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Abstract
In 2015, a ten-year innovative and comprehensive study on female genital mutilation (FGM) in Iran under the auspice, In the Name of Tradition – A Comprehensive Research Study on Female Genital Mutilation / Cutting (FGM/C) was undertaken. [2] The study analysed the underlying rationales why FGM is mainly practised in four Iranian provinces and refuted a long-standing but erroneous belief that FGM only takes place within the African border. It was the culmination of a long, perilous and poignant journey from discovering with horror that the females in my own family had been subjected to FGM, to understanding its perpetuation.
It was during this period that the probing of another tradition that affects male children in Iran, namely male genital mutilation/cutting (MGM/C) was ensued. Any consideration of FGM/C naturally provoked thoughts on how dissimilar and similar MGM/C is to FGM/C. No doubt, the previous study on the removal of healthy skin tissue for no medical rationale on the female genitalia was a prelude into this enquiry of the removal of healthy skin tissue on the male genitalia, absent a medical rationale This led to the exploration of genital mutilation of young Iranian young boys as another harmful tradition on children. It resulted in the publication of The Blade of Tradition in the Name of Religion – A Phenomenological Investigation into Male Circumcision in Iran[3].
The objective of the article is to illuminate the complex challenges posed by MGM thru the prisms of societal acceptance and the interlinking holy triumvirates of masculinity obedience, tradition and the potent role of religion. Particularly, MGM’s complexity, societal norms and attitudes are operating within an interlocking wreath of culture and religion. The remarkable similarities between FGM and MGM are riveting and ring tragically familiar: strongly-held religious convictions and cultural motivations that are employed to justify the demands of this male gendered practise. Similar to FGM, despite MGM’s widespread prevalence, the rising chorus decrying MGM demands a re-examination of this harmful tradition that is forced on little boys for no other reason than that they are male. Ultimately, the purpose of this article is to present an examination of MGM against the backdrop of double standards. Whether undertaken on boys or girls the two are intractably linked. What is lamentably obvious that in both tragic scenarios, the external genitals of vulnerable children are being mutilated in the name of tradition, absent a medical urgency and under the blade.
Keywords: FGM, FGM/C, Iran, patriarchy, masculinity, MGM, MGM/C male circumcision complications, health policy, the right to bodily integrity, human rights
Main Text Introduction
The debate encompassing FGM and MGM has simmered into heated emotional discourses on whether or not FGM and MGM are the same. At loggerheads, these two seemingly irreconcilable positions have escalated into bitter rhetoric as both elicit strong emotions.
MGM, whether performed within a medical or religious context, is a practice that holds a myriad of meanings. It is primarily rooted in the beliefs of two Semitic religions, Judaism and Islam. It can take place as part of a religious ceremony as in the Jewish faith when male infants undergo MGM on their eighth day of life, providing there is no medical contraindication.[4] And yet, religion can operate as a deterrent. Buddhism and the Hindu religions oppose MGM. Indeed, in the Hindu religion the body is a creation of God and no one has the right to change it without the permission of the person to whom the body has been given.[5] However, due to alleged touted health benefits, MGM has now seeped beyond religious boundaries.
Although FGM and MGM share overlapping similarities, the two greatly differ in terms of risks and health consequences. MGM is unconsented genital surgery that carries potential health risks whereas FGM, equally unconsented, has an egregious compilation of acute and long-term complications that have been firmly established. MGM is the surgical removal of the foreskin, the elastic sleeve of sensitive tissue that normally covers and protects the penile glans or head of the penis. This partial or total removal occasionally addresses medical problems but is most often for ethnoreligious or cultural reasons. This is sometimes but not always, performed in hospital shortly after birth or at a young age.
FGM is the various degrees of cutting on the female external genital and is considered to be more violent and socially suppressive, with drastically heightened serious and damaging physical repercussions. In terms of surgical removal, MFM and FGM are stark in their differences. For MGM to be equivalent to FGM, the entire tip of a male penis would need to be mutilated. Indeed, the sheer level of harm entailed by FGM passes a threshold of intolerability that is not passed by MGM.[6] Depending on the degree of mutilation, FGM is anatomically much more extensive.
Nevertheless, the FGM/MGM acrimonious debates centres on MGM as either a preventative health basis, a religious mandate or as a human right quandary. A drumbeat of derision has ensued with some vehemently voicing “How dare I compare the innocuous and beneficial removal of the foreskin with the extreme mutilations enacted against females in other societies!”[7] Others have argued that MGM should not be considered in isolation from FGM. (Hellsten, Sirkuu 2004). Many have pointed out that [I]n addition to anatomical differences, the expected health risks and social-cultural context for each, make male and female circumcision two distinct modern health topics; [8] and “to discuss FGM in the same breath as male circumcision is to trivialize the former and to cause all manner of moral confusion. ”[9]
MGM has been frequently encouraged either as part and parcel of a particular religious or cultural tradition, or as a health measure. MGM, with its fluctuating rationales of its glorious benefits, has been tolerated as just a minor harm with the implication that the tip of the penis is of minute consequence. This position tacitly assumes that MGM is an insignificant matter; however as drily noted by the renowned anti-FGC activist Hanny Lightfoot-Klein,” It is highly unlikely that one would find many volunteers amongst those who shrug off removal of the male foreskin as being insignificant, were they asked to prove their point by allowing a comparable amount of skin to be removed-even with anaesthesia-from their own genital.” [10] Unquestionably, the perception of FGM is implicated in the understanding of MGM.
