Belly Tales

Without getting into a huge amount of detail here…I had a new OB patient recently who came in for her initial visit and eventually told me that she wasn’t sure who the father of the baby was….becasue she had been raped by four men. She had gone to a different hospital immediately afterwards and had had a rape kit collected, and had already been through one round of testing for STIs and HIV, all of which had come back negative. The semen analysis is still pending. She’s been seeing a therapist weekly since the rape, and has the full support of her very large family. Because of her religious beliefs she will be continuing with this pregnancy and plans on giving birth in early September at our hospital. I was stunned, and didn’t even know where to begin with her. I talked a little bit about how rape and trauma can come up again during pregnancy, and especially during birth, but she’s only 10 weeks pregnant at the moment, so I didn’t see any point in getting into that deeply just then. I suggested that we could talk a lot more about it as the birth approached, and she agreed that that sounded like a good idea. We talked a little bit about postpartum depression, and depression in general, and I made a very thorough assessment of her support system and resources, and they all seem ample. In addition to the therapist she’s currently seeing at the other hospital, she was also visited by our social worker, so that additional resources at our hospital can be offered to her as well. I asked a few very broad questions about what she was thinking or feeling about the pregnancy, but she didn’t want to talk about it very much, so we moved on to other topics. And then we did the actual physical exam. She had as much control over the process as possible. We made a deal that whenever she felt uncomfortable or scared or uncertain, all she had to do was say “stop” and I’d stop. So that’s what we did. My assistant held one of her hands (her other hand was between her legs and on top of my hands as I guided in the speculum) and we gently talked her through it. She would tense up, say stop, then we’d stop, let her collect herself and calm down, and then when she was ready, we’d guide in the speculum another half inch. We went inch by inch. It took about 10 minutes total to get the entire speculum in, then I collected the samples and removed the speculum as soon as possible. She actually seemed to handle it amazingly well (I was close to tears).

I can only imagine how birth, which can be so traumatic in its own right, can bring up so many terrifying memories and associations with trauma and rape. Birth is another situation where she can potentially feel vulnerable and exposed, in a situation that she can’t really control, experiencing pain, perhaps feeling helpless and angry and powerless (and keep in mind that this will be a hospital birth and not a woman-on-her-own-turf-at-home-birth). So here’s my question to all you midwives and doctors and nurses who’ve been doing this a lot longer than I have, and who have probably been present at births with women who have a history of trauma or rape (or women who have survived rape or trauma and gone on to birth yourself). Do you have any suggestions? When it comes closer to the time of the birth, what should we focus on? I have many thoughts about where to start: avoiding vaginal exams during the birth, offering early pain relief if desired (maybe a prophylactic epidural before the strong contractions even begin), letting her dictate when and how to push, making her environment as calm and serene as possible…what else am I missing? Any good books on this topic? Any posts that you’ve written which I should read? Anything at all would be helpful, because I still have another 8 months of prenatal care with this woman prior to her birth, and I want to try to make it as healing and empowering as possible (or, at the very least, not compound the trauma with more trauma).

A few weeks ago, Dark Daughta over at One Tenacious Baby Mama asked me for a contribution to her new weekly series entitled Reloaded, which happens every Sunday and features old posts that are worth posting and reading a second time (oldies but goodies, as she calls them). She wanted posts that I was particularly proud of, “something that really kicks ass analytically, politically” etc., and I quickly discovered when I was combing through my old posts that I don’t really have much in the analytical/ political/ highly opinionated/ kick-ass vein. It seems that my blogging style overall tends to be of the objective-news-reporting variety, or at best the highly-researched highly-factual variety; in other words, the variety that is so factual and evidence-based that no one can really argue or disagree with what you’re saying; in other words, the risk-free variety. Which is good to know about yourself, I guess, because it then prompts a bunch of really good questions, like: WHY AREN’T YOU TAKING MORE RISKS? Why aren’t there more highly opinionated, highly political, highly analytical, highly kick-ass posts on your blog? What are you scared of? Pissing someone off? Causing controversy? But really…is there any other point to a blog than opinion? If all we’re after is the news, we’ll read newpapers and news sources, thank you very much. Blogs are supposed to comment on things. So, good to know. Note to self: enough with the reporting on things. Get commenting instead. Go out on that limb. It’s about time, don’t you think?

