COLUMN: Tradition or Mutilation?

From Bertie Bregman's "On Call," Winter '94 From Bertie Bregman's "On Call," Winter '94When former Mayor Dinkins wanted to praise New York's ethnic diversity he would refer to the city as a tossed salad, with each vegetable standing proudly on its own, unassimilated, easily distinguished from the rest. He also called the city as a "gorgeous mosaic," providing us with two multiculturalist alternatives to the old assimilationist "melting pot" metaphor. But culture is a vast and all-encompassing thing. It transcends food and dress to shape all the public and hidden aspects of a person's life. In truly diverse societies it invariably generates conflicts of belief and principle, putting theories of cultural relativism to the test. The stew in a melting pot may be blander than a brightly-colored salad, but it's often more easily swallowed. Consider female circumcision. Practiced in over 40 countries in Africa, the Middle East and South East Asia, as well as in many immigrant communities in the West, female circumcision has a 2,000 year-old history. According to the World Health Organization, it affects over 80 million girls and women worldwide, a cultural tradition by any standard. In its mildest form, female circumcision involves the removal of the foreskin of the clitoris. More commonly, the clitoris is removed as well, along with all or part of the labia minora and labia majora. The vulva is then stitched closed in a process called infibulation, leaving only a small opening for the passage of urine and menstrual flow. Traditional midwives generally perform the ceremony under unsterile conditions (especially in immigrant communities, where they must operate secretly) and without anaesthesia, using a knife, a razor, or a piece of glass. The immediate medical complications of such a procedure often include acute infection – sometimes spreading to adjacent organs – tetanus, shock resulting from the intense pain, and hemmorhage. If the girl survives the operation, she can expect a lifelong series of related health problems. In one African study of 290 Somali women, 37% reported long-term complications ranging from chronic pelvic infections and vulval abscesses, to sterility, dermoid cyst at the site of the amputated clitoris, urinary incontinence, and painful urination. Most infibulated women are "naturally" defibulated by their husbands, which involves cutting or tearing the scar tissue to allow for sexual intercourse, obviously a painful and joyless affair. Childbirth involves even greater risks, both to the fetus and the mother, who must be cut open to allow for passage of the baby, and resewn closed afterward. In addition to these physical effects, psychological trauma also results. The ceremony is performed on girls from infancy to puberty, depending on the tribe, and can cause severe anxiety, depression, and even psychosis. Female circumcision is not a harmless custom. It is, however, a ceremony deeply rooted in traditional African society. Efforts by the British to ban the practice in Kenya led to tremendous resistance; the controversy lasted from 1929 to 1932, and some scholars mark it as the genesis of Kikuyu cultural nationalism. In his eloquent work, "Facing Mount Kenya," Jomo Kenyatta describes the initiation ceremonies preceding the surgery, making clear that no uncircumcised Kikuyu girl can be considered a full member of the tribe. Although female and male circumcision share a tribal initiation, coming-of-age significance, the two practices are not comparable. For one thing, male circumcision carries none of the grave medical risks listed above. In fact, circumcised men are at less risk for urinary tract infections, sexually transmitted diseases, and penile cancer than their uncircumcised counterparts. Female primary sex partners of circumcised men may even be at less risk of cervical cancer. Also, while male circumcision limits none of the man's enjoyment of sex, female circumcision restricts and controls a woman's sexuality. Infibulation guarantees premarital virginity, and is used to separate "decent" women from prostitutes and slaves. Indeed, although mainly Islamic countries practice it, the Koran does not require, or even mention female circumcision; it seems to have developed independently of religion as a surgical way to control female sexuality – a chastity belt of scar tissue. Because of these differences, many writers on the subject believe the term "circumcision" is a whitewash. They prefer to call it "female genital mutilation." Whatever you call it, it's still legal in this country, partly because of ignorance, and partly because it throws into conflict two basic American principles: religious freedom and human rights. On the one hand, we want to protect individuals, particularly children, from abuse. On the other hand, we want to allow immigrant communities to remain free to practice their traditions without government interference. One problem is that many highly educated African women – themselves circumcised – say they want to circumcise their daughters, discrediting the theory that women are mutilated against their will. But interviews show that their reasons stem more from cultural pressure – the fear that uncircumcised daughters will have trouble finding a husband – than from any devotion to the ritual itself. It may be hard to separate the two, which is why serious attempts at reform must center on community education, not force of law. Nevertheless, the law should provide a framework, a forceful backup, for any community outreach program. If we really want to eliminate female circumcision in this country, then we must legislate against it, as have France, Britain, Sweden and Switzerland. Last October, Pat Schroeder of Colorado, and Barbara Rose Collins, of Michigan, jointly sponsored a bill in Congress to do just that. On the other side are critics ranging from academics to community activists, who oppose the bill on the grounds of racial and religious discrimination. Everyone claims the moral high ground, but who really has it? Generally, multiculturalism and racism are mutually exclusive. To discriminate based on someone's dress or accent or skin pigment is both racist and culturally intolerant. But at the extremes of cultural difference multiculturalism and racism can also converge. To permit certain cultural traditions – slavery, human sacrifice, wife-beating, suti (the ancient Indian practice of burning a widow on her husband's funeral pyre), or female circumcision – is to deny that all people, regardless of race, have basic, universal human rights. Condoning female circumcision provided only that it doesn't occur in your ethnic group, your tribe, may reflect a distinct form of bigotry masquerading as cultural sensitivity. The question boils down to this: is it progressive to tolerate in African immigrant communities a practice that would be seen as child abuse in White (or, for that matter, African-American) communities? Or is it rather a timid reluctance to protect "their" children along with "ours?" Bertie Bregman is a second-year medical student from New York City. On Call appears alternate Wednesdays.

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