A nick for Nick, but nix to nicks for Nickie?
The American Academy of Pediatrics (AAP) has come under fire for a policy statement that has a more nuanced approach to female circumcision (FC) than its previous absolute opposition. The new policy proposes that the law be changed to allow pediatricians to perform a ritual ‘nick’ as a compromise where families request female circumcision. The AAP document strongly opposes all female circumcision that would lead to physical or psychological harm, but suggest that pricking or incising the skin of the external genitalia in females is less harmful than ear piercing. This has led to outrage from groups who oppose female circumcision in all forms.
The AAP argues in favour of the ritual nick on several grounds:
“There is reason to believe that offering such a compromise may build trust between hospitals and immigrant communities, save some girls from undergoing disfiguring and life-threatening procedures in their native countries, and play a role in the eventual eradication of [female circumcision].”
One objection to the compromise is that it would lead to worse outcomes overall for women. Opponents of the policy claim that allowing the compromise would undermine efforts to reduce far more harmful forms of female circumcision, and so lead to more mutilating forms of FC. The authors of the AAP statement argue that the compromise would prevent at least some parents from going overseas to have far more extensive, risky and harmful procedures (or having them illegally). It is hard to be sure what the overall effect of this more permissive policy would be. But the AAP statement is very clear that it does not condone any form of FC, and that damaging forms of FC should remain illegal. It appears plausible that allowing the ritual nick would prevent some harm.
However, Lakshmi Anantnarayam writing in the Guardian claims that even if the compromise were effective in reducing FC it should not be permitted
“human rights standards are absolute and not to be compromised upon in the name of possible harm reduction”
If all forms of FC, including the suggested ‘nick’, represent serious human rights violations, then perhaps it should not be allowed in any circumstances. But if the AAP authors are correct in their claim that there is no physical or psychological harm attributable to this procedure, how or why are the rights of the female infant violated by having it performed? The claim might also lead us to ask another question. Why does the ritual nick violate the rights of female infants, but far more extensive genital surgery performed routinely on males not violate their rights?
Part of the motivation for the AAP’s change of view appears to be recognition that its previous positions on male and female circumcision were inconsistent. There are two consistent positions
A. Surgery on the genitals of the newborn for religious/cultural reasons or parental preference should not be permitted in either females or males.
B. Minor surgery, of an equivalent risk and extent, for religious/cultural reasons or parental preference should be permitted in both males and females.
The new statement from the AAP, although it moves towards B does not in fact achieve consistency. For that it would need to either permit more extensive genital cutting in females than the ritual nick, or prohibit excision of the foreskin in males (but allow a nicking or piercing of the foreskin). However, given that there are some reasons(1) to be more liberal about male circumcision than female circumcision, it appears to be a reasonable compromise.
The other point to note is that the AAP takes great pains to distinguish between interventions that should be discouraged, criticised and avoided, and those that should be criminalized. Not all activities that are morally wrong should be legally prohibited. No parent should subject their child to medically unnecessary genital surgery in infancy. If such procedures are culturally significant they should be performed in later life when the individual can choose for themselves whether to undergo it. Circumcision procedures with significant risks of physical or psychological harm should be outlawed. Nevertheless, even if we disapprove, we may allow parents to choose minor low-risk forms of circumcision for their males or female infants.
(1) Male circumcision (but not FC) has some potential health benefits, offering a degree of protection against HIV. Female circumcision, unlike the male form includes a spectrum of far more pernicious forms, and often occurs within a social context of oppression, discrimination and rights violations.
Ritual Genital Cutting of Female Minors PEDIATRICS Vol. 125 No. 5 May 2010, pp. 1088-1093 (doi:10.1542/peds.2010-0187)
Female Genital Mutilation PEDIATRICS Vol. 102 No. 1 July 1998, pp. 153-156
Why are US doctors allowing genital mutilation? Lakshmi Anantnarayam Guardian 11/5/10
Cultural Rite, Medical Wrong Elizabeth Reis Bioethics Forum