Anyway, I sent Dark Daughta a few posts. One on the Keeper (still one of my proudest feminist and environmentalist statements), one on the UK’s new birth agenda (Maternity Matters), and two on female circumcision (Circumcision or Mutiliation? and Further Thoughts on FGM).

I was curious to see what Dark Daughta would think of them. Leave it to Dark Daughta to not only think about them, but to write an explosive 1000 word treatise as well. She picked my posts on female circumcision, of course, and then ran with them. Ran is a polite word for what she did. More like smacked the posts upside down, flipped them inside out, and then shook all of the loose change out of their pockets. She took everything I had thought after my first encounter with a circumcised woman, and all of the conclusions I had come to at that time (and this had involved a lot of thinking back then, trust me), and managed to turn all of those thoughts, all of those culminations of thought, absolutely, irrevocably, upside down. In the space of just one post. Leave it to Dark Daughta to challenge the hell out of you.

Just a few highlights, here:

Dear Student Midwife:I’m glad that you’re asking yourself questions about how best to proceed. …Maybe examining the culturally based and biased and ofttimes downright racist, response of many privileged feminists who were not born into cultures where genital circumcision is practiced might offer some much needed space inside which there might be less emotionally and politically charged room for a true examination of the issues.There is a power relation here. Are parents in western societies hunted down and denied access to safe male circumcision? Why is the WHO advocating for this procedure when there is a fast growing segment of the male population that is crying out against it?

When male circumcision of babies who can’t make the choice for themselves is enshrined as a part of at least major world religion, are health care practitioners strategizing about how best to stigmatize grown men who present penises that are mutilated? Are feminists of conscience refusing to sleep with men who are circumcized? Are we looking on them with pity and defining them as mutilated? Are we strategizing about how best to divest them of custodianship of their sons so that we can keep them safe from circumcision? Is anyone noticing that the actual side effects of male circumcision…besides those that go horribly wrong…are minimal because these surgeries are done by skilled practitioners in sterile settings?

I don’t agree with either kind of circumcision. But I can’t fail to notice that one is filled with shame and stigma heaped on those who experience it, while the other is thought of as a throwback that should be done away with but is still tolerated and executed in hospitals.

Being useful is definitely not going to include making any circumcized wimmin feel uncomfortable and on the spot about the decisions of their parents. So, labeling a woman’s cuts “mutilations” without checking to see what if anything she says about her own genitalia will go a long way to making a practitioner seem like a judge and not as someone a woman can potentially confide in or turn to.

Because really, the shock and the unfamiliarity with the view below is ours, not theirs. If we’re gonna pay lipservice to accepting the anatomy of the vulva, we’re going to need to work at really understanding and respecting that wimmin come in all sorts of configurations for all sorts of reasons.

This “who is civilized” and “who is babaric and uncivilized” binary split that serves the west/the north, giving our cultures a much needed oppressive ego boost needs to GO!

Yowsa. And those are just the highlights. I’d highly reccommend that you go and read the rest of the post, because she writes with so much passion and conviction, and has this incredible way of phrasing things in ways that I would never, ever think of.

Now, how do you respond to a post like that? I didn’t even know where to start. First I had to do a lot more thinking on the subject, which I’ve been doing for the past several days and nights. I wrote an e-mail response to her, which she published in last Sunday’s Reloaded V which started to flesh out some of my thoughts. And now I find myself here again, having done yet another 180 on the subject (my apologies for repeating some parts of my e-mail, but this is pretty much where my thinking is at right now).

