United States: AAP Policy Statement on FGM 'ill-advised'

In 1994, a frightened 17 year old girl boarded a plane to flee an impending forced marriage to a much older man with three other wives. In a small room waiting for the groom, in Togo, West Africa, Fauziya Kassindja was also warned that a woman would soon arrive to excise her clitoris and other parts of her genitalia in preparation for her impending nuptials. From time immemorial, women in her community needed to be "clean" for their husbands and to gain acceptance into society. In honor of her father who had protected her until his sudden death, Fauziya refused that day to undergo the harmful practice of female genital mutilation, or FGM, and escaped.

Thanks to her mother's savings, Fauziya wound up at Newark International Airport claiming political asylum. However, instead of receiving protection from the authorities, Fauziya was incarcerated for 16 months in New Jersey prisons because FGM was not yet established as persecution under United States' laws. That was about to change.

Fauziya's case generated the first massive campaign in the US that effectively broke the silence about FGM. The campaign led to a decision establishing that the threat of FGM could constitute persecution, which subsequently led to the enactment of the 1996 federal law and a handful of state laws prohibiting FGM. A number of medical associations also issued clear statements condemning FGM as a human rights violation, including the American Association of Pediatrics (AAP). In its 1998 Policy Statement, the AAP clearly stated that it "oppose[d] all forms of FGM," counseling its members not to perform it as it would perpetuate the practice "with its cultural implications for the status of women."

Twelve years later, on 26 April 2010, the AAP has inexplicably retracted that position in its confused and ill-advised Policy Statement - Ritual Genital Cutting of Female Minors, not only downgrading the terminology to female genital "cutting," but also in effect promoting a form of FGM that would involve the "nicking" of a girl's clitoris, in order to remain sensitive to the cultural and religious backgrounds of their patients' parents.

The World Health Organization estimates that 140 million women and girls have undergone FGM, mostly in Africa, and in some countries in the Middle East, Asia and wherever FGM-practicing communities have emigrated, including the U.S. The organization classifies FGM into four types, ranging in severity, with Type IV as procedures to female genitalia for non-medical purposes, such as the "nicking" that the AAP is now suggesting US pediatricians contemplate performing on certain girls to satisfy their parents' traditional customs.

Harmful cultural practices against girls have brought us early marriage, foot binding, marriage through rape and abduction, and FGM, to name a few. Thanks to education, community outreach and political will, a few abuses have disappeared, but most persist because of efforts by conservative forces to perpetuate the status of girls as second class citizens. The revised AAP Policy Statement is at risk of mirroring this resistance to progress. Their Statement defies decades of efforts at the grassroots level across Africa and internationally to end FGM and the recognition that FGM is a form of violence and discrimination aimed at safeguarding a girl's virginity, controlling her sexuality and guaranteeing her marriageability.

Hundreds of African women - and men - have dedicated their lives to end FGM in their own communities through awareness-raising, education, and advocacy for legal and policy changes. While resistance to progress may be at times fierce, as in most social change movements, stories of girls and their families who are successfully rejecting the practice and mobilizing their communities and governments to eradicate FGM are proliferating. The AAP should honor those commitments and not seek to undermine such advances.

The international outrage to the revamped AAP Policy Statement is mounting. The Inter-African Committee on Traditional Practices and the European Network for the Prevention and Eradication of FGM are among the extensive networks that are denouncing the AAP Policy Statement and drawing their attention to the 61st World Health Assembly Resolution (WHA61.16), which urges medical personnel to protect girls from all forms of FGM. It is time for the AAP to retract their 2010 Statement.

Pediatricians must protect girls against FGM through culturally sensitive training about the unfounded myths surrounding FGM. Supporting community-based programs that could help families abandon the practice is also key. Contrary to many other countries, abysmally little has been done in the US to holistically address FGM since Fauziya was released from jail over a decade ago. Culture is fluid and dynamic and its harmful elements can also change with education, enlightenment, and the rule of law. The AAP must stand on the side of their patients. In lieu of calling for an amendment to federal and state laws that protect girls' bodily integrity, the AAP should join the movement to end FGM and ensure that pediatricians first do no harm to girls' physical and psychological well-being or jeopardize their inalienable, indivisible and universal rights to equality.

Taina Bien-Aime

Executive Director of Equality Now