Beware of criminalizing physicians and parents for their religious traditions

We agree that FGM should disappear immediately. We only ask that all sides of this complex and difficult issue be heard.

An anti-FGM emblem, left, and Dr. Jumana Nagarwala.  Emblem courtesy of Creative Commons. Nagarwala image courtesy of Henry Ford Hospital

(RNS) — Michigan lawmakers recently passed a series of laws that outlaw performing female genital mutilation. These laws build upon, and stiffen penalties of, a federal law that bans any nonmedical procedure performed on the genitals of a female minor.

On the surface this criminalization seems reasonable, if not blatantly obvious and morally appropriate. The new laws, however, come against the backdrop of a Michigan physician having been indicted for breaking the federal law by performing a procedure on two girls.


ANOTHER VIEW: The ’Splainer: What is female genital mutilation, and what does it have to do with Islam?



Dr. Jumana Nagarwala — born in America, with a medical degree from Johns Hopkins — is believed to be the first U.S. doctor ever charged for this offense in America.

Some legal authorities and public commentators have hastily equated the procedure that Nagarwala performed with female genital mutilation (FGM) procedures carried out in certain East African, Middle Eastern and Asian countries. The doctor, however, insists she performed a much smaller, essentially benign procedure, a ritual to assuage the religious sentiments of the Dawoodi Bohra religious community, while safeguarding the children’s physical well-being.

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Scholars note that the Dawoodi Bohra ritual practice, termed “khatna,” involves a minor incision, scraping or wiping of the clitoral hood, and stands apart from the female genital mutilation that involves at least partial or total removal of the clitoris and more. This smaller procedure is sometimes classified as a “ritual nick” or even a female genital cut (FGC). Thus Nagarwala’s supporters argue that she was driven by a harm reduction strategy; that she substituted a painful, permanently debilitating procedure often performed in nonsterile settings with something more benign.

Indeed, her lawyer insists that the doctor used a “scraper” to remove tissue the size of a sesame seed.

Percentage of girls and women aged 15 to 49 years who have undergone FGM, by country. UNICEF, 2013

Some might claim there is no ethical and legal difference between FGM, FGC and a ritual nick — all involve acting upon female genitalia. Yet, confusing terminology obscures reasoned debate. Indeed misinformation about female genital surgeries in Africa led prominent researchers to issue an advisory report to debunk myths around how African women view procedures and what the long-term health effects are.

Within the bioethics academy moral differences between these procedures are hotly debated. Some scholars painstakingly debate terminology and weigh how best to prevent harm while recognizing the importance of cultural and religious rituals. Indeed physicians perform many procedures upon children that might not have health benefits from ear piercing to male circumcision, and each has to be considered carefully.  


For example, in April 2010 the American Academy of Pediatrics Committee on Bioethics considered the professional ethics dimensions of the ritual nick.

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They considered whether the ritual nick was medically harmful, and whether performing a nick might enable parents and their daughters to live out faith beliefs. Allowing for nicking might also build trust between minority groups and the health care system, and save some girls from being subject to more harmful procedures. Opponents of FGC denounced the AAP’s statement and in June 2010, the academy clarified their position, stating that this “minimal pinprick is forbidden under federal law and the AAP does not recommend it to its members.”

We worry that the press reports and legal discussions fail to clarify confusing terminology, conflate some religious rituals with other practices, and obscure the reasoned professional debates about the controversy.

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We also are concerned that children being taken away from parents and being subject to invasive genital exams might breed distrust and traumatize a minority group. Moreover such actions might add further injury to children.

We agree that FGM should disappear immediately, not just in this country but worldwide. We hope that will happen soon. Until it does, we only ask the judicial process and public debate to take care to clarify terms, and hear all sides of this complex and difficult issue.  

(Aasim Padela is an emergency medicine physician and director of the Program on Medicine and Religion at the University of Chicago. Rajan Dewar is director of the Hematology Laboratory at the University of Michigan. The views expressed in this opinion piece do not necessarily reflect those of Religion News Service)


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