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Protecting Children or Policing Gender?

Laws on genital mutilation, gender affirmation and cosmetic genital surgery are at odds. The key criteria should be medical necessity and consent.

By Brian D. Earp (@briandavidearp)

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In Ohio, USA, lawmakers are currently considering the Save Adolescents from Experimentation (SAFE) Act that would ban hormones or surgeries for minors who identify as transgender or non-binary. In April this year, Alabama passed similar legislation.

Alleging anti-trans prejudice, opponents of such legislation say these bans will stop trans youth from accessing necessary healthcare, citing guidance from the American Psychiatric Association, the American Medical Association and the American Academy of Pediatrics.

Providers of gender-affirming services point out that puberty-suppressing medications and hormone therapies are considered standard-of-care for trans adolescents who qualify. Neither is administered before puberty, with younger children receiving psychosocial support only. Meanwhile genital surgeries for gender affirmation are rarely performed before age 18.

Nevertheless, proponents of the new laws say they are needed to protect vulnerable minors from understudied medical risks and potentially lifelong bodily harms. Proponents note that irreversible mastectomies are increasingly performed before the age of legal majority.

Republican legislators in several states argue that if a child’s breasts or genitalia are ‘healthy’, there is no medical or ethical justification to use hormones or surgeries to alter those parts of the body.

However, while trans adolescents struggle to access voluntary services and rarely undergo genital surgeries prior to adulthood, non-trans-identifying children in the United States and elsewhere are routinely subjected to medically unnecessary surgeries affecting their healthy sexual anatomy — without opposition from conservative lawmakers.

Read More »Protecting Children or Policing Gender?

Mandatory submission of patient information about FGM: a pointless, damaging, discriminatory mess

Brenda Kelly and Charles Foster

Female Genital Mutilation (‘FGM’) is a term covering various procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons (WHO, 2012). It can be associated with immediate and long-term physical and psychological health problems. FGM is prevalent in Africa, Middle East and South East Asia as well as within diaspora communities from these countries

The Government, keenly aware of the political capital in FGM, has come down hard. The Serious Crime Act 2015 makes it mandatory to report to the police cases of FGM in girls under the age of 18. While we have some issues with that requirement, it is at least concordant with the general law of child protection.

What is of more concern is the requirement, introduced by the cowardly device of a Ministerial Direction and after the most cursory consultation (in which the GMC and the RCOG hardly covered themselves in glory), by which healthcare professionals, from October 2015, are legally obliged to submit patient-identifiable information to the Department of Health (‘DOH’) on every female patient with FGM who presents for whatever reason, through the Enhanced Dataset Collection (EDC). The majority of these women will have undergone FGM in their country of origin prior to coming to the UK.Read More »Mandatory submission of patient information about FGM: a pointless, damaging, discriminatory mess

Female genital mutilation (FGM) and male circumcision: should there be a separate ethical discourse?

Female genital mutilation (FGM) and male circumcision: should there be a separate ethical discourse? This month, the Guardian launched a campaign in conjunction with Change.org (the petition is here) to end “female genital mutilation” (FGM) in the UK—see Dominic Wilkinson’s recent analysis on this blog. I support this campaign and I believe that FGM is impermissible. Indeed, I think that all children, whether… Read More »Female genital mutilation (FGM) and male circumcision: should there be a separate ethical discourse?