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Female genital mutilation: a different approach?

In the UK and many other Western jurisdictions, it is now mandatory for health professionals to report any finding of female genital mutilation (FGM) in girls under 18 to the authorities. This is considered by some to be too indiscriminate, and potentially provocative to some immigrant communities. A discussion in the Journal of Medical Ethics takes this a stage further (Arora K, Jacobs A. doi: 10.1136/medethics-2014-102375). The American authors suggest that differing degrees of what they prefer to call female genital alteration (FGA) have greatly differing implications for the girl’s future sexual, reproductive and physical health, and should be considered proportionately. They propose five ‘categories’ which differ from the currently accepted four ‘types’, in that they are related to long-term functional effect. The proposed categories range from, for example, a small nick in the vulvar skin or similar (category 1), retraction of the clitoral hood (category 2), clitorectomy (category 3), full infibulation (category 4), to life-threatening mutilation (category 5). They argue that categories 1 and 2 are no worse than male circumcision, which is universally accepted, and no worse than the ‘cosmetic’ genital procedures becoming more popular in the West. They point out that in some cultures it is considered a religious obligation, and girls may not be considered ‘marriageable’ if they have not been cut, and thus forbidding it in any form may not be in the girl’s best long-term interests. They do not condone FGA, and make no claim for any health benefits to the girl, but argue that if procedures in categories 1 and 2 were not illegal, then women from communities where it is traditional practice might opt for the less damaging procedures: ‘If a girl, by undergoing a small vulvar nick in infancy, forestalls subsequent vulvar infibulation done under dangerous conditions, we would consider this a worthwhile trade-off.’ This is obviously hugely controversial, and many will feel strongly that no concession should be made towards acceptance of this traumatic and painful procedure. As more cases come to light where minor degrees of FGM lead to distressing child protection procedures being instigated, and some communities becoming alienated from the medical profession, attitudes might change.