Methods (Methodology)
The purpose of this article is to draw attention to the double standards within mutilation that need to be addressed. The genesis of this paper is the assertion that the source of male mutilation are cultural or religious values that feeds its prevailing nonchalant acceptance. This article assesses the consequences of MGM within cultural and social dynamics, and obstructions to eradication. As MGM is not an overtly researched field, and the extent of the mental health consequences have been under-researched, especially within the United States, where available it was important to explore all sources of information in order to generate the best understanding of MGM’s mechanical hold. In order to retain the integrity of the informational sources, a literature review of peer‐reviewed journal articles was conducted. The inclusion criteria for the literature search included articles and websites of institutions or organizations that have been involved in MGM that were purposively identified. In addition to extrapolating data from the medical organisations Academy of Paediatrics (AAP)and the Centre for Disease Control (CDC), four international organizations that address MGM were reviewed for relevant information: specifically, the United Nations (UN), the World Health Organisation (WHO) and the Brussels Collaboration on Bodily Integrity. A peruse of three international treaties: the Universal Declaration of Human Rights, (UDHR) The Convention on the Rights of the Child, (CRC) The United Nations Children’s Fund (UNICEF) was also undertaken.
Part 1 The disturbing threads of commonality between FGM and MGM
Although there are significant differences between FGM and MGM and difficulties involved in juxtaposing the practices of FGM and MGM, there are also certain parallels. There is an intentional alteration of the genitals. “[C]certainly the two procedures are related.”[11] The reasons given for routine FGM and MGM are essentially the same: both are perpetrated by force on the generally unanaesthesia , helpless bodies of unconsenting infants and children.[12] There are several uncomfortable similarities between FGM and MGM that extend beyond sharing the same terminology: custom, religion and tradition.
The complex challenges posed by FGM and MGM reveal that both are indispensable to idealistic femininity and hegemonic masculine identities. Both operate vis à vis the quadruples interlinking circles of patriarchal, societal obedience, societal acceptance and the automatic genuflecting to tradition that has coalesced into solidarity. Both function within a logical rational of custom and mechanical adherence. Many young girls grow up aware of FGM as it coalesced as a social norm blending into their childhood. FGM is strictly enforced upon females before puberty and during the reproductive years of young girls in preparation for adulthood and eventual marriage. MGM has been elated to a level of normalcy vis à vis medical settings. It is genuinely believed that MGM is a necessary part of becoming a man, and one cannot be a man without it. MGM is considered a symbol of manhood and perceived as a natural process. [13]
Both FGM and MGM are cultural practices that serve a dominant paradigm that directly affects the lives of boys and girls. Virtually all societies that practice medically unnecessary FGM also practice medically unnecessary MGM, usually in a parallel ceremony serving similar social functions.[14] In practically all societies where FGM is practised, boys are as well.[15]
In preparation of marriage Ensuring that a female will be considered worthy of marriage by a potential partner is one of the underlying drivers of FGM. MGM also acts as a gateway to marriage and social wellbeing. The manner in which one becomes a man is not simply socially constructed; such construction comes with pressure to conform to the ideals of manhood (Pleck 1981), and marriage.
FGM and MGM developed within specific socio cultural and economic contexts that mirror social orders and strict codes of behaviour. Both are undertaken as part of an intricate and complex cultural system that influences parents’ decision to have it done; in turn, both are cloaked in adherent entrenched values as an intricate sociological root. Consequently, the sociological roots have now spun into a widely accepted cultural societal norm in order for females to be considered feminine by their communities and in order for men to be considered masculine by their communities.
Both involve the removal of healthy skin tissue absence a medical urgency. FGM ravishes the quintessential symbol of femininity: the vulva. MGM ravishes the quintessential symbol of masculinity: the penis. Both genders are left with an irreversible diminished mark on their external genital.
MGM and FGM come in escalating degrees of severity
World Health Organisation (WHO) has classified FGM into four broad typologies:
Type I: Partial or total removal of the clitoris and/or the prepuce.
Type II: Partial or total removal of the clitoris and labia minora, with or without excision of the labia majora.
Type III: Narrowing of the vaginal orifice by cutting and bringing together the labia minora and/or the labia majora to create a type of seal, with or without excision of the clitoris. The cut edges of the labia are stitched together, which is referred to as infibulation.
Type IV: All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization.[16]
FGM Pain
FGM’s stark pain consequences have been firmly established. It is the testimony from the women themselves that one is cognisant of FGMs’ brutal reality and hellish effects even years after the procedure. These countless stories speak of a literal ambush deliberately arranged by their mother and the cutter.
