Race, Health Care and the Law
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AnnotationsNahid Toubia M.D., Female Circumcision as a Public Health Issue, New England Journal of Medicine, vol. 331, no. 11, pages 712-716, (1994). It does include a bibliography.
This article examines the practice of female genital mutilation, describing the different types of procedures used. The article describes the unique medical needs of women who have undergone the various procedures, and how doctors should deal with these women on both a medical and emotional level. The doctor classifies the types of "female circumcision into two broad categories, clitoridectomies . . . and infibulations."(1) Both of these practices are described as health hazards because of the conditions under which they are performed. The infibulation provides a more long-term serious effect in the health of women because of interference with menstrual and urine flow. Infibulation provides an additional risk in the birth of children because if the mother has not been deinfibulated, there may be tearing of the tissue.
Doctor Toubia also describes the cultural purposes of
female circumcision. It is part of the socialization of
women in many countries. The procedures are used as a means
of controlling the sexuality of female populations. However,
it is a means of cultural identity for the female. It is a
marking of marriageability. This is particularly true of
women who have been infibulated. Infibulation virtually
ensures that the woman is a virgin, because the opening left
is only so large as to allow the passage of urine and
menstrual blood. The opening must be cut open prior to a
woman's first sexual experience or prior to childbirth.
Finally, doctor Toubia deals with the legal and ethical
issue associated with this practice and its implications of
physicians. This article was good to get a background on the
actual procedures used to circumcise women. [Back]
This article, like the one above, was excellent in getting a background on female genital mutilation. It concentrates on the practice of genital mutilation in Africa. It describes the types of circumcision, the health and psychological consequences to the female, and legal issues dealt with in the practice of female circumcision. In Africa, this procedure is usually performed when the female is a child. The article also described the practice of reinfibulation, the process of resealing the vagina after childbirth. The author noted that many women request this procedure to increase the sexual pleasure for their husbands. Doctor Toubia argues that physicians should not perform reinfibulation on women because it is physically harmful. Instead, women and their spouse should be encouraged to attend counseling about its harmful effects to prevent them from going to a lay practitioner.
Doctor Toubia describes in detail the actual process of female genital mutilation. It is often done with no anesthesia and nonsterile instruments. It produces emotional and physical wounds that may never heal. Most importantly in this article, Doctor Toubia describes the physical complications associated with this practice. These descriptions are given with hope that everyone will appreciate and understand this brutal practice. The practice is describes as a human rights violation and a form of child abuse. The article explains the development of laws outlawing the use of these procedures. [Back]
This article argues that the threat of female genital mutilation should give rise to political asylum. The author noted that at the time this article was written, several countries had either passed or had pending legislation to make female genital mutilation illegal. However, the author notes that the way female genital mutilation in viewed has an effect on the treatment is given in asylum law. It must be seen as a detrimental practice, or even torture in able to grant asylum. The article describes two different immigration hearings where women were seeking to not be deported in order to protect their daughters from female circumcision. This two situations occurred in Canada and the United States. Canada granted one woman political asylum based on the threat of circumcision to her daughter. The United States, did refuse to deport the woman but did not grant her political asylum. At that time female circumcision did not qualify as a form of persecution under U.S.
The author gives recommendations for changing the United States asylum laws. He describes the practice of female circumcision as discrimination. The female often has no choice whether or not to undergo the procedure. It is done to preserve the woman's virginity until marriage. Usually, a woman does not submit to female circumcision, but rather is forced to. She is held down while her genitals are mutilated. If a woman refuses to have the operation performed, she is often ostercised from society. The author's argument is very persuasive for granting asylum to females subject to genital mutilation. [Back]
This article describes in detail the procedures and the resulting lives of women who undergo some type of female genital mutilation. She outlines the justifications presented by proponents of this practice. Some of the justifications include "tradition, religion, the sexual control of women, and social acceptance."(2) The author gives very persuasive reasons why these justifications are faulty and should not be used to support this brutal practice. For example, she explains that the Muslims believe that it is a religious necessity to subject women to genital mutilation. However, the author points out that it is not mentioned in the Koran or any other theological text of Islam.(3) The practice is believed to be effective in controlling sexual behavior of women because the removal of the clitoris makes it virtually impossible to experience orgasm.
