US: Equality Now campaign against Female Genital Cutting prompts back down by Pediatric Academy Print E-mail

 "Nicking" of girl's genitalia being an unacceptable medical compromise which perpetuates the practice of Female Genital Mutilation (FGM)

 27 May 2010

Press Release


Scroll down to also read Equality Now's letter to the American Academy of Pediatrics and related media items

New York - International human rights organization Equality Now welcomes the AAP’s decision to withdraw its ill-conceived revised policy statement on female genital mutilation (FGM) issued on April 26, 2010. The new policy statement essentially promoted Type IV FGM, as categorized by the World Health Organization (WHO), and suggested that federal and state laws might be more effective if they “enabled pediatricians to reach out to families by offering a ‘ritual nick’.” In a release issued today, the AAP stated that it has “retired” its 2010 revised statement on FGM, is opposed to “all forms of female genital cutting” and “does not endorse the practice of offering a 'clitoral nick.'”

Immediately following the announcement about AAP’s new policy statement on April 26, 2010, Equality Now launched a global campaign, which called on its membership of over 35,000 individuals and organizations from 160 countries to put pressure on the AAP to revoke its statement. The outpouring of deep concern demonstrated by several women’s rights advocates, human rights organizations, health care providers, and individual members around the world in response to this campaign has been inspiring and overwhelming. A significant outcome of Equality Now’s campaign was also a statement jointly signed by WHO and United Nations agencies, UNICEF, UNFPA, and UNIFEM, that challenged the AAP’s contentions about FGM and the harm any of its forms, including ‘nicking’, cause girls and women. The WHO/UN statement also confirmed the importance of looking at all forms of FGM as a form of violence and discrimination against women and girls.

“This is a crucial step forward in the movement to continue raising awareness about FGM, especially in the U.S., where it is practiced by some immigrant communities. This campaign has brought to light the importance of identifying FGM as a harmful cultural practice that together we must and can end. The work of the African anti-FGM grassroots movement has finally reached our shores and we hope to move forward and ensure the protection of girls in the U.S. and elsewhere from the practice,” says Taina Bien-Aimé, Equality Now’s Executive Director. Ironically, news reports today indicate that the AAP is not isolated in its misunderstandings about FGM and the Royal Australian New Zealand College of Obstetricians is now planning to discuss backing "ritual nicks", a modified form of genital mutilation, next month.

Taina Bien-Aimé further warned, “Before heading in the wrong direction on this issue, the Royal Australian New Zealand College of Obstetricians must learn from the experience of the international campaign against AAP, and from the resounding clarification provided in the WHO/UN joint statement.”

Equality Now hopes that the momentum built around discussions about FGM continues in the US with the swift passage of The Girls Protection Act (H.R. 5137), a new bipartisan legislation introduced by Congressman Joseph Crowley (D-NY) and Congresswoman Mary Bono Mack (R-CA) that would close the loophole in the federal law prohibiting FGM by making it illegal to transport a minor girl living in the U.S. out of the country for the purpose of FGM. The bill will hopefully also call for the launch of culturally sensitive outreach programs in FGM-practicing immigrant communities in the U.S. to educate parents about the lifelong harms of FGM.
Contact: Lakshmi Anantnarayan, Equality Now, +1 212 586 0906


 is an international human rights organization that works to protect and promote the civil, political, economic and social rights of girls and women around the world. For more information visit HERE
 28 April 2010

Letter from Equality Now to the American Academy of Pediatrics regarding its policy on FGM

Errol R. Alden, M.D. FAAP
Executive Director/CEO, American Academy of Pediatrics
141 Northwest Point Blvd
Elk Grove Village, IL 60007-1019
Via fax: (847) 434-8385

Judith S. Palfrey, M.D. FAAP
President, American Academy of Pediatrics
300 Longwood Ave
Boston, MA 02115-5724
Via fax: (617) 730-0049

