Urgent Alert: United States: Equality Now calls on the American Academy of Pediatrics to retract a portion of their policy statement endorsing Type (IV) female genital mutilation of female minors

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Date: 
29 Apr 2010
Update Date: 
27 May 2010

On 26 April 2010, the American Academy of Pediatrics (AAP) issued a “Policy Statement – Ritual Genital Cutting of Female Minors” (AAP Statement) that in effect promotes changes in US federal and state laws to “enable[] pediatricians to reach out to families by offering a ritual nick” such as “pricking or incising the clitoral skin to satisfy cultural requirements.”

FGM is a harmful traditional practice with serious health risks that affects up to 140 million women and girls around the world. It is acknowledged internationally as a human rights violation and an extreme form of discrimination against women and girls. This practice involves the removal of various parts of female genitalia and is carried out across Africa, some countries in Asia and the Middle East, as well as in locations where FGM-practicing immigrants reside, including the United States. The U.S. Department of Health and Human Services estimated in 1997 that over 168,000 girls and women living in the U.S. have either been, or are at risk of being, subjected to FGM.

Contrary to the assertion in the AAP Statement that the World Health Organization (WHO) is “silent on the pros and cons of pricking or minor incisions,” the WHO recognizes that pricking, piercing and incising of girls’ genitalia are forms of female genital mutilation (Type IV) with no health benefits and only harmful consequences. The WHO has acknowledged an increasing trend for medically trained personnel to perform FGM and has strongly urged health professions to refrain from performing such procedures. Furthermore, a United Nations interagency statement on “Eliminating Female Genital Mutilation” issued by 10 UN agencies in 2008 states, “[T]he guiding principles for considering genital practices as female genital mutilation should be those of human rights, including the rights to health, the rights of children and the right to non-discrimination on the basis of sex.”

Human rights groups in Africa and around the world have campaigned tirelessly for decades to put an end to FGM. International and African human rights instruments recognize that FGM is a harmful cultural practice that is steeped in inequality and is a form of gender-based violence and discrimination. The Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa, which is a groundbreaking women’s rights legal instrument, requires African States to prohibit all forms of FGM, including specifically the medicalization of FGM.

On 26 April 2010, ironically on the same date as the issuance of the AAP Statement, the United States Congress introduced new legislation amending the 1996 federal law prohibiting FGM to make it illegal to transport girls out of the country for purposes of FGM, also known as the “vacation provision.” Such laws exist in European countries with substantial immigrant populations and there is evidence that legislation can act as an effective tool as part of the strategy against FGM. The AAP Statement itself gives the example of Somali immigrants in Scandinavia who abandoned the practice due to legal consequences.

In light of all the work done by human rights groups, the United Nations and other organizations to eradicate all forms of FGM, as well as efforts in the United States to protect girls from this practice, the AAP Statement stands out as lacking clarity on the issue and fails to recognize the established basic principles of girls’ rights as affirmed and reaffirmed by international human rights standards. A reduction in the severity of a human rights violation does not minimize the gravity of such a violation.

Equality Now urges the AAP to retract the portions of its Statement that in effect promote changes in US federal and state laws to enable physicians to “nick” girls’ genitalia. Doctors must instead be encouraged to identify and protect girls at risk of FGM by advising and referring their patients’ parents to not-for-profit or government agencies that can help parents understand the consequences of FGM.

What You Can Do: 

Please write to the American Academy of Pediatrics asking it to retract the portions of the AAP Statement that in effect promote changes in US federal and state laws to enable physicians to “nick” girls’ genitalia. Urge the Academy to abide by the principles of gender equality in its practice and to recognize that human rights are universal and indivisible.