I think Dark Daughta is right on a lot of counts. There is indeed an inherent racism/ oppression in a viewpoint which has decided to call one form of ritual cutting “mutilation” while at the same time leting so many other types of cutting fall under the category of “circumcision” or some other word, and therefore under the umbrella of cultural acceptability (male circumcision, labioplasty, clitoral hood piercing, episiotomy etc.). I can see how that is indeed our culture (and by that I mean western culture) taking its own viewpoint on what constitutes a healthy vulva and setting it forth as “right” and “correct” and that anyone else who does anything different to their vulva (especially something brutal or harmful and something we as a culture don’t fully understand) is therefore wrong and backwards and oppressed and brutalized by their own culture…and that this “mutilation” is therefore a form of violence against women. This viewpoint then lays the groundwork for our invasion of their culture; in other words, this viewpoint basically gives us permission to enter their culture and tell them what’s right and wrong, and that they have to stop this cultural practice. And many huge, big name organizations like UNICEF, the World Health Organization, the US Dept. of State, Amnesty International, USAID etc. etc. have all issued policies and statements which call for an end to this practice, and have programs or policies in place which exist to help educate and save these women from their fate.

Calling something “mutilation” implies, by its very nature, that those who are “mutilated” need to be saved. That makes sense, and I see that now, but I had never before thought of it in those terms. So further thinking on this is prompting me to start to refer to this ritual as “circumcision” again rather than “mutilation”. I do appreciate that my view of what constitutes a healthy vulva is certainly not everyone’s view, and who am I (or who are we?) to decide what is or is not the right kind of vulva? Why is labioplasty or clitoral hood piercing okay, while female circumcision is not? And what would happen if circumcision was done well, by medically-trained people using sterile instruments, sharp instruments, making clean, hygienic cuts? So many of the problems inherent in this practice comes from the scarring and infection which is secondary to the cuts themselves. If there was no scarring, if there was no infection, would the damage be less? As Dark Daughta pointed out, female sexuality stems from a lot more than the tiny nub of flesh which is the clitoris. If the clitoris is removed, but in a clean and precise manner, using sharp, sterilized instruments (rather than a rusty tin can or a piece of glass etc.), would women be able to retain a higher level of sexual functioning? I never, ever would have thought that an underground feminist movement to provide clean, hygienic, medically-trained female circumcisions is not that far off from what feminists were doing in the 70s with their underground abortion clinics to provide clean, hygienic, medically-trained abortions, but yeah, I do see the similarity.

I wrote in a comment on my first post that “I undrstand that there are a lot of cultural and personal reasons involved in choosing [male] circumcision, and I don’t feel like it’s my place to say.” So if I can so graciously back out of the debate when it comes to males, why can’t I do the same with females? To say that these girls aren’t educated about the pros and cons of the procedure, that they’re forced into it by their parents and their culture at a young and vulnerable age (usually at puberty), and that they therefore aren’t making informed consent doesn’t hold up, either, because the same can be said of male circumcision. Baby boys are absolutely, positively NOT making an informed decision when it comes to having their penises cut or not. It’s a decision that their parents are making for them for many different reasons, just as it’s a decision that the culture/ parents are making for the girls who are receiving female circumcision. And I ask again: what right do I have to step in to this decision-making process and tell someone that they’re wrong, or that this decision is wrong? I have no right whatsoever.

Now, before someone comes along and rips into me, let me just make this very very clear: I am not advocating female circumcision, nor am I advocating male circumcision. I am not condoning either practice, nor am I saying that they’re both fine and acceptable, and that they should continue unhindered. All I am saying is that it’s not my place to judge these practices, and it’s not my place to make these decisions. Since I’m not a member of a culture that practices female circumcision, the rich cultural context with which this practice resides is lost on me. The shame or humiliation someone of that culture might feel by not being circumcized and therefore not being a full participant of their culture is something I’m never going to be able to empathize with. And I am questioning whether it is right for our culture (Western culture) to go on huge “Stop Violence Against Women” campaigns in cultures which are not ours, in contexts which we don’t fully understand (and probably can never fully understand).

I do think that these practices need to stop. But I don’t think that the impetus for changing this is going to come from us (from the West), and I don’t think it should. If it’s going to change, it needs to come from within; from women and advocates who are of these cultures, who understand the context, who can see the patriarchy at work in such acts, and who want to rise up against it. And when they do, we as Westerners can and should support them with all of the resources our rich, privileged cultures afford us.

