18 Responses to Things I’ve learned (so far) about how to do practical ethics

  • Helmut says:

    I agree on the “sarcastic” and other similar “tones” in this debate. But:
    No more mentioning of children rights? No more mentioning of the impractibility of effective harm reduction during neonatal circumcision, if ever? “Autonomy” just “local”? No “strong-armed ban” for infant male circumcision” but for female genital mutilation?
    If you want to change the “tones” you don’t have to change your arguments.

    • Hello,

      I’m not sure I follow your concerns. This was not a post about circumcision, but rather about my approach to conducting debates in practical ethics generally. The first example I mentioned had to do with circumcision, that’s true, but the point applies more broadly: just because something is morally impermissible, doesn’t mean, necessarily, that it should be legally prohibited. Perhaps it should be, whatever the thing is, but there isn’t an automatic entailment from moral to legal impermissibility, and that was my only point. The case of circumcision is complicated. In my original post, I suggested that non-therapeutic, non-consensual circumcision should be “banned” — but I did not actually provide an argument for this view (hence, I have not “changed my argument,” at least as concerns this point). I do think, ultimately, that in order to have a consistent legal code, non-therapeutic, non-consensual circumcisions (NTC to keep it short) will have to be legally prohibited (in fact it may already be illegal on numerous existing statutes), but the question for me is when, under what circumstances, and at what stage of the cultural conversation. There is a meaningful debate to be had here, and I am certainly open to arguments that NTC should be banned more quickly than I have come to think is advisable, but an argument to that effect would have to be provided; it cannot be simply assumed on the basis of one’s ethical views regarding NTC.

      No mentioning of children’s rights? I wrote a post just last month in which I highlighted children’s rights, and also discussed the double standard with FGM. Here is the link to the post in case you didn’t see it: http://blog.practicalethics.ox.ac.uk/2014/02/female-genital-mutilation-and-male-circumcision-time-to-confront-the-double-standard/. Again, the current post was not about circumcision, and I have given my arguments about children’s rights elsewhere. I do think here, too, the specifics of the debate are complicated: even if one grants that a child has a “right to bodily integrity” there is considerable philosophical dispute about what that right consists in, what exactly bodily integrity is and what its value is, and what it would take to violate it. Those disputes may not be of interest to you, or you may think it is just “obvious” that circumcision flies in the face of such rights (however they are to be defined), but I have a different agenda: my job is to convince my colleagues in bioethics — many of whom have not previously considered circumcision to be very problematic at all — that it is indeed a troubling practice when it’s done without a diagnosis or consent, and so I have to do the nit-picky work of showing why this is so on grounds other than that is it is simply “obvious.” That means taking seriously some of the nuances of the concepts involved. None of that entails “changing my arguments,” and I’m not sure on what grounds you’ve suggested that I have.

      Finally, I didn’t say that autonomy is “just local” (except in the sense that it is “local” throughout most of Western civilization). I said that the value of autonomy is not universally appreciated, and if what is being evaluated is a practice that operates by a different moral logic, then it won’t be enough simply to pound one’s opponent over the head with how wonderful and self-evident the value of autonomy is. Instead, an actual argument has to be given for why the meta-ethic of autonomy is preferable to other moral views, and I have been at pains to provide such an argument. Indeed, I do think that autonomy-based ethics are better than other moral systems, all things considered (including community-based moral systems and divinity-based moral systems), and I linked to a paper in which I defended that position in detail. So perhaps you would consider reading my paper in which I provide an argument for the (contingently) universal value of autonomy, before suggesting that I’ve somehow “changed my argument” concerning its importance (by implying it is “merely” a local preference).

      One of the main points of the present post was that showing charity toward another’s viewpoint is important for moving the conversation forward. By suggesting I’ve “changed my arguments” by floating a couple of rhetorical questions, mis-stating what I actually wrote, and failing to read the arguments I presented in support of my views (on, e.g., autonomy), I worry that you may not have been entirely charitable to my position in this case. Or perhaps there has been some simple misunderstanding, in which case I hope sincerely that we can sort it out. Please let me know why you think I’ve changed my arguments, which arguments you think I’ve changed, and why I ought not to have changed them (if I did), and then I can have a better idea about what your concerns are.

