Text and followup of our May 10 letter to the American Academy of Pediatrics (AAP) in response to its recent position statement on female genital cutting (FGC), which condones minimal forms of FGC. The AAP reversed its postition and sent a letter of retraction to ARC.

AAP Reverses Policy

On June 1, the American Academy of Pediatrics (AAP) publicly retracted its May 1 policy statement condoning mild forms of female genital cutting (FGC). On June 2, the AAP sent a letter to Attorneys for the Rights of the Child (ARC) announcing this retraction. As you can see from comparing the two retractions, which are reproduced below, some interesting differences exist between the two. The public version twice attempts to shift responsibility to unnamed third parties for “misinterpreting” the AAP’s statement as endorsing certain forms of FGC, but such a “misinterpretation” was actually simply a straightforward reading of what the AAP actually said. In its June 2 letter sent to ARC, however, the AAP refrains from any attempt to imply mistakes by those interpreting its policies. Amusingly, even stunningly, the AAP attempts to pat itself on its back for unintended benefits of its misguided May 1 policy, concluding that, “One good thing to emerge is that the discussion has shown a bright light on this issue and raised the world’s awareness about this harm to young women.” In the June 1 public retraction, a version of this statement appears but in a more modest, less questionable form. (The italics appearing in the public retraction below appear in the original, which can be viewed here.)

Public Retraction:

Academy clarifies position denouncing all forms of female genital cutting
By Alison Sulaski Wyckoff
Associate Editor, Pediatrics
June 1, 2010
aapnews.aappublications.org

Reaffirming its strong opposition to female genital cutting (FGC), the AAP Board of Directors retired a recent policy statement on FGC and replaced it with another statement clearly denouncing the practice.

The original version, Ritual Genital Cutting of Female Minors, from the AAP Committee on Bioethics, was published in May Pediatrics and featured in AAP News (aapnews.aappublications.org/cgi/content/full/31/5/31). Updated from a 1998 version, the statement detailed the health risks of FGC, provided historical perspective and urged members to counsel families not to have such procedures performed.

However, confusion ensued when a few sentences were mistakenly interpreted as endorsing a milder version of FGC for some immigrant girls who could be returned to their home countries for more severe forms of the practice.

The controversy ignited wide discussion via telephone calls, letters and blog posts from all over the map.

On May 27, after hearing from members and others, the AAP Board of Directors and leaders responded by retiring the statement and replacing it with the following:

The American Academy of Pediatrics (AAP) reaffirms its strong opposition to female genital cutting (FGC) and counsels its members not to perform such procedures. As typically practiced, FGC can be life-threatening. Little girls who escape death are still vulnerable to sterility, infection and psychological trauma.

The AAP does not endorse the practice of offering a “clitoral nick.” This minimal pinprick is forbidden under federal law and the AAP does not recommend it to its members.

The AAP is steadfast in its goal of protecting all young girls from the harms of FGC.

AAP President Judith S. Palfrey, M.D., FAAP, emphasized that the Academy’s goal is to protect the health and well-being of all children.

“The May 2010 statement aired some important controversies in the field about how to end these practices worldwide,” said Dr. Palfrey. “Unfortunately, the discussion about the controversial ‘ritual nick’ led to confusion and misinterpretation of our policy.”

She said the Academy published the clarification to reaffirm that the Academy is “opposed to all forms of female genital cutting including the ritual nick,” whether it is in the U.S. or elsewhere in the world.

The practice of FGC is widespread, with 4 to 5 million girls being subjected each year to dangerous procedures, according to Dr. Palfrey. She said the discussion has increased worldwide awareness about this issue.

Letter of Retraction Sent to ARC

June 2, 2010

J. Steven Svoboda
Executive Director
Attorneys for the RIghts of the Child
2961 Ashby Ave.
Berkeley, CA 94705

Dear Mr. Svoboda:

The American Academy of Pediatrics (AAP) has retired its 2010 policy statement on female genital cutting (FGC). The AAP Board of DIrectors has approved the following as AAP policy on FGC:

“The AAP reaffirms its strong opposition to FGC and counsels its members not to perform such procedures. As typically practiced, FGC can be life-threatening. Little girls who escape death are still vulnerable to sterility, infection, and psychological trauma.

