Date: Sat, 18 Mar 1995 10:11:48 -0500
From: CircInfoNe@aol.com
Subject: Action Alert!


              EDITORIAL
                         FEMALE GENITAL MUTILATION
>From American Medical News, 13 March 1995

     We take it for granted in Western culture that girls will enter
womanhood with their sexual organs intact.  That's not always the case in
other parts of the world. 
     An estimated 80 million to 110 million women worldwide have undergone
medically unnecessary surgery of their genitalia -- so called female
circumcision -- to meet the cultural and religious demands of the
societies they live in. 

     The practice of female genital mutilation clashes profoundly with our
own Western values.  Increasingly, physicians in this country are finding
themselves caught in the middle of this cultural conflict. 
     Doctors con expect to encounter the after-effects of the surgery when
treating immigrants and students on visa from Africa, the Middle East and
Muslim area of Indonesia and Malaysia.  Even more troubling, some
physicians may be asked by parents from those cultures to have the surgery
performed on their daughters. 
     The AMA has developed guidance for physicians.  At its most recent
meeting, the AMA House of Delegates adopted a report from the AMA Council
on Scientific Affairs calling on physicians to actively discourage the
practice.  To further protect female patients the AMA pledged to make
female genital mutilation illegal here -- that there is no federal law
against it is in itself disturbing -- and to join with other organizations
seeking to ban it worldwide. 
     The origins of the practice are largely in superstition, medical myth
and misguided religious interpretation. (one common belief is that Islam
requires the practice.  It does not, although some fundamentalists
disagree.) Nevertheless, in societies where the practice is normative, the
genuine threat of becoming an outcast creates tremendous pressure to have
it one. 
     Cultural relativists may embrace the abstraction that we shouldn't
pass judgement on practices that aren't acceptable in our own culture.
Let's weigh that against the medical and physical realities of female
genital mutilation.  It's dangerous.  It's medically unnecessary.  And
it's downright shocking.  Even in the detached language of the AMA council
report, the descriptions of excision and infibulation, the two main types
of mutilation, chill the soul. 
     Excision is the milder procedure.  It entails a "clitorectomy and
sometimes the removal of all of the labia minor." 
     Infibulation consists of the removal of the entire clitoris, the
whole of the labia minor and at least two thirds of the labia majora
     "The two sides of the vulva are stitched together by silk or cat gut
or held together by thorns.  A small opening is left -- usually by the
insertion of a match stick -- for the passage of menstrual blood and
urine. The legs of the girl are then bound hip to ankle for up to 40 days
so that scar tissue will form." 
     The typical age for female genital mutilation is 7, although girls
from infancy to puberty are at risk. 
     The greatest immediate risk is death from hemorrhage.  In England
alone four girls have bled to death since 1978.  The worldwide number is
unknown.  The practice can lead to a number of other serious medical
problems -- shock, damage to the urethra or anus, sterility, infant-
threatening complications complications at childbirth, and a host of
infections.  Obviously vaginal intercourse is affected as well. 
     Laws against the practice are clearly needed -- especially in the
United States.  Physicians also must take an active role. (The medical
profession's own track record is not pristine -- excisions were done in
this country up to the 1950s, for medical reasons that now appear to ring
hollow). 
     The AMA encourages physicians to educate patients and their families
about the health hazards of female genital mutilation.  The Council on
Scientific Affairs report emphasizes that treatment of the after effects
and counseling against the practice should be done with great sensitivity
to the cultural beliefs of those involved. 
     One option is to suggest social support groups that can help with the
transition to Western culture.  A British group that fights the practice
suggests a sensitive but firm approach," dispelling medical myths and
drawing the parallel to other outmoded practices, such as foot-binding or
use of a chastity belt. 
     Stopping female genital mutilation probably will not be easy.  If the
problem remained far away, it might be easy to ignore it, along with the
other distant cruelties of the world, but it is on our own doorstep now,
and the medical profession's response should not be one of inaction.
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[Thanks to typist George Hill]
Let's wake these folks up!