      Best,
      Brian

  • Rebecca Roache says:

    This is great, Brian. It would made good required reading for new philosophy undergrads 😀

    A huge YES to 2. It can be hugely tempting to use snark, especially if you’re confident that you’ll come out of the exchange looking like you ‘won’. But as you say, often it doesn’t get you very far. I’d also add that it encourages people to be defensive (as you also note) rather than to reconsider their views, with the result that the ensuing debate isn’t really philosophical at all. I find that, if you instead engage earnestly with people, some will lose interest but others will respond earnestly by questioning their views (or getting me to question mine). It’s more satisfying to come away from an exchange feeling like you got someone to reconsider an objectionable position, or that you learned something from them, than to feel like you won a playground game and made your friends laugh. Philosophy is not a spectator sport.

  • Helmut says:

    Thank you very much, Brian, for your polite and elaborate answer on my much too short comment. I am sorry for that.

    I agree with Reinhard Merkel who – discussing the limitations of religious freedom – stated: “As with any other freedom right, these end where another person’s body begin.”

    In your article “Female genital mutilation (FGM) and male circumcision: time to confront the double standard” you wrote:

    “Indeed, I think that all children, whether female, intersex, or male, should be protected from having parts of their genitals removed unless there is a pressing medical indication; I think this is so regardless of the cultural or religious affiliations of the child’s parents…”

    I agree that it absolutely necessary to discuss the “cultural or religious affiliations”, the “local” (i.e. “western”) standards of autonomy etc. (you have done that extensively in many articles) but in the end I come to the conclusion that “all children should be protected” “regardless of the cultural or religious affiliations…of the parents”. So why not protect the cildren by legally banning NTC in the same way as FGM (by the way: circumcision IS mutilation concerning the consequences for the child. So why not using the word “MGM”?) und why not supporting campaigns against NTC the same way we are supporting campaigns against FGM – and not questioning “under what circumstances, and at what stage of the cultural conversation” after a “considerable philosophical dispute” etc. How do you explain that to the boys who are mutilated every day?

    I agree that “there isn’t an automatic entailment from moral to legal impermissibility” in general but NTC (as Reinhard Merkel noted) it is in the same way legally impermissible as FGM and should be legally banned the same way. I mean banned and not limiting to hospitals for “harm reduction”. There is no effective harm reduction during neonatal circumcision.

    Obviously I misunderstood that you do proclaim a legal ban on NTC the same way you would do that on FGM (because on NTC more philosophical dispute and cultural conversation is needed) but – I am sorry to say that – as for me this a double standard.

    I apologize for my bad english.

    • Hello again Helmut,

      Thank you very much for your thoughtful reply. It seems that we agree on many issues. The sticking point seems to be about the advisability of a legal “ban” on NTC, so let me try to address your concerns. First, it has been convincingly argued, by a number of legal scholars, that NTC is already illegal based on accepted definitions of criminal assault in many Western jurisdictions, so a “ban” may not even be necessary in some states/countries, but rather the enforcement of existing law. However, there are further points to consider. First, the situation is very different in Europe (I assume you are writing from Germany) than it is in the United States. In the US, circumcision is not seen as a religious custom, apart from its being practiced among the ~1.7% of the population who are Jews (excepting those who are atheists or otherwise non-religous, which is a rather large proportion) and the 1% or so who are Muslim. Among the rest of the population, circumcision is a dominant cultural norm, and is seen (albeit misguidedly) as a quasi-“medical” procedure — good for health and hygiene — or else simply more aesthetically appealing. These attitudes seem to be shifting (and circumcision rates are falling) but my point is that non-therapeutic circumcision is so taken for granted in American culture, that there is currently very little chance that a proposed ban would ever be ratified, by any legislature, anywhere in the country (much less at the federal level). In fact, when a ban was recently proposed, in San Francisco, it led to a backlash, including a subsequent law that was passed to formally protect NTC, making it immune from future legal challenges. This is exactly what I am referring to about the potential bad effects of pushing “bans” before the culture is ready for them. Such blunt legal maneuvers can lead to reactionary efforts, thus making it even harder to eliminate the practice. If your goal, therefore, is to get rid of NTC, then you need to consider: “What is the most effective way of actually achieving this outcome?” In the United States, in any case, the answer to this question is not, in my view, “try to pass a ban,” but rather, “try to change people’s attitudes through social activism, ethical argument, and step-wise regulation, so that a proposed ban in the future will not lead to specific laws that actually protect NTC from being legally challenged.” I do think NTC is unethical; I think it is inconsistent with the norms of medicine; I think it is in tension with numerous legal principles, and I think it violates a number of statues. Nevertheless, in the United States, the only actual effort to “pass a ban” was so dramatically unsuccessful that it led to the precise opposite of the outcome that was hoped for.

