, 2007) cite that there is "substantial evidence" that male circumcision protects against urinary tract infections, syphilis, penile cancer, and HIV. However, this "substantial" evidence is not enough to have the American Academy of Pediatrics to fully support the procedure (AAP, 2012).
Before accepting this information as pure fact, I want to propose a possibility. Male circumcision is something that is done here at the US quite frequently (75% at the age of 15+ (WHO & UNAIDS, 2007)). As a country that is a scientific powerhouse, it is logical that we try to find justifications for our societal practices. Compared with countries which typically practice FGM (Sub-Saharan Africa mainly (WHO, 2013)), these do not have the money, expertise, or motivation to find scientific justifications for their actions. So, I believe it is most likely that there are benefits to FGM that are probably not found. We as a society don't want to find support for something we condemn, after all.
But FGM is so terrible to the women, yeah? However, FGM is typically done using inappropriate tools (razor blades, knives, pieces of glass) or environments (not in a hospital) (Skolnik, 2008). What if FGM was actually performed in hospital by doctors with appropriate tools? Would the consequences decrease? What if FGM existed in a society where medical practices were becoming better and safer?
Finally, let's look at the real reasons why both male circumcision and FGM are still practiced today. Both WHO sources cite social reasons as being the main driving force behind both. As both are the result of social forces, I find the two to be more similar than is presented.
Ethically I think that we need to understand that we are not any better than they are. Yes our medical system is better and our ability to practice safe medicine is better and our research is better. Does this mean the procedure itself is inherently "better" or "more acceptable"? No. The facts are that we as a society are regularly cutting away at male genitalia using little evidence that we actively search for to support the continued practice. Do you think FGM is bad? I do. Now that I have become aware of the social factors and influences behind male circumcision I can say my opinion has changed, or perhaps been truly formed for the first time. Male circumcision is and unnecessary and archaic procedure which has no place this day and age.
Sources:
AAP. (2012). Circumcision Policy Statement. Pediatrics, 130(3), 585-586.
Siegfried, N., Muller, M., Deeks, J., Volmink, J.,
Egger, M., Low, N., . . . Williamson, P. (2005). HIV and male circumcision - a
systematic review with assessment of the quality of studies. The Lancet, 5(3),
165-173.
WHO & UNAIDS. (2007). Male circumcision: global
trends and determinants of prevalence, safety and acceptability. Geneva.
World Health Organization. (2013, February). Female
genital mutilation. Retrieved from World Health Organization:
http://www.who.int/mediacentre/factsheets/fs241/en/
Greg, I really like the angle you are coming from. I think what you are bringing up is a good example of culture being used as a scapegoat for practices that don't coincide with our own. It really makes you wonder what countries like the US would say about another western, developed country that was practicing FGM in the manner that we practice MGM. I think what biomedical professionals often fail to consider is the impact of culture and social forces and how that shapes popular procedures we deem socially acceptable. I don’t know much about the controversy over the medical reasons for circumcision, but I wonder which came first in our country...the social desireability of male circumcision, or the "proven" scientific advantages of circumcision?
ReplyDeleteVery interesting perspective, Greg. Your post caught my because I recently watched a documentary on female genital mutilation (FGM) and I thought it was very eye opening. The documentary was titled “The right to femininity fighting female circumcision in Africa today”. It can be found in the HSSE library. The film interviews women from countries that practice FGM and explores the reasons the support it or are against it. We so often only hear Western opinions on FGM, that I found it to be very enlightening to hear what women who have encountered FGM think about the practice. Some women talked about how either they wanted the circumcision or they wanted their daughters to be circumcised because it was an important part of becoming a woman and being eligible for marriage. Other women (who had been circumcised) were fighting for their daughters to no be circumcised and other grown women chose not to be circumcised (sometimes with consequences in terms of marriage. Another focus of the film was the grassroots movement in Africa to end FGM. Community health workers and advocates are currently going to the villages where FGM is still practiced and educating both men and women on the dangers of FGM. They are also teaching the women who perform the circumcision safer techniques and better sanitation. Anyway, I think it did a great job of capturing many perspectives, as well as the social and cultural context, which, as you mentioned, is so important when discussing these issues.
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