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Cultural Imperialism at the W.H.O.?

The post from World Health Organization researchers on the practice they call female genital mutilation (FGM) has prompted a couple of critical responses from other researchers. One is a comment from Richard Shweder of the University of Chicago, who calls it “bureaucratic boilerplate” and says it’s further evidence that “identity politics has triumphed over science and critical reason at the W.H.O.”

The other is from Bettina Shell-Duncan, an anthropologist at the University of Washington, who has been conducting research in Africa for 10 years on this custom, which she calls female genital cutting (FGC). She has been a technical consultant for the W.H.O. and UNICEF. Dr. Shell-Duncan is the co-editor, with Ylva Hernlund, of two books, “Female ‘Circumcision’ in Africa: Culture, Controversy and Change” and “Transcultural Bodies: Female Genital Cutting in Global Context.” Here’s her response:

I am pleased to see my colleagues from WHO enter into this fruitful and lively series of discussion on TierneyLab. As they note, there is no shortage of research on the health effects of various forms of female genital cutting. Their commentary, however, illustrates three problems that will not be resolved by any amount of further research on the medical consequences of female genital cutting because they are interpretive rather than empirical issues. These are:

1. Conclusions about the “medical sequelae of FGM” are applied to the monolithic, undifferentiated practice, and do not seriously differentiate the risks posed by widely various forms of FGC that are performed under a diverse set of circumstances.

Yes, researchers who review the enormous literature on health risks posed by female genital cutting try to differentiate the magnitude of risk by type of cutting. The conclusions, however, are all too often applied to the entire range of practices that are classified as “FGM” without differentiating the obvious difference in risk posed by varied forms of the practice. Yes, there are blindingly obvious risks associated with infibulations. But it is also obvious that nicking, a practice that involves no removal of tissue or permanent alteration of the female genitalia, is not more risky than forms of male circumcision or body piercing that are widely (though obviously not uniformly) condoned in Western society.

In a 2006 BMJ commentary about the WHO study, Conroy made two points. First, Conroy pointed out the modest magnitude of risk. He noted that that in comparing risk factors in pregnancy, this places female genital cutting (treated as a whole) somewhere behind maternal smoking.

Conroy’s second point was that the results of the study do show that medical risks are not equal for all forms of FGC. He wrote that “for women with WHO type III mutilations (the most severe) there was a relative risk of 1.3 for both caesarean section and infant resuscitations, and 1.6 for stillbirth or early neonatal death, and there was no increased risk for the 32% of women who had WHO type I mutilation.” While the WHO study recognizes that “risks seems to be greater with more extensive FGM,” their conclusion is applied to all forms: “Adverse obstetric and perinatal outcomes can therefore be added to the known harmful immediate and long-term effect of FGM.” This then is used to frame all forms of the practice as a “pressing human rights issue.”

The conflation of all forms of female genital cutting, performed under widely varying circumstances, and labeling all as human rights violations oversimplifies a much more complex reality.

2. The determination of what is non-trivial harm versus acceptable risk is an interpretive question, and those involved in the global campaign to end FGM are answering this question on behalf of practitioners of female genital cutting.

Epidemiological research tells us how much risk of various types is associated with different forms of the practice. This does not tell us how much risk is too much risk. And who gets to decide how much risk is too much risk? Should this be dictated by international organizations? Governments? When does this become a new form of cultural imperialism?

3. The question of consent remains unresolved.

The issue of consent is contested not only for minor girls, but also for adult women. Opponents of FGC have argued that it is impossible for adult women to provide informed consent since only someone who was coerced, manipulated or highly irrational will agree to undergo female genital mutilation. Such opponents of FGC therefore argue that the practice should be banned overall, irrespective of age.

Perplexing and disturbing contradictions arise when this logic is applied to adult African women, but not applied to cosmetic surgeries on Western women. The irony of differential treatment of FGC and cosmetic surgeries has become magnified with the growing popularity in Europe and the U.S. of female genital cosmetic surgeries (FGCS). Such surgeries include labia reduction, labia remodeling, clitoral reductions and vaginal “tucks” (see www.altermd.com). The arrogance of the implication that Western, but not African, women can rise above the pressure of societal norms of ideal physical form in order to provide valid consent is disturbing.

Under what conditions, if any, are adult women capable of providing informed consent to undergo even milder forms of FGC? How is coercion defined and assessed, and what steps can be taken to reduce or eliminate coercion? Are we ignoring the bigger question about how to protect women’s autonomy and right to self determination? With such questions unanswered, I find it difficult to deny adult African women the decision-making authority granted to Western women, and to support a staunch zero tolerance platform. At the same time, it is clear that situations exist in which protective measures clearly are warranted and urgently needed, and in which a hands-off strategy would be as equally unethical as a cultural imperialist approach. This delicate balance will not be found through epidemiological research.

Bettina Shell-Duncan
Associate Professor of Anthropology
University of Washington

Dr. Shell-Duncan raises some good questions. Does a zero-tolerance policy concerning even adults amount to cultural imperialism? And what kind of line should be drawn concerning minors? If, as Dr. Shell-Duncan says, some forms of FGC are no more risky than a male circumcision and make no permanent alteration, should parents be permitted to make this choice for their children?

SOURCE: The New York Times

AUTHOR: John Tierney

URL: Click here

DATE: 01/02/2008

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