R. S. Stewart. Draft. Not for use outside of phil 2222 without the consent of the author

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R.S. Stewart. DRAFT. Not for use outside of PHIL 2222 without the consent of the author.

Section 2: Genital Alteration (GA) and Female Genital Mutilation (FGM)

Female Genital Mutilation (FGM) is defined by the World Health Organization (WHO) as “[a]ll procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons” (WHO, 2010). They specify four different types: (1) removal of the clitoral hood, almost invariably accompanied by removal of the clitoris itself (clitoridectomy); (2) removal of the clitoris and inner labia; (3) infibulation -- removal of all or part of the inner and outer labia, and usually the clitoris, and the fusion of the wound, leaving a small hole for the passage of urine and menstrual blood—the fused wound is opened for intercourse and childbirth; (4) Several miscellaneous acts ranging from a symbolic pricking or piercing of the clitoris or labia, to cauterization of the clitoris, cutting into the vagina to widen it (gishiri cutting), and introducing corrosive substances to tighten it (WHO, 2010).

According to the WHO, FGM is practised in 28 countries in western, eastern, and north-eastern Africa, in parts of Asia and the Middle East, and within some immigrant communities in Europe, North America, and Australasia. The WHO estimates that 100–140 million women and girls around the world have experienced the procedure, including 92 million in Africa. Around 85 percent of women who undergo FGM experience Types I and II, and 15 percent Type III, though Type III is the most common procedure in several countries, including Sudan, Somalia, and Djibouti (WHO, 2010).

According to Xiaorong Li (2001), we in the developed world living under democratic and liberal governments, have a series of issues to sort out regarding what our stance ought to be towards FGM. Most importantly: How should we treat it within our (liberal democratic) borders, and how we should react to it when performed in other countries? Since 1996, performing a “clitoridectomy” (type 1 FGM) on underage persons in the United States has been a crime. The U.S. has also condemned the practice in other countries, and has at times placed economic sanctions on those countries which haven’t outlawed FGM. In addition, the U.S. has granted asylum to some who have fled from their home countries in order to escape coerced FGM.

This policy of the U.S. government has been applauded by human rights activists and many liberals who insist that harming someone without their consent is simply intolerable, either at home or abroad. But others have suggested that such an attitude smacks of cultural imperialism and of our colonial past where we imposed our cultural views on others. Moral relativists in particular maintain that we must not interfere with the cultural practices of others, whether they are minorities within our borders or majorities living in other countries. Li suggests and argues for a third possibility; that we ought to work toward a ban of the practice in other countries where, she maintains, it is very difficult for women of any age to refuse the procedure and where girls are typically subjected to the procedure when they are underage and hence cannot consent. Internally, however, we ought to be tolerant of the practice so long as it is performed consensually on adults. Let us look at this more closely.

The first thing to note about this debate is that supporters of cultural practices that involve some form of genital alteration object to the phrase FGM. In their minds, it is not mutilation and hence we ought to refer to such practices as genital alteration or clitoridectomy. For the purposes of this discussion, then, let us refer to the practice, in whatever form, as genital alteration/female genital mutilation (GA/FGM).

Anthropologist Richard Shweder is opposed to Western nations interfering in AG/FGM practices. In particular, he maintains that any attempt to criminalize AG/FGM internally or abroad is nothing but an “official attempt to force compliance with the cultural norms of American middle class life” (cited in Li, 2001, p.5). Moreover, defenders of GA/FGM maintain that circumcision plays a central role in their culture. As the Nigerian born medical doctor, Nowa Omoigui (2001), says: “Our children do not speak our language, do not wear our clothes, do not practice our religion, and our ancient customs are under assault. In 50-100 years we will be unrecognizable as a distinct cultural entity – all under the guise of globalization. Is this beneficial? To who? This rush to western judgement will have to be slowed down at some point.” In a sense, this argument is reminiscent of the one put forward by Devlin, which we discussed earlier in this chapter. That argument asserts that a society has a right (and perhaps a duty as well) to construct laws that are necessary to keep a society from disintegrating.