“It’s been 41 years but the sound of the blade still rings in my head. The pain I felt was so intense that even today I cannot describe it. Why did my mother do this to me? “[17]
“I tried to make sense of what was happening amid the shouting and howling… my legs were spread apart. A woman ten times my size sat on top of my chest…”[18]
“What hurt me the most was the indifference of the people around me. Three or four other girls were sitting on the ground with their legs spread. They were screaming, and soon I was screaming too because I was so scared. [19]
“It was very painful and this was done without any medical procedure. No anaesthesia, no disinfectant, no sterile instruments. Even today, 31 years later, I and many girls who went through these horrible practices still suffer from PTSD and trauma.” [20]
A survivor: “It’s been 41 years but the sound of the blade still rings in my head the pain. I felt was so intense that even today I cannot describe it. Why did my mother do this to me? [21]“
“I had no idea what was going to happen. I was thrown onto the ground with force, my eyes were [bound shut], and they opened my legs. … I was screaming [with] pain. faces… I could hear [their shrieks] and I still do. I will never forget their sad faces. To this date, I cannot forget this experience; it still hurts… he pain is still raw. I suffer in my daily life.[22]”
“Since my childhood, this deep wound in my body never healed. But the deeper wound has been the one left in my spirit, in my soul. I cannot forget that day in the summer of 1937. Fifty-six years have gone by (El Saadawi, N. S. (2018).
As eerily seen in FGM, four broad typologies in MGM have been put forth by Swiss Palestinian researcher Dr Sami Aldeeb Abu-Sahlieh
Type 1: A portion or all of the skin covering the glans of the penis, the foreskin, is removed. This skin is called the ‘prepuce.’
Type 2: A portion of the foreskin is pulled taut, the cutter selects an appropriate amount to cut, and applies a shield to protect the glans from injury… then the foreskin in one stroke with a knife in their right hand, along the edge of the shield. This is referred to as ‘milah,’ which reveals the glans. The remaining lip of the foreskin is then cut from the underside of the glans. The second part of this procedure is called ‘periah,’ traditionally performed by circumcisers with longer fingernails.
Type 3: This is the complete removal of the skin covering the entire penis, the testicles and some of the skin above the penis.
Type 4: This involves an open incision from the testicles to the glans, creating a cleft similar to a woman’s vagina. [23]
The only type of FGM that is anatomically similar to MGM is Type I: Partial or total removal of the clitoris and/or the prepuce. Although Type IV FGM is unquestionably worse than the usual form of MGM, the worst forms of MGM are also far worse than Type I FGM.
MGM pain
The foreskin is a labyrinthine structure that protects and moisturizes the head of the penis; as the most densely innervated and sensitive portion of the penis, it is essential to provide the complete sexual response. (WHO Male Circumcision 2008). The foreskin is a normal, functional part of the body. The non therapeutic removal of this structure is painful. Not only does this invoke lifelong consequences, this removal is irreversible (Kristel A. (2024)
The lifelong embedded memories of FGM’s pain are equally recalled in MGM. Many men, including myself, remember the painful mutilation odyssey that some still erroneously liken to a minimal thing. The traditional MGM tools combined with the absence of anaesthesia, have created painful and traumatic memories for those who have undergone it in this manner. [24]Even with the use of local anaesthesia to minimize discomfort, there may still be some sensation experienced during and after the operation. The results of a questionnaire that was given to the parents of 1235 children under sixteen years of age at the Children’s Clinic of Gaziantep University and ten primary healthcare centres in Ankar were telling. Many fathers who recalled their own MGM experience admitted that they were afraid of it, describing the procedure as painful. [25]
Similar to FGM, it is the testimony from the men themselves that one is cognisant of MGM’s brutal reality, even years later, a stark reminder of the pain associated when healthy skin being removed.
Next thing I know, the two nurses held down my arms, and I would guess the maid servant was holding down my legs… I felt a sharp cut on my penis. That alone was insanely painful. I remembered it. Perhaps, it was so painful, the memory of it pretty much masks the memory of me enjoying my life with friends.[26]
I was four and a half years old, and I didn’t really understand what was happening. My brother Akbar, who was seven years old, knew exactly what was going on. That day, my father took my brother and me inside the house, undressed me from the waist down, and laid me on a mattress. My brother Akbar was also laid on another mattress. A few people sat around us. Then, when they started cutting with a knife-like blade, I cried out in pain. My crying intensified when someone named Salmani [the barber] lit a small piece of cloth on fire and put the hot ashes on my wound. After that, they circumcised my brother Akbar in the same way [27]
A 65-year-old man living in Canada. We were living in Torbat-e-Jam, because of my father’s job. Then I remember that we were supposed to be circumcised – it was done in a very traditional way. The circumciser came with basic tools and circumcised all three of us in one day, starting with the oldest, then me, and then the youngest. We didn’t go to the hospital; it was done at home… all of our attention and focus was on enduring the pain. We knew that a cut was going to be made and that it would be somewhat painful… we also knew that there was no other option and that we had to go through with it.[28]
The scale of damage for male circumcision complements WHO categorization of FGM. (Hellsten, S., (2004).
FGM and MGM evoke strong ethical considerations.