      I think that Americans are morally aware enough to be able to change their minds on this topic, so long as they are confronted with thoughtful ethical arguments, the stories of men who have suffered from their circumcisions (physically, psychologically, or both), and other forms of consciousness-raising. Once the rates are low enough, and the attitudes have shifted against this hoary custom, then I think a proposed ban might be successful. In the meantime, however, such an outcome is unlikely, in my view, and pushing for a ban in this context is likely to alienate many of the people who might otherwise be open to reconsidering their views. In Europe the situation is very different. In Europe circumcision is almost exclusively associated with Jewish and Muslim practice, and so the focus of the debate is on competing rights claims: the right of a child to bodily integrity, and the right of parents to practice their religion. I agree that a parent’s religious beliefs cannot morally justify cutting off a healthy part of their child’s body, and I have raised several arguments to that effect in previous articles. However, the question in Europe, too, is what would be the effect of a ban? You brought up the the case of FGM. As you must be aware, in England, in any event, FGM has been “legally banned” since 1985, and yet there were no prosecutions prior to this month in the entire stretch of time since then. Clearly, the “ban” was ineffective in rooting out the morally problematic behavior; instead, it carried on underground, or took place during overseas trips to countries that were more permissive. The “ban” on FGM has also been argued to be racist and politically motivated, and I am sympathetic with this view: adult women in England, Australia, and elsewhere — so long as they are white or otherwise of European descent — are permitted to undertake “cosmetic” alterations to their genitals, including trimming of the labia (FGM type 2) and clitoral unhooding (FGM type 1); whereas if a brown woman of African descent asks for an anatomically equivalent procedure on grounds of “culture” or “tradition,” she will be denied the operation. A better law, in my view, would be based on informed consent: minors (of whatever gender) would not be allowed to have their genitals surgically altered for any non-medical reason; whereas adults (of whatever gender, and whatever cultural background) would be allowed to have their genitals surgically altered for whatever reason was in keeping with their own values. Perhaps you will agree on this point, I don’t know. The upshot is that even the ban on “FGM” has not been very successful in eliminating the practice in its various forms: it was passed out of a sense of shock and horror at the “barbaric” behavior of Africans/Muslims, long before anyone took the time to understand the custom in its cultural context. So: I do think that the non-consensual, non-therapeutic surgical alteration of any child’s genitals is morally impermissible, and I endorse efforts to eliminate these practices. But history shows me that shouting “mutilation” and calling for a “ban” does not always lead to the outcomes one hopes for. So, I choose to focus my efforts on building understanding with the communities involved, creating dialogue, and shifting hearts and minds. Your approach is different, and perhaps there is room for a range of strategies in effecting social change; but I think we would do well to remember that calling in the force of law to change people’s behavior is just one tool among many, and not always the best.

      One more point, if I may, about the term “mutilation.” I don’t use this term for female genital cutting, and I don’t use it for male genital cutting. Here’s why. Most women who have undergone a genital cutting procedure do not, themselves, feel mutilated, nor do most men who have been “circumcised.” Some women do, and some men do, and I think their feelings are perfectly well justified, but they are in the minority in both cases. Let’s say that I am an adult woman, and I like to get piercings on my body as a form of self-expression. I have piercings on my ears, one in my nose, and maybe even piercings in my nipples. Now I decide that I would like a piercing on my clitoral hood, because, perhaps, I think it will encourage stimulation, or maybe I just like how it looks. Well, “piercing” of the genitals is defined as a “mutilation” by the World Health Organization, and is included in FGM type 4. I think this is a bad definition: in the case of the adult woman, the piercing is seen as an enhancement, not a mutilation. So the problem is not that the procedure is inherently “mutilating,” but rather that it is sometimes done without consent, on someone whose preferences about her own genitals may be different from what has been assumed. The same for male circumcision. Let’s say I’m an adult male, and I prefer the “look” of a circumcised penis. Or perhaps I have converted to Judaism, and I would like to forfeit this part of my penis in order to be welcomed into that community. Well, then, in both cases, I would not regard my penis as “mutilated,” but rather as “enhanced” — and who could tell me I am wrong? Hence it cannot be the case that merely removing the foreskin from someone (or piercing someone’s clitoral hood) is to “mutilate” them, on any reasonable definition of that term. But when either of these things is done to someone who has not consented, and who may or may not feel “enhanced” by the procedure, then the action is a bodily assault. The problem is not “mutilation,” therefore, but consent (or lack thereof).

