FGM: A Radio Interview with Dr. Nahid Toubia

Quick links to products available in the Campaign for Genital Integrity . . .

     INFORMATIVE VIDEOS:
     Facing Circumcision Eight Physicians Tell Their Stories
     Restoration in Focus   Instructional Video for Foreskin Restoration
     They Cut Babies, Don't They?   One Man's Struggle Against Circumcision
     Whose Body, Whose Rights?   Award-winning documentary seen on PBS!

THE BOOK THAT EXPOSES IT ALL:
     Circumcision Exposed
Rethinking a Medical and
Cultural Tradition

FORESKIN RESTORATION with:
The P.U.D. new low pricing!
and The VacuTrac at special pricing!
plus the Foreballs device

Selected excerpts from
"New Paradigms" hosted by Maureen Primerano - KMUD/Garberville, California - 26 December 1996

[Note: Ms. Primerano has done several provocative radio programs focusing on the damaging effects of circumcising unconsenting male children and exploring the human rights violation inherent in the practice.]

Maureen Primerano (MP): This evening, I’ll be interviewing Dr. Nahid Toubia, who is a physician and director of RAINBO, which stands for Research Action Information Network for the Bodily Integrity of Women, and that’s based in New York City, and the topic is female genital mutilation. [After an overview of the problem of FGM, MP introduces Dr. Toubia.] Dr. Nahid Toubia was born in Khartoum, Egypt in 1951 and attended medical school in Egypt. In 1981 she became a Fellow of the Royal College of Surgeons in England and the first woman surgeon in Sudan. She served as the head of the Pediatric Surgery Department of Khartoum Teaching Hospital for many years. Recently, she worked for four years as an associate for Women’s Reproductive Health at the Population Council in New York City. Dr. Toubia is currently an Associate Professor at Columbia University School of Public Health. She is also a member of several scientific and technical advisory committees of the World Health Organization, UNICEF and UNDP and vice-chair of the advisory committee of the Women’s Rights Watch Project of Human Rights Watch, where she serves on the Board of Directors. She publishes widely on issues of reproductive health, women’s rights and gender inequality, particularly in Africa and the Middle East.

[Dr. Toubia is also on the Editorial Board of the international quarterly journal "Health and Human Rights," published by the Harvard School of Public Health.]

MP: I understand that in the communities where female genital mutilation occurs, it is often referred to as female circumcision, however, this term implies an analogy with male circumcision, which is not the case. Could you explain the difference?

Nahid Toubia (NH): Well, I disagree with you that it’s not the case. I think there are similarities and then there are differences. I think the people who say that there are no similarities are people who don’t want to address male circumcision basically. I think I’ll start with the similarities by saying, number one, it is done as a ritual. It’s not done to mutilate anybody. It’s done as a positive cultural ritual even though it creates damage. But the intent of it is something to keep the child part of the community, part of their peer group, part of an ancestral ritual that’s based on culture, sometimes in a misperception, sometimes some people feel it’s based on religion. So in that sense, it’s not that different from male circumcision. And many of the societies that do female circumcision actually do male circumcision around the same time. They don’t see this difference. The other similarity, I think, is the fact that it’s done on a child without the child’s consent. Now, regardless of the degree of damage, I think any physical cutting of a child, to our understanding today in the 1990s is a human rights violation of that child. Now, in terms of the degree of damage, that’s where people might differ in terms of whether it’s the same or not. Yes, in the male type it’s just removal of the skin around the prepuce [correction: The entire prepuce is removed. She may have meant to say "the skin around the penis"] but some people maintain that still is not very healthy, and science today tells us more and more that it’s not. But, of course, for the female it’s much more dramatic in the sense that a whole body organ is removed even if it’s the part of the clitoris, or the whole of it, or even the more extensive part. So yes, the female circumcision is basically quantitatively, in terms of amount of tissue removed, is a bigger problem, is a bigger operation. But, as I said, in many ways people are starting to see that it’s not that different from male circumcision.