Letters should go to:

Errol R. Alden, M.D. FAAP
Executive Director/CEO, American Academy of Pediatrics
141 Northwest Point Blvd
Elk Grove Village, IL 60007-1019
Phone: +1 847 434 7500
Fax: +1 847 434 8385
Email: ealden@aap.org

Please send copies of your letters to the American Board of Medical Specialties and the American Board of Pediatrics at the addresses listed below:

Kevin B. Weiss, M.D., MPH
President and CEO, American Board of Medical Specialties
222 North LaSalle Street
Chicago, IL 60601
Phone: +1 312 436 2600
Fax: +1 312 436 2700
Email: kweiss@abms.org

Alan R. Cohen, M.D.
Chair, The American Board of Pediatrics
111 Silver Cedar Court
Chapel Hill, NC 27514
Phone: +1 919 929 0461
Fax: +1 919 913 2070
Email: abpeds@abpeds.org

Please also ask your own doctor to take action on this issue.

 

Letters: 

Sample Letter

Errol R. Alden, M.D. FAAP
Executive Director/CEO, American Academy of Pediatrics
141 Northwest Point Blvd
Elk Grove Village, IL 60007-1019

Dear Dr. Alden,

I am writing to express my deep concern about the American Academy of Pediatrics “Policy Statement–Ritual Genital Cutting of Female Minors” (AAP Statement) issued on April 26, 2010, that in effect promotes changes in US federal and state laws to “enable[] pediatricians to reach out to families by offering a ritual nick” such as “pricking or incising the clitoral skin to satisfy cultural requirements.”

Female genital mutilation is a harmful traditional practice with serious health risks that affects up to 140 million women and girls around the world. It is acknowledged internationally as a human rights violation and an extreme form of discrimination against women and girls. The WHO recognizes that pricking, piercing and incising of girls’ genitalia are forms of female genital mutilation (Type IV) with no health benefits and only harmful consequences and has strongly urged health professions to refrain from performing such procedures.

In light of all the work done by human rights groups, the United Nations and other organizations to eradicate all forms of FGM, as well as efforts in the United States to protect girls from this practice, the AAP Statement needs to be corrected. Instead of enabling pediatricians to reach out to families by offering “pricking or incising the clitoral skin to satisfy cultural requirements,” the AAP should steadily work to educate parents about the harmful effects of FGM and the absence of any medical benefits to the girl. I urge you to take action to retract the portions of the AAP Statement that appear to promote an amendment of laws in order to enable physicians to “nick” girls’ genitalia. I ask that the AAP recognize that human rights are universal and indivisible.

I thank you for your attention.

Yours sincerely,

CC: Kevin B. Weiss, M.D., President and CEO, American Board of Medical Specialties

Alan R. Cohen, M.D., Chair, The American Board of Pediatrics

Letter from Equality Now to the American Academy of Pediatrics regarding its policy on FGM

Errol R. Alden, M.D. FAAP
Executive Director/CEO, American Academy of Pediatrics
141 Northwest Point Blvd
Elk Grove Village, IL 60007-1019
Via fax: (847) 434-8385

Judith S. Palfrey, M.D. FAAP
President, American Academy of Pediatrics
300 Longwood Ave
Boston, MA 02115-5724
Via fax: (617) 730-0049

28 April 2010

Dear Dr. Alden and Dr. Palfrey,

I am writing on behalf of Equality Now, an international human rights organization that works for the protection and promotion of the rights of women and girls worldwide. Issues of concern to Equality Now include all forms of violence and discrimination against women and girls, including female genital mutilation (FGM). This letter expresses our deep concern regarding the American Academy of Pediatrics’ “Policy Statement – Ritual Genital Cutting of Female Minors,” (“the AAP Policy Statement”) released on April 26, 2010 suggesting changes in US federal and state laws to “enable[] pediatricians to reach out to families by offering a ritual nick” such as “pricking or incising the clitoral skin to satisfy cultural requirements.”