      As a final point, again, I think there is a pragmatic concern here as well. I am from the United States, and so most of my friends are circumcised. Some of them feel upset about this, but the very large majority do not. If my goal is to reduce the prevalence of circumcision in the United States, then, I will immediately undermine myself if I walk around to all of my friends and try to convince them that they have been “mutilated.” They will simply not agree, they will react defensively, and they will stop listening to my arguments. So why don’t I say “MGM”? For the same reason that I don’t say, “Let’s ban it!” — in both cases, I think to do so would be counterproductive, at least given the current state of the discussion.

      Thank you again for considering my views, and I would be happy to learn what you think in light of my comments.

      Warmly,

      Brian

      P.S. Please do not apologize for having bad English; your English is very good, and you express yourself eloquently and with conviction.

      • Helmut says:

        Thank you very much for your clarifications. I have learned a lot. But in the end my English is indeed too bad for a real participation on this difficult discussion. It takes too long to translate my thoughts. I regret that.

        Let me just add a remark concerning what is contraproductive and what is not in these discussions. I am sure you know that right after the Cologne court decision some representatives of religious groups in Europe said that a ban on circumcision would be like a new holocaust. Some said the ban would be even be worse than the holocaust. This kind of statement goes on and on until today.
        What I want to say by this: productivity in discussions is not a one-way road.

        • I certainly agree with you that the unproductive language flies both ways in this debate – and you’re right to point that out. Thank you, Helmut, for engaging with me on this topic; I’ve really appreciated learning your views and thinking through their implications. Let’s keep being in touch.

          Best,
          Brian

  • Justin Caouette says:

    Excellent post and great idea, Brian. I think I will follow suit and post something similar in the near future on my blog. Well done!

  • Helmut says:

    I am sure you remember the angry reactions on this blog about one year ago by some american intactivists and I am also very sure that you know that most (if not all) german intactivists (very prominent persons, not just “folks”) had been and still are voting for a ban. Some of these prominent german personalities (Franz, Putzke, Hartmann, Herzberg and others) have just published a comprehensive book on the issue. Many more european intactivists ( in Scandinavia for example) are also fighting for a ban.

    I would be very interested to learn what you would like to tell them. Are they all incompetent on “cultural dialogue”? Is it their fault that there is a “backlash” and an “immunization” by the german circumcision law? How should they initiate a dialogue with representatives of religious groups for whom just discussing this matter is blasphemic or antisemitic?

    Nobody will and can seriously oppose “cultural dialogue”. But as for me it is not sufficient, much too abstract and, as I said, needs both sides. I still believe that using the “Background Argument” as an argument against a ban of NTC while ignoring it concerning FGM is a inacceptable double standard. And I am not able to speak for “harm reduction” knowing for sure that this is impossible for neonatal circumcisions.

    Again:, Brian, I appricate your articles and thoughts very much, and I thank you for listining to my obviously bad English. A challenge for me on both aspects…

    • Thank you, Helmut, for your further thoughts. I have a lot of respect for Putzke and other German scholars on this issue, and I agree that circumcision is in serious tension with the right to bodily integrity as enshrined in the basic law of Germany. I can’t speak for their skills at “cultural dialog” because I haven’t seen any specific efforts to engage in it, although I do recognize that the response from at least certain Jewish representatives in Germany has been to “short-circuit” the conversation by bringing up anti-Semitism, rather than actually engaging with the ethical and legal arguments being raised by Putzke and others — a point I bring up in this essay: https://www.academia.edu/2589570/Criticising_religious_practices. I guess all I can say is that my thoughts on “banning” are shaped by the situation in the United States more than in Europe. In the US, I think a ban would be counterproductive, because circumcision is so taken for granted. I also think that such a measure currently does not stand a chance in the United States, although I don’t tell others that they should not be calling for a ban: I simply don’t feel that’s the best approach for me, given my particular set of skills. In Europe, a ban might be more successful, but note that there is some serious scholarship, such as that recently done by Joseph Mazor, to question whether indeed a ban is indeed justified, all things considered, and not all legal scholars in Germany agree with the position of Putzke, Merkel, and others. One point on which we certainly agree is that the current legal attitude of most Western countries concerning “FGM” versus male circumcision is entirely inconsistent, and shows a morally indefensible double-standard. This double-standard could be resolved either by being more permissive of “mild” forms of FGM, or being less permissive of male circumcision; but, given the state of the conversation on FGM (such that I don’t think it’s very likely that even “mild” forms will ever be permitted), then the only logical solution for the sake of moral consistency is to prohibit most forms of male circumcision done without consent or a medical diagnosis. Believe me, Helmut, I am entirely sympathetic to your point of view. I appreciate your arguments and your passion. There are many different factors to take into account, and while I think we share the same end-goal, we might simply have different approaches for how to achieve it. I do wish you all the best in your efforts, and if various bans are enacted in Europe, I guess we will be able to see whether they are effective or not, or lead to more harm than good.