NT: It all depends, of course. People like to exaggerate, this sort of "Oooh! Ahhh!" of the bleeding, the infection, the this, the that. Of course, all that happens. It depends on the degree of cutting. …But there’s also the psychological problems of children who might be traumatized by it, although not all children are traumatized by it. Sometimes they perceive it as a positive experience, even though they somehow suppress their fear of it. It’s quite a complex psychological process. [True also for males circumcised as children.] Also its effects on sexuality tend to vary quite a bit, depending on the severity and also the social constructs of sexuality in any particular place.

MP: Could you talk about the cultural significance of this practice and perhaps discuss the patriarchal underpinnings of this…?

NT: The cultural significance is what it’s really all about. …Although if you ask people immediately why they do it, most people would just tell you, "Well, it’s just a tradition, we have not thought about why we do it". But underlying a lot of it is suppression of women’s sexuality or interfering it in some way.

[Most Americans are unaware of the medical documentation that circumcision in the U.S. began as an attempt to control the sexuality of children of both sexes by allegedly preventing masturbation. According to the 12^th Century philosopher and rabbi, Moses Maimonides, the true reason for Jewish circumcision is to make the male more sexually moderate by desensitizing him and thereby controlling his lust. Islamic circumcision is an outgrowth of its Jewish predecessor, and is seen as a way to "purify" males of "excessive" sexuality that might interfere with men’s spiritual life. In all cases, these anti-sexual "roots" are unknown to most people today, having been replaced by the modern "religion" of medical hygiene.]

NT: It is a patriarchal practice, even though it’s so dominant in the culture that the people who perpetuate it, a lot of the time, are women, just like in many cultures women do things to themselves to keep up with the cultural definition of what femininity is about [as do men – e.g., pectoral implants, adult circumcision, penile lengthening]. A lot of people make the comparison with how women mutilate themselves whether they do plastic surgeries on their faces or their breasts, sometimes in Western cultures they do plastic surgeries on their genitals for reasons also of cosmetics [e.g. aesthetic "trimming" of "excess" labia. This is the female counterpart of men who get circumcised for non-medical cosmetic reasons.] Admittedly, these are adult women who, rightly or wrongly, have the right to do what they like to themselves. That’s very different from doing things to children. We have to make that distinction very clear. I think the idea behind this idea that women are never whole, they’re never complete, they can’t be who they are, they have to be changed and mutilated and cut to fit some accepted male-dominated prescription of what women should be like. [Similarly, misandrist concepts, which devalue the whole, intact male and attempt to literally cut boys to fit a prescribed male image, abound in dominator societies where circumcision of male children is widespread - like the U.S., Africa and the Middle East.]

MP: The prevalence of female genital mutilation varies according to education and social class and rural and urban dwelling. Can you expand on that?

NT: To some extent that’s true. It depends on what’s happening in the country. In many countries, including Sudan, where I come from, it’s still quite dominant among people who are educated and prevalent in urban areas.

MP: It does seem that there’s a lot of social status [associated with those who perform circumcisions] and it’s hard for people to give it up because of that and because it is a lucrative thing, so that it would take something very strong to replace that. Is that a fair thing to say?

NT: I agree with you. I think working on, what I would call, the "supply side" of the market for circumcision would be very wrong because like any other practice you cannot stop the practitioner. As you said, they could have either a financial investment in it or a social status. I think it’s much more important to work on the "demand" side, that is, the people who actually request it, because even if you worked on the supply side, there’s no incentive for someone to stop doing it. And even if you gave the incentive and removed some of the suppliers, new suppliers will come through because as long as there is money in it, somebody is going to do it.

MP: Do you think it would seem fair to say that an important long-term consequence of annihilating an essential part of a girl or woman’s anatomy might impact her ability to assume leadership roles or to feel empowered generally in life?

