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05.20.10

Why Are American Doctors Mutilating Girls?

A new proposal by the American Academy of Pediatrics would have doctors assisting families in the ritual of female circumcision, but activist and Nomad  author Ayaan Hirsi Ali says they’d just be complicit in perpetuating a grave injustice.

Update: After only a month of criticism—including from Nomad author Ayaan Hirsi Ali, below—the American Academy of Pediatrics has reversed a policy that advised American doctors to give a ceremonial pinprick to girls of immigrant families so that they would avoid seeking a full circumcision.

The American Academy of Pediatrics recently put forward a proposal on female genital mutilation. They would like that American doctors be given permission to perform a ceremonial pinprick or “nick” on girls born into communities that practice female genital mutilation.

Female circumcision is a custom in many African and Asian countries whereby the genitals of a girl child are cut. There are roughly four procedures. First there is the ritual pinprick. This is what Pediatrics refers to as the “nick” option. To give you an idea of what that means, visualize a preteen girl held down by adults. Her clitoris is tweaked so that the circumcizer can hold it between her forefinger and her thumb. Then she takes a needle and pierces it using enough force for it to go into the peak of the clitoris. As soon as it bleeds, the parents and others attending the ceremony cheer, the girl is comforted and the celebrations follow.

Ali Talks to The Daily Beast's Editor-In-Chief, Tina Brown, About "Nicking"

There is a more sinister meaning to the word “nick” if you consider the fact that in some cases it means to cut off the peak of the clitoris. Proponents compare “nicking” to the ritual of boy circumcision. But in the case of the boys, it is the foreskin that is all or partly removed and not a part of the penis head. In the case of the girls, the clitoris is actually mutilated.

Then there is the second method whereby a substantial part of the clitoris is removed and the opening of the vagina is sewn together (infibulation). The third variation adds to this the removal of the inner labia.

book-cover---from-islam-to-america
Nomad : From Islam to America, A Personal Journey Through the Clash of Civilizations. By Ayaan Hirsi Ali. 277 pages. Free Press. $27. ()

Finally, there is a procedure whereby as much of the clitoris as possible is removed along with the inner and outer labia. Then the inner walls of the vagina are scraped until they bleed and are then bound with pins or thorns. The tissue on either side grows together, forming a thick scar. Two small openings roughly equal to the diameter of a matchstick are left for urination and menstruation respectively.

Often these operations are done without anesthesia and with tools such as sharp rocks, razor blades, knives or scissors depending on the location, family income, and education. It is thus more accurate—as does the World Health Organization—to speak of female genital mutilation (FGM) instead of the obscure and positive-sounding “circumcision.”

According to the American Congress of Obstetricians and Gynecologists, more than 130 million women and girls worldwide have undergone some form of female genital cutting. Some immigrant parents from countries like Egypt, Sudan, Somalia, and others in Europe and the United States, where FGM is common, continue this practice in the West even though they know that it is criminal. Some of them sneak their daughters out of the country during the long school summer vacation so that they can be subjected to any one of these forms of FGM.

Congressman Joseph Crowley (D-NY) recently introduced a bill to toughen federal laws by making it a crime to take a girl overseas to be circumcised. He argued, rightly, that FGM serves no medical purpose and is rightfully banned in the U.S.

While the American Academy of Pediatrics agrees that FGM serves no medical purpose, it argues that the current federal law has had the unintended consequence of driving some families to take their daughters to other countries to undergo mutilation. The pediatricians say that “it might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm.”

But is this plausible? I fear not.

I am familiar with this debate in two ways. First, I come from a culture where virtually every woman has undergone genital cutting. I was 5 years old when mine were cut and sewn. Second, while serving as a member of parliament in the Netherlands, I was assigned the portfolio for the emancipation and integration of immigrant women. One of my missions was to combat practices such as FGM.

To understand this problem, we need to begin with parental motives. The “nicking” option is regarded as a necessary cleansing ritual. The clitoris is considered to be an impure part of the girl-child and bleeding it is believed to make her pure and free of evil spirits.

Tunku Varadarajan: Ayaan Hirsi Ali's Controversial Call to ArmsBut the majority of girls are subjected to FGM to ensure their virginity—hence the sewing up of the opening of the vagina—and to curb their libido to guarantee sexual fidelity after marriage—hence the effective removal of the clitoris and scraping of the labia. Think of it as a genital burqa, designed to control female sexuality.

When the motive for FGM is to ensure chastity before marriage and to curb female libido, then the nick option is not sufficient.

Moreover, the nick option does not address the main problem in Western liberal democracies where FGM is outlawed, which is that it can almost never be detected, so that few perpetrators are brought to justice. Even if we were to consider tolerating it in its most limited form, how could we tell that parents who want to ensure that their daughter will be a virgin on her wedding night will not have her (legally) nicked and then a few months later (illegally) infibulated? I applaud the compassion for children that inspires the pediatricians’ proposal, but they need to eliminate this risk for little girls.

Legislation is only a first step and even with that there is no uniformity. Some states have passed bills that define FGM in all its manifestations and punish it. Some states have none, but place FGM under existing laws of child abuse. So Rep. Crowley’s next move should be to push for uniform enforcement of his bill.

But even once the legislative flaws are fixed, there remains the really difficult question of detection.

For the law to have any meaningful effect in eradicating FGM in the U.S., we need to work out a way of knowing when a girl has been mutilated. As a legislator in the Netherlands, this was for me the thorniest issue. In the United States, where civil liberties are even more jealously guarded, the thorns are likely to be sharper still.

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Ayaan Hirsi Ali was born in Mogadishu, Somalia, and escaped an arranged marriage by immigrating to the Netherlands in 1992. She served as a member of the Dutch parliament from 2003 to 2006 and is a research fellow at the American Enterprise Institute. Her autobiography, Infidel, was a 2007 New York Times bestseller.