  • Todd says:

    Just want to say I appreciate your level headedness and clarity. It’s really helpful for me to have your example before me, when I am tempted to get emotional and defensive in debate. #2 and #3 are really key things that I’ve found as well, and are easy to forget in the heat of argument.

  • Michael Glass says:

    There appear to be similar problems about ritual slaughter of animals. I can’t understand why it should be religiously taboo to stun an animal before slaughter. The stunning of animals doesn’t seem to be a problem for Australian Muslims. See http://kb.rspca.org.au/What-is-halal-slaughter-in-Australia_116.html Why should it be different in Europe?

    In the matter of circumcision there are so many things that could be done to reduce its harm. Here are a few suggestions:
    * Treating the forced circumcision of men as a serious crime. I believe it should he treated as a sexual assault.
    * Insisting that before anyone is circumcised he is tested for any bleeding disorder.
    * Insisting that before anyone is circumcised that proper infection control procedures be observed.
    * Insisting that unqualified people be banned from performing circumcisions.
    * Insisting that incompetent people be stopped from performing circumcisions.
    * Insisting that children should not be circumcised without the written agreement of both parents. If parents disagree then the owner of the foreskin should decide, when he’s a grown man.
    * Discouraging harmful traditional practices such as oral suction of the circumcision wound.

    None of these provisions would ban circumcision but they might reduce the really bad outcomes. And that would be an ethical improvement in itself.

    • Helmut says:

      There is one issue, Michael, that you left out: the pain management during and after neonatal circumcision. There are some interventions (penile block, caudal block, topical cream, sucrose etc.) that are discussed and studied but none of them are sufficient to surpress the pain completely. This needs to be ethically adressed as well.

      But anyway. Most of the suggestions you made are included in the German circumcision law and I assume that there will be similar regulations in some Scandinavian countries in the very near future. The aim of these laws and regulation is “harm reduction instead of prohibition”.

      But I wonder if this harm reduction policy that oviously works successfully in some issues, for example drug addiction, will work on ritual circumcision. The German circumcision law legitimates circumcisions on minors not only for religious oder medical reasons but for ANY reasons with the consent of both parents, and there is no possibility to prevent parents to circumcise their male minors for educational or any ideological reason. Furthermore because of the legal legitimation of circumcision more surgeons could be encouraged to circumcise because of penile “diseases” like “physiological” or “primary” phimosis instead of offering a steroid cream treatment. This is a serious and often discussed issue in Germany also because it can be assumed that many muslim circumcisions are funded by the public healthcare system after they had been diagnosed as “phimosis”. For all these reasons more children in Germany are tend to be at risk because of harm reduction policies.

      Why are harm reduction policies successful? One important reason is the common agreement that, for example drug addiction, is a dangerous habit that produces serious harm to one’s health and high costs for the public health system. That’s not the case with ritual or the “medical” circumcision in America. On the contrary: these circumcisions are deeply rooted in religious oder cultural customs. But as far as I can see the reduction of American circumcision rates are not founded in “cultural dialogue” but due to the increased number of Latino immagrants, who do not circumcise, and the denial of the public healthcare system of some states to take over the costs.

      As I said before nobody can seriously oppose “cultural dialogue” or “harm reduction policies” but I am still missing the ethical rationales that in the mean time the circumcision practices go on and on. In my point of view we have to act in both ways at the same time: harm reduction AND – as an aim – prohibition and not harm reduction OR prohibition.

  • Michael Glass says:

    Hello Helmut,

    I think you have made some very good points. While it would be hard to argue against some of the points I have raised, other problems would not be touched by my list. The first one, of course, is pain control for infant circumcision, I don’t have an answer to that one, except to say that the issue of pain control need to be publicised.

    The second problem is the question of who has the right to authorise a circumcision. If it is the parents, then parents without a religious reason to circumcise would be able to have their sons circumcised. If it is only for religious and medical reasons, then there is sure to be bogus claims of religious belief or medical conditions like phimosis, as well as complaints from parents who claim that their “right” to circumcise their son is denied on the ground of a religious test.