FGM and MGM are intrinsically linked by an absent of meaningful consent and medical emergency. Even if one acknowledges the extent and the complications of FGM and MGM are different, the truth of the matter is healthy tissue is removed without consent. Manifestly, there are ethical questions about altering any minor’s genital tissue. Removing a part of a child’s penis through MGM fundamentally conflicts with a child’s rights to make a decision that should be made in adulthood. Physicians are often asked questions by well-meaning parents, “that may be rooted in cultural or religious values, or perhaps … social preference rather than good medical practice.[29] MGM must be deferred until the child can provide his own fully informed consent.[30]
Zealous support. In the Name of Tradition,[31] what was observed was an unsettling gendered perception of FGM. Women are more often than not at the forefront of FGM’s perpetuation and zealously support it despite their own chronic suffering. If one bears in mind the cascading layers of abysmal suffering women had experienced with their own mutilation and that the effects remain throughout their lives, even years after it has taken place, it is difficult to comprehend why a mother would obediently submit her own child to the very same pain. This is a searing attestation of FGM’s powerful force that is strictly enforced and operates as silent pressure. Mutilation is a condition of society itself and women’s silent obedience to mutilation is a reflection of how deeply it is embedded. This zealous support is also a duplicated scenario in MGM as it is rigorously enforced upon males. “Fathers who have themselves suffered the pain and suffering of circumcision not only have no conception of standing up to traditions, but also have no ability or intention to confront them… they only try to heal their children’s wounds in any way possible, by soothing them.[32] It is passed down one generation to another; fathers … will nevertheless carry the torch. [33]
FGM and MGM are synonymous with notions of purity, modesty, and cleanliness. Women with mutilated external genitals are simply considered normal. It is widely believed that the clitoris connotes maleness, the prepuce of the penis connotes femaleness and that the female genitalia is ugly and dirty and thus must be removed to enhance beauty and cleanliness. This is observable in the MGM context. “The [main] reasons given for FGM in Africa and… for routine male circumcision in the US. are essentially the same. Both promise cleanliness, the absence of odours… greater attractiveness and acceptability.”[34]
Societal pressure. The social pressure to conform to what others do and have been doing and the fear of being ostracised are compelling incentives operating within FGM and MGM. One cannot afford to be different; thus, individuals will conform to the prevailing norms of femininity and masculinity. The tenacity of mutilation in both sexes is heavily depended on individuals’ obedience to the ideology that mutilation is simply the way things are, a normal occurrence that happens to men and women. Women with mutilated external genitals are simply considered normal. MGM is perceived not abnormal and mysterious but natural and legitimate. Consequently, it is conceivable that MGM, seen as a social male condition of life itself, has never found conditions to become a social issue and attract the attention of sociologists. MGM remains a normalised part of the Iranian male identity, [35] and important practice with deep cultural significance and the basis upon which manhood and identity is determined. [36]
Men who have not undergone MGM are regarded as social outcasts by their peers[37] as they may feel unnatural and unequal to other members of their ethnic group. [38] This desire to conform is an important motivation for MGM in places where the majority of boys undergo it. A U.S. survey revealed that parents, particularly the fathers of newborn boys, cited social reasons as the main determinant for choosing MGM. “The main correlate of circumcision status was circumcision status of the father, with 90% of circumcised fathers choosing to circumcise their son, compared with 23% of non-circumcised fathers.”[39] The social pressure is acute. One man was told ‘If you wish to become my son-in-law, then you must first undergo circumcision.”[40] Parents may choose MGM for their child just to avoid this social stigma, even without fully understanding the underlying reasons.
Both are wide spread. FGM is often performed in privacy in rural areas and amongst those who see it as an extremely personal matter. Although, it has been arduous to gather accurate or comprehensive data, [41] there have been harrowing statistics put forth by various reputable agencies. Around the world, over 230 million girls and women have been mutilated. Africa alone accounts for the largest share of this total, with over 144 million.[42] Asia follows with over 80 million, and a further 6 million are in the Middle East. Another 1-2 million are affected in small practising communities.
Out of approximately 30% of males estimated to be mutilated, two thirds are Muslim. [43] In Iran, uncircumcised men are almost non-existent as estimates reveal that 99.7% of Iranian men have been circumcised [44] 69% of Muslims, 80% of Jews, and 13% of non-Muslims and non-Jews living in the U.S. practice circumcision[45] (WHO, 2007). Approximately 80% of the male population in the USA (14–59 years old) have had their genitals cut.[46]
Lack of Consent. Both FGM and MGM are typically performed on children during their infancy or childhood, many too young to even speak. It is usually the parents who make such a decision, a decision based on a religious belief and tradition that has not been scientifically proven and lacks comprehensive information.[47] FGM/MGM takes place at an age where children are unable to make decisions, unable to effective protest, lack an understanding of the procedure, lack maturity and lack an awareness of their rights. An individual can choose only amongst the options of which one is both aware and can consider seriously. It is inconceivable and begs the imagination that children at such a tender age can genuinely comprehend and appreciate the nature of this harmful act.
