Professionals should not collude with abusive systems

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7012.1088b (Published 21 October 1995) Cite this as: BMJ 1995;311:1088
  1. Janet Menage, General practitioner
  1. Holbrooks Medical Centre, Coventry

    EDITOR,--J A Black and G D Debelle do not go far enough in their article on female genital mutilation.1 They state, “genital mutilation is a form of child abuse, though this term should not be used when discussing the procedure with families as it would be greatly resented.” This suggests that the feelings of the families and doctors should be given precedence over the feelings of the child(ren) being permanently mutilated. This represents collusion with an abusive system, which, unfortunately, is not unusual when children's feelings are concerned.2

    They state that “there is little point in prosecuting parents for something which has already occurred.” If this principle was applied wholesale there would be no point in having a law prohibiting the act, nor would any prosecutions be brought for acts of sexual abuse, of which genital mutilation is a gross example.

    In addition, they state that “genital mutilation differs from other forms of child abuse in that it is done with the best intentions for the future welfare of the child.” This represents another collusion with the abusive system: there is no benefit to the child. The only people to benefit are the oppressors who wield their power within that particular culture.

    The authors seem to dismiss the importance of resulting psychological trauma. In my research on post-traumatic stress disorder in women who had undergone obstetric or gynaecological procedures I found that women could be severely traumatised psychologically by painful, mutilating vaginal procedures that were carried out without clear consent in an unsympathetic environment.3 Obstetric and gynaecological procedures are an accepted form of medical practice in Britain that women are taught to expect, yet women may still develop posttraumatic stress disorder as a result of their “culturally accepted” experiences.

    Black and Debelle casually refer to “male circumcision” as if it is benign. It is also medically unjustifiable genital mutilation, which is sanctioned by a culture purporting to be civilised.4 5

    It is time that genital mutilation was banned completely and that the medical profession faced up to its collusion in the harming of patients.


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