I guess the only sticking point I still have at this point is the following: if you’re a member of a culture, and if it’s all you know, and if you’re never exposed to anything else, you will never have the objectivity necessary to ever question or rise up against these practices that you have seen and been a part of since birth? And maybe that is where an organization can step in and offer education to members of these cultures; ideally, the education should come from members of the culture themselves. I think the folks over at RAINBO are on the right track, and if we as Westerners want to support the education of women (and therefore indirectly the hope that eventually these practices might stop), we can do this by supporting organizations like this.

As far as being a practitioner, the take-home lesson here is once again very simple, and very difficult to fully learn: LISTEN TO WOMEN, and DON’T JUDGE. How is it that I can see this so clearly on issues like abortion, where I absolutely, 100% feel that it is not my place to say, and that since I’m not carrying her baby or walking in her shoes, I have no right to judge at all….and yet issues like female circumcision still bring about huge, heaping amounts of judgement? As a white woman from a privileged background, I’ve been trying for awhile to own my privilege, and see the way that this affects my point of view on everything. This is a difficult, never-ending task, and while I feel that I’ve managed to own this on several more obvious issues, this is an issue I hadn’t even picked up on. I guess the ultimate, life-long goal for every evolving human soul is to continue to move towards a state of less and less judgement. To become as close to non-judgemental as you can possibly be. I say possibly, and “close to” because I think being non-judgemental is an impossible goal. Our psyche, our sense of self, our identities, our culture, our experiences and background and upbringing, everything we use to know ourselves as who we are–all of this is based on judgements which we have formed through living, judgements which we have consciously or unconsciously absorbed, and I think it’s impossible to seperate yourself from them. I am not using this as an excuse. Moving towards a more non-judgemental state requires very close and painful examination of those life experiences and background and upbringing and culture. It requires seeing the ways that your life experiences and culture has potentially prejudiced you, seeing the ways you are privileged, seeing the ways that power affects your identity–power you have, or don’t have, or have in some areas but not others. It requires seeing where you come from, seeing the way that this has formed your world view, and then seeing the way that this outlook affects how you see others. That’s a huge part of becoming less judgemental.

The LISTEN TO WOMEN and DON’T JUDGE take-home message means that all future encounters with women who have been circumcized will involve calling it circumcision, following her cues, and letting her talk or not talk about it, as she desires.

Anyway, those are my thoughts on this subject at this moment in time. Granted, I will continue to think, and I’m sure my thoughts will continue to evolve. I’d be really interested to hear what others think about this as well. It is a very sticky subject, and it’s not about to get any more clear any time soon.

Today I missed one hell of an opportunity: I was invited, along with several other feminist bloggers and activists (and cheers to Melissa from A Womb of Her Own for asking them to extend the invitiation my way), to partipate in a conference call with Lynn Paltrow, the executive director of National Advocates for Pregnant Woman, aka NAPW. Unfortunately, my class on shoulder dystocia ran late, and I wasn’t able to join the call in time. Nevertheless, something needs to be said about Lynn Paltrow and NAPW. This is an oganization that seems truly committed to starting up a sincere dialogue on the inequalities, challenges and legal barriers that are placed in front of women—and in particular pregnant women—that prevent them from accessing the help they need and deserve. And not just “opening up a dialogue” in the politically-correct sense that looks good on a mission statement, but an honest, open, all-encompassing debate that encourages women, lawmakers and organizations to move beyond the pro-this/ anti-that polarity. And not just “inequalities” in the abstract sense, but a real examination of the socioeconomic, racial, educational, sexual and gender unfairness that every woman on this planet has to deal with every day (to quote Shannon from Egotistical Whining, who was able to attend the conference call: “I’m just saying it’s not super difficult to include people of color in your political movement.”) It seems like this is an organization that doesn’t dwell on whether or not a woman should be allowed to have an abortion (although NAPW has a pretty strong opinion on that, I’d wager), but on the social circumstances which lead women to seek abortions in the first place, or to carry unplanned pregnancies to term. This is an organization that asks “how” instead of “why”, taking the punitive blame off of the woman, and turning the microscope onto the world she lives in which forces such choices to be made.