This article also examines the problems that occur in trying to outlaw the practice of female genital mutilation. Several problems arise in the context of the rights of children. Most countries hold the view that genital mutilation is a form of child abuse. Even more difficult, according to the author, is determining the rights of consenting adult women, some of whom desire to be reinfibulated after childbirth. The author examines these difficulties in the context of American society, where body piercing, tattooing, and cosmetic surgery all are allowed. She describes the dilemma involved because, sometimes, reinfibulation is a less invasive process than some others that are socially accepted in America. Finally, the author explores International laws regarding female genital mutilation. This article was helpful because it developed many areas of the process of female genital mutilation. [Back]
This article, is actually an essay examining the practice of female genital mutilation in two context, through the actual practice of the procedure, including the reasons advanced for its necessity, and through Alice Walker's novel, Possessing the Secret of Joy. The article begins with an examination of cultural bias, and how women in the western world who are trying to incorporate the ban of female genital mutilation into the feminist agenda don't really understand what the procedure is. The author encourages the use of common language to describe the procedure as "female genital mutilation" instead of the terms "female circumcision" of even "female genital surgeries" to better display the magnitude of the experience. She argues that the procedure should be called mutilation, because that is exactly what it is. She then goes on to describe the way in which the procedure is performed.
The author explores the justifications given for the procedure to better understand why women sometimes consent. The reasons traditionally advanced are religion, hygiene, and sexual control of women. However, the author shows that often the reasons asserted are not persuasive reasons for allowing this practice to continue. To combat the hygiene justification, the author gives real life examples of women who have had sometimes deadly results from infibulation. She posits that it is hard to believe that such a belief can exist with all the evidence that exist proving the health harms it causes to women. In this article she also describes the contents of Alice Walker's novel. She says that even though the book is fiction, it allows everyone who is not a part of a culture that practices female genital mutilation to imagine what to many of United States is beyond the scope of imagination.
Finally, the author speaks about the practice of female
genital mutilation on American soil. The practice of
clitoridectomy was used to "cure" a variety of
female disorders, such as lesbianism and excessive
masturbation.(4) She also
describes the use of elective cosmetic breast surgery as a
barbaric procedure to which women willing commit themselves.
She analogizes this to the feelings of women who undergo
genital mutilation. They are both used to be seen as more
This article describes the uses of female genital mutilation as a means to persecute and control women. It asserts that the practice is used generally in countries where women are considered second class citizens. Women are infibulated to protect their virginity. However, once a woman is married, her husband will cut an opening in the skin large enough to ensure penetration during intercourse. If a woman has a child, she is often deinfibulated, to allow the child to pass. Once the child is born, the woman often goes through a process of reinfibulation. If a woman is widowed, divorced, or even temporarily separated from her husband, she is often reinfibulated to ensure that she does not engage in sexual intercourse with someone she is not married to. The author describes the use of this process as a means of dominating the women.
The author goes on to describe the current state of
asylum law. In the United States, for a woman to be granted
asylum for female genital mutilation, she must prove that
she is a refugee. Being a woman in fear of genital
mutilation is often not enough to qualify. However, the
author points out that a memo was generated in May 1995 by
the INS calling for the United States to follow the same
refugee guidelines as Canada. The Canadian guidelines
include gender persecution. The author notes the potential
shortcomings of the memorandum such as the lack of
commitment to protection of females displayed by the memo.
The article concludes with a determination that the United
States government must take action to protect women who are
threatened with genital mutilation. [Back]
This article gives an in depth look at the United States' treatment of female genital mutilation. While the procedure is not ritualistically practiced in the United States, doctors receive request to perform the surgery. The state of the law in the United States is unclear as to the legality of such practices. As of 1996, the practice of female genital mutilation was not illegal. The author argues that there are no constitutional obstacles to prohibit the practice in the United States, but that the criminalization of the practice may not decrease its occurrence. This is evident because even in countries which have made the practice illegal, it still continues. The author describes various legislation by states that has attempted to end the practice of female genital mutilation.