    The best that the law can do may be to ban forced circumcision of men and older boys, to prohibit unqualified operators, to help weed out incompetent operators, to help discourage harmful traditional practices (like oral suction of the wound) and to insist that if parents don’t agree on circumcision, then the boy must be the one to decide when he is an adult. Even if this is the most that the law could do at this time, it would still be a great advance on the legal free-for-all that prevails at the moment.

    If the aim is to ban juvenile circumcision, then my proposals would be woefully inadequate. However, in a climate where two powerful religious groups insist on circumcision, and many doctors also favour the practice, this might be the most that could be done at this time. In that case, all I could ask is please don’t make your aim to ban juvenile circumcision the enemy of a modest reform that might reduce the harm of circumcision.

    • Dear Michael and Helmut,

      I strongly recommend reading “Female ‘Circumcision’ in Africa: Dimensions of the Practice and Debates” which discusses, among other things, the use of legislation to try to “eradicate” female genital cutting practices, and shows how very poor outright “bans” are at actually getting rid of the practice. MUCH more effective are educational campaigns, allowing the individuals committed to the practice to decide to give it up themselves. Whether the same would be true of male circumcision is not certain, but there are too many parallels not to try to learn from the example of anti-FGM legislation (which has been almost a total failure). Here is a link to the chapter I’m referring to (click on the first item; if the link doesn’t work just go to Google Scholar and type in the title of the chapter):

      http://scholar.google.co.uk/scholar?hl=en&q=female+circumcsion+in+africa%3A+dimensions+of+the+practice+and+debates+shell-duncan&btnG=&as_sdt=1%2C5&as_sdtp=

      Here is a relevant passage:

      Strategies to Eliminate Female Genital Cutting: “Eradication” Efforts:

      By juxtaposing divergent views, based respectively on idealistic and pragmatic perspectives on change, we are forced to confront a profoundly moral dilemma in regard to what Obiora calls “interim transitional strategies” (Obiora 1997:365). Should we assist in the improved health of women while lending legitimacy to a destructive practice? Or should we hasten the elimination of the practice while allowing girls and women to die from preventable conditions? In many African communities, particularly those only recently confronted with disapproval of female genital cutting, “circumcision” will for the time being be performed, the only question being under what conditions. The debate forces us to look more critically at some of our own assumptions and question why those who recoil in horror at the thought of African girls being genitally cut for the sake of marriageability spend no effort reflecting on the numerous, nonmedically indicated surgical procedures performed on Western women to make them more desirable (one anthropologist once remarked about breast implant surgery: “You don’t hear anyone call that `mammary mutilation.”‘). However, as has been pointed out by Gunning (1997:457), for example, and others, medicalization of female genital cutting may, as has been the case with birth, lead to it coming under the control of male practitioners of biomedicine, thus resulting in loss of female influence.

      If FGC can, in fact, be legitimately opposed on the basis of its health consequences, the question remains as to how women’s health can best be protected. Some opponents advocate that legislation against female “circumcision” is a compelling solution. For example, Laila Bashir argues that criminalization will assist in deterring the practice by “fostering an environment . . . that is clearly intolerant to FGM” (Bashir 1996: 13), and Gunning concurs that “for those who are opposed to the surgeries already, the law could provide that extra needed support against social pressures to circumcise their daughters” (Gunning 1991 1992:228 229).” This view is receiving increasing support from Western nations, whose influence through economic means is perceived to threaten countries that do not outlaw or formally denounce all forms of genital cutting. The U.S. State Department now requires for its Human Rights Report that individual countries produce evidence of legislation or bans against FGC. …

      Formal legislation has proven, however, to be a poor instrument of cultural change. The few attempts to outlaw clitoridectomy or infibulation in Africa have been largely unenforceable. For example, the 1946 law criminalizing infibulation in the Sudan caused public uprisings, and following its enactment the prevalence has actually increased. Moreover, such efforts have triggered unexpected incidents of backlash, both in anticipation of and in response to legislation. When the British in 1945 made it known that infibulation would soon become illegal in the Sudan, “parents rushed to have their daughters infibulated, resulting in what one British observer reported as an unprecedented orgy of bloodletting” (Boddy 1991:16). Similarly, communities in varied locales that have been targeted by anticircumcision campaigns following film and media exposure have feared the enactment of legislation and have responded by performing excisions on all uncut females, including newborn infants (Eliah 1996; Chapters 11 and 12 in this volume). In Chapter 7, Thomas discusses the ban on clitoridectomy in the Meru District of Kenya in 1956, when adolescent girls defied the ban by excising each other.