Risk and Mortality
FGM has a long trajectory of acute and long-term complications. It is the leading cause of death in some nations. Researchers found a 50 per cent surge in the number of girls undergoing FGM that causes an estimated 44,000 excess deaths of females each year in countries where the practice occurs.[48] Estimates also imply that FGM is a leading cause of the death of females in those countries where it is practised accounting for more deaths than any cause other than enteric and respiratory infections, or malaria.[49]
Some assert MGM attendant risks are low, but the operation is associated with a definite morbidity and rare deaths have been reported.[50] Although medical complications in MGM are generally rare, especially in medical settings, there still are risks involved. [51] Between 2008 and 2014, more than half a million boys were hospitalized due to botched circumcisions in South Africa alone; more than 400 lost their lives.[52] In rural settings, such as amongst the Xhosa of South Africa, deaths as well as penile amputations are common: between 2006 and 2013, more than five thousand Xhosa boys were hospitalized due to botched circumcisions in the Eastern Cape alone, with 453 recorded deaths among this group and 214 penile amputations. [53]In 2011, nearly a dozen infant boys were treated for “life threatening haemorrhage, shock or sepsis” as a result of their non-therapeutic circumcisions at a single children’s hospital in Birmingham, England. [54] Some babies die of complications of circumcision, due to secondary loss of blood or systemic infection from the circumcision wound.[55] It has been estimated that around 1% of the patients would experience complications, either acute or later in life due to cosmetic or medical reasons.[56] Baby boys can and do succumb as a result of MGM. MGM related mortality rates, similar to FGM, are not known with certainty; some studies finds that more than 100 neonatal circumcision-related deaths (9.01/100,000) occur annually in the US, about 1.3% of male neonatal deaths from all causes. (Bollinger D., (2010). Unfortunately, in Iran, there is a dearth of a reliable national data or available epidemiological studies on MGM related mortalities in Iran. This could be attributed to parents not recognizing the death was a result of the MGM. [57]
In both FGM and MGM the death of one child is one child too many.
The Centers for Disease Control and Prevention (CDC) encourage male circumcision on the basis that it appears to reduce the risk of HIV infection during vaginal sex. (Smith, D. K., et al (2010). However, this view is not unanimous and the recommendations remain somewhat controversial. (Morris BJ, et al (2017).
MGM medical benefits has been often touted: reduction of the risk of certain diseases; lower urinary tract infection (UTI) and sexually transmitted diseases (STI). Nevertheless, it has been opined that this perceived benefit is higher for those children with urological conditions, such as UH, vesicoureteral reflux and ureteropelvic junction obstruction. [58] For the majority of unmutilated boys, these medical benefits are also achievable through proper hygiene measure.[59] “Some scholars and activists have argued compellingly about the disputable value of studies claiming health benefits for MGM.” [60] Professional organisations and medical literature contains swooping contradictions making it difficult to find a common ground. The American Academy of Paediatrics (AAP) has issued several conflicting statements on routine neonatal mutilation. In 1971, AAP stopped endorsing the routine MGM and concluded there was “no absolute medical indication.” In 1989, this position was modified slightly. AAP has now maintained that health benefits are not great enough to recommend routine circumcision for all male newborns. Parents ultimately should decide whether MGM is in the best interests of their male child and weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices. APA continues to maintain that MGM may have potential benefits, but then confusingly asserts that available studies are inconclusive and insufficient to justify recommending routine MGM. [61]
FGM and MGM are brutal. Although the various euphemisms employed plausibly reflect the unease in discussing male and female genitalia, it is heinous and searing. Labelling it circumcision does not magically erase the harm Indeed, these euphuisms mitigate the brutally of what is actually taking place when performed on a male child often too young to even speak. In FGM, knives, stones and blades are the favoured tools. In the U.S.,” the modern form adopted is significantly more invasive: it typically removes between one-third to one-half of the movable skin system of the penis. [62] The memories of the tools and methods used stand out as the most significant and vivid memories of the experience, [63] and naturally raise queries about post traumatic stress disorder. In Algeria, a stone knife is used. Amongst the MGM tools are the dallak blade (or razor), wooden split reed, scissors and knife. [64] This includes a blade and a cane 12 to 15 centimetres long with the thickness of the middle finger and a slit at one end. The purpose of the slit is to place the skin of the child’s penis tip in it and cleanly remove it. Khalif Ibn Abbas Zahravi, a fourth-century physician, has described the method and tools of MGM used during his time. These methods continued with minor changes. [65]
Patriarchy incarnates. FGM and MGM are deeply ingrained social phenomena sustained by patriarchy. FGM emerged with the rise of patriarchal societies that support it [66] as it is the imposition of some puissant men’s will quite literally onto the bodies and minds of women and girls.” [67] However, the identical over-arching patriarchal power is applicable to men who are also victims of culturally trained patriarchy, taught manly virtues and hegemonic traditional masculinity. Patriarchy has hardened into a warped view of males whose lives are set within this culture parameter. Men are symbolically asked to submit the sexual part of themselves and their sons to patriarchal authority.
PART II MGM thru the prisms of human rights
It has been firmly established that, no matter how it is practiced, FGM is a violation of universal human rights principles, a violation of personal integrity and right to health. The mutilation of the external female genital translates to physical genital mutilation. FGM has been likened to torture. [68] It stands to reason that the mutilation of the external genital and penis violates the principles of equality and non-discrimination on the basis of sex. It violates the right to freedom from torture and cruel, inhuman or degrading treatment. It also violates the right to the highest attainable standard of health, the right to physical integrity, and the rights of the child. In the worst cases, it even violates the right to life.[69]
FGM and MGM are entrenched in the folds of human rights issues. The removal of healthy skin tissue from an infant is only justifiable if there is an immediate medical indication. In FGM this unjustifiable genital removal is looked upon with horror and abject rejection. In MGM, there is no justification that defends the urgent need to mutilate on healthy infants absent a medical urgency. MGM is downplayed as this non-therapeutic invasive surgery carries on unchecked throughout the world.