Dear Dr. Alden and Dr. Palfrey,
I am writing on behalf of Equality Now, an international human rights organization that works for the protection and promotion of the rights of women and girls worldwide. Issues of concern to Equality Now include all forms of violence and discrimination against women and girls, including female genital mutilation (FGM). This letter expresses our deep concern regarding the American Academy of Pediatrics’ “Policy Statement – Ritual Genital Cutting of Female Minors,” (“the AAP Policy Statement”) released on April 26, 2010 suggesting changes in US federal and state laws to “enable[] pediatricians to reach out to families by offering a ritual nick” such as “pricking or incising the clitoral skin to satisfy cultural requirements.”

Equality Now has partnered for close to two decades with grassroots groups across Africa to end all forms of FGM and initiated in 2000 the Fund for Grassroots Activism to End FGM, counting 36 organizations in 19 African countries since the inception of the Fund. These and other groups working in their communities to end FGM all convey the clear message that FGM in all its forms, including “nicking” or “pricking”, is a human rights violation that must be eradicated through awareness raising, education, community involvement, and the enactment and enforcement of laws prohibiting this 5,000 year old harmful traditional practice. This vibrant grassroots movement that has been combating FGM also coordinates efforts with social service agencies and law enforcement in European and other Western countries to ensure that girls whose parents are from FGM-practicing communities are protected from harm in their new homelands and in cases where girls are at risk of FGM upon return to their parents’ countries. The AAP Policy Statement works against these goals.

International and African human rights instruments recognize that FGM is a harmful cultural practice that is steeped in inequality and is a form of gender-based violence and discrimination. The Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa, which is a groundbreaking women’s rights legal instrument, requires African States to prohibit all forms of FGM, including specifically the medicalization of FGM. In the United States, on 26 April 2010 Congress introduced new legislation amending the 1996 federal law prohibiting FGM to make it illegal to transport girls out of the country for purposes of FGM, also known as the “vacation provision.” Such laws exist in most European countries and, as pointed out in the AAP Policy Statement, have been found to be effective in getting communities to abandon this practice.

In light of all the work done by human rights groups and United Nations and other agencies to eradicate all forms of FGM, as well as efforts in the United States to protect girls from this practice, the AAP Policy Statement stands out as lacking clarity on the issue and fails to recognize the established basic principles of girls’ rights as affirmed and reaffirmed by international human rights standards.

Harmful traditional practices, such as FGM, not only have no medical purpose, they contribute to the classification of girls as second-class citizens. Some other harmful traditional practices include early marriage, which occurs in many countries in which FGM is practiced, and, historically, foot binding in China. In comparison, the AAP’s recommendations to “nick” a girl’s clitoris would be the equivalent of suggesting marriage at 12 years old, instead of 8, or binding the girl’s toes, instead of her entire foot. A reduction in the severity of a human rights violation does not supplant the gravity of such a violation. In addition, contrary to the assertion in the AAP Policy Statement that the World Health Organization (WHO) is “silent on the pros and cons of pricking or minor incisions,” the WHO recognizes that pricking and piercing of girls’ genitalia are forms of FGM (Type IV) with no health benefits and only harmful consequences. The WHO, in fact, “strongly urges health professionals not to perform such procedures.”Furthermore, a United Nations interagency statement on “Eliminating Female Genital Mutilation” issued by 10 UN agencies in 2008 states “the guiding principles for considering genital practices as female genital mutilation should be those of human rights, including the rights to health, the rights of children and the right to non-discrimination on the basis of sex.” The AAP Policy Statement falls short of these standards.

Protecting girls in the United States from FGM requires community-based outreach, health and human rights education, affirmative engagement of social services, as well as supporting and implementing the FGM law. Equality Now therefore urges the AAP to retract the portions of its “Policy Statement–Ritual Genital Cutting of Female Minors” that call for an amendment of laws in order to enable physicians to “nick” girls’ genitalia. Doctors must instead be encouraged to identify and protect girls at risk of FGM by advising and referring their patients’ parents to not-for-profit or government agencies that can help parents understand the consequences of FGM.

