The debate surrounding the practice of Clitoraid, the organisation that provides reparative surgery for women who are victims of female genital mutilation (FGM), has come to a head as Clitoraid published a rebuttal of their critics, accusing them of being sex-negative, likening them to defenders of slavery and Nazism, and accusing them of prejudice against the organisation’s Raelian background. Clitoraid’s rebuttal misrepresents what their critics have been saying and fails to engage with most of the questions asked of them. Dr Petra Boynton has posted a detailed response, explaining why the questions remain unanswered, and strongly challenging the manner in which Clitoraid have responded. More detailed background to the Clitoraid debate to date can be found on the blogs DrPetra, Can We Save Africa?, and Sex in the Public Square.
Although I have been following the discussion closely, I have not yet posted any analysis on Clitoraid, as I am focussing on trying to find out more about their activities in Burkina Faso. My blog contains a few links containing information I have discovered so far. However, having seen Clitoraid’s latest response I want to contribute some thoughts, because this discussion has a lot to do with appropriate international health and development practice.
Responses by Clitoraid and its supporters to criticism have consistently tried to imply that critics condone FGM – and this despite repeated, robust statements to the contrary. A point that has repeatedly been made by those asking questions relates to how reconstructive surgery is perceived in countries like Burkina Faso, where Clitoraid is building a hospital for the purposes of offering this surgery. Critics have pointed out that there is already a strong indigenous movement against FGM in Burkina Faso, leading to criminalisation of the practice and to provision of reconstructive surgery in some public facilities. But just because there is active opposition to FGM at policy level, it can’t be assumed that attitudes towards female sexuality have changed in the same way and across the whole country.
Clitoraid makes out like critics are calling for sensitivity to the community’s attachment to FGM, but they are being disingenuous. In health practice, community sensitivity is crucial, because developing healthcare often involves introducing new technologies that are poorly understood or mistrusted. But talking about community acceptability or community preparedness does not mean condoning traditions and practices. It means understanding how and why cultures, traditions and practices exist, who is maintaining them, who is opposed to them, and what the barriers are to tackling them. In the context of FGM it means identifying the overall context within which the practice takes place, because in countries where FGM is prevalent, women often suffer a range of abuses, inequalities and rights violations, not just FGM – and all of these need to be addressed. For instance, UNICEF has identified six key elements for effectively addressing FGM and its effects. Interventions like reconstructive surgery are incredibly important, but on their own, specific interventions are unlikely to have a major impact.
Talking about community context also means appraising the risks of trying to influence attitudes and practices, in particular the risks for those community members who wish, against majority opinion, to stand up and oppose abusive and barbaric practices. Health and development practitioners do worry about imposing their own values (or being seen as doing so), but most of the time there are already people – albeit sometimes in the minority – who are challenging practices that are damaging.
Sex positive approaches are very important in my field, HIV prevention and treatment, but this doesn’t mean that it makes sense for westerners to barge in to every community in Africa insisting they reject widespread sexually conservative rhetoric. I have worked a fair bit with stigmatised people in Africa, such as men who have sex with men and sex workers, and people living with HIV and AIDS. Discussions on HIV prevention and treatment with these groups very quickly turn to their status in society and under the law, and in many countries (and not just in Africa) groups like this have become vocal in challenging the marginalisation and discrimination that they suffer. But they do so at great risk to themselves. People have been ostracised and some have even been killed for standing up for their rights in this way.
This is why it is important to start off by working out what changes in society’s attitudes they can realistically achieve in the shorter and longer terms, who their allies are, and who will oppose them at all costs. The call for thoughtful community development work is about responsible and effective practice, and about working with the most marginalised; it is not about appeasement.