Childhood is not always magical moments. The United Nations Children’s Fund (UNICEF) has recognised that children experience insidious forms of violence, exploitation and abuse that takes place where children should be most protected – their homes, schools and communities. Violence against children (VAC) can be physical, emotional or sexual and in many cases, children suffer at the hands of the people they trust.[70] Children are human beings with concomitant rights and are entitled to the same basic rights as adult individuals. Indeed, children warrant special protections that recognise their unique vulnerability. “The unnecessary removal of a functioning body organ in the name of tradition, custom, or any other non-disease related cause should never be acceptable to the health profession. All childhood circumcisions are violations of human rights. [71] The human rights activist Mahmoud Amiri-Moghadam has stated that … people must come forward and say that we are victims of this violation of human rights and shed light on the physical and psychological effects of this act, especially in childhood. [72]
The welfare of children has been reverberated in various statutes and relevant instruments of specialized agencies and international organizations. This need to protect children had been held in the1924 Geneva Declaration of the Rights of the Child, a historical document that recognises and affirms the existence of rights specific to children and the responsibility of adults towards children. Its preamble succinctly recognizes “that mankind owes to the Child the best that it has to give.” [73] This is echoed in the Universal Declaration of Human Rights, (UDHR); the United Nations (UN) has proclaimed that childhood is entitled to special care and assistance and that children should be fully prepared to live an individual life in society… in the spirit of the ideals proclaimed in the Charter of the UN. [74]
Double standards
One of the greatest challenges facing lawyers and activists who advocate a halt to MGM is achieving universal agreement that it is a human rights violation. FGM has already been condemned as a human rights abuse and internationally is recognized as a violation of the human rights of girls and women. [75] MGM has not. Despite the surgical alterations to both male and female genitals and an absence of consent, there appears to be a segregation of discourses and a refusal to see the commonalities between any form of MGM in conjunction with FGM. The world is openly hostile to FGM but seemingly indifferent to MGM. MGM has separately not been subjected to such strict scrutiny. Male circumcision is a human rights abuse. (Svoboda 2013)
FGM is looked upon with horror and revulsion [76] and yet there is conspicuous silence about a male’s right to genital integrity.[77] Even the mildest form of FGM that is less invasive than the male analogy that is commonly practiced in the USA, is widely condemned as conflicting with human rights. (Svoboda 2013) Nonetheless, there is no comparable condemnation of MGM male. The highly selective condemnation of FGM but simultaneously excluding MGM lends itself to accusations of double standards. If the law and principles pertaining to FGM are applicable, they must be applicable to both sexes. The right to physical integrity and individual self-determination applies to all children. Is the mutilation of females an establish human rights violation but the mutilation of boys a debated human rights topic? [78] Whilst the consequences of the MGM and FGM are differ, the violence involved is the same. The laudable campaign to end FGM whilst duplicitously ignoring what is systematically happening to male babies is glaringly tendentiousness. Asserting that FGM is categorically unacceptable whilst supporting MGM is erroneous as a matter of principle. This is at odds with the commitment to equal children’s rights. Why should boys not have the same legal protection as girls against non-medically motivated alterations of their genitals?[79] Genital mutilation is gendered. This is untenable
If the goal of FGM is complete eradication one must accepted that mutilation, whether on a female or male, is wrong. Ones gender is being altered from one’s body. It is utterly irrelevant the child’s sex. Young girls and boys are also are harmed for the same tiresome reasons: custom and or religion. Neither should be subject to this indefensible and harmful traditional practice. Are the hard-fought human rights being upheld only for certain people in certain circumstances? And as is so often the case, the vulnerable members of society are the one who pay the greatest price. Who is speaking for those who cannot speak and too young to speak when surrounded by an adult brandishing a knife or blade?[80] Forcibly amputating male genitals is no different from forcibly amputating female genitals. This falsely assumes that the prepuce itself has no value. All children regardless of sex should be afforded this protection and have the same right. FGM is a harmful traditional practice. As stipulated in Article 24(3) of The Convention on the Rights of the Child, (CRC) the right of the child to the enjoyment of the highest attainable standard of health.[81]
Children need robust protection from the atrociousness of having parts of their genitals routinely removed unless there is a pressing medical urgency. Both are done without a medical indication. Both sexes are vulnerable and physically powerless. This is staunchly and egregiously inconsistent with medical ethics, deeply-rooted moral and legal ideals about bodily integrity, the principle of personal autonomy, and in the best interest of the child. A child is subjected, without consent, to an irreversible surgical procedure, often without anaesthetic. MGM is not in the best interest of the child and it violates the cardinal principles of respect for autonomy, to do good and to do no harm. MGM was skated over the UN Commission on Human Rights 1986 Report of the Working Group on Traditional Practices Affecting the Health of Women and Children statement that, “(W)hen normal, there is absolutely no reason medical, moral or aesthetic, to mutilate or suppress all or any part of these exterior organs.[82] Is this not applicable to MGM? By condemning FGM and not MGM, another basic human right, namely the right to freedom from discrimination is at stake. Regardless of whether a child is a boy or a girl, neither should be subject to a harmful traditional practice. [83]
Bodily Integrity
