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      Complexities of biomedicine, theology and politics in Islamic bioethical deliberation over female genital procedures: a reply to ‘The prosecution of Dawoodi Bohra women’ by Richard Shweder

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      Global Discourse
      Bristol University Press

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          Abstract

          Professor Richard Shweder’s target article, ‘The prosecution of Dawoodi Bohra women: some reasonable doubts’, lays bare the ways in which political motivations influence moral, ethical and legal deliberations over female genital cutting/circumcision in society. He argues that activist stakeholders deploy a provocative lexicon and biased clinical data in order to silence dissenting views about, and legally restrict the practice of, female genital cutting/circumcision. He suggests that a more balanced approach to discourse and more nuanced data analysis would open up avenues for tolerating religiously motivated female genital procedures carried out among Dawoodi Bohra communities residing in liberal democracies. Building upon his sociocultural analysis, this reply will explore the confluence of biomedical, theological and political considerations influencing contemporary Islamic bioethical discussion over the practice. I use my participation in the 2017–19 Fiqh Council of North America’s deliberations over female genital cutting to explore how (1) biomedical understandings and health outcomes data, (2) theological concerns over scriptural evidence and juridical best practices, and (3) political and social considerations influenced religious evaluation of the practice. I contend that Islamic juridical academies pursuing bioethical deliberation are not (and should not consider themselves to be) engaging in the routine application of scriptural reasoning in order to furnish guidance to a Muslim polity; rather, bioethics questions are necessarily layered with social and political considerations that require focused examination. This added dimensionality underscores the need for Islamic bioethics deliberation to move beyond the dyad of clinicians and jurists, and to include social scientists, public policy experts and other relevant scholars in order to properly conceive of and address the ethical problem space. Moreover, in the case of female genital cutting/circumcision, the bioethics veers towards biopolitics, making multidisciplinary deliberation all the more important in both religious and secular spaces.

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          Most cited references44

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          Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis

          Objective Worldwide, an estimated 125 million girls and women live with female genital mutilation/cutting (FGM/C). We aimed to systematically review the evidence for physical health risks associated with FGM/C. Design We searched 15 databases to identify studies (up to January 2012). Selection criteria were empirical studies reporting physical health outcomes from FGM/C, affecting females with any type of FGM/C, irrespective of ethnicity, nationality and age. Two review authors independently screened titles and abstracts, applied eligibility criteria, assessed methodological study quality and extracted full-text data. To derive overall risk estimates, we combined data from included studies using the Mantel-Haenszel method for unadjusted dichotomous data and the generic inverse-variance method for adjusted data. Outcomes that were sufficiently similar across studies and reasonably resistant to biases were aggregated in meta-analyses. We applied the instrument Grading of Recommendations Assessment, Development and Evaluation to assess the extent to which we have confidence in the effect estimates. Results Our search returned 5109 results, of which 185 studies (3.17 million women) satisfied the inclusion criteria. The risks of systematic and random errors were variable and we focused on key outcomes from the 57 studies with the best available evidence. The most common immediate complications were excessive bleeding, urine retention and genital tissue swelling. The most valid and statistically significant associations for the physical health sequelae of FGM/C were seen on urinary tract infections (unadjusted RR=3.01), bacterial vaginosis (adjusted OR (AOR)=1.68), dyspareunia (RR=1.53), prolonged labour (AOR=1.49), caesarean section (AOR=1.60), and difficult delivery (AOR=1.88). Conclusions While the precise estimation of the frequency and risk of immediate, gynaecological, sexual and obstetric complications is not possible, the results weigh against the continuation of FGM/C and support the diagnosis and management of girls and women suffering the physical risks of FGM/C. Trial registration number This study is registered with PROSPERO, number CRD42012003321.
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            Does Female Genital Mutilation/Cutting (FGM/C) Affect Women’s Sexual Functioning? A Systematic Review of the Sexual Consequences of FGM/C

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              Health consequences of female genital mutilation/cutting in the Gambia, evidence into action

              Background Female Genital Mutilation/Cutting (FGM/C) is a harmful traditional practice with severe health complications, deeply rooted in many Sub-Saharan African countries. In The Gambia, the prevalence of FGM/C is 78.3% in women aged between 15 and 49 years. The objective of this study is to perform a first evaluation of the magnitude of the health consequences of FGM/C in The Gambia. Methods Data were collected on types of FGM/C and health consequences of each type of FGM/C from 871 female patients who consulted for any problem requiring a medical gynaecologic examination and who had undergone FGM/C in The Gambia. Results The prevalence of patients with different types of FGM/C were: type I, 66.2%; type II, 26.3%; and type III, 7.5%. Complications due to FGM/C were found in 299 of the 871 patients (34.3%). Even type I, the form of FGM/C of least anatomical extent, presented complications in 1 of 5 girls and women examined. Conclusion This study shows that FGM/C is still practiced in all the six regions of The Gambia, the most common form being type I, followed by type II. All forms of FGM/C, including type I, produce significantly high percentages of complications, especially infections.
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                Author and article information

                Journal
                Global Discourse
                Bristol University Press
                2043-7897
                February 2022
                February 2022
                : 12
                : 1
                : 115-129
                Affiliations
                [1 ]Medical College of Wisconsin, USA
                Article
                10.1332/204378921X16334660756430
                56b33c48-fe6d-453d-98a1-182116b1f95f
                © 2022

                https://creativecommons.org/licenses/by/4.0/

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