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Zero Tolerance for Genital Mutilation: a Review of Moral Justifications

  • Sociocultural Issues and Epidemiology (J Abdulcadir & D Bader, Section Editors)
  • Published:
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A Correction to this article was published on 05 April 2021

This article has been updated

Abstract

Purpose of Review

To summarize and critically evaluate the moral principles invoked in support of zero tolerance laws and policies for medically unnecessary female genital cutting (FGC).

Recent Findings

Most of the moral reasons that are typically invoked to justify such laws and policies appear to lead to a dilemma. Either these reasons entail that several common Western practices that are widely regarded to be morally permissible and are currently treated as legal—such as intersex “normalization” surgery, female genital “cosmetic” surgery performed on adolescent girls, or infant male circumcision—are in fact morally impermissible and should be discouraged if not legally forbidden; or the reasons are being applied in a biased and prejudicial manner that is itself unethical, as well as inconsistent with Western constitutional requirements of equal treatment of individuals before the law.

Summary

In the recent literature, only one principle has been defended that appears capable of justifying a zero tolerance stance toward medically unnecessary FGC without relying on, exhibiting, or perpetuating unjust cultural or moral double standards. This principle holds that, in countries whose ethicolegal traditions are shaped by a foundational concern for individual rights, respect for bodily integrity, and personal autonomy over sexual boundaries, all non-consenting persons have an inviolable moral right against any medically unnecessary (or medically deferrable) interference with their genitals or other private anatomy. In such countries, therefore, all non-consenting persons, regardless of age, race, ethnicity, parental religion, assigned sex, gender identity, or other individual or group-based features, should be protected from medically unnecessary genital cutting, regardless of the severity of the cutting or the expected level of benefit or harm.

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Notes

  1. According to a recent consensus statement by the Brussels Collaboration on Bodily Integrity, “an intervention to alter a bodily state is medically necessary when (1) the bodily state poses a serious, time-sensitive threat to the person’s well-being, typically due to a functional impairment in an associated somatic process, and (2) the intervention, as performed without delay, is the least harmful feasible means of changing the bodily state to one that alleviates the threat. ‘Medically necessary’ is therefore different from ‘medically beneficial’—a weaker standard—which requires only that the expected health-related benefits outweigh the expected health-related harms. The latter ratio is often contested as it depends on the specific weights assigned to the potential outcomes of the intervention, given, among other things, (a) the subjective value to the individual of the body parts that may be affected, (b) the individual’s tolerance for different kinds or degrees of risk to which those body parts may be exposed, and (c) any preferences the individual may have for alternative (e.g., less invasive or risky) means of pursuing the intended health-related benefits” [3••] (p. 18). Definition based on [4].

  2. Transgender women and girls can be harmed in particular ways by the pre-emptive removal of their penile foreskins through circumcision [56]. For example, the penile foreskin, which amounts to between 30 and 50 square centimeters of highly sensitive, erogenous tissue in the fully developed organ [11, 57, 100,101,102], can be used in the construction of a neovagina if the individual decides to pursue certain gender-affirming procedures, thereby reducing the need for extensive skin grafts from other parts of the body, such as the thigh [103].

  3. Referring to the current UK anti-FGM law, which is similar to the one in Australia, Arianne Shahvisi has recently argued that the law “codifies the idea that women of particular cultures are not as capable of making their own decisions as are other women, let alone as capable as men. For, if a woman requests a labiaplasty (say) from a private cosmetic surgeon in the UK, her ethnicity will likely be used to determine her consent status, and in turn whether or not the procedure can occur legally. The current law enforces differential access to [genital cutting] procedures on the basis of race” [109] (p. 105).

  4. For a selection of arguments in this vein, see these references: [5, 36, 61, 67, 70, 82, 85, 86, 109,110,111,112,113].

  5. Ironically, advocates of “selective zero tolerance” do not criticize the performance of medically unnecessary female genital cutting when it is done for ostensibly “cosmetic” reasons by medical professionals in a clinical environment (“FGCS”), while at the same time, they categorically oppose the performance of medically unnecessary female genital cutting when it is done for “cultural” reasons (“FGM”) even when it is done by medical professionals in a clinical environment (that is, they oppose the so-called “medicalization” of non-Western-associated FGC, arguing instead that it must be stopped altogether) [16, 117]. However, it is hard to see why Western-style “cosmetic” practices should not be regarded as just as “cultural” as non-Western-associated FGC practices. For as Alice Edwards argues, “any woman’s choice to have a procedure on her genitals cannot be separated from the culture in which this decision is made” [118] (p. 27). As such, “highly restrictive esthetic ideals, widespread anatomical ignorance about the range of ‘normal’ appearances for the vulva, marketing campaigns designed to prey on bodily insecurities, and normatively questionable social pressures undoubtedly [play] a role in motivating requests” for FGCS in Western countries [4] (p. 62). In short, “the rationale [for cutting] cannot be separated from cultural associations” irrespective of the culture in which it occurs [118] (p. 27).

  6. For an extensive recent discussion, see Earp and Johnsdotter [114•]. Only a brief outline can be given here.

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    Brian D. Earp

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Earp, B.D. Zero Tolerance for Genital Mutilation: a Review of Moral Justifications. Curr Sex Health Rep 12, 276–288 (2020). https://doi.org/10.1007/s11930-020-00286-0

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