Harm Reduction, Moral Relativism, and Female Genital Mutilation

In a first-of-its-kind legal case, Dr. Jumana Nagarwala is being prosecuted in Detroit, Michigan for violating a 1996 federal law against female genital mutilation. Nagarwala was indicted alongside another woman who was allegedly present in the room during the mutilation. Nagarwala’s husband, who owns the clinic where the procedure occurred, is also being prosecuted. Nagarwala is accused of performing female genital mutilation on two seven-year-old girls who had been brought from Minnesota for the procedure.

It is difficult to discuss this topic in a neutral fashion. For one, there is intense controversy even over the language used to describe it. The World Health Organization uses the term “female genital mutilation” (FGM) to name the practice. On the other hand, Celia Dugger, the editor of Health and Science for the New York Times, prefers the term “genital cutting” rather than the more negative “mutilation” because she thinks “mutilation” serves to “widen the chasm” between activists who campaign against the practice and the people who still perform it. Others have argued that, on a pragmatic level, use of the word “mutilation” may be offensive to the women who have been subjected to the procedure, and thus may harm efforts to grow consensus against the practice. The practice has also been called “female circumcision,” but most agree that this term is a euphemism that draws inaccurate comparisons to the much less harmful practices of male circumcision. I will follow the WHO’s terminology, which defines female genital mutilation (FGM) as “all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.” I recognize there is a reasonable debate to be had about what language to adopt in discussing this practice.

From the perspective of individual health, FGM can be extremely harmful and has no positive health benefits. The WHO notes such negative immediate consequences as extreme pain, excessive bleeding, fever, injury to surrounding genital tissue, and even death. Potential long-term consequences include urinary problems, vaginal problems, menstrual problems, pain during intercourse, increased risk of childbirth complications, and psychological problems. The WHO recognizes no potential health benefits of FGM.

The WHO frames its moral argument against FGM in terms of human rights. People have a right to health, security, and physical integrity. More specifically, people have a right to be free from torture and degrading treatment. FGM violates these rights of individuals. Given that FGM is usually carried out on girls between infancy and 15, FGM cannot be defended on the basis of consent given by the victim, for children are unable to give rational consent to undergo procedures with such serious potential consequences. FGM also constitutes a form of sexual discrimination, because it is practiced exclusively on women, is associated with cultural ideals of femininity, and is often done to satisfy male desires for what they consider to be pleasurable sexual intercourse and marriageable partners.

So, the case against FGM seems straightforward from a Western perspective. However, there are philosophically interesting wrinkles worth considering. First, some have preferred a harm-reduction approach to FGM. Harm reduction originated as a public health approach to drug abuse. Operating under the assumption that drug abuse is an unavoidable public health problem, harm-reduction policies seek to reduce the harm associated with drug abuse, rather than seeking to end drug abuse altogether. One example is needle exchange programs, which provide intravenous drug users sterile needles so as to reduce the chance of contracting HIV or hepatitis. Those who defend a harm reduction approach to female genital mutilation argue that decades of attempts to eradicate the practice completely have not succeeded, and are unlikely to succeed soon. Trained health professionals and governments should, instead, promote the least invasive and least harmful forms of genital mutilation—such as very minor symbolic incisions—and provide communities safe and sterile environments to perform them in.

A more radical dissent against the Western consensus opposition to FGM argues that the Western critique of FGM is not applicable to the cultures where it is practiced, because these cultures do not accept the same moral standards of human rights. On this line of thought, moral standards are culture bound, rather than universal. It is important to differentiate a descriptive and a normative interpretation of this moral relativism. The descriptive version claims that, as a matter of fact, different cultures adhere to different moral standards. While Western cultures may believe in individual human rights, other non-Western cultures place more emphasis on the moral value of the community, at the expense of the individual. The normative version claims that the rightness or wrongness of an action really is relative to the cultural background of the individual person.

It is not only true that Westerners believe in human rights and non-Westerners believe in some other moral standards. It is also the case that Westerners are morally obligated to respect human rights, while non-Westerns may not be. Since FGM is practiced in cultures whose moral standards do not include human rights, those cultures cannot be morally obligated for failing to respect human rights by practicing FGM. The normative moral relativist will say that some people are morally justified in practicing FGM, while some people are not, depending on the culture to which they belong.

No doubt there are more sophisticated accounts of moral relativism than presented above that are worth considering in more depth. Nevertheless, it is worth pointing out that many relativist defenses of cultural practices like FGM depict cultures as monolithic and mostly homogenous. However you define a culture, it will be difficult to identify a clear set of moral standards that are dominant in that culture. Simply put, people disagree. Not all people who live in cultures where FGM is practiced participate or support the practice. Even if most people in a culture accept moral standards that justify FGM, relativists must provide an explanation for why dissenters should also be held to the moral standards they oppose.