Equality Now has partnered for close to two decades with grassroots groups across Africa to end all forms of FGM and initiated in 2000 the Fund for Grassroots Activism to End FGM, counting 36 organizations in 19 African countries since the inception of the Fund. These and other groups working in their communities to end FGM all convey the clear message that FGM in all its forms, including “nicking” or “pricking”, is a human rights violation that must be eradicated through awareness raising, education, community involvement, and the enactment and enforcement of laws prohibiting this 5,000 year old harmful traditional practice. This vibrant grassroots movement that has been combating FGM also coordinates efforts with social service agencies and law enforcement in European and other Western countries to ensure that girls whose parents are from FGM-practicing communities are protected from harm in their new homelands and in cases where girls are at risk of FGM upon return to their parents’ countries. The AAP Policy Statement works against these goals.

International and African human rights instruments recognize that FGM is a harmful cultural practice that is steeped in inequality and is a form of gender-based violence and discrimination. The Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa, which is a groundbreaking women’s rights legal instrument, requires African States to prohibit all forms of FGM, including specifically the medicalization of FGM. In the United States, on 26 April 2010 Congress introduced new legislation amending the 1996 federal law prohibiting FGM to make it illegal to transport girls out of the country for purposes of FGM, also known as the “vacation provision.” Such laws exist in most European countries and, as pointed out in the AAP Policy Statement, have been found to be effective in getting communities to abandon this practice.

In light of all the work done by human rights groups and United Nations and other agencies to eradicate all forms of FGM, as well as efforts in the United States to protect girls from this practice, the AAP Policy Statement stands out as lacking clarity on the issue and fails to recognize the established basic principles of girls’ rights as affirmed and reaffirmed by international human rights standards.

Harmful traditional practices, such as FGM, not only have no medical purpose, they contribute to the classification of girls as second-class citizens. Some other harmful traditional practices include early marriage, which occurs in many countries in which FGM is practiced, and, historically, foot binding in China. In comparison, the AAP’s recommendations to “nick” a girl’s clitoris would be the equivalent of suggesting marriage at 12 years old, instead of 8, or binding the girl’s toes, instead of her entire foot. A reduction in the severity of a human rights violation does not supplant the gravity of such a violation. In addition, contrary to the assertion in the AAP Policy Statement that the World Health Organization (WHO) is “silent on the pros and cons of pricking or minor incisions,” the WHO recognizes that pricking and piercing of girls’ genitalia are forms of FGM (Type IV) with no health benefits and only harmful consequences. The WHO, in fact, “strongly urges health professionals not to perform such procedures.”1 Furthermore, a United Nations interagency statement on “Eliminating Female Genital Mutilation” issued by 10 UN agencies in 2008 states “the guiding principles for considering genital practices as female genital mutilation should be those of human rights, including the rights to health, the rights of children and the right to non-discrimination on the basis of sex.” The AAP Policy Statement falls short of these standards.

Protecting girls in the United States from FGM requires community-based outreach, health and human rights education, affirmative engagement of social services, as well as supporting and implementing the FGM law. Equality Now therefore urges the AAP to retract the portions of its “Policy Statement–Ritual Genital Cutting of Female Minors” that call for an amendment of laws in order to enable physicians to “nick” girls’ genitalia. Doctors must instead be encouraged to identify and protect girls at risk of FGM by advising and referring their patients’ parents to not-for-profit or government agencies that can help parents understand the consequences of FGM.

We urge the AAP to abide by the principles of gender equality in their practice and to recognize that human rights always trump harmful practices performed under the guise of a particular culture, tradition or religion. We would welcome the opportunity to discuss this issue with you further and look forward to hearing from you.

Sincerely,
Taina Bien-Aimé
Executive Director

CC: Kevin B. Weiss, M.D., MPH, President and CEO
American Board of Medical Specialties

Alan R. Cohen, M.D., Chair
James A. Stockman III, M.D., President and CEO
The American Board of Pediatrics

Larry C. Gilstrap, III, M.D., Executive Director
The American Board of Obstetrics and Gynecology

Gerald F. Joseph Jr., M.D., President
American College of Obstetricians and Gynecologists

Lamar S. McGinnis, M.D., President
American College of Surgeons

William D. Steers, M.D., President
American Board of Urology

Anton J. Bueschen, M.D., President
American Urological Association

1 http://www.who.int/mediacentre/factsheets/fs241/en/index.html