P1253037218Sqibz

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Global Health Case Study Female Genital Cutting
Bettina Shell-Duncan Department of Anthropology
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Day 1

• Introduction to the Topic

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Types of Female Circumcison

• Clitoridectomy (sunna, Type I)
• Excision (Type II)
• Infibulation (Pharaonic circumcision, Type III)
• Intermediate circumcision (matwasat, Type III)
• Introcision (hymenectomy, zur-zur cuts, gishiri
  cuts, Type IV)
• symbolic circumcision (Type IV)

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African countries in which FGC has been reported
since 1979.
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Global Campaign to Elimimate FGC

• Colonial government and missionary campaigns
• Conferences honoring the United Nations Decade
  for Women (1975-85)

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Learning Objectives

• To understand terminology and classification of
  types of female circumcision
• To understand origins and distribution of the
  practice
• To be familiar with broadly stated reasons for
  the practice
• To understand the political climate fueling
  international opposition to female circumcision

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Day 2

• Evidence Female Genital Cutting as a Health
  Issue
• What are the Medical Facts?

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Short-Term Complications

• hemorrhage
• severe pain
• local and systemic infection
• shock
• keloid scars
• urinary retention

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Long-term Complications

• difficulties with menstruation and urination
• urinary tract infection
• pelvic inflammatory disease
• infertility
• dermoid cysts
• neuroma
• diminished sexual pleasure
• Higher risk of STDs and HIV/AIDS

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Obstetrical Complications

• Obstructed labor
• Hemorrhage
• Vesico-vaginal and Recto-vaginal fistulae

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Learning Objectives

• To review findings from survey data, and
  understand shortcomings of survey approaches to
  understanding health outcomes of FGC
• To review clinic and case studies of FGC, and
  discuss the limitations of information derived
  from these studies
• To understand how findings on health consequences
  are interpreted and employed in intervention
  programs and in arguments used to justify or
  condemn intervention

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Day 3

• Why Is FGC a Priority?

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Relative Ranking by Physicians of the Importance
of FGC as a Health Problem in Nigeria
Responses to the statement FGC is as important as Percent Agreeing
Maternal mortality 0
Diarrheal diseases 0
Malnutrition 0
Hypertension 25
Alheimers disease 75
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Genital mutilation should be treated as a public
health problem and recognized as an impediment to
development that can be prevented and eradicated
much like any disease.
-Fran Hosken, 1978151
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Medicalization Approaches

• provision clean razors, prophylactic antibiotics,
  and anti-tetanus injections
• training programs for circumcisers and TBAs
• have FGC performed by trained medical
  professionals in clinics or hospitals

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1982 Statement from the World Health
Organization WHO has consistently and
unequivocally advised that female circumcision
should not be practiced by any health
professionals in any setting - including
hospitals and other health establishments. Thi
s position has been joined by many other
organizations, including Unicef the
International Federation of Gyn. and
Obstetrics the American Medical Association
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Tostan

• Public declarations to abandon FGC
• First declarations among 10 intermarrying
  villages in 1997
• Emanated from a basic education program

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Learning Objectives

• To outline arguments for opposing medicalization
  of FGC, and to critically review evidence
  supporting or refuting these arguments
• To outline principles of harm reduction, and
  assess how they do or do not fit with efforts to
  medicalize FGC
• To discuss the merits and drawbacks of including
  FGC in broader integrated programs addressing
  reproductive health and other community needs

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Day 4

• Cultural Meaning and Insider Perspectives

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Reasons for the Practice

• Control of female sexuality
• Enhance fertility
• Female gender identity
• Ethnic identity
• Religion
• Marriageability

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Western forms of Body Modification

• Male circumcision
• Breast Enhancement
• Female Genital Cosmetic Surgeries
• designer vaginas
• www.altermd.com

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Learning Objectives

• To discuss insider perspectives on the cultural
  value and meaning of FGC
• To compare FGC to other forms of body
  modification found in Western societies
• To discuss the ethics of condoning procedures
  such as male circumcision and female genital
  plastic surgeries, but opposing and outlawing
  FGC.

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Day 5

• Recasting FGC as a Human Rights Issue Cultural
  Imperialism or Protection of Womens Rights?

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Who, if anyone, has the moral authority to
condemn this practice?

• Cultural Relativism there are no value
  judgements that are objectively falsifiable
  independent of specific cultures, and as such,
  moral judgements and social institutions are
  exempt from legitimate criticims by outsiders
• Universalist Stance certain individual rights
  are so fundamental to humankind that they are
  upheld as universal human rights

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Human Rights Approach

• 1) Rights of the child
• 2) Rights of women
• 3) Freedom from torture
• 4) The right to health and bodily integrity

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Learning Objectives

• To understand principles of the
  universalist/cultural relativist debate, and to
  discuss how FGC features as a test case in this
  debate
• To understand historical changes in the concept
  of human rights that have allowed FGC to become
  classified as a human rights violation
• To understand strengths and shortcomings of
  doctrinist approaches to framing FGC as a human
  rights violation

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Day 6

• Legislative Approaches and Asylum
• National and Transnational Concerns

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Effects of National Legislation

• Deterrence
• Backlash
• Underground
• Enforcability

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Asylum in the U.S.

• Kassindja
• Abankwah
• 9th Circuit Court of Appeals Ruling

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Learning Objectives

• To understand the context and consequences of
  enacting legislation that specifically bans FGC
• To discuss the role and responsibility of foreign
  governments in protecting African women from FGC