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UK colleges criticise “compromise” in US guidance on female genital mutilation

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2586 (Published 13 May 2010) Cite this as: BMJ 2010;340:c2586
  1. Zosia Kmietowicz
  1. 1London

    Two UK Royal Colleges have raised concerns about guidance issued by American paediatricians on female genital mutilation in which they suggest that doctors could offer families “a ritual nick as a possible compromise to avoid greater harm.”

    The Royal College of Obstetricians and Gynaecologists and the Royal College of Paediatrics and Child Health say in a statement that, “To suggest that a qualified medical practitioner is involved in this practice as a ‘compromise’ does not make it less brutal and has the danger of giving legitimacy to FGM [female genital mutilation]. Two wrongs do not make a right. The main objective for all civilised societies has to be the complete eradication of an unacceptable practice.”

    In its guidance the American Academy of Paediatrics, published on 26 April, says it opposes all types of female genital mutilation and advises its members against performing such procedures and to dissuade families from “carrying out harmful forms of FGC [female genital cutting].”(Pediatrics 2010;125:1088-93; doi: 10.1542/peds.2010-0187)

    The Royal Colleges say that in many areas the US guidance echoes their own views that female genital mutilation is “essentially barbaric, resulting in long-term morbidities and needless distress for women.”

    The US academy reminds doctors that performing any non-medical procedure on the genitals of a female minor, including nicks, is a criminal offence in the US and constitutes child abuse.

    However, in a section entitled “Education of patients and parents” its guidance says that in some countries where female genital mutilation is a common practice “substituting ritual ‘nicks’ for more severe forms” of mutilation is helping to eliminate the practice.

    The academy contends that a “nick” is not physically harmful and “is much less extensive than routine newborn male genital cutting.”

    It adds, “There is reason to believe that offering such a compromise may build trust between hospitals and immigrant communities, save some girls from undergoing disfiguring and life threatening procedures in their native countries, and play a role in the eventual eradication of FGC.”

    In conclusion the academy suggests, “It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm.”

    In response the royal colleges say in their statement, “Female genital mutilation is in itself a ritual practice and to suggest that another ritual ‘nick’ replaces the FGM does not change the simple fact that pre-pubescent girls in some societies are expected to go through a violent and painful procedure which will scar them for the rest of their lives. For clinicians in any country, the act of engaging in any ritual female genital cutting, no matter how token, will make them complicit in continuing the practice of FGM.”

    Notes

    Cite this as: BMJ 2010;340:c2586