“The AAP does not endorse the practice of offering a ‘clitoral nick.’ This minimal pinprick is forbidden under federal law and the AAP does not recommend it to its members.

“The AAP is steadfast in its goal of protecting all young girls from the harms of FGC.”

AAP President Judith S. Palfrey, MD, FAAP, said, “Our intention is not to endorse any form of female genital cutting or mutilation. We retracted the policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere else in the world.

“The AAP’s goal is to protect the health and well-being of children,” Dr. Palfrey said. “One good thing to emerge is that this discussion has shone a bright light on this issue and raised the world’s awareness about this harm to young women.”

Regards,

Errol R. Alden, MD
Executive Director/CEO

First Retraction:

May 27, 2010

As announced in today’s print edition of the New York Times, the American Academy of Pediatrics (AAP) has reversed its May 1 policy statement that condoned certain forms of female genital cutting (FGC). The New York Times article can be found at www.nytimes.com/2010/05/27/health/27brfs-DOCTORSREVER_BRF.html?ref=todayspaper and the policy statement can be found at aappolicy.aappublications.org/cgi/content/abstract/pediatrics;125/5/1088. To date, by my count, no fewer than 23 letters have been published by the AAP’s flagship journal, Pediatrics, denouncing its May 1 statement. The letters can be found at pediatrics.aappublications.org/cgi/eletters/
125/5/1088. ARC’s published letter can be found at pediatrics.aappublications.org/cgi/eletters?lookup=by_date&days=30#50145. The AAP’s about-face has occurred as an apparent response to the storm of outrage its position produced, including the 23 published letters to Pediatrics and also, for example, the following letter that ARC sent the day before yesterday to the members of the AAP committee that authored the statement:

ARC’s Letter:

Attorneys for the Rights of the Child
2961 Ashby Avenue, Berkeley, CA 94705 Fax/phone 510-464-4530

American Academy of Pediatrics Committee Members
May 25, 2010
Dear Committee Members:

We have reviewed the AAP’s latest policy statement on Ritual Genital Cutting of Female Minors and we are shocked to see such an ethically and medically incoherent document issue from your Committee and from your venerable organization. What truly is paradoxical is for the nation’s leading organization of doctors treating children to weaken its opposition to a practice proven to cause substantial, irreparable, lifelong harm to children.

Moreover, your proposed, seemingly innocent “ritual nick” almost certainly violates the Federal Prohibition of Female Genital Mutilation Act, whose criminal provisions became effective in March 1997. You acknowledge in your statement the contradictory impression that may be conveyed by policies that condone male circumcision (MGC) while attempting to restrict female genital cutting (FGC). The only course that is consistent with the US Constitution (including the Fourteenth Amendment right to equal protection), statutory and case law, medical ethics, and human rights is to prohibit all genital cutting that is not medically necessary and that is performed on individuals unable to consent to the procedure, including children. Parental assent is not an adequate substitute for individual consent with regards to male circumcision as it lacks a therapeutic benefit that exceeds the harm from complications and loss of functional tissue.

We trust that lightening your opposition to female genital cutting is not being done to help set up a parallel move toward diluting your 1999 statement on MGC. Flawed as the latter statement was, it did acknowledge the lack of medical benefit to the procedure on males. It is imperative that both statements be maintained or strengthened.

The AAP has no business brokering cultural procedures, even those that may support future revenue streams for some of its members. In this time of reduced resources, more than ever, it is imperative that medical organizations such as the AAP focus on what matters most-promoting the safety of our children, and working to eradicate-not condone or justify-harmful, non-beneficial, unethical practices such as FGC and MGC. Sincerely,

J. Steven Svoboda
Executive Director
Attorneys for the Rights of the Child

Congratulations to everyone involved in inducing the AAP to reverse its position. However, the battle is not over. We need to highlight the AAP’s hypocrisy in approving its now disavowed statement and the legal and ethical necessity to equally protect the genital integrity of all children, male as well as female.

Steven Svoboda
Attorneys for the Rights of the Child