We urge the AAP to abide by the principles of gender equality in their practice and to recognize that human rights always trump harmful practices performed under the guise of a particular culture, tradition or religion. We would welcome the opportunity to discuss this issue with you further and look forward to hearing from you.

Taina Bien-Aimé
Executive Director

CC: Kevin B. Weiss, M.D., MPH, President and CEO
American Board of Medical Specialties

Alan R. Cohen, M.D., Chair
James A. Stockman III, M.D., President and CEO
The American Board of Pediatrics

Larry C. Gilstrap, III, M.D., Executive Director
The American Board of Obstetrics and Gynecology

Gerald F. Joseph Jr., M.D., President
American College of Obstetricians and Gynecologists

Lamar S. McGinnis, M.D., President
American College of Surgeons

William D. Steers, M.D., President
American Board of Urology

Anton J. Bueschen, M.D., President
American Urological Association

ABC World News June 14 2010

Female Genital Cutting: Affecting Young Girls in America

Many U.S. doctors faced with decision when asked to cut young girls


 To many, female genital cutting seems like a tribal tradition. It seems like a practice that girls only in countries in Asia and Africa undergo as their rite of passage into womanhood. But the procedure is all too familiar for many women living in the U.S. (Getty Images)

Female genital cutting (FGC) is a tradition that many assume to be affecting girls living only in Africa and Asia. But this rite of passage procedure is an all too familiar for many women living in the U.S.

Video: More than three million girls are subjected to genital cutting each year.

The practice of cutting encompasses all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons, according to the World Health Organization. In some countries, many of these girls will have their clitoris completely removed to deny them sexual pleasure. And at its most severe, some of them will have their vaginas sewn shut to preserve their virginity.

For resources on female genital cutting, see's additional resources HERE

"It's worse than anything in this world," said one young woman living in America, known as Mary, who asked to conceal her real name for fear of retribution from her community.

Mary had the most radical form of cutting performed on her in her home country. Her clitoris was removed and her vagina was stitched together.

Another young woman, anonymously identified as Amy, told ABC News that if her parents found out she was speaking out about female genital cutting they would "literally" kill her.

Although the procedure has been officially banned in the U.S. since 1996, some parents who want to stay true to their traditions ask American doctors to cut their daughters, leaving many doctors with a complicated choice.

Female genital cutting, a ritual thousands of years old, is a tradition many mothers and fathers feel obligated to have their daughters undergo because, without it, they are deemed unworthy of marriage. It is a cultural practice, without religious basis or any medical benefits. In fact, studies show that women who have been through it may suffer a lifetime of devastating complications, from severe infections, to pain and bleeding, and even a higher risk of death during childbirth. Some women die from the procedure itself.

Each day in Africa and Asia, more than 8,000 girls between infancy and age 15 undergo female genital cutting, an estimated total of three million girls annually.

"Obviously [parents] don't use the word 'female genital mutilation,' said Terry Dunn, an obstretrician gynecologist in Denver, Colo. "What the mom of the patient says is, 'I want to have the procedure that makes my daughter like me.'" Many physicians who consider FGC a horrifying treatment of a girl suffer a dreadful dilemma. If they say no, the young patient may become one of tens of thousands of young girls taken back to their home countries, in a process known as 'vacation-cutting.' Once there, the girls are often cut using a broken glass or unsterilized razor blades, and, more often than not, without anesthesia. While FGC may be banned in the U.S., there is no law protecting girls from being taken overseas to have the procedure in another country.

The CDC estimates that between 150,000 to 200,000 girls in the United States are in danger of being taken overseas during their time off from school to undergo vacation cutting. In fact, Amy said her parents were pressuring her to return to their home country. Instead, Amy said, she ran away from home.

"If I went back, I would have been cut," said Amy.