Omoigui’s claims regarding the preservation of traditional cultures is questionable, however, since we have no evidence to suggest that such cultures will collapse if this practice is abandoned. Conservatives, like Omoigui and Patrick Devlin, tend to assume that all cultural practices are necessary for the survival of the culture. Hence, we hear calls all the time that our society/culture will be destroyed if we allow, e.g., same sex marriage, liberal divorce laws, or allowing Protestants (or Catholics, or Muslims, or Hindus, etc.) to practice their religion. Yet, our society has survived (or is in the process of surviving) all these changes without disintegration. That does not mean that our societies have remained the same. Clearly, they have not. But the disintegration argument should not be taken as a carte blanche defense of the status quo, even though it has sometimes been used in that way. A society that depends upon slavery, for example, has no right to continue that practice even if it means the society will indeed disintegrate without it.

Particular cultural practices are often defended by a type of moral relativism. Such a position maintains that there is nothing to morality in addition to cultural practices. That is, there is no morally objective and/or universal right or wrong; morality is simply a matter of what one culture chooses to accept as legitimate and illegitimate at a particular point in time. We would argue that there are a number of problems with such a theory, at least in this form. But for our purposes here, we simply need to point out, as Li does, that Shweder’s position does not seem to distinguish what might be illegitimate instances of cultural imperialism with instances of what appear at least to be unacceptable practices from any rational or reasonable perspective – such as widow burning, honor killing, and female infanticide (Li, 2001, p.5). Another way of putting this is to claim that no cultural practice is immune from critical investigation. The fact that many cultures have at one time accepted slavery of other races, ethnicities, or religions does not justify such a practice. Moral relativism, we would suggest, does not run that deep. Thus, the question becomes how we can engage in cross-cultural moral critique.

This is a much disputed issue, which we make no attempt to resolve completely here. Our suggestion, however, is that if there is harm caused to an individual or a group that does not consent to the procedure, and/or is a practice that has no overriding benefit to that same person or group, then the action is at least morally questionable. As result, the burden of proof is on those who want to continue such an action or practice. On the face of it, GA/FGM certainly has the appearance of such a practice since many, both internally and externally, do claim that such practices cause harm. Moreover, the harm is often non-consensual because it is typically performed on girls who are not yet old enough to give their consent. So, if we are going to accept GA/FGM as legitimate, we must at the very least provide some evidence that the practice serves some ‘legitimate’ cultural purpose and/or that, despite appearances, it does no harm.

Fuambai Ahmadu attempts to do just this. She is an anthropologist originally from the Kono of Sierra Leone who as an adult has undergone her own clitoridectomy. According to her, “…women who uphold these rituals do so because they want to — they relish the supernatural powers of their ritual leaders over against men in society, and they embrace the legitimacy of female authority and particularly the authority of their mothers and grandmothers (Ahmadu, 2007). Ahmadu maintains that both male and female circumcision in Kono culture represent symbolically the separation of child from parent and the feminization or masculinization of the child. For women in particular,

Women’s initiation is highly organized and hierarchal: the institution itself is synonymous with women’s power, their political, economic, reproductive, and ritual spheres of influence. Excision … is a symbolic representation of matriarchal power … [by] activating the women’s ‘penis’ within the vagina (the clitoral ‘shaft’ or ‘g-spot’ that are subcutaneous). During vaginal intercourse, women say they dominate the male procreative tool (penis) and substance (semen) for sexual pleasure and reproductive purpose, but in ritual they claim to possess the phallus autonomously (Ahmadu & Shweder, 2009, p. 14).

Female circumcision achieves this, she argues, without harmful effects, sexual or otherwise.

According to the women I interviewed, sexual foreplay is complex and requires more than immediate physical touch: emphasis is on learning erotic songs and sexually suggestive dance movements; cooking, feeding and feigned submission, as powerful aphrodisiacs, and the skills of aural sex (more than oral sex) are said to heighten sexual desire and anticipation. Orgasms experienced during vaginal intercourse, these female elders say, must be taught and trained, requiring both skill and experience on the part of both partners (male initiation ceremonies used to teach men sexual skills on how to ‘hit the spot’ in women – emphasizing body movement and rhythm in intercourse, and importantly, verbal innuendos that titillate a women’s senses. This, from the viewpoint of these women elders, vaginal intercourse is associated with womenhood and adult female sexuality (Ahmadu & Shweder, 2009, p. 16).