We live in a scary, scary world right now. I was looking over some of the articles Lynn Paltrow has written or commented on, such as Blaming Pregnant Women, The Pregnancy Police Are Watching You, The Rights of “Unborn Children” and the Value of Pregnant Women and Do Pregnant Women Have Rights? , and I was shocked, not to mention frightened, by how far current and proposed laws have gone at eroding the civil liberties of women. While the Unborn Victims of Violence Act was blinking somewhere on my radar, it was mostly framed in terms of what this meant for abortion rights, without taking in the larger picture. I had no idea things had gotten so bad (guess I need to be reading The Mommy Blawg more often, huh?). These articles talk about cases where women have been forced to undergo surgery against their will; where women have been jailed as criminals for “murdering” their children through drug use; where fetal rights have been found to trump the rights of the living, breathing women who are “housing” them…women who used to be entitled to their own personal freedom and life, liberty and the pursuit of happiness…until they got pregnant, that is. Granted, these cases are rare, and seem like aberrations rather than the norm, but in a legal system that is built on precedent, even a single case can yield terrifying future implications.

As Melissa from A Womb of Her Own rightly pointed out, though, this goes beyond the abortion debate. This isn’t even remotely about abortion any more. This is about women losing their voice, their rights, their power. And this is about a system that seeks to punish individual women, isntead of asking: why do so many women turn to drugs? How can we help them with that? Why do so many women live in fear for their lives? Surely it’s not just because abuse is a pattern, and some women “just keep dating the wrong guys”, like it’s her fault for choosing such a poor partner, instead of his fault for beating her in the first place? Why do so many women live in poverty? Why do so many of these women happen to be brown or black? Why is the health of a fetus more important than the health of the mother? And if we’re so concerned with the pain of the fetus that we’re now requiring doctors to counsel women about it before performing abortions after 22 weeks, why are we so unconcerned about invasive procedures during pregnancy that hurt the fetus, or circumcision, or children living in poverty and neglect?

Hummm. I bet some of these questions were addressed in the conference call that I missed. *sniff* However, the good news is: NAPW is hosting a summit in January, and we’re in the process of putting together another conference call or interactive chat with Lynn Paltrow and NAPW for midwives, student midwives and doulas. Because, let’s face it: this is something we should be more than just up-to-date on. This is something we should be razor-sharp-cutting-edge on, because as midwives, these aren’t just abstract questions to us, but the lives and choices and challenges of the women we’re taking care of every day.

If anyone is in New York in the next two weeks, be sure to check out Until the Violence Stops: NYC, a two week festival organized by playwright Eve Ensler to help educate and promote awareness about violence against women, with events and venues all over the 5 boroughs. Like V-Day, which uses creative events to increase awareness, raise money and revitalise the spirit of existing anti-violence organisations, this festival includes monologues, plays and spoken word performances by artists such as Rosario Dawson, Brittany Murphy, Cynthia Nixon, Isabella Rossellini, Kerry Washington, Selma Hayek, Rosie O’Donnell and more, workshops and forums to discuss the issue and ways to change the alarming statistics, and even a self-defense class. Topics include rape, domestic violence, incest, female genital mutilation (FGM) and sex trafficking, and even a panel discussion with women from global conflict zones. Read more about the festival over at Time Out New York (Antiviolent Femme)

And for those of you who are in town this weekend, come to Friends of the Birth Center’s 3rd Annual “Celebrate Birth” Picnic, which will be in Central Park this Sunday (June 18th). It should be a great afternoon, including birthday cake and lots of entertainment for the kiddies, and the $10 suggested donation goes towards (re-) opening a free-standing birth center in Manhattan after the tragic close of the Elizabeth Seton Childbearing Center. For more information, visit the link above. (Unfortunately, I’m going to be out of the city camping this weekend, but we get back on Sunday, and if we get back in time…I’ll be there).

