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Some thoughts on Clitoraid and the ethics of intervention

April 12, 2010

This is a fantastic post by Elizabeth of Sex In The Public Square.org.  Reprinted in its entirety with her gracious permission:

Some thoughts on Clitoraid and the ethics of intervention

Sexual pleasure is a human right and I wholeheartedly support the providing of free surgery to those who need it and can’t afford it. This is the case for many women who underwent the excision of their clitorises during ritual cutting (FGM/C). There is also no question in my mind that “Adopt a Clitoris” – the campaign rally of Clitoraid.org – is a deeply problematic slogan for a deeply problematic organization. If you’re new to the Clitoraid story here’s some background:

Several years ago the Raelians (a religious group that believes humans were created by intelligent designers from outer space) founded an organization, Clitoraid, to offer free clitoris reconstruction surgeries to women who had undergone clitoridectomy – one form of female circumcision or female genital mutliation/cutting (FGM/C) – so that they could have the pleasure of clitoral stimulation restored to them. Clitoraid uses language that reduces sexual pleasure to clitoral orgasms and that treats African women’s bodies as objects that can be reduced to clitorises and adopted. That said, it is true that their mission is indeed to provide free surgery to women who need it. They do this by funding surgeries at a clinic in Trinidad Colorado, and also by using donations to build a hospital in Burkina Faso.

There are a number of problems with Clitoraid’s work and I’m going to talk about only two. Dr. Wanjiru Kamau-Rotenberg raises questions about the connection between Good Vibes and Clitoraid (more on that below) and Dr. Petra Boynton raisies questions about Clitoraid from a medical and research ethics point of view. Please read their work. I’ve included a list of sources explaining the work already going on in Burkina Faso at the bottom of this post as well.

One of the problems I want to address is that, while the Raelians are collecting money to build a brand new hospital that they will control, there are already hospitals in Burkina Faso, both public and private, that are performing these surgeries and have been for years. According to IRIN nearly 1000 surgeries, funded by the state, to reopen womens vaginas had been performed between 2001 and 2009. In 2006 surgeons began performing clitoral reconstruction surgeries. Over 100 such surgeries have been performed at a cost of roughly $140, well out of reach of many women in Burkina Faso. Still there is a waiting list because not all the women who want the surgery can be accomodated. Given all this work already going on in the country, it puzzles me that the Raelians are choosing to build a new hospital instead of supporting local efforts that are desperately in need of the funds being syphoned into this new initiative. In the IRIN article I linked above, Dr. Michel Akotionga and Dr. Charlemagne Ouedraogo outline the tragic lack of resources to support the work they are doing. Dr. Akotionga

said he has helped train 20 doctors to perform the 30-minute operation but “lack of equipment prevents them from [performing] the surgery.” Ouedraogo said were it not for the equipment problem, surgeons could reconstruct clitorises during genital repair operations. “We are right there before the clitoris – why not reconstruct it?”

Why build a whole new hospital, ignoring local cultural issues while doing so, and running into all the troubles that generally accrue to top-down, outsider-focused interventions? Why not donate equipment, help expand the existing surgeries, and donate funds for subsidizing the surgeries for women who can’t afford it? There may be reasons that collaboration with institutions in Burkina Faso is problematic but none are mentioned in any of the Clitoraid literature about this. (And specifically regarding the choice of Good Vibes to donate via Clitoraid, it may also be the case that Clitoraid is the only organization working on women’s sexual health care who will take money from a sex-related business. I wrote a few years ago about how the Breast Cancer Society of Canada would not except a donation from Exotic Dancers for Cancer because of the stigma attached to the work of the donors. If this is part of the story it is evidence of how limited the opportunities for philanthropy might be for an organization like Good Vibes and how far we need to go to distigmatize sexuality here in the United States.)

Difficulties aside, it is critically important that any efforts to help women through reconstructive surgery be paired closely with those efforts to transform the cultures that caused the harm they are trying to reverse. That brings me to the second problem I want to address which is linked to the first through Clitoraid’s apparent lack of focus on local cultural context. A 2005 report posted on IRIN, the news and analysis project of the UN’s Office for the Coordination of Humanitarian Affairs, notes that though FGM/C was outlawed in Burkina Faso in 1996 (punishable by a fine of up to US $1,800 and 3 years in prison), and excisions had dropped in the decade since, that still many people were willing to risk the fines and indeed some people had been jailed more than a few times.  In addition, in a 2007 Reuters article Alice Behrendt of Plan International notes that despite the government making available reconstructive surgery “Men are still very afraid of women being unfaithful, and most parents refuse to abstain from excision because they fear their daughters will express sexual desire and it will bring problems for the family such as early pregnancy.” She “worries that some families may try to re-excise women who have the reconstructive surgery.” In fact Benjamine Doamba, an active campaigner against FGM/C in Burkina Faso who is also quoted in the Reuters article, suggests that an unintended consequence of making surgeries available without sufficient cultural change may be that FGM/C becomes harder to resist: “If everyone is saying girls have to be excised, well maybe a parent will say to himself or herself ‘I’ll fulfill my role as a father, as a mother, and excise her, and when she grows up, if she wants, she can go to the hospital to put back her clitoris.” This does not mean that the surgeries should not be performed, of course. Instead it means that the surgeries must be accompanied by internal educational and cultural change efforts.

So, if Clitoraid began all this several years ago, why the attention now? Clitoraid’s US operation was featured in Newsweek last October, after all. The attention comes now because of a recent press release circulated by Good Vibes announcing their support for the project through donations of vibrators for the very important rehabilitative work that is needed after surgery. That release made the rounds of several feminist sexuality email lists and raised some eyebrows. A bit of investigating raised anger. And that anger will, I hope, create an opportunity for some important discussions. It is worth noting that had it been another sex toy retailer I suspect the explosion of interest would not have happened in the same way. Though Good Vibes does not brand itself as feminist, I think that many of us who love the store for its woman-friendly, nonjudgemental, educationally-oriented space in the sex toy retail wold think of it as feminist. We associate it with the creative, intellectual and activist work of people like Carol Queen as if the two are one entity.

In writing about this I’m made painfully aware of the parallels to disagreements ways to write about and support sex worker advocacy. The emotionally-charged nature of the issue is similar. The need felt by those with greater privilege to help those with less is similar. The risk of running over community-based initiatives without noticing is similar. The potential for us/them divides among people who would otherwise be allies is similar.

In sex work research, advocacy and intervention as in public health work we know that if we are not members of the population we are trying to help we cannot impose our models and assumptions on those who are. We need to work collaboratively with local organizations, we need to involve the population we are working with in developing strategies and frameworks. We know these things and yet they seem to have been neglected here. In this case there are local anti-FGM/C and local health care initiatives that can be supported. I hope that what comes of the new attention to this issue is not divisiveness but discussion. I hope this generates discussion about the best ways to support locally organized anti-FGM/C campaigns where they have started, the best way to provide reconstructive surgery to those who want it, and sex education and rehabilitation along with relationship and family support to those who have surgery, and the best ways to support each other in doing all of this important work.

I invite comments with suggestions for ways to start and to sustain such conversation.

News coverage of clitoral reconstruction surgery and anto-FGM/C efforts in Burikna Faso

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