Let’s consider these arguments in turn beginning with the claim that there is no evidence to suggest that GA/FGM is harmful. While Ahmadu cites some studies in her work that either reject that GA/FGM adds any health risks or maintains that the increased risks are rather small – less than the risk of maternal smoking, for example (Ahmadu & Shwader, 2009) – the great preponderance of evidence suggests that the health risks of FGM are serious and significant. The WHO study published in the Lancet (2006) was comprehensive and, according to most, conclusive: AG/FGM significantly increases the risks of:

  • recurrent bladder and urinary tract infections;

  • cysts;

  • infertility;

  • an increased risk of childbirth complications and newborn deaths;

  • the need for later surgeries. For example, the FGM procedure that seals or narrows a vaginal opening (type 3 above) needs to be cut open later to allow for sexual intercourse and childbirth. Sometimes it is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing and repeated both immediate and long-term risks (WHO, 2010).

In addition, many have argued that GA/FGM also causes harm by greatly reducing sexual pleasure in women. This is only to be expected. Lots of research shows conclusively that females are much more likely to orgasm from direct clitoral stimulation than from vaginal penetration (and indirect clitoral stimulation). This is why when women masturbate, they typically do so by direct clitoral stimulation, and not by vaginal penetration (see, e.g., Lloyd, 2005). In other words, direct clitoral stimulation is the source of a great deal of pleasure for many women, and this is not possible for those who have been subjected to AG/FGM. Indeed, opponents of GA/FGM say that ending and/or reducing women’s sexual pleasure is the main reason for the practice. By limiting the pleasure that women will receive from sexual activity, women are less likely to be promiscuous and/or adulterous.

As the above passage indicates, however, Ahmadu rejects this. She maintains that while sexual pleasure changes and is differently focused for women after a clitoridectomy, their pleasure is just as, if not more powerful and satisfying. But we need to note that her claims in this regard require that both women and men must commit to a complex set of prescriptions about the nature of sexuality – including its aural elements – and that there is a further commitment by men to learn techniques to pleasure women who do not possess an external clitoris. Many women will surely be skeptical of this, whether we are speaking of men in Wichita, Kansas; Saskatoon, Saskatchewan; or Freetown, Sierra Leone. Moreover, Ahmadu’s prescriptions for sex after clitoridectomy makes no mention of non-heterosexual sex or indeed of non-penetrative sex. How, for example, do her prescriptions apply to lesbian sexual activity?

Finally, we need to note the degree to which Ahmadu’s language here regarding the switch from clitorally induced orgasm to vaginally induced ones mirrors the (sexist) language of Freud in his discussion of the same topic in the early twentieth century. Recall Freud’s arguments, discussed in Ch. ???, that women who focus on clitorally induced orgasms are immature and need to refocus their attention to the vagina if they are to become mature and mentally healthy women. Ahmadu’s claim that “vaginal intercourse is associated with women hood and adult female sexuality” is, many would think, frightening close to Freud’s claims.

Another possibility open to defenders of AG/FGM, is to say that Westerners are too preoccupied with sexual pleasure and orgasm and miss the ‘more important’ elements of sexual intercourse. Yael Tamir (1996, 21) makes such an argument:

Nuns take an oath of celibacy, but we do not usually condemn the church for preventing its clergy from enjoying an active sex life. Moreover, most of us do not think that Mother Teresa is leading a worse life than Chichulina [a former pornographic star and former Member of the Italian Parliament], though the latter claims to have experienced an extensive number of orgasms. It is true that nuns are offered spiritual life in exchange for earthly goods, but in the societies where clitoridectomy is performed, the fulfilling life of motherhood and child bearing are offered in exchange. Some may rightly claim that one can function as a wife and a mother while experiencing sexual pleasures. Others believe that full devotion to God does not require an oath of celibacy. Yet, these views are, after all, a matter of convention.1

Martha Nussbaum (1999) agrees with some of the spirit of Tamir’s claim that we do at times in the West focus too much on pleasure in general and on orgasm with respect to sexual actions in particular. Indeed, part of our argument in Ch.10 regarding the infiltration of large Pharmaceutical Corporations in the promotion of drugs such as Viagra rests on just such a view. But, as Nussbaum correctly goes on to point out, what Tamir misses in her account is that folks like Mother Teresa actively chose their celibacy whereas young girls who have received GA/FGM have not.