The author examines the effectiveness of laws banning female genital mutilation in the context of the British law. Efforts by the government have not proven very effective. The author also examines the response of the United States to female genital mutilation in the asylum laws. As of 1996, the United States still refused to legally expand the refugee status to women seeking to escape female genital mutilation. The author argues that one reason for this is because of fear that doing so will dramatically increase the amounts of immigrants seeking refugee status. The article outlines the current requirements for asylum and describes how a woman seeking asylum must prove these elements. Finally, the article calls for the legal condemnation of the practice of female genital mutilation in the United States. [Back]
In the introduction of this article, the author gives a gruesome case history of a young girl's experience with female genital mutilation. This young girl was subjected to infibulation, which is a requirement in some countries for marriage. The author notes that the size of the opening left after infibulation is that of a kernel of corn.(5) It is important to make the opening small, because this is a display of family honor. "[T]he smaller the artificial passage is, the greater the value of the girl and the higher the brideprice."(6) The article goes on to give a description of the history of female genital mutilation, including its use in the United States.
The author discusses the problem encountered by countries
when immigrants from countries that practice female genital
mutilation move into countries that do not. Most countries
have enacted legislation to criminalize the procedure. The
United States has not. The author examines all the possible
arguments that could be raised constitutionally for not
prohibiting female genital mutilation in the United States
and gives persuasive counter arguments. For example, the
practice of female genital mutilation is justified as being
a religious practice. Therefore, some believe that
criminalizing it would violate the freedom of religion
clause of the Constitution. However, the author argues that
female genital mutilation is not rooted in religious
doctrines, but in a desire to control women. The article
also examines the possible defenses that may be raised to
criminal prosecution. However, she argues that such defenses
should not be allowed because it would undermine the
purposes of the legislation. Finally, the article proposes
what language would need to be present in legislation to
criminalize female genital mutilation. [Back]
This article explores many of the aspects of female genital mutilation. It begins with an examination of a case in which a woman from Nigeria sought not to be deported from the United States so she could protect her two daughters from the horrors of mutilation. She won the right to stay in America in order to protect her daughters. The article notes that while there is no rule requiring it, some judges have permitted women to remain in the United States to protect daughters from female genital mutilation. It then examines the origins of the practice of female genital mutilation. This practice is often deeply rooted in the culture of societies. She examines the actual practice of the procedure, and the justifications advanced by its supporters.
This article also examines the Western response to this practice. While the United States had not formally passed legislation to prohibit the practice of female genital mutilation, it has taken steps to prevent its occurrence. For example, legislation was proposed to prohibit the procedure on American soil. Education about the procedure is emerging. Finally the United States is providing financial support to organizations in Africa that are trying to end the practice of female genital mutilation.
The response of African women is also explored in this article. The author notes that some African women are offended by the stance that the Western World has taken. She notes that while the Western cultures view this practice as a form of oppression, not all the women who deal with it on a daily basis see it as so. Further, it is noted that the practice of genital mutilation was used in the United States to treat female disorders. The author concludes that while the West may see this practice as barbaric, it may not be our job to try to stop it. Rather, the author argues, we should encourage education of these women so that they can put a stop to it. [Back]
This article gives an in depth examination of the violence against women that occurs around the world, but particularly in areas that practice female genital mutilation. The description begins with an look at the procedure used, as televised on CNN in the fall of 1994. This brought the issue to the attention to many Americans. The justifications for female genital mutilation are set out, with an observation by the author that most of these justifications have to do with keeping women in a submissive state. However, even more shocking is the data on violent crime attacks on women throughout the world. And in some cultures, if a woman is raped, she may be forced to marry her attacker or sometimes she is killed to protect the family honor.
The article concludes with an examination of the laws used to attempt prevention of female genital mutilation. In this conclusion is a description of a nineteen year old who flew to America seeking asylum. She was being forced to marry, and was scheduled to be mutilated prior to the marriage. As of the time of this article, there had been no decision in the case. [Back]
This article examines the "nature, extent and consequences of [female genital mutilation]."(7) It provides an overview of the different types of procedures that are used to perform these operations. The author notes that depending on the culture, the timing of these procedures varies. The timing ranges from infancy to after a woman has delivered her first child. There have been reports that the number of genital mutilations have been decreasing in the last couple of years. However, "[t]he WHO estimates that 85 to 115 million girls and women worldwide have been subjected to some form of genital excision."(8) The many justifications for genital mutilation are presented. It provides the historical roots to many of the beliefs about the necessity of the practice.
