Suppose it were reported that three baby girls had bled to death following Female Genital Mutilation (FGM) in the UK.
Or that a whistleblower had reported that FGM was being carried out by British doctors, leaving girls ‘maimed for life’.
Or that a pharmacist had masqueraded as a girl’s mother in order to subject her to genital cutting but the judge had spared her prison, noting in mitigation that FGM ‘has great cultural and religious significance’ to her.
Readers would rightly be outraged by these incidents. Clearly, girls must be protected from parents who seek to surgically impose their religious or cultural views upon their daughters’ genitals. We naturally abhor these practices which violate bodily autonomy, provide no medical benefit, are rooted in misogyny and explicitly seek to constrain female sexuality.
But here’s the catch: horrors like those described above have actually happened, not to girls who have undergone FGM, but to boys, from circumcision.
Celian Noumbiwe, Angelo Ofori-Mintah, and Goodluck Caubergs were the baby boys who bled to death at the hands of their circumcisers between 2007 and 2012. Circumcision legally performed by British doctors is leaving boys ‘maimed for life’ according to the paediatric surgeon and whistleblower, Shiban Ahmed. Martina Obi-Uzom was the pharmacist entrusted with the care of an 11 month-old boy, only to have him circumcised against his parents’ wishes.
I do not write this article in the spirit of one-upmanship: I am not trying to instigate an ethical arms race between FGM and circumcision. Rather, I would like to persuade you that both practices are morally beyond the pale, and equally worthy of our disapprobation and contempt. In Finland last month, anti-FGM legislation that would have effectively treated FGM and circumcision as comparable practices stalled because a majority of lawmakers refused to accept them as comparable. This kind of failure is what happens when the two practices are treated as morally and legally distinct.
But perhaps there are important distinctions between FGM and circumcision that render them incomparable. After all, circumcision has much-vaunted health benefits. It is, surely, a safe and simple procedure that cannot in good conscience be compared to the barbarism of FGM. And FGM is steeped in patriarchal attitudes; the diminution of the female sexual experience is fundamental to its practice. Can the same be said for circumcision?
The first point can be dealt with quickly: there is not a single medical organisation worldwide that recommends the universal circumcision of newborn boys on health grounds. The much-cited 60% relative risk reduction in female-to-male HIV transmission for circumcised men sounds rather less impressive when converted to an absolute risk reduction of 1.3%. To explain: 1.18% of circumcised men across three trials became infected with HIV compared to 2.49% of controls. This can be reported either as an absolute risk reduction of 1.3% or a relative risk reduction of 60%. The fact is that, even when men are circumcised, condom use remains essential. In the US, where cultural circumcision is routine, HIV rates are higher than in the UK, where the practice remains relatively rare. And as for the so-called ‘hygiene’ argument that a circumcised penis is supposedly cleaner than one that is not, there really is a very simple solution: keep the penis clean by rinsing with water.
Let us turn now to a qualitative comparison of circumcision and FGM. Type 3 FGM, also known as infibulation, is the suturing shut of the vagina. It may also involve the removal of the clitoris. It is typically performed by medically untrained practitioners with non-sterilised equipment. Picture, by contrast, a male circumcision carried out by a doctor, in a hospital, under sterile conditions. Between the brutality of the former and the medicalisation of the latter there is, for the most part, no comparison.
A second comparison, then: the Australian aboriginal practice of subincision, carried out under crude conditions, involves ‘slicing open the urethral passage on the underside of the penis from the scrotum to the glans, often affecting urination as well as sexual function’. By contrast, picture a doctor, in a hospital, under sterile conditions, carrying out a form of FGM called clitoral nicking, which requires only the extraction of a single drop of blood. Again, for the most part, one of these procedures is incomparably more brutal than the other.
Clitoral nicking, however, is commonplace in Malaysia, where up to 99% of Muslim girls undergo FGM and a 2009 fatwa issued by the National Council of Islamic Religious Affairs deemed it obligatory. Ayan Hirsi Ali, an anti-FGM campaigner and herself a victim of FGM, said of the comparison: ‘I think male circumcision is worse than an incision [clitoral nicking] of the girl.’ In case you still have any doubts about the dangers of circumcision, consider the fact that four hundred South African boys died as a result of it between 2008 and 2014 and over half a million were hospitalised.
The point is this: there is a spectrum of invasiveness, harm and medicalisation in both FGM and male genital mutilation. The UK, however, rightly bans all forms of FGM under the Female Genital Mutilation Act 2003, which holds that ‘it is immaterial whether she [the girl in question] or any other person believes that the operation is required as a matter of custom or ritual.’ This includes those forms of FGM which, in the case of Re B and G [2015] , a British judge held were ‘less invasive’ than male circumcision. The judge also ruled that male circumcision constitutes ‘significant harm’ under the Children Act 1989.
