Ending a brutal practice

FOR a group dedicated to the health and well-being of children to advocate the cutting of girls' genitals seems inconceivable. But the American Academy of Paediatrics (AAP), in a review of its policy on the practice known as female circumcision, did tentatively ask if, in order to avoid the most dangerous behaviour, doctors should be allowed to perform some kind of “ritual cut” in the clitoral skin. The academy likened it to ear-piercing and said that it might satisfy the cultural requirements of people wedded to the practice.

After a chorus of condemnation the AAP swiftly released a new statement, anxiously stressing that it does not endorse “clitoral nicks”. Judith Palfrey, the group's president, says there is absolutely no case for it and that doctors must oppose all forms of genital cutting on girls. The academy's British and Australian counterparts, and the UN, have voiced a similar position.

Cutting girls' genitals is still common in 28 mostly African countries and among their migrants abroad. The World Health Organisation (WHO) estimates that 100m-140m women have been subject to the practice and thinks that some 3m girls are at risk each year of one of four forms of cutting, ranging from the symbolic to life-ruining. In countries such as Somalia, Egypt and Guinea, over 95% of women have undergone some version of it.

Some see it as a matter of hygiene, others as a rite of passage into womanhood. Its Muslim, Christian and animist defenders all cite religious grounds. Where the practice is a prerequisite for marriage, economic factors play a role too.

Attempts to stamp out the practice have gathered pace since the 1980s. Now 18 African countries have banned it, although laws are patchily observed. Nawal El Saadawi, an Egyptian who suffered mutilation and has campaigned against it for more than 50 years, says that education is needed, not just prohibition. A mixed approach probably works best. Burkina Faso has a hotline to the police for girls who feel they are in danger. Tasaru Ntomonok Initiative, a group in the Narok district in Kenya, has a safe house for girls fleeing their families. Maendeleo ya Wanawake Organisation, a Kenyan women's NGO, offers “circumcision through words”, an alternative rite of passage without the bloodshed.

A bigger trend is medicalisation. In the past the procedure was typically performed by a local woman using anything from a razor blade to a piece of broken glass, sometimes even using battery acid to stop the bleeding. More families now ask doctors to carry out the cut, in the hope that this will make it safer. A study in Kenya in 2000 showed that using sterile razors, anti-tetanus shots and antibiotics cut the risk of immediate complications by 70%. Such thinking led to the debate in America about whether using doctors was the lesser of two evils. But campaigners against cutting say the use of professionals undermines efforts to end the practice, as making it safer may encourage more parents to inflict it on their daughters.

The unkindest cut

Ayaan Hirsi Ali, a public intellectual from Somalia who renounced Islam and now lives in America, is entirely against the practice, even the symbolic form. She argues that “the motive for cutting off a girl's clitoris is to reduce her sexuality”. Most Western countries ban it: in Britain, where around 66,000 women have undergone some form of cutting and some 33,000 girls are thought to be at risk, it is also a crime to take a British resident abroad in order to cut her. American campaigners want a similar law.

The idea that a legalised symbolic cut would be the lesser of two evils is not new: it was discussed and rejected in Germany and the Netherlands, for example. A hospital in Seattle, the Harborview Medical Centre, considered it in response to requests from local Somali women, who wanted an alternative to the extreme versions of the practice (which can involve forcing the almost complete closure of the vagina with scar tissue). The suggestion brought a storm of abuse.

Dena Davis, a law and ethics professor at Cleveland State University and the legal consultant on the AAP's policy review, says that she personally favours considering a symbolic cut, because of the potential for harm reduction. She cites Indonesia, where cutting has died out, according to the WHO, but a ritual form persists, involving a symbolic scratch of the clitoris.

The weakest point for the critics of cutting girls' genitals is that it is still so prevalent where boys are concerned. No laws exist against male circumcision in any Western country. No records are kept of circumcisions performed outside of hospitals and there is no regulation of ritual practitioners. The AAP took a neutral stance on male circumcision when it last considered the practice in 1999. The policy is up for review in the next year or so. Supporters of it may note that male circumcision is unlikely to lead to, or provide cover for, the extreme mutilation that happens too often with female cutting. Many also believe that male circumcision is helpful in slowing the spread of HIV/AIDS.

Ms Davis argues that in America at least, it is not acceptable to criminalise all female genital cutting while adopting a relaxed stance to the male sort. She suspects that by allowing male circumcision while forbidding even a symbolic cut on girls, Western countries show respect for only those religious and cultural practices with which they are already comfortable.