With the incidence of African immigrants coming to America, the need for legislation prohibiting female genital mutilation is explained. This explanation begins with a look at legislation that was proposed in the United States to have the practice be regarded as child abuse. The legislation arose partly as a response to the perceived failure of the United States to respond to physical violence to the women of the world. Next there is an examination of the United Kingdom's approach to prohibiting genital mutilation. Finally, there is a call by the author for legislation to prevent the incidence of genital mutilation in the United States. [Back]
The purpose of this article seemed to be to explore the cross-cultural views of the practice of female genital mutilation. The author examines the importance of the terminology used when dealing with this procedure. Commonly, the West referred to the practice as female circumcision, which the author suggest is misleading. Unlike male circumcision, which only removes the foreskin of the penis, female circumcision is an invasive, physically and emotionally damaging procedure. Further, human rights activist did not like the term. They wanted one that was more likely to convey the pain and horror of the procedure. Therefore, the term female genital mutilation was adopted.
The remainder of the article explores the difficulties
with this issue both as a human rights and feminist issue.
It explains the differences between the agendas of the
Western feminist and African feminist. Some women who live
in cultures that require genital mutilation have resisted
mutilation, while others have accepted it as a cultural
This article begins with a young girls experience with genital mutilation, describing the fear and pain. It is an account of a Somolian woman's "rite of passage"(9) into womanhood. The different types of procedures used are described in detail, with particular attention paid to the practice of infibulation. In this background, the author explores the justifications given by the supports of this practice. For example, she explains that tradition, one of the most given explanations for performing the procedure, is often perpetuated by older women who were subjected to genital mutilation when they were girls. It is done, because it always has been done.
The legal response of other countries is briefly examined. It explains that the United States does not have laws to protect immigrants from the risk of genital mutilation. However, Congress and several state legislatures have introduced legislation to make the practice of genital mutilation illegal. Finally, the article explores the varying constitutional issues that may arise with legislation aimed at criminalizing the procedures. However, the author believes many of these can be combated with legitimate justifications. [Back]
The focus of this article is the legal battle of an mother seeking to suspend her deportation to protect her two daughters from female genital mutilation. The mother, Oluloro's, genitals were mutilated when she was four years old. All she remembers is the excruciating pain she felt. The article examines the tensions of the West and countries that practice female genital mutilation, noting that many believe the West does not understand the culture behind this practice. Often the strongest proponents of the practice are the African women. The mythology surrounding the practice is described. "Both female and male circumcision are supported by the widespread belief that the human body is androgenous at birth. To enter adulthood, girls must be relieved of their male part , the clitoris."(10)
The practice is continued in part to bring a good marriage to the family. However, the author concludes that the only way to end this practice is to help in educating the women. Many African women look at genital mutilation as a duty that must be borne. [Back]
Emily MacFarquhar, et al., The War Against Women in Much of the World, Political and Economic 'Progress' has been Dragging Them Backward, U.S. News & World Report vol. 116, no. 12, pages 1-9; 1994 WL 11127331.
This article focuses on the women's movement throughout the world. Despite advances in the rights of women, as of 1993, there were no countries that "treat[ed] its women as well as its men."(11)
Details of the ways in which woman are victims in various countries reveals that women are still often considered second class citizens. Women are still be controlled by sex in several countries. The author gives the example of a woman's hotline in Beijing that deals with concerns of sexual harassment by encouraging the woman to "give in if they want to get ahead."(12)
Even more disturbing is the realities that women suffer in many of these countries. There is an Islamic ordinance that requires that rape victims be jailed for adultery. This practice puts the blame on the woman for a violent attack, and treats it as if it were consensual sex. In many countries, there is a cultural bias against women. Female fetuses are often aborted in Countries such as China and India. This exemplifies the low value placed on the life of women. [Back]
Footnotes1. Nahid Toubia, Female Circumcision as a Public Health Issue, The New England Journal of Medicine, vol. 331, no 11, page 712 (1994).
11. Emily MacFarquhar, et al., The War Against Women in Much of the World, Political and Economic 'Progress' has been Dragging Them Backward, U.S. News & World Report vol. 116, no. 12, pages 1-9, 1; 1994 WL 11127331.
Copyright @ 1993, 2008. Vernellia R. Randall