      Many advocates for women’s health fear that legislation against genital cutting may result in increased risks for young girls and women as the practice goes underground. In a parallel to the abortion debate, it has been argued that victims of botched infibulations may simply be allowed to bleed to death rather than receive medical care when parents, circumcisers, and community members fear prosecution. In response to such a fear, in 1994 the Egyptianminister of health lifted a 1959 ban prohibiting health professionals from performing FGC. Since it is illegal for unqualified health professionals to perform surgical procedures, the regulation meant that no individuals were legally allowed to perform FCG (Toubia and Izett 1998). The 1994 reversal of this decree opened the opportunity for medicalization, with the intent of reducing harm and risk of death. However, deaths following medically supervised genital operations attracted widespread media attention and international scrutiny, resulting in a reinstatement of the original ban.

      Despite the fact that legislation has been shown to be a poor tool for effecting change, under international pressure legislation continues to be drafted.” According to Toubia and Izett (1998), in 1994 Ghana became the first independent African nation to pass an explicit law prohibiting FGC. Similar laws have now been passed in Burkina Faso, Togo, the Central African Republic, Djibouti, and most recently in Senegal. The case of Senegal tragically illustrates the fact that legislation may, in some instances, actually undermine the success of programs aimed at ending FGC. Through a basic education program designed and implemented in 1998 by the Senegalese nongovernmental organization (NGO) Tostan, thirty one villages publicly pledged to end the practice of female “circumcision” (see Chapter 13 for a more complete account). The success of this voluntary abandonment of FGC was reportedly stalled by opposition to a coercive law (The Economist, February 13, 1999), and top down authority is being defied by communities who are continuing to “circumcise” girls, thus challenging whether the law will actually be enforced. Mackie’s response, once again, emphasizes the limited utility of legislative action: “You simply can’t outlaw cultural practices …. It is not possible to criminalize the entirety of a population, or the entirety of a discrete and insular minority of the population, without methods of mass terror. People have to decide to stop on their own” (The Economist, February 13, 1999).

      An alternative view sees neither education, medicalization, nor legislation as central to attempts at eradication but argues instead that a decline in the incidence of female genital cutting will be the consequence of larger social change. This has been termed the “development and modernization approach.” It is suggested that improvements in socioeconomic status and education, particularly for women, will have far reaching social effects, including a decline in the demand for female “circumcision.” Indeed, such changes have been shown to have an important effect on morbidity and mortality patterns (van der Kwaak 1992). Recognizing that “circumcision” is in many African societies a prerequisite for marriage and that marriage and children are vital aspects of women’s roles and economic survival helps to contextualize this practice in a larger social setting. Hence, it is believed that effective change can occur only in the context of a women’s movement directed at the social inequality of women, particularly economic dependency, educational disadvantages, and limited employment opportunities (Gruenbaum 1982). It leas been argued, however, that changing social conditions will not automatically change strongly held beliefs and values on female “circumcision”; it is ,till important to convince men and women that female “circumcision” has an overall negative effect on their lives (van der Kwaak 1992).

      Others scholars stress that in the context of development and modernization, the practice of female “circumcision” is actually spreading. Leonard’s 1 1996) research among the Sara in Chad reveals that excision is a recently ac,luired practice, dating back only a single generation in some subgroups. Mackie (1996) reports that the practice of infibulation is spreading in the Sudan from the Arabized north to western and southern Sudan. He suggests that in urban areas, the less advantaged adopt the practice of infibulation to make their daughters more marriageable to the high status Arab traders that migrated from northern Sudan. Similarly, Pia Gallo and Franco Vivani (1992) report that infibulation, unknown a century ago among the Sab of Somalia, was adopted to emulate the nobility. Further El Dareer finds that reinfibula-tion is associated with urban residence and higher levels of education in the Sudan, and Lightfoot Klein (cited in Balk 1996b:14) concurs that the practice was initiated by wealthy Sudanese women within the past fifty years.