Via Feministing, there’s a rally being held today by the New York City Alliance Against Sexual Assault at Union Square, which started at noon today. While this notice is a bit late, there’s a 24-hour vigil and “Say-So” (Sexual Assault Yearly Speak Out) with continuous reading of survivor’s stories that will be going on all night until tomorrow at noon. So, if you’re around the Union Square area today or tomorrow (you know who you are), stop by and show your support. I’m definitely going to try to stop by sometime tomorrow. (And I wonder why I can’t seem to find the time to finish all of my modules…)

The pendulum swings in one direction, and then it swings back again. Last night I was awash with guilt and worried that I hadn’t done the right thing. Today, as I continue to process and sift through my thoughts on this subject, I am beginning to change my mind on some of it. The circumcision v. mutilation question is one that I’ve firmly figured out in terms of advocacy: when talking about FGM, when discussing it in class or with colleagues or other health professionals, I will absolutely refer to it as mutilation, because that’s what it is. But is telling a woman she’s been mutilated, and calling it “mutilation” to her face, the right thing to do? On reflection, probably not. Especially if she doesn’t view it that way at all. And as for always addressing it every time I see it…I don’t know that that’s the right call either. The more I think about yesterday, the more I think that maybe I did do the right thing by not pursuing it: she was making it very clear that she didn’t want to talk about it, tackling this issue was in no way relevant to the current exam or her current situation as a postpartum woman with a new baby, and as a student in a clinic, chances are good that I will never, ever see this woman again. So was it my place to try to get her deal with something she didn’t want to deal with at that time? Absolutely not. And yes, FGM is something that can’t be ignored in the clinical setting, and is absolutely something that shouldn’t be tip-toed around, especially when discussing this issue in general, and educating and advocating against FGM in public…but in terms of doing the best thing for the women we serve, bringing up painful memories or turning FGM into an “issue” for her (when in fact it might not be) is definitely not the right call. So, I guess the motto should be: follow her cues. And if this is something that’s going to be addressed, it’ll need to be done over the course of several months, in a situation where the woman and midwife will be able to establish a trusting relationship, especially since it’s such a delicate subject. It might take several visits before she’s even able to talk about it. Who knows what I’ll say next time I see it, but at least I have a better idea of where I stand now.

And with that, I’m off to cook dinner, and then work on my neverending modules.

The exam today began like any other routine postpartum exam: we talked about her birth, cooed over her baby, was she having any problems? Breastfeeding was going well? Bleeding had stopped? Had she started having sex again? What was she planning on using for birth control? Then, after all the listening and talking and note taking and question answering, we finally moved around to the exam, which also seemed routine enough until we got to the pelvic portion. It didn’t hit me immediately—I just kept staring at her vulva while a small voice in the back of my mind kept nudging me that something wasn’t quite right—and then I finally saw it: she had no clitoris. She had no labia minora. There wasn’t anything except her outer labia, and the introitus (opening) to her vagina, and a thin, white, well-healed scar running up the center of her vulva, from her vagina to where her clitoris should have been. You’d think this would have been glaringly obvious, except that I think some subconscious part of me was in denial, willfully trying to make me see something that wasn’t there.

And breathe.

“Oh,” I said, as calmly and casually as I could, “I see you’ve been circumsized.”

“Yes,” she said, “back in my country.”

And then I sat there for another few seconds, on my stool with her legs in stirrups on either side of me, wondering if I should say anything else. What should I say? Should I ask her how she feels about it? Should I ask her if it bothers her? Should I ask her if she’s planning on having her daughter circumsized? Was there anything I could do for her? Was there anything I should do for her? We’d learned about female genital mutilation (FGM) in school—the different types and degrees of mutilation, the different surgical procedures that can be done to de-infibulate women—but actually seeing it was like a slap of cold water to the face. And yet, at the same time, I was very hesitant to impose my judgements on her. Asking her if it bothered her implies that it should bother her; asking how she feels about it is a more neutral question, but she was definintely giving me signals which seemed to indicate that she didn’t really want to talk about it.

So what did I do? I didn’t say anything. I proceeded with the rest of the exam. It was a Type II mutilation, her introitus and vagina were perfectly normal, the laceration from her delivery had healed nicely, there wasn’t any infibulation present, and she was obviously able to give birth vaginally without complications from the FGM. I finished the exam, wrote my note, talked about it briefly with my preceptor, and then moved on to the next woman.