Defending an inclusive right to genital and bodily integrity for children is not limited to females. Nowadays, with the dominance of postmodernist thought that is based on body management and human ownership of one’s body, it is time to question MGM’s validity. It is an egregious example of denying management and human ownership of one’s body with the assumption that children are passive under the protection of adults due to their inability and ignorance.[84] If one accepts the argument that it is impossible to define an individual without their body and their decisions about it are inseparable, the right to individual freedom is also not perceptible without a person’s domination over their body. Therefore, the right of ownership over the body is an intricate right to personal freedom and security. Without the recognition of the person’s control over their physical and mental integrity, this right to freedom and personal security will not be secured.[85] Naturally, the aim is to protect all children from medically unnecessary genital cutting and modification practices until they reach an age of legal majority. [86] Munzer argues that “salient parts of the human body, such as the face, breasts, vulva, or penis, are “socially important and valued, and are often considered striking or tied to a person’s sense of identity. Interfering with a child genitals has exceptional salience compared to interference in the absence of a medical indication and is generally considered worse. ”[87] A child’s right to genital integrity is infringed when the child is subjected to a bodily encroachment that substantially deviates from what is in the child’s best interest. Under the Brussels Collaboration on Bodily Integrity, “an intervention to alter a bodily state is medically necessary when the bodily state poses a serious, time-sensitive threat to the persons wellbeing” [88] This ideology of a child’s right to bodily integrity has increasingly been defended in bioethical, philosophical, and legal scholarship. [89]
Religious /Cultural Entanglements
In Iran, MGM has become part and parcel of the inseparable part of the lives of Muslims as the largest number of MGM in the world today.[90] It is a significant part of many Muslim cultures and traditions with supporters referencing religious decrees and cultural norms to justify the practice. [91]For many Muslim communities worldwide, MGM is simply a prevalent practice that is deeply rooted in religious and cultural traditions. The unparalleled power of tradition and social norms, has resulted in many individuals following social norms and the ways of their ancestors mechanically.[92] Insufficient information is also a contributing factor; [93]particularly when therapeutic, and traditional advertisements endorse it. The overzealous emphasis of MGM as a religious mandate is of such primordial importance, that many individuals genuinely believe that MGM is the only way, even at the intangible price of their well-being. One man stated that if his son ever asks him why he was subjected to MGM, he would definitely tell him that since you are a Muslim, and if I did not have you undergo MGM, you could not be a son-in-law and your prayers would not be accepted. [94] Some have asserted that it is essential for a man to have undergone MGM in order to make the haji(pilgrimage) to Mecca, one of the five Islamic pillars of Islami belief. (WHO 2008)
Religious discourses have fused with medical discourses. [95] MGM with its underlying puissant religious tonalities, is the only surgical procedure that has been widely supported as a tool to prevent disease. WHO has stated that MGM is more prevalent and persistent amongst indigenous communities that follow their highly valued traditions and religious mandates seriously as seen in the Middle East and Africa. Paradoxically, in the U.S. the reasons are not based on a valued traditions, norms and religious orders but rather on perceived medical benefits. [96]
Human rights activists Mahmoud Amiri-Moghadam states that if the global community comes to the conclusion that MGM is a form of child abuse, ultimately religion cannot be a serious obstacle to its creation. He has questioned who can decide to perform surgery on an infant or underage boy when the child’s parents make such a decision based on a religious belief and tradition for which scientific foundations are not established, or at least comprehensive information is not available. [97]
Religion cannot be a justification for violence against children
Financial incentives
MGM has been, and carries on being shamefully financially exploited. One of the motives for FGM and MGM’s sustainability and continuity lies in its underlying economical rewards. The accumulated financial incentives play a significant role in its persistence. MGM has economically drifted into a viable thriving commercial phenomenon, that bows to a financially rewarding economic system. In the U.S. the economic ramifications cannot be overlook. Additional hospital stays for MGM and its complications and repairs… is a few million dollars per state, and over $11,000,000 per state when additional lifetime costs are included. “ [98] AAP has “warrant third-party payment for circumcision of male newborns.”[99]
For elderly cutters, FGM is a source of revenue as females’ pain is short shifted and goes unheeded in exchange for a lucrative source of income. Numerous advocates have voiced this cringing observation. “FGM can be big business. Practitioners are often paid. Operators – quite frequently matriarchs who gain status and power from their ‘profession’ – often charge to ‘guarantee’ ‘purity’; and fathers are willing to pay for that and sometimes for elaborate rites of passage for their daughters. [100] It has become an irreplaceable source of income and revenue… a thriving gender economic market. [101] A whole economic ecosystem … develops around FGM as everyone is doing everything to preserve their privileges and benefits, thus creating a real resistance to change. FGM is a lucrative business. Similar to FGM, in many communities, MGM is performed by a religious or culturally accepted cutter rather than qualified medical personnel. “A high proportion of MGMs are carried out by untrained traditional operators, who have limited knowledge of the male anatomy. The preference toward using traditional cutters is problematic when the MGM leads to complications that necessitates further medical assistance. Crept to [102] Most prevalent MGM operators in Iran are the traditional cutters at 45.5%, followed by surgeons and specialists at 25.74%. [103]
At the same time, MGM has now slowly crept to modernisation. Although MGM is still prevalent amongst individuals born into the Muslim faith at a rate of 100%, in the modern world, doctors have started to taken over the role of traditional cutters. The economical and significant financial rewards plausibly explain why physicians continue to perform it. [104] The underlying profit motive plausibly produced discernment in some doctors to overlook the potential risks associated with MGM, even more so when there is governmental endorsement. This can be seen vis à vis well-equipped upscale clinics as the traditional MGM cutters are now being replaced by specialists in white coats, who in turn, incorporate the cost under the auspices of childbirth expenses. The measurable financial benefit to the doctor is greater than the speculative benefit to the child. This social-economic incentive ignores the maxim in the best interest of the child; instead, it is a footnote against profits that not only blinds the medical community to potential harms but also effectively promotes and defends MGM. Similar to FGM that has become a big business, the MGM industry, the ceremony and its profits, the religious emphasis, and the legal voids, all operate as an obstruction and hinderance to change. What should not be compromised is the respect for children’s rights intact bodies.