Dilemma Doctors Face
According to Dr. Doug Diekema, a pediatrician at Seattle's Children's Hospital and former chairman of the American Academy of Pediatrics' bioethics committee, by refusing to cut girls in the U.S., many doctors may be putting these girls' lives in jeopardy.

"It's very easy to take the high road in cases like this," said Diekema. "But when you're dealing with religious or cultural beliefs, saying no sometimes is not sufficient for people and it will not necessarily eliminate the practice."

In fact, Diekema and a few of his colleagues put forth the idea that American doctors use a so-called ritual nick as an alternative , to keep parents from seeking more dangerous methods of cutting. And, based on Diekema's recommendation, the American Academy of Pediatrics (AAP) released an official policy statement saying, "the ritual nick would not cause physical harm."

"The cut itself would be tiny, really just like a poke with a needle so that there might be a drop of blood," said Diekema.

But to many opponents of any form of procedure resembling the traditional female cutting, a ritual nick should not be acceptable as a substitute.

"What the AAP is in fact doing is 'wink, wink, nod, nod' in order to protect your patient from a possible worse form of [FGC], let's just spread her legs and nick her," said Taina Bien-Aime, president of the international human rights organization, Equality Now. "The reality is that what [that] statement does is perpetuate female genital mutilation. There is no other way around it."

But Diekema said that the proposed ritual nicking should not be considered a form of mutilation. "If you look up any definition of mutilation in the dictionary, it doesn't apply to this particular procedure," said Diekema.

Running Out of Options
For Mary, who has seen too many friends suffer through this, ritual nicking is not an acceptable compromise by doctors to keep parents from vacation cutting.

When asked by senior health and medical editor, Dr. Richard Besser, what pediatricians should do when faced with a family who wants to take their daughter back to their home country to undergo genital cutting, Mary said, "Call child services on them."

But, Dr. Nawal Nour, director of the African Women's Health Center at Brigham and Women's Hospital in Boston, Mass., said it is important not to vilify the immigrant community.

"Blame is never the solution," said Nour. "Empower them, rather than let's cut them and hurt them."

The center, which exclusively helps immigrant women deal with the complications caused by FGC, educates women about the dangers of FGC to prevent cutting for future generations. Layla Guled, a Somali language interpreter, says parents often feel as though they don't have a choice. Moreover, she says, they have the best intentions.

"Our mothers are trying to do the right thing for us," said Guled. "But our generation is trying to fight it."

The AAP offered clarification to their initial policy statement, saying that while the ritual nick may be considered an option, the practice of cutting is still harmful to girls. But after questions by ABC News regarding ritual nicking recommendations, the AAP withdrew their policy statement completely, saying that it had caused too much confusion and controversy.

"I want to make it very clear that the American Academy of Pediatrics opposes any form of female genital cutting, and that would include the ritual nick," Dr. Judith Palfrey, president of the AAP, told ABC News.

Still, Diekema said he stands behind the idea of ritual nicking as an alternative to vacation cutting.

Yet so many U.S. doctors still face a terrible set of options. And while millions of young girls wait for some answer on their fate, some who speak publically about it say they are not giving up the fight.

"We have to change a whole culture," said Mary. "Maybe we can't change their generation but we can change our own generation. We know it's wrong. There's nothing right about this."
London ~ June 10 2010

Female genital cutting

Ending a brutal practice

Westerners debate, afresh, how best to stop the cutting of girls’ genitals 

FOR a group dedicated to the health and well-being of children to advocate the cutting of girls’ genitals seems inconceivable. But the American Academy of Paediatrics (AAP), in a review of its policy on the practice known as female circumcision, did tentatively ask if, in order to avoid the most dangerous behaviour, doctors should be allowed to perform some kind of “ritual cut” in the clitoral skin. The academy likened it to ear-piercing and said that it might satisfy the cultural requirements of people wedded to the practice.