Except that now I can’t shake the feeling that I didn’t handle the situation correctly—in fact, the more I think about it, the more certain I am that I handled it very incorrectly. I’m not sure exactly what the correct way of handling it is, but I feel like I didn’t advocate or educate or do my job as well as I potentially could have. And I can’t get the image of her vulva out of my mind, either. It’s not something you ever want to see, and having seen it now, it’s not something I’m ever going to be able to unsee.

What’s the right balance to strike? We try so hard as midwives to be tolerant and respectful and non-judgemental of the cultural practices and beliefs of the women we serve that it’s too easy to look at FGM as a cultural practice, and avoid questioning it or challenging it for fear of stepping on any toes, or making a woman feel that we’re not being respectful of her beliefs and practices. I was scared of saying anything because I didn’t want to impose my own judgements of what’s right and wrong on her (i.e. my culture thinks clitoral hood piercing is cool, sexy and trendy, but I’m going to sit here and tell you that your cultural practice of FGM is actually violence against women?). How can you tell her that FGM is an act of violence when she might firmly believe that it is actually an act of love? When she might be grateful to her parents for insisting that she have it, so that she wouldn’t be unsightly and ugly in the eyes of her culture? Should I be the one to challenge her, or dissuade her of her long-held beliefs? And what if challenging this ends up throwing her entire worldview into chaos, and whereas before she was accepting of the FGM, afterwards she starts to think about it more and it begins to torture her? As if she hasn’t been injured enough. Is it my place to be the one to tell her that it’s wrong?

Was all of this floating around somewhere in my head when the word “circumcision” came out of my mouth? Probably. And that’s probably why I did say “circumcision” instead of “mutilation”. Mutilation is such a loaded word—such a terrible word! How horrible to tell someone that they’ve been mutilated! And yet calling it “circumcision” is like putting a thick veneer of acceptability onto a procedure that is unacceptable. Circumcising men doesn’t cause medical complications such as shock, homorrhage, possible death, long-term urinary incontinence, lifelong reproductive problems, cysts, keloid scars, absesses, not to mention permanently destroying their sexual function or ability to enjoy sex—or sometimes just their ability to walk without difficulty or pain.

Calling female genital mutilation “circumcision” is like calling genocide “ethnic cleansing” or calling rape a “forced sexual encounter”. It’s making something that’s violent and painful and oppressive and horrific into something that’s clinically palateable, something that can be politely discussed in the literature from a safe, removed distance, something you can say in a professional setting as if we were discussing a new haircut: “Oh, I see you’ve been circumsized. Yes, do you like it?” No! If beating women into a bloody pulp every Friday night was a specific cultural practice (and some days, it feels like it is), would we turn our heads and say: well, that’s just their cultural belief, and who are we to question it? If a man had no testicles and no penis, but just a thin white scar exactly where those organs should be, would we call that “circumcision”? I think not. FGM is a prevalent, worldwide form of descrimination and violence against women. Notes to self: it can’t be glossed over with antiseptic terms like “circumcision”, it can’t be tolerated as a cultural belief, and it can’t be ignored in the clinical setting.

So…that’s what happened today. I’ve been trying to wrap my head around it all night. I have no idea what I’ll say next time I’m in this situation, but I know for sure that I will definitely call it what it is: mutilation. And I will definitely say something, instead of just letting it slide. But what to say?????

Here are some great resources on FGM, most of them courtesy of Women’s Health News:

Female Genital Cutting — National Women’s Health Center
Female Genital Mutilation: Legal Prohibitions Worldwide — Center for Reproductive Rights
Female Genital Mutilation: A Human Rights Information Pack — Amnesty International
Female Genital Mutilation — Unicef
STOPFGM
RAINBO — Research, Action and Information Network for the Bodily Integrity of Women
Prevalence of FGM — US Dept. of State
Female Genital Cutting — USAID
Female Genital Mutilation — AAP Bioethics Committee Policy Statement
Possessing The Secret of Joy — a novel by Alice Walker