      Mackie (1996 and Chapter 13 in this volume) similarly criticizes the “development and modernization” approach and proposes an alternative strategy modeled after successful efforts that eliminated footbinding in China. Footbinding, which was practiced on women in China for 1,000 years, ended in a single generation once successful eradication campaigns took hold. Mackie points out that footbinding and infibulation share a number of features in common, including near universality in communities where practiced and the aim of controlling sexual access to females and ensuring chastity and fidelity. Mackie argues that both “female genital mutilation” and footbinding are conventions maintained by interdependent expectations in the marriage market; once in place, conventions regarding access to reproduction are deeply entrenched since those who fail to comply also risk failing to reproduce. For footbinding, eradication efforts focused not only upon education about negative health consequences but also on forming associations of parents who pledged not to bind the feet of their daughters or let their sons marry women whose feet had been bound. Mackie suggests that the development of a similar “convention” approach for the elimination of female genital cutting may, as in China, decisively lead to change. Interestingly, whereas most suggestions for change include the caution to proceed slowly, Mackie’s model and the Tostan project involve rapid change once a convention shift is in place. Although the Tostan initiative is arguably the most promising initiative for eliminating FGC, it does not necessarily indicate that rapid abandonment of FGC is imminent across Africa. As Shell Duncan (in press:21) notes, “The time required to change beliefs and establish a consensus may take years in some societies. Parallel to the case of drug use, delivering the message of `just say no’ in this case to female `circumcision’ is much more simplistic in principle than application.”

      A few communities have also experimented with alternative initiation rituals for girls, what Hernlund calls “ritual without cutting.” In areas where FGC is associated with coming of age ceremonies, it is thought that a noncutting ritual event can contribute to elimination of the physical procedure. Most well known is perhaps a project in Meru, Kenya, run by Maendeleo ya Wanawake Organization (MYWO) and the Program for Appropriate Technology in Health (PATH), in which a number of communities have organized events classified as “circumcision with words.” In six years of operation, the project has prevented just over 1,000 genital cuttings (a formal evaluation of the project is forthcoming from the Population Council).” Likewise, the I Igandan group REACH received a UN award in 1998 after conducting similar replacement rituals in Sabiny communities. More recently, the Water for Life project in Somalia has carried out alternative rituals for girls, including .embolic infibulations (Gallo, personal communication). The success of such projects remains to be seen, however. A recent report from Uganda cautions that in the most recent “real” female initiation among the Sabiny, there was an increase in participation of 300 percent (Newsweek, int. ed., July 5, 1999:46).

      In Chapter 12 of this volume, Hernlund describes the first such alternative ritual carried out in the Gambia. Although the success of these rituals remains to be seen, she argues that in the Gambian context these events have she potential to accomplish more than simply eliminate genital cutting and may assist in creating what one recent article terms “communities of resistance” (James 1998:1045). She cautions, however, that not everyone agrees that these rituals make sense, a view echoed by both Mackie and Johnson. In addition, Ahmadu warns that in the context of war torn Sierra Leone, the idea of “new ritual” has taken on a far more sinister character. Nonetheless, in areas where FGC is closely tied to rites of passage, noncutting ritual may often be applicable, especially in political climates in which activists struggle to deiced themselves against the argument that “to give up female `circumcision’ is to give up one’s culture” (see Chapter 12).

      In the preceding summary, we have for reasons of analytic clarity presented intervention strategies as if they were discrete and mutually exclusive, although in reality most campaigns combine a variety of strategies (see also Kratz 1994:346). “Integrated approaches,” suggests one commentator, “combine domestic legal and nonlegal approaches, international standard setting, and technical assistance and monitoring, with grassroots health and education campaigns” (Lewis 1995:45). Another scholar argues that it is the role of research “to show that these practices are unlikely to be challenged by a simple argument or to be changed by a single intervention” (Obermeyer 1999:97), and it is our hope that this collection of essays is a step in this direction.

  • Helmut says:

    Thank you very much, Brian, for this very instructive summary of the Pros and Cons of the female genital cutting policies in Africa.

    I would agree that there are some parallels that have to be considered but in the end I am still not convinced. Without being able to discuss the details I suppose that there are much more differences then parallels. I think we would agree that there had been (and still are) a lot of differences between Africa on one hand and Europe and the US on the other hand concerning politics, power, jurisdication, access to information, social and economic development, religious and cultural believes, gender mainstreaming and so on and on. Because of this even if you prefer “cultural dialogue” instead of banning circumcision of minors in the Western world this dialogue would have to be very different compared to Africa.

    In two previous articles you mentioned “acces to information” and comparing own cultural views with the ones of others by travelling around als “agents” of cultural change. Let’s take the German Jews as an example: they are in general very well educated and have any access to any information. They continue to circumcise although they know (most of them) everything about the (possible) negativ outcomes of their rite. Information will cange nothing for them because they follow a religious commandment. And second: they don’t have to travel because they are as a minority surrounded by a culture that has very differing views on circumcision.
    That means that some of the most important policies to abondon female circumcision in Africa do not work somewhere else unter diiffering circumstances.

    Nevertheless I would never give up “cultural dialogue”, participate on it as much as I can and will continue to learn from others.

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