There is a great deal of difference between fasting and starvation; just so, there is also a great difference between a vow of celibacy and FGM. Celibacy involves the choice not to exercise a capability to which nuns, insofar as they are orthodox Roman Catholics, ascribe considerable human value…. FGM, by contrast, involves forgoing altogether the very possibility of sexual functioning – and, as I said, well before one is of an age to make such a choice (Nussbaum, 1999, 127).

Considered in this context, Ahmadu’s clitoridectomy was very much an anomaly since she was an freely consented to the practice as an adult. In addition, she made the decision to have her clitoridectomy she was living, and safely ensconced, in the United States. Her clitoridectomy then was indeed analogous to a nun choosing a celibate life, but dis-analogous to the vast number of women subjected to AG/FGM. For reasons such as this, Li (2001) maintains that we should accept the decision of adult women to have a clitoridectomy when that decision is made within the borders of free, democratic, and secular nations. We should not, however, accept the practice in other non-liberal, non-democratic countries, even with respect to adults, because there is too much social pressure placed upon women for them to come to a genuinely free choice. Though there is of course a concern here that women living within minority groups in our culture may also be under social pressure to conform to their groups’ customs. But, she says, we are all under social pressure of some sort and we must trust that people in our culture have the freedom to leave their cultural group without fear of reprisal.

In her discussion of AG/FGM, Nussbaum considers three other arguments that might be presented by defenders of GA/FGM. We shall consider them now, along with her rejections of these arguments.

  1. It is morally wrong to criticize the practices of another culture unless one is prepared to be similarly critical of comparable practices when they occur in one’s own culture….

  2. It is morally wrong to criticize the practices of another culture unless one’s own culture has eradicated all evils of a comparable kind….

  3. Female genital mutilation is morally on a par with practices of dieting and body shaping in American culture… (Nussbaum, 1995, p.121.).

While the claim made in (1) is true, there is no reason to think, Nussbaum argues, that our cultural criticisms have been made only with respect to the cultures of others and not to our own. Indeed, much of the feminist movement has been occupied with just such criticism. The second claim, however, is false according to Nussbaum. No culture could ever attain moral perfection. That ought not to prevent us from legitimate criticism. If it did, we would not have been able to criticize the apartheid policy of South Africa or the genocide perpetrated in various countries such as Cambodia or Rwanda. Moreover, “the fact that a needy human being happens to live in Togo rather than Idaho does not make her less my fellow, less deserving of my moral commitment. And to fail to recognize the plight of a fellow human being because we are busy moving our own culture to greater moral heights seems the very height of moral obtuseness and parochialism” (Nussbaum, 1995, p.122).

The third claim is a bit more complex, however. But it rests on the claim that GA/FGM is morally on a par with our cultural practices of dieting and body shaping. While these practices in our culture are indeed troubling and need to be critically investigated, they are not, Nussbaum argues (1995, pp. 123-124), the same as GA/FGM. Very briefly, they differ in that GA/FGM is irreversible, is associated with lifelong health problems, is performed in unsanitary conditions and is typically performed coercively on children in cultures where illiteracy rates, particularly among girls and women is very high. It is also done in a way that restricts female sexual capability while simultaneously reinforcing male domination. None of these things is true of dieting or body alteration.

Although we agree with Nussbaum’s general point that there is are morally significant differences between GA/FGM and dieting/body alteration, we do take issue with some of Nussbaum’s specific points. In particular, dieting and body alteration, especially in the context of the recent war on obesity and new cosmetic surgeries such as labiaplasty, can be irreversible and/or have lifelong ill effects on health. We suggest, though, that this means that we must continue to urge people to think more critically of such practices and to resist the urge to engage in these practices despite the social pressures to do so. That is quite different than GA/FGM which is typically perpetrated coercively on young girls.

There is one final issue to consider with respect to GA/FGM. Many supporters of these practices maintain that a clitoridectomy in particular is analogous to male circumcision since it too is typically done on an infant who cannot consent to it. An argument could be made that since we allow male circumcision, we must allow clitoridectomies if we are to avoid inconsistency. Let us, then, look carefully at male circumcision with a view to determining whether it is morally on a par with GA/FGM.

