Monday 24 April 2017

“Gender and Genital Cutting: A New Paradigm” – bioethicist Brian Earp’s and my recent paper for the European Parliament

My bioethicist colleague, Brian Earp, and I have recently published a paper for the European Parliament on the non-therapeutic cutting of children’s genitals.

In it, we explain that though moral and legal opposition to the non-therapeutic cutting of children’s genitals has traditionally focused on female children, a growing movement of scholars, activists, and individuals affected by childhood genital cutting have argued that all children, regardless of sex or gender, should be protected from such intimate violations.

In our paper, we argue, first, that the conventional distinctions based on sex or gender do not reliably reflect the actual harms that are entailed by various forms of NGC; and secondly that distinctions based on autonomy and informed consent do provide coherent grounds for an empirically justifiable analysis of the moral permissibility of NGC.

These conclusions have significant implications for policy. At a recent WHO-sponsored conference on female NGC held at Geneva University Hospitals, we argued that a gender-inclusive approach, based on an individual’s capacity to provide informed consent to NGC, is not only better supported by the available evidence, but also offers several practical advantages:

  1. It deflects accusations of sexism by recognizing that boys and intersex children are also vulnerable to non-therapeutic genital alterations that they may later come to seriously resent. 
  1. It clarifies the moral confusion that stems from Western-led efforts to eliminate only the female “half” of childhood NGC practices in communities that practice both male and female NGC in parallel. 
  1. It neutralizes accusations of cultural imperialism by applying the same standards to medically unnecessary genital cutting practices primarily affecting white minors in North America, Australasia, and Europe (i.e., medicalized routine or religious male circumcision, and intersex genital normalization surgery) as it does to such practices primarily affecting minors of color in Africa, the Middle East, and Southeast Asia (i.e., male and female peripubertal initiation ceremonies and other customary forms of childhood NGC). 
Adopting such an approach does not necessarily mean seeking to prohibit all pre-consensual forms of NGC. Experience shows that the enactment of strict legal prohibitions prior to cultural readiness can backfire, creating intense resistance among those who are dedicated to the practice, and often driving it further underground. Prohibition of childhood female NGC, for example, has been largely unsuccessful in many countries where it is customary and deeply embedded, and recent attempts to criminalise circumcision of boys have been blocked, ignored or overturned.

There are, however, many “levers” society that can pull to discourage harmful practices: the law is only one among many, and not necessarily the most desirable or effective. Some authors have proposed step-wise regulation of childhood NGCs, along with community engagement and education, as alternatives and/or supplements to formal prohibition.

Whatever specific policies are implemented, it is clear that fundamentally different treatment of female, male, and intersex children, in terms of their protection from nontherapeutic genital cutting, will become increasingly difficult to justify, morally, legally or medically, in years to come.


Our thanks go to Eduardo Zugasti, assisting MEP Teresa Giménez Barbat, for inviting us to prepare this essay, and to Professor Elizabeth Reis and Dr. Robert Darby for feedback on an earlier draft.