Years ago, before I went to Africa, I arranged to spend time at the Gallup Indian Hospital, doing high risk Obstetrics.

Growing up in a large city with many immigrants, I was aware of cultural differences in treating patients, so I asked the local nurses for a book that would allow me to understand Navajo culture.

They handed me a book by Tony Hillerman…the mystery novelist.

When I politely asked about anthropology textbooks, the Navajo nurses laughed and said that they weren’t accurate: That often Navajos often would lie when asked personal questions or private questions by outsiders, but that Hillerman, who was brought up among Indians, got much of the culture right.

I ran into a similar problem when I went to Africa. Often the texts on African culture were by Europeans, who projected their own agenda into African culture: Often this was either seeing everything as if it were the garden of Eden, or else despising locals for not being Europeans.

But in Africa, I ran into another problem: People would tell you what they thought you wanted to hear, not the truth. Sometimes the nurses could let you know the truth, but to an outside authority figure, it could be a problem…

This is not a problem only in Africa: those of us who worked with abused women in the US know that often the abuse is not brought up until we ask or the patient has enough trust in us to bring up the abuse.

So in today’s NYTimes, there is a discussion of Female Genital Mutilation. I have discussed this before, and last week protested to the NYTimes editorial board for an article discussing the minor type of female circumcision done in Indonesia, which then mentioned the more severe type and defended all cases by quoting anthropologists.

In today’s article, the anthropologist Richard A. Shweder dismisses discussions in Lancet and at the WHO websites about problems of labour and delivery, pointing out that there was no increased morality in these women in Sweden, and accusing activists of having an agenda when they condemned the practice.

The Morison et al Gambia study reported that there were NO statistically significant differences between “circumcised” (typically Type 2) women and “uncircumcised” women for all of the following reproductive health outcomes: infertility, painful sex, prolapse, menstrual problems, vulval tumors/cysts, incontinence, damaged perineum, any stillbirths, anal sphincter insufficiency, BMI weight/height ratio, vaginal discharge problems (itching, irritation, odor). They reported that “circumcised” women had more herpes simplex and bacterial vaginosis; and that “uncircumcised” women had more syphilis.

What’s wrong wih this picture?

All those with weak stomachs are warned to stop reading here.

Well to start with, like the NYTimes article about Indonesia, it’s about a less severe form of circumcision: Neither type one nor type II circumcision do much except make the lady’s pee leak into the vagina; Indeed, I have no strong opposition to the milder types as a custom that allows cleanliness (similar to the health improvements for circumcized males).

But to deny the high physical and medical problems by the common type 3 female circumcision is ridiculous.
It’s like comparing apples and oranges, or (to put it more bluntly) comparing a dorsal slit type of male circumcision to removal of the entire male organ.

The Swedish study involved type II…notice the fairly normal looking perineum? Type II looks almost normal…no major scarring here, folks.
And in Sweden, if labour was prolonged, they have available episiotomies (cutting the hole to make it bigger), Caesarian sections, blood transfusions, and antibiotics…none of which are available for villagers who deliver at home.

Now look at type III and the small hole. Now remember about ten percent of Bantu women are prone to keloid (heavy scar tissue formation)…and so the scar tissue might be an inch thick and won’t stretch.
Any questions, class?

By failing to distuguish exactly what you are talking about, you are making a true discussion impossible.

Ah, but then you have Jacob Hickman defending the Anthropologist’s defense of female mutilation.

the idea that we should actually interview these women is a key point in this “anti-FGM” debate, and a point that is largely ignored as people from outside these cultural perspectives seek to eradicate a practice that simply seems disgusting to their own cultural sensitivities.

In sum, Judy, if “anti-FGM activists” were to actually take the voices of these women seriously and listen to what they have to say on the topic (a stance that Shweder, Ahmadu, and other anthropologists advocate), then I think the tone of the debate would change dramatically changed as we come to understand why these women get circumcised and the meaningfulness of the practice to them.

Ah, but as I pointed out: the idea that an interview or survey by a professional anthropoligist will find the truth is itself a Western idea.

Western societies believe if you ask questions, you will be told the truth and nothing but the truth, so that surveys will be accurate.

But other cultures put emphasis on not complaining, on not criticizing, and of telling the interviewer what the interviewee thinks he or she wants to hear.

This is especially true in cultures where women are powerless and have to endure hardships without complaint…and where complaints will result in their being divorced or worse.
That is why the voices of educated local women activists may be more accurate than “surveys” by sympathetic anthropologists, who hear no evil, see no evil, and speak no evil.
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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes about medicine on Hey Doc Xanga Blog.