Thursday, October 21, 2010

Nasty cuts

The closing session at Mont Pelerin included Ayaan Hirsi Ali. She's a neoconservative, so I do disagree with her on a good number of things, but I also have great admiration for her achievements.

In the same session, another presenter asked how much we ought to tolerate intolerance, suggesting female circumcision as an absolute line for that which ought not be tolerated.

I would, of course, agree. But recall that a more modern variant of the procedure is far more symbolic than damaging:
The committee settled on calling the procedure “female genital cutting,” or FGC, and in the process of revising, rewording and rethinking its policy, it considered an approach for minimizing harm first proposed by doctors at Harborview Medical Center in Seattle. In the mid-1990s, some of them were attending pregnant women from Seattle’s Somali community. “If your baby is a boy, do you want him circumcised?” they would ask. Some of Somali mothers-to-be would reply, “Yes, and also if it’s a girl.”

The Harborview doctors proposed that the hospital offer these mothers a “clitoral nick” for their daugthers — a needle prick, really — in the small hood of tissue that covers the clitoris.
Again, it's superstitious nonsense and a violation of the child's autonomy. But the modern procedure is harm minimizing: the gains from folks substituting away from far worse things well outweigh the costs to those whose parents would otherwise have chosen to avoid the procedure.

Nobody applauding the speaker's comment on intolerance asked why we oughtn't apply the principle without gender distinction. The modern form of the procedure for girls is less invasive than the modern form for males.
“We’re talking about something far less extensive than the removal of foreskin in a male,” a common procedure in the United States, said Dr. Diekema. Such a compromise, the doctors argued, would discourage parents from sending their girls back to their native countries for unregulated and unsanitary procedures.

“They weren’t trying to propagate FGC,” said Dr. Diekema, who had heard the stories of female circumcision requests from his colleagues at Harborview. “If this nick could prevent harm for a few girls, they wanted to have it in their back pocket as an option.” But when news of the proposal broke, anti-circumcision groups and stunned citizens swiftly put an end to the discussion.

When the AAP resurfaced the idea last month, the public reacted with similar outrage.
I wonder what the reaction would have been at MPS had I asked about extending intolerance in gender neutral fashion. But I didn't because I couldn't think of a way of phrasing it that wouldn't have come off as outrageously insensitive given the panel's composition.

Chesnokova & Vaithianathan discuss the economics of female genital cutting here. Their model has multiple equilibria with threshold effects - if sufficient women have had the procedure, then if men put a premium on brides who have had the procedure, the procedure will take place unless female opportunities outside of marriage are sufficiently attractive. Below that threshold, it will die out. The data (Burkina Faso) suggest those having undergone the procedure marry younger and live in wealthier households, so it seems correlated with marital success.

But they're silent about why migrants to the west might seek that the procedure be undertaken. We're well below any tipping threshold and external opportunities are pretty decent. My best guess would be a mix of two motives: tradition and seeking to ensure that the daughter takes a husband from within the ethnic community. Access to the modern form of the procedure may placate the former; I can't see how it would worsen outcomes for the latter.

And so I'm pretty weak on the "don't tolerate intolerance" question. I'm a pluralist - rights matter, but so does utility. It's hard to make a utilitarian case against the modern symbolic forms of the procedure if they can induce substitution away from the far worse versions. If we were in a world where male infant circumcision were banned, I could understand the outrage at allowing even the symbolic version for girls. But in this world, I wonder about the folks who shout a lot about banning even the mild form of the female procedure while saying nothing about the worse treatment accorded a (thankfully decreasing) number of male infants.

5 comments:

  1. Why not let everyone choose once they turn 18?

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  2. That would be first best, Robert. But we can't get there: it would just induce some parents to bring their child overseas for a worse form of the procedure.

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  3. It's apparently more important to express righteous indignation than to save a girl's clitoris. As to slippery slope arguments - first, that is a logical fallacy; and second, it's a bit much to worry about a slope when we are already in the process of sliding down one.

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  4. Outrage over routine infant circumcision in the English speaking countries has been building for nearly 30 years. One of the gravamen is that standard operating procedure is to dispense with anesthesia. Doctors and parents have allowed routine infant circs to be videoed, and YouTube does not delete the results. The screaming babies are a public relations disaster. The rational response of doctors would be to incorporate lidocaine into the protocol. And indeed, all Australian circs are done in this way; I know nothing about the sitch in Canada. While lidocaine use has gone from 0% to 30-50% over the past 15 years in the USA, it unaccountably isn't 98%+. Hence persisting USA medical practice is feeding the lay opposition to routine baby circ the best possible argument: the procedure is inhumane. I cannot explain this outcome, except to repeat an old saw of my mother's "The USA has an aristocracy. They call it the medical profession."

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  5. Diekema, a professional medical ethicist and the holder of an academic appointment, told an NPR journalist that American intactivism is "emotional." This patronising remark did not do his reputation for decency any favours.

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