NT: …If you talk on an individual basis, I think that would not be the right thing to say because individuals have passed all kinds of obstacles. By that I mean people who are blind or paralyzed. …On the individual level, I think women who are circumcised could still be leaders. But if you talk on the population level, …at the group level, I think it probably does have an effect, although we haven’t really measured it. [Equally true for males circumcised as children.]

MP: Are there any studies that demonstrate what the effect might be on children?

NT: No, there is no scientific systematic study of the effects on children, but there are testimonies now, increasingly. One of the problems of this issue was that there was a real veil of silence. There was very little research, very little documented evidence for years. Only in the last five to ten years has there been more courage for people to come forth and talk and tell about their personal experiences as children as they go through this, and through that we’re getting a lot of testimonies of how potentially traumatic it is to the child [A similar disclosure phenomenon is occurring for males circumcised as children.] Some children take it better than others, it’s very difficult to generalize. If you go through the experience of any kind of trauma, some people take it better than others. In general, it is quite traumatic to children.

MP: Perhaps it’s a "tall order," but how does one come to grips and overcome the resistance to change to try to stop this from happening?

NT: I don’t think it’s a "tall order." It’s only a "tall order," if people see things very narrowly. If you say, "I want only to stop circumcision… I think that’s even more difficult. If you see it in the context of -- "I’m going to help women understand their situation. I’m going to help empower women to say no to this happening to themselves." -- it does not become a tall order. [This is NOHARMM’s philosophy, but with a male focus.]

The problem with people in the West is … they want to go in and change it. I’m just telling them, "You won’t be able to change it. You cannot change it. Only the women in Africa can change it". The only way to do it is to help them empower themselves.

Male Caller: Two comments. On the aspect of the patriarchy, and obviously men have done all kinds of crazy things. A lot of that has evolved, If you look at animal behavior, like gorillas and territoriality and mating rituals, a lot of the crazy male behavior has developed over the millennia, and a lot of this is based on primitive, superstitions, and like you mentioned, religion. Young males go through horrible initiation rituals at the age of 12 or 13 by these societies where they’re scarred because they’re looking forward to a future of fighting usually to the death before they’re 20 years old. Another thing is the mentality of Western people. We think we’re so civilized, in our medical people, and yet we take babies and we don’t give them any anesthetic and we remove the foreskin of the males, and I’m sure the babies are screaming while this happens. People wonder why American men are so screwed up. Maybe one aspect is your first day of life, one of the most sensitive areas of your body is totally violated and I’m sure that creates a mental state that manifest later in life with anger and violence. That’s recognized in the general birth movement where they’re trying to have babies and not spank them even. A baby is more sensitive, probably, than at any stage of life, and how medical people can think "Oh this baby can’t feel anything. Let’s cut its foreskin off." I mean, where has all this science brought us to?

NT: I really commend you for these points. I think they are two very, very important points. I think sometimes we simplify things and divide this society into men and women. I think society creates power structures and when I spoke about "patriarchy," I really meant a certain power structure in which sometimes men suffer just as much as women, or maybe not just as much, but they do suffer too. It’s a status quo that men think, at some point, benefits them. I don’t know if it always does, if they really think about it. I definitely agree about the circumcision of boys, which because it’s so widely practiced still in America, it’s still a very taboo subject to talk about. But I think there ought to be some serious reconsideration of its utility, if not of its ferocity or its unfairness, to say the least.

Female Caller: …I’d also like to make a comment about male circumcision. My son was circumcised. There was no discussion with our doctor in advance. I didn’t know it was going to happen. I feel it should be outlawed. I don’t feel that there’s any reason these days for male circumcision. I think that it takes away quite a lot of the male enjoyment of sex.

NT: I just want to make a quick comment about male circumcision. Especially in the Eastern part of the United States, where I live, New York, Boston, Washington and all these areas, it’s still quite highly prevalent – much more acceptable, as I understand, from the Western part of the United States. It’s no longer practiced in Europe. People who still defend it on the basis of medicine should know that in Western Europe they don’t perform it. They don’t believe that there’s any benefit from it.