After a chorus of condemnation the AAP swiftly released a new statement, anxiously stressing that it does not endorse “clitoral nicks”. Judith Palfrey, the group’s president, says there is absolutely no case for it and that doctors must oppose all forms of genital cutting on girls. The academy’s British and Australian counterparts, and the UN, have voiced a similar position.

Cutting girls’ genitals is still common in 28 mostly African countries and among their migrants abroad. The World Health Organisation (WHO) estimates that 100m-140m women have been subject to the practice and thinks that some 3m girls are at risk each year of one of four forms of cutting, ranging from the symbolic to life-ruining. In countries such as Somalia, Egypt and Guinea, over 95% of women have undergone some version of it.

Some see it as a matter of hygiene, others as a rite of passage into womanhood. Its Muslim, Christian and animist defenders all cite religious grounds. Where the practice is a prerequisite for marriage, economic factors play a role too.

Attempts to stamp out the practice have gathered pace since the 1980s. Now 18 African countries have banned it, although laws are patchily observed. Nawal El Saadawi, an Egyptian who suffered mutilation and has campaigned against it for more than 50 years, says that education is needed, not just prohibition. A mixed approach probably works best. Burkina Faso has a hotline to the police for girls who feel they are in danger. Tasaru Ntomonok Initiative, a group in the Narok district in Kenya, has a safe house for girls fleeing their families. Maendeleo ya Wanawake Organisation, a Kenyan women’s NGO, offers “circumcision through words”, an alternative rite of passage without the bloodshed.

A bigger trend is medicalisation. In the past the procedure was typically performed by a local woman using anything from a razor blade to a piece of broken glass, sometimes even using battery acid to stop the bleeding. More families now ask doctors to carry out the cut, in the hope that this will make it safer. A study in Kenya in 2000 showed that using sterile razors, anti-tetanus shots and antibiotics cut the risk of immediate complications by 70%. Such thinking led to the debate in America about whether using doctors was the lesser of two evils. But campaigners against cutting say the use of professionals undermines efforts to end the practice, as making it safer may encourage more parents to inflict it on their daughters.

The unkindest cut
Ayaan Hirsi Ali, a public intellectual from Somalia who renounced Islam and now lives in America, is entirely against the practice, even the symbolic form. She argues that “the motive for cutting off a girl’s clitoris is to reduce her sexuality”. Most Western countries ban it: in Britain, where around 66,000 women have undergone some form of cutting and some 33,000 girls are thought to be at risk, it is also a crime to take a British resident abroad in order to cut her. American campaigners want a similar law.

The idea that a legalised symbolic cut would be the lesser of two evils is not new: it was discussed and rejected in Germany and the Netherlands, for example. A hospital in Seattle, the Harborview Medical Centre, considered it in response to requests from local Somali women, who wanted an alternative to the extreme versions of the practice (which can involve forcing the almost complete closure of the vagina with scar tissue). The suggestion brought a storm of abuse.

Dena Davis, a law and ethics professor at Cleveland State University and the legal consultant on the AAP’s policy review, says that she personally favours considering a symbolic cut, because of the potential for harm reduction. She cites Indonesia, where cutting has died out, according to the WHO, but a ritual form persists, involving a symbolic scratch of the clitoris.

The weakest point for the critics of cutting girls’ genitals is that it is still so prevalent where boys are concerned. No laws exist against male circumcision in any Western country. No records are kept of circumcisions performed outside of hospitals and there is no regulation of ritual practitioners. The AAP took a neutral stance on male circumcision when it last considered the practice in 1999. The policy is up for review in the next year or so. Supporters of it may note that male circumcision is unlikely to lead to, or provide cover for, the extreme mutilation that happens too often with female cutting. Many also believe that male circumcision is helpful in slowing the spread of HIV/AIDS.

Ms Davis argues that in America at least, it is not acceptable to criminalise all female genital cutting while adopting a relaxed stance to the male sort. She suspects that by allowing male circumcision while forbidding even a symbolic cut on girls, Western countries show respect for only those religious and cultural practices with which they are already comfortable.