The WHO has estimated that 664,500,000 males aged 15 and over are circumcised (30% global prevalence), with almost 70% of these being Muslim. Circumcision is most prevalent in the Muslim world, parts of Southeast Asia, Africa, the United States, the Philippines, Israel, and South Korea. It is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia and Oceania. Prevalence is near-universal in the Middle East and Central Asia. (WHO, 2007). While the WHO (2007) estimates that approximately 75% of all American males and 30% of Canadian males (i.e., from newborns to seniors) are circumcised, these statistics are beginning to change quite drastically. In Canada, rates of circumcision for newborns have dropped from about 50% in 1998 to about 20% in 2000, and to about 13.9 percent for the year 2003 (Canadian Children Rights Council, 2011). In the United States, the drop in rates has been more recent. Up until 2006, more than 50% of newborn males were still being circumcised, but that fell to 32% in 2009 (Circumcision Reference Library, 2010).

Although some types of male circumcision are highly invasive, such as “superincision” and subincision”, which are practiced in some small pockets of the Pacific Islands and among some Aboriginal groups in Australia (Bell, 2005), male circumcision is typically a very minor procedure where the foreskin (prepuce) is removed. It has, that is, no major affect on function, sexual or otherwise. In fact, some males claim that they prefer being circumcised because it reduces the sensitivity of their penis and they can as a result engage in sexual intercourse for longer periods of time before they reach orgasm. This is one of the main reasons why Nussbaum rejects the analogy between male and female circumcision. According to her (Nussbaum (1999, p. 119), “The male equivalent of the clitoridectomy [Type 1 FGM] would be the amputation of most of the penis. The male equivalent of infibulation [Type 3 FGM] would be ‘removal of the entire penis, its roots of soft tissue, and part of the scrotal skin.”

We can take the dis-analogy between male circumcision and FGM even further. All types of GA/FGM, even type 1, have serious deleterious effects both on health and sexual functioning (WHO, 2006; WHO, 2010), which male circumcision does not seem to have. Moreover, though the majority of male circumcisions are carried out for religious reasons, it may be the case that there are health benefits in male circumcision. In particular, to reduce the risk of penile cancer and reduce rates of various types of infection, improved hygiene, and lower incidence of penile cancer, although these claims are disputed by some. This perhaps helps to explain the fact that while no western medical association currently recommends that newborn males be circumcised as part of a regular practice, none of them completely rule it out either leaving it as a matter for parents to decide in consultation with their physician. However, in 2007, the WHO did endorse male circumcision as “an important intervention to reduce the risk of heterosexually acquired HIV” (Cited in Rubin, 2010).

There are no analogous health benefits – claimed or otherwise – for FGM. The main similarities then, between FGM and male circumcision are restricted to: (i) they are performed on the genitals, and (ii) they are typically done without the consent of the one receiving the procedure. Neither of these points necessarily makes male circumcision morally unacceptable though since newborns, infants, and children are often subjected to medical procedures to which they did not, and in fact can not consent. This is allowed for the substitute decision maker, such as a parent, when the procedure is deemed to be medically appropriate. No such argument is available to supporters of FGM since, to repeat, there is no medical reason whatsoever for the procedure.

It seems clear, then, that AG/FGM is problematic, and that there is good reason for those of us in the developed world to be intolerant of having the procedure done on anyone without their consent. This will rule out all instances of AG/FGM performed on underage children. Though the issue is more complex, we also believe, following Li and Nussbaum, that we ought not tolerate AG/FGM being performed on adult women in certain non secular, non democratic countries because it is not clear that women are truly free there to refuse AG/FGM. Following Li, we also suggest that AG/FGM is tolerable when performed on consented adult women in secular, democratic countries. In these cases, however, we must keep a vigilant eye on such practices to ensure that they do not slip into cases where the ‘consent’ is more ostensible than real.

1 Though we won’t pursue the matter here, one could argue that the Roman Catholic Church’s obsession with the celibacy of its nuns, and especially its priests has caused all sorts of problems, and that its unhealthy views on sex has contributed to the many sexual abuse cases that currently haunt that institution.

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