Conclusion
The world is witnessing mounting resistant to MGM due to the significant evolution of international attitudes and opposition. It is up against new socio-cultural dynamics that views it as antithetical to contemporary values and standards. The profound changes in attitudes towards harmful traditions affecting children has resulted in a rethinking of mutilation’s validity within the needs of shifting cultural realities. There is a need for a greater gender neutrality in the approach to this contentious issue. (Hellsten, S., (2004).
The idea of personal and bodily autonomy has been seeping into almost every society the world over. And with that idea comes the logical conclusion that consent is a right. [105] Dr. Akbar Karami a physician and professor at NOVA college in Virginia, accurately stated that “we should not remain slaves to the customs of our ancestors. It is pointless to look at what our ancestors did and praise it blindly. Circumcision caused great suffering to children fifty years ago. How can we defend this practice now? We must accept that we were wrong. We must be the men of our own time and lay the foundation of our identity in such a way that we can be proud of it in the new era.”[106]
This senseless attack on baby boy’s genitals is merely because they are male. This alone ought to cause pause for reflection. There is only one simple narrative: We must unequivocally reject MGM.
MGM is an insult to reason, an assault on common sense and a perversion of the fundamental maxim: in the best interest of the child.
Funding: None
Competing interests: None declared.
Ethical approval: Not required.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Acronyms
AAP The American Academy of Paediatrics
CDC The Centers for Disease Control and Prevention
CRC The Convention on the Rights of the Child
FGM female genital mutilation
STI Sexually Transmitted Disease
UDHR the Universal Declaration of Human Rights
UN United Nations
UNAIDS Joint United Nations Programme on HIV/AIDS
UNDRC United Nations Declaration of the Rights of the Child
UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
U.S. UNITED STATES
UTI urinary tract infection
VAC Violence Against Children
WHO World Health Organization
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[54] Ibid.
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[65] Ibid. p351
[66] Ibid. pp 338- 339
[67] Ibid. at p 22
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[79] Children’s Consent and the Zone of Parental Discretion, supra note 21 at 11
[80] Lightfoot-Klein, H., (2008). Children’s Genitals Under the Knife, by Nunzio Press
[81] UN General Assembly, Convention on the Rights of the Child, United Nations, Treaty Series, vol. 1577, p. 3, 20 November 1989,
[82] Report of the Working Group on Traditional Practices Affecting the Health of Women and Children.
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[85] Ibid. at 289
[86] Townsend, KG., (2020). The child’s right to genital integrity. Philos Soc Criticism. 46:878–98.
[87] Brussels Collaboration on Bodily Integrity.,( 2019). Medically Unnecessary Genital Cutting and the Rights of the Child: Moving Toward Consensus. Am J Bioeth. 10):17-28 at 18
[88] Ibid.
[89] Herring J, Wall J. (2017). The nature and significance of the right to bodily integrity. Camb Law J.; 76:566–88.
[90] The Blade supra notes 3 at 138
[91] Ibid. at 169
[92] Ibid. at 361
[93] Ibid. p40
[94]Ibid. p367
[95] Ibid p 284.
[96] Ibid. pp 357- 358
[97] Rouzgar, S. (2024). Circumcision of boys; A Health Procedure or Child Abuse supra at note ?( 2024). In Conversation with Mahmoud Amiri Moghadam / Simin Rouzgar
[98] Circumcision Resource Centre, Medicaid Funding for Circumcision
[99] publications.aap.org, (2012), American Academy of Pediatrics Circumcision Policy Statement
[100] Burrage, H., supra at note 23
[101] Cutting the Rose, supra note 17 pp 50-51
[102]Arshadi, H., Abedi, A., Nematollahi, S., Shojaeefar, E., Abbasi-Fashami, M., & Hosseini, J. (2020). , Men’s Health Journal, Vol. 4 No. 1 Complications of male circumcision in Iran: A systematic review and weighted averaged analysis at p8
[103] Ibid. p 2
[104] Ibid. at 350
[105] Ibid.
[106] Ibid at p363