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Ethical concerns in female genital cutting.

Harmful traditional practices, including female genital cutting (FGC), may be eliminated under the impact of internationally-respected human rights principles, guidelines for healthcare professionals and national laws. At least 2 million girls per year are at risk of female genital cutting, some in regions where it has not been prevalent. Four types of female genital cutting have been identified by the World Health Organization. Even the mildest forms can have harmful, even life-threatening effects if done with crude instruments, in unhygienic conditions and/or without anaesthesia. The practice persists as a cultural rather than religious requirement, since it is not mandated in sacred texts or doctrines of relevant religions. The cultural motivation is to uphold the stereotype of female purity as the focus and token of the family's honour, since some types of FGC reduce feminine sexual desire and/or vulnerability to rape. This motivation reflects a wider historical context of the social control of female sexuality. Although FGC would theoretically be safer in medical than in unskilled hands, the procedure bears an irreducible minimum risk of injury, and is almost always non-therapeutic. Therefore, the practice violates physicians’ professional obligation to “Do No Harm.” Supported by international and national profesional guidelines, healthcare professionals should oppose any attempt to medicalize the procedure or allow it to occur in health establishments. Underpinning the guidelines is the UN Convention on the Rights of the Child, ratified by all countries except Somalia and the U.S. Physicians should clearly explain why they cannot perform FGC and educate requesting parents and others about risks of such procedures in unskilled hands, and protest the violation of women’s bodily integrity. Physicians can also note its modern decline as an expectation in more educated communities. They should note any legal liability associated with performance or request of FGC, while generally aiding parents, families and communities to understand the medical profession’s benevolent purposes in banning such procedures. Medical associations and individual physicians are also urged to collaborate with national authorities, non-governmental organizations and, for instance, religious leaders, to support measures aimed at elimination of this harmful traditional practice.