* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
The American College of Obstetricians and Gynecologists (ACOG) recently issued guidelines for medical professionals, which outline how to carry out “labial surgery” on adolescent girls. These refer to surgeries which are carried out for medical reasons, but also “cosmetic procedures” which are “performed to reshape normal structures”. In practice, this means operations on a girl's labia when she is not experiencing any physical pain or discomfort. Even ACOG admits that such procedures may not be safe and could have serious consequences.
The college does not seem to realize that any surgery which is carried out for non-medical reasons on the genitals of a minor is against United States law. Under this country's anti-female genital mutilation (FGM) act, it is illegal to cut a girl's labia unless it is "necessary to the health of the person". The World Health Organization has categorized all cutting of a girl's labia as Type IV FGM. A key reason for this outright ban is to ensure that no loopholes exist, which would make it possible for a girl to undergo any form of FGM.
In addition to the harmful health and legal consequences, the facilitation of surgery to change perfectly healthy genitalia can also be hugely harmful to a girl’s sense of self and confidence in her own body. It reinforces unhealthy norms on how a girl or woman’s genitalia should look – apparently driven by financial motivations.
Over 10,000 Americans have already joined Jaha Dukureh, FGM survivor activist and one of this year's Time 100 most influential people, who is challenging these guidelines, with the support of Equality Now. This is the latest turn in a long-standing campaign to ensure U.S. health personnel do not violate anti-FGM laws and policies. In 2010, Equality Now successfully pressured the American Academy of Pediatrics (AAP) to retract portions of a statement, which instructed doctors that they could “nick” a girl’s genitals - a form of FGM. The surgery that ACOG is now referring to is potentially even more invasive.
Earlier this year, the Centers for Disease Control and Prevention updated prevalence estimates in response to a change.org petition by Jaha Dukureh, lead survivor-activist from Safe Hands for Girls and Equality Now, with support from The Guardian. We now know the scale of the issue in the U.S. – 513,000 American women and girls have been affected. This is a huge human rights issue in the U.S. and around the world, where at least 200 million women and girls have been affected.
While the U.S. has shown leadership in foreign policy commitments, including supporting the new Global Goal to End FGM and the U.S. Global Strategy to Empower Adolescent Girls, American health officials may need a wake-up call about practices within our own borders. The violation does not change simply because ACOG or others refer to “labiaplasty” on minors, rather than FGM.
We simply cannot continue to effectively tackle FGM in the U.S. and internationally, while highly respected professionals – who are supposed to protect a girl’s health and well-being – are not playing their role in ending it. The U.S. medical community should take a close look at the United Kingdom, where health personnel are actively leading anti-FGM efforts. Equality Now worked with the U.K.-based Royal Colleges of Obstetricians & Gynaecologists, Midwives and Nursing, and the union, Unite, to issue a set of recommendations for health professionals and others to protect girls at risk of FGM and to support survivors. This directly informed U.K. policy and that country’s national health service now has a clear system for identifying, recording and reporting instances of this abuse. The International Federation of Gynecology and Obstetrics (FIGO) has also pledged to be at the forefront of the generation where FGM ends and the World Health Organization just launched new guidelines for medical professionals on treating FGM survivors.
In the U.S., the Department of Health and Human Services (HHS) should support the development of guidelines for medical practitioners, which are based on a clear understanding of FGM as violence against girls. Appropriate services should be urgently provided to all women and girls who have undergone FGM.
The Department of Justice should also play its part in making sure that existing anti-FGM laws are understood and enforced against all perpetrators. The FGM inter-agency working group should ensure that international commitments and national-level efforts to end FGM are properly aligned. At the moment, funding for this effort is extremely low. The General Accounting Office released a report earlier this month on how woefully inadequate funding by the U.S. of anti-FGM work globally really has been, something which Senator Harry Reid has described as “shameful”.
For several decades, momentum to end FGM has been growing, on the African continent and globally. Despite incredible challenges, we are finally making real progress, but with only a tiny funding pool available for activism from innovative foundations including the Wallace Global Fund, Comic Relief and the Human Dignity Foundation, there is still a huge mountain to climb.
Against this backdrop, we urge ACOG to consider how its guidelines may be adversely affecting the health and well-being of American girls and to focus instead on helping health personnel to be much-needed ambassadors for ending FGM in the U.S.