Twenty Years Of Zero Tolerance Day To #EndFGM: But No End To Gender Debates And Genital ‘Treatments’

February 6 is International Day of Zero Tolerance to Female Genital Mutilation.  Begun twenty years ago today (2023), the Zero Tolerance initiative has seen considerable success. But much remains to be done.  One major issue is that other forms of elective genital surgery / ‘cutting’ continue unimpeded: male circumcision, genital cosmetic surgery and transgender surgeries are widely accepted, even in some cases for minors unavoidably unable to give informed consent. This is a major problem for #EndFGM.

Consent

We are already aware that FGM is a practice where the consent of the girl or woman to receive it is usually far from central to decisions about when and how.  It is generally an imposed tradition, enforced rather than consensual.  It is likewise routine in parts of the world ranging from Africa to North America to the Middle East and Asia to ‘circumcise’ a male baby, small boy or young teenager.

Moving to modern-day western practices, only rarely is genital surgery an essential and urgent procedure in children and young people such that surgeons may be able to go ahead without parental consent.  Yet increasingly genital surgery is performed in modern clinics on western adolescents who give nominal consent to the cosmetic or ‘trans’ procedures.

In none of these instances can genuine and meaningful informed consent be given by the child, since they are not of age; in most countries 18 indicates legal adulthood, albeit other regulations may seem odd: e.g. a minor can marry at 16 in parts of the US – or younger (if indeed any age is set) depending on the state – but must still wait until 18 to vote or buy a firearm, and be 21 to buy alcohol or tobacco.  Yet fully adult brains may not be acquired till about age 25.

Female genital cosmetic surgery: double standards?

In some countries female genital cosmetic surgery (FGCS) is increasingly reported.  Whilst legal bodies may be clear that FCGS should not normally be an option for minors, it seems that sometimes this does occur.  As some #EndFGM activists claim, there are reasons to see FGCS as similar to FGM – it is often imposed because the woman or girl (or her mother or partner) believes that her external genitals can be made to ‘look nicer’, or in more traditional language, perhaps ‘purified’?  Plus, in some communities a young woman may need to ‘prove’ – despite the fact that this is not possible – that she is a virgin, by demonstrating an ‘intact’ hymen.

But whilst the parallel of FGCS with FGM has some validity, the accusation of double standards because FGM is banned and FGCS may not be is questionable, at least from the perspective of the women involved.  Those girls and women who request cosmetic procedures are likely unaware of the parallel with FGM, even if the lawyers and activists amongst us are.

Whatever, whilst the charge of double standards bears consideration, that in itself does not explain the influences and values which underpin such practices.

Transgender surgery / treatments

The issues around transgender surgery are even more complex.  In the past such surgery has been primarily the preserve of men who wish to ‘transition’ to become women: one report (2019) estimates that transgender females (females assigned ‘male’ at birth) are usually identified at higher rates than transgender males (males assigned ‘female’ at birth). In some studies, the proportion of transgender women to men is as high as 2:1.

But that is no longer the case, as research in 2020 indicates: The age at initiation [of trans surgery] has been dropping over the past 25 years, and we have seen a steady increase in the number of FTM [female to male] such that the incidence now equals that of MTF [male to female].

It is this shift to younger people, especially children, receiving ‘treatment’ to transition which is most concerning. It is simply not possible that children can know what they are giving up forever if they receive significant medical and surgical treatments.  Children don’t fully understand adult sex resulting in orgasm, and obviously they don’t usually have babies, or know the joy (for most of us) of parenthood.  Neither do they give much weight to future physical frailties such as possibly weak bones, or nor perhaps to how much their minds and bodies will over the next few years mature, let alone to the psychological or developmental changes which may result from medications.

In short, children are not in a position to give informed consent to life changing pharmaceuticals and procedures.

Rapidly growing numbers

Increasingly, reservations are being expressed, eg by the 2022 Interim Cass Review, about the approach of some paediatric mental health providers such as GIDS (the Gender Identity Development Service) at the Tavistock NHS Clinic in London.   Thousands of children there have now been put on the path to transition with, it is said, too little (if any) attention to the strikingly high incidence of psychological comorbidities or disturbing social contexts.

The revelations of writers such as Hannah Barnes, in her 2023 book Time to Think, make concerning reading. Earlier concerns around gender identity (ID) in children are found in publications such as the 2021 Safer School Alliance UK Advice Note.

Significantly, in many locations the majority of adolescents seeking gender identity treatments are now girls wishing to transition to male identity, whereas previously the much smaller total number of patients comprised boys wanting to be girls. Abigail Shrier’s 2021 book, Irreversible Damage: Teenage Girls and the Transgender Craze, hypothesizes that ‘far too much’ of the discourse around being female is negative, and transitioning is seen, when some girls hear about it, as a way around this problem.

Whose influences?

FGM, FGCS and gender ID issues all pivot around the choices for, or of, girls and young women.

Even in the case of FGM there are repeated reports in some places of girls approaching adolescence who actually demand they undergo ‘the cut’.  For them (what proportion of those who have FGM insist is probably uncertain), this act is their initiation to womanhood, even if their community does not mandate it – though many still do. As with male ‘circumcision’ (MGM – which, to be clear, I also oppose; both are dangerous and pain-inflicting practices), the rite is about entitlement, either immediately or in the future, to become recognised as fully adult.

But whilst MGM does bring with it constraints and obligations on boys, those are often much more constraining on girls: once ‘cut’ girls are usually expected to forgo further education, and often to be sold in marriage (perhaps to an older man, and not as his only wife). In the meantime, however, the girl or young woman will probably lose to some degree her health (especially if the FGM is harsh, or if she becomes prematurely pregnant) and her options for autonomous adulthood will close.

The fundamental purpose of the act of ‘cutting’ is economic, and the major beneficiary is usually the father, who thereby disposes of his costly obligation to provide for his daughter, whilst also gaining both direct commercial benefit from selling her and, maybe, a walking, talking pension plan via her spouse.

And so also with FGCS.  The wish by a girl or women to have genital cosmetic surgery is rarely an option considered only by the (mostly young) women alone.  There is often pressure – from the media, or from partners or even female relatives – which convinces such women that their genital area needs improvement; it must look perfect to fit a stereotype, or it doesn’t match the requirement of sexual partners, or whatever (see Burrage, 2019).  The intended final beneficiary, whether acknowledged or not, is likely a man.

Put another way, both FGM and FGCS are underpinned by patriarchy.

Does patriarchy apply to trans and gender ID issues?

The massive increase in the ratio of girls to boys in seeking treatment around their transition is telling.  As we noted above, one probable influence has been the perception by girls that being female is a ‘negative’ experience.  Girls absorb from early on the incontrovertible  message that overall they have less standing, will earn less and will have less influence than boys.

Particularly for girls who may be neurodiverse, or have disturbed social / family backgrounds, transitioning to become male may seem a way of avoiding these difficulties.  A clinical focus solely on transitioning, rather than a diagnosis also of concurrent conditions, is perhaps unlikely to make that child’s life long-term safer or more comfortable. Both aspects must be considered; but to the young woman herself ‘becoming male’ could seem at the time a way to avoid all the obvious disadvantages and challenges which still beset overtly ‘female’ people.  For some children, claiming trans status may feel ‘safer’ and more socially acceptable, than thinking they are gay.

Further, families may be more willing to think that their daughters are ‘really’ male (or sons, ‘really’ female), than to accept that these daughters are lesbian, or sons, gay – a status which for some, perhaps including parents and others in particular cultural settings, will give rise to homophobia.  Being a boy trapped in a girl’s body is okay, being perhaps a gay girl may in some communities not be okay.

We know, now that the genie of ‘gender’ has emerged from the black box of conformity, that many more girls say they want to become trans men, rather than the converse. How could it not be that the patriarchy is in action?  Becoming a man is deemed a means to autonomy and a degree of influence.  It is seen by some contemporary young women as an ‘answer’ to what they perceive as complex and confusing situations. Sadly, that may not be how matters turn out.

Patriarchy, again

In a previous post here I wrote it is helpful in considering patriarchy to refer to the Costa Rican feminist jurist Alda Facio Montejo, who reminds us that (quote):

…[i]n any given Patriarchy all men will not enjoy the same privileges or have the same power. Indeed, the experience of domination of men over women historically served for some men to extend that domination over other groups of men, installing a hierarchy among men that is more or less the same in every culture or region today. The male at the top of the patriarchal hierarchy has great economic power; is an adult and almost always able-bodied; possesses a well-defined, masculine gender identity and a well-defined heterosexual identity….

The details of the domination and violence vary across different places and times, but the key feature is that women are controlled by powerful men.  Sometimes the control is direct, sometimes it is via others (women or men) who do the bidding of the dominant males; but always it is to the advantage of these controlling dominators.

We must continue to be grateful for Facio Montejo for her clear explanation of how sex and gendered power operate.  Few of us however much consider the depth and breadth of this mechanism.  Yet every sort of incursion into the bodies of girls and women – and often also the incursions into male bodies (“…the creation and reinforcement of masculine dominance orders“) – demonstrates the strength of this elemental influence.

In such a considered context it becomes clear that all the ‘procedures’ discussed here demonstrate aspects of patriarchy incarnate – the imposition of (some, powerful) men’s will on the bodies and minds of girls and women.  This specific feature / phenomenon may not be the only aspect of importance, but it is an important one. In my view [there is a] ‘hierarchy of harm which patriarchy unchallenged can impose to varying degrees on the soma and psyche of female human beings, and in fact on all less powerful people.  Patriarchy is not of itself about sex or gender, it is about the accrual of wealth and influence as a means to dominate others; and patriarchy incarnate does that very well.’

Genital cutting is power

Patriarchy is like the air we breathe; most of the time it is invisible, but it is also inescapable.  We don’t see patriarchy precisely because it is so fundamental to our existence.  It exists in almost every culture, traditional or modern, informed by ancient beliefs or by ‘science’.  FGM, FCGS, and sometimes trans surgeries or similar, have a common theme. ‘Cutting’ the genitals of children and young people is a way to mark them as a part of patriarchal society, a society geared to the interests and benefit of particular sorts of men.

It is crucial to acknowledge firmly that the practices considered here are rarely perceived in the way just described by those who undergo (or persuade / permit others to undergo) them.  To those quite literally at the sharp end and old enough to have formulated a view, the reasons for genital cutting will pivot around custom and tradition, or bodily ‘improvement’, or perhaps a wish for acceptance by an influential other. These are not rationales to be dismissed; for some they have deep significance.

These perceptions demand meaningful respect.  None of this however obviates the fact that genital cutting is painful and needlessly dangerous; it can leave life-long scars, physical and mental, which sometimes tear also into the lives of others in a family or community.

When will it end?

Many admirable efforts around the globe are at last in action to protect girls and young women (along with various and increasing efforts to protect boys and young men, too) from genital ‘surgeries’.

Genital cutting of all kinds – however rationalised and presented, on female bodies or on male ones – is an elemental symbol of over-arching patriarchal power, a grievous breach of individuals’ human rights.

Until that fundamental truth is acknowledged and addressed it is unlikely that these cruel practices, FGM amongst them, will fully and finally cease.

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Read more about Patriarchy, FGM and Economics,  Child, Early and Forced Marriage (CEFM) and Male Circumcision (MGM)

Your Comments on this topic are welcome.  
Please post them in the Reply box which follows these announcements…..

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Books by Hilary Burrage on female genital mutilation

https://orcid.org/0000-0002-6684-2740

Eradicating Female Genital Mutilation: A UK Perspective
Ashgate / Routledge (2015)  Reviews

Hilary has published widely and has contributed two chapters to Routledge International Handbooks:

Female Genital Mutilation and Genital Surgeries: Chapter 33,
in Routledge International Handbook of Women’s Sexual and Reproductive Health (2019),
eds Jane M. Ussher, Joan C. Chrisler, Janette Perz
and
FGM Studies: Economics, Public Health, and Societal Well-Being: Chapter 12,
in The Routledge International Handbook on Harmful Cultural Practices (2023),
eds Maria Jaschok, U. H. Ruhina Jesmin, Tobe Levin von Gleichen, Comfort Momoh

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PLEASE NOTE:

The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children, which has a primary focus on FGM, is clear that in formal discourse any term other than ‘mutilation’ concedes damagingly to the cultural relativists. ‘FGM’ is therefore the term I use here  – though the terms employed may of necessity vary in informal discussion with those who by tradition use alternative vocabulary. See the Feminist Statement on the Naming and Abolition of Female Genital Mutilation,  The Bamako Declaration: Female Genital Mutilation Terminology and the debate about Anthr/Apologists on this website.

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This article concerns approaches to the eradication specifically of FGM.  I am also categorically opposed to MGM, but that is not the focus of this particular piece, except if in any specifics as discussed above.

Anyone wishing to offer additional comment on more general considerations around male infant and juvenile genital mutilation is asked please to do so via these relevant dedicated threads.

Discussion of the general issues re M/FGM will not be published unless they are posted on these dedicated pages. Thanks.