Consider, then, the following proposition:
- All forms of FGM are illegal in the UK
- FGM is illegal because it is harmful
- Some forms of FGM are less harmful than male circumcision
- Therefore, male circumcision should be illegal
This is the irresistible legal and moral conclusion to which one is drawn. Unless, that is, you are willing to advocate for the legalisation of those forms of FGM which are less harmful than male circumcision.
In fact, that is exactly what the American Academy of Paediatrics briefly did in 2010: ‘the ritual nick [Type IV FGM] suggested by some paediatricians is not physically harmful and is much less extensive than routine newborn male genital cutting … It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm.’ While it is to the AAP’s eternal shame that they ever proposed legalising ‘less harmful’ forms of FGM, one must, at least, credit the internal consistency of their argument.
* * *
It is uncontroversial that FGM is practised, at least in part, to curb female sexuality. But what of male circumcision? The Sephardic Jewish philosopher Maimonides, considered one of the foremost Torah scholars of the Middle Ages, wrote of circumcision: ‘one of its objects is to limit sexual intercourse … for there is no doubt that circumcision weakens the power of sexual excitement.’ It was, he said, ‘a means for perfecting man’s moral shortcomings. The bodily injury caused to that organ is exactly that which is desired.’
Philo of Alexandria, the Hellenistic Jewish philosopher, concurred: ‘of all the delights which pleasure can afford, the association of man with woman is the most exquisite, it seemed good to the lawgivers to mutilate the organ which ministers to such connections.’ For the avoidance of doubt, both of these men were in favour of circumcision.
Perhaps less well known is that circumcision was also legitimised by the medical establishment of Victorian Britain. According to historian Ronald Hyam:[1] ‘Widely believed to dampen sexual desire, circumcision was seen positively as a means of both promoting chastity and physical health.’ ‘Spermatorrhea’ – an imagined pathology supposedly caused by loss of semen through any means other than marital sex – enjoyed widespread credence. Hence why circumcision, seen as a prophylaxis against masturbation, was an important treatment.
Naturally, these ideas also migrated across the pond. John Harvey Kellogg – of Cornflakes fame – advocated a plain diet and universal neonatal circumcision as a ‘remedy’ to masturbation. In 1894, the Maryland Medical Journal even suggested circumcision as a ‘solution’ to the racist moral panic in America surrounding the possibility of black men attacking white women: ‘the legal enforcement of the circumcision among the negro race would effectually remedy the predisposition to raping inherent in this race.’
It is only since the sexual revolution of the 1960s and ’70s that proponents of circumcision have sought to downplay, rather than emphasise, its effects on male sexuality. But the evidence base for its harms is only growing. The NHS website includes ‘permanent reduction in sensation in the head of the penis, particularly during sex’ as a complication of circumcision. This should come as no surprise given that the foreskin is the most sensitive part of the penis to light touch and warmth. The adult male foreskin contains up to 20,000 erotogenic nerve endings and makes up to 50% of the motile skin of the penis. Circumcision leads to the keratinisation of the head of the penis, keratin being the tough structural protein which fingernails are made of, which in turn leads to desensitisation and diminished sexual pleasure.
Slowly but surely, however, the human rights community is waking up to the inconsistency of its treatment of male circumcision when compared with FGM. After all, Article 24(3) of the UN Convention on the Rights of the Child explicitly enshrines the right to protection from harmful traditional practices. The Parliamentary Assembly of the Council of Europe has said that circumcision constitutes a ‘violation of the physical integrity of children.’ It is also opposed by the Royal Dutch Medical Association and the Danish Medical Association. In 2018, Icelandic parliamentarian Silja Dögg Gunnarsdóttir proposed a ban on circumcision, arguing that ‘[e]very individual, it doesn’t matter what sex or how old… should be able to give informed consent for a procedure that is unnecessary, irreversible and can be harmful. His body, his choice.’ Despite Icelanders supporting the bill by a 13% margin, it was abandoned after lobbyists mischaracterised it as religious discrimination.
In its 2016 concluding observations on the UK, the UN Committee on the Rights of the Child recommended that the government should ‘ensure that no one is subjected to unnecessary medical or surgical treatment during infancy or childhood, guarantee bodily integrity, autonomy and self-determination to children concerned.’ The Committee were referring to FGM and intersex surgery. If only they had the courage to take their recommendation to its logical conclusion, by applying it to circumcision as well.
[1] Quoted by Robert Darby in A Surgical Temptation: the demonization of the foreskin and the rise of circumcision in Britain, 2005: University of Chicago Press.
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