Ritual Nicks and the American Academy of Pediatrics

For the second time, a sensible effort to prevent female circumcision has been stymied.  Last week, the American Academy of Pediatrics (AAP) bowed to intense pressure and rescinded a policy statement that suggested doctors in certain communities could perform a ritual pricking or nicking of the clitoral tissue. 

Perhaps this outcome could have been predicted by doctors who work at a Seattle-area medical center which serves a large Somali population.  As I’ve previously described on this site:

Many Somali mothers requested that the medical center circumcise their daughters; they were mystified that the hospital would circumcise boys but not girls. The mothers were clear about what they wanted: a symbolic cut on the hood of the clitoris, one that would draw blood but not excise any tissue. The mothers believed that as a cultural and religious matter, some form of genital cutting was necessary. If the hospital did not do it, the mothers would take their daughters to Somali “midwives” in the Seattle area or send them back home. In either event, their daughters would experience far more genital cutting than the mothers were proposing, possibly even complete removal of all external genitalia. The medical center convened a special panel to consider the matter. Eventually the hospital agreed to perform the cut suggested by the Somali mothers, with the use of a local anesthetic, and only on girls old enough to understand the procedure. The hospital was hopeful that this would serve as a transitional measure and that second-generation Somalis would abandon the rite.  (This tale is recounted more fully by Doriane Lambelet Coleman in The Seattle Compromise: Multicultural Sensitivity and Americanization, 47 Duke L.J. 717 (1998)).

When the media got wind of the hospital’s intentions, it was besieged by critics.  Under immense public pressure and the threat of litigation, the hospital abandoned its plan.  Professor Coleman hypothesizes that most of the interests that lobbied against the hospital did not even understand what it was proposing; once they heard “female circumcision,” they stopped listening.

The AAP announced that it  “retracted the policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere else in the world.”  Could anyone seriously have argued otherwise?  The now-rescinded policy was aimed at preventing female circumcision.  It reflected the reality that parents who want their daughters circumcised will find a way to have the procedure done.  Because a ritual nick would save some girls from far more drastic procedures, the AAP should have been congratulated for its pragmatism instead of pilloried for seeming to condone violence and discrimination against women. 

The other point is that anyone who opposes the now-rescinded policy but endorses neonatal male circumcision lives in a glass house.  Like female circumcision, male circumcision is a cultural phenomenon.  (You can read other posts on this point herehere and here, and an article here).  Unlike the sort of ritual nick proposed by the AAP, however, male circumcision involves tissue removal and permanently changes the penis.  Most of us are comfortable with this result because we are socially and culturally accustomed to it.  A ritual nick of the clitoris, on the other hand, is entirely foreign to most people in the United States.  But we should not hold the cultural choices of others to more exacting standards than we hold our own.

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1 Response

  1. Stephanie Farrior says:

    Readers might be interested in the statement issued jointly by the World Health Organization (WHO), UNICEF, UNFPA and UNIFEM regarding the AAP’s (now-rescinded) policy. Amongst other things, their statement says:
    “The AAP new policy statement erroneously states that ‘WHO and other international health organizations are silent on the pros and cons of pricking or minor incisions’. In fact, the 2008 ‘Eliminating Female Genital Mutilation – an Interagency Statement’ signed by 10 UN agencies devotes a full section to the issue of pricking, piercing, incision and scraping.”

    These organizations state: “We are concerned that the American Academy of Pediatrics (AAP) Policy statement . . . contain[s] statements that could weaken the efforts to eliminate the practice. Of particular concern is the suggestion that some forms of FGM are not harmful and can be supported and performed by medical personnel.

    “Convinced that the AAP also wishes to contribute to reaching the objective of ending FGM, we are writing to raise the issues of concern and to strongly encourage AAP to revise its policy statement.”

    Full statement available here: