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PERSPECTIVE OPEN
Defending an inclusive right to genital and bodily integrity for
children
Kate Goldie Townsend
1
✉
© The Author(s) 2021
IJIR: Your Sexual Medicine Journal; https://doi.org/10.1038/s41443-021-00503-x
At the time of writing in mid-2021, policy on child genital cutting
and modification is inconsistent in the UK, US, and most European
states, and there is growing consensus that this inconsistency
should end [1–10]. The question addressed here, is whether
Western liberal democracies ought to discourage, if not legally
prohibit, all forms of medically unnecessary child genital cutting
and modification, or permit some relatively minor forms. Given the
core political values of Western liberal democracies, including a
commitment to human rights, this piece takes a liberal normative
approach and argues that individual rights to bodily –and
especially genital –integrity should take priority over group rights
if they come into conflict.
CURRENT INCONSISTENCIES IN LAW AND POLICY
The idea of the child’s right to bodily integrity has increasingly
been defended in bioethical, philosophical, and legal scholarship
[1–10]. Some authors argue in favour of the child’s right to genital
integrity grounded in the value of genital and sexual autonomy
for all individuals [6–8]. The aim is to protect all children, whatever
their sex-trait characteristics or associated sex category assign-
ment, and whatever the sociocultural preferences of their parents,
from medically unnecessary (The Brussels Collaboration on Bodily
Integrity [10]defines ‘medically necessary’in the following way:
‘(1) the bodily state poses a serious, time-sensitive threat to the
person’s well-being, typically due to a functional impairment in an
associated somatic process, and (2) the intervention, as performed
without delay, is the least harmful feasible means of changing the
bodily state to one that alleviates the threat’.) genital cutting
and modification practices until they reach an age of legal
majority [6–11]. Once a person has become an adult and is
deemed competent to make considered decisions about practices
that involve surgical risk and typically permanently alter their
sexual anatomy, the state should not seek to prevent them from
pursuing such operations. The position I advocate is fairly simple:
children should be protected from medically unnecessary genital
cutting and/or modification until they are adults; once they
become adults, they should be permitted to have their genitalia
modified should they so choose.
Though simple, this position is at odds with most current policy
in Western liberal societies [4,7,8,10–14]. Children with female-
typical sex characteristics in Western (and many other) societies
are legally protected from medically unnecessary genital cutting
and modification, however ‘minor’the cutting may be, and even if
sought by parents for religious reasons. Children with male-typical
sex traits on the other hand, are not legally protected from genital
cutting practices, even when the practice is considerably more
physically invasive than some of the prohibited types affecting
children with female-typical sex traits, for instance, symbolic
nicking [7–11]. Children with intersex traits or differences of sex
development also lack legal protection from medically unneces-
sary genital cutting and modification, even when the modification
is as if not more physically invasive than prohibited procedures
affecting children with female-typical sex characteristics [8,15],
with a few notable exceptions [8,16].
Different treatment of child genital cutting practices depend-
ing on the sex of the child is morally problematic and could
potentially be ruled unconstitutional in Western states [17]. It is
indicative of cultural bias that bestows preferential treatment on
the practices of Western majority and established minority
groups, even when those practices are materially similar to the
strictly prohibited practices of marginalised minority groups
[4,7,8,11–14]. This bias is evident in the genital cutting policies
of international liberal institutions including the World Health
Organisation (WHO) [18,19], and it is transparent in current UK
legislation on Female Genital Cutting (FGC). The Female Genital
Mutilation Act 2003 [20] criminalises the cutting of adult female
genitals for ‘cultural’reasons even if the woman has made it
clear that she wants to be cut or sewn [12,20]. Genital
modification practices are permitted if the modification is
‘necessary for her…mental health’but ‘it is immaterial whether
she or any other person believes that the operation is required
as a matter of custom or ritual’([20], section 1). This means that
in practice, the policy mainly affects women from marginalised
cultural and ethnic groups whose cutting practices are under-
stood to be ‘matter[s] of custom or ritual’, while (primarily white)
majority group women can have their genitals modified if it is
deemed important for their mental health [8,12,20].
Policy inconsistency of this kind, that infantilises women from
marginalised groups (the UK law explicitly describes them as
‘girls’), is a hangover from a long trend of cultural supremacism
in Western policy-making and political theorising [3,5,8,12–14].
Policymakers who target groups practising medically unneces-
sary female child genital cutting (FGC) but remain silent over or
even endorse medically unnecessary male and intersex child
genital cutting (MGC, IGC) fail to consider how all child genital
cutting practices are maintained and driven by ‘cultural’norms
[7,8,12–14,18,19]. Shweder’s[5] contribution to the debate
Received: 18 August 2021 Revised: 3 November 2021 Accepted: 15 November 2021
1
Department of Politics, University of Exeter, Exeter, United Kingdom. ✉email: kb256@exeter.ac.uk
www.nature.com/ijir
IJIR: Your Sexual Medicine Journal
1234567890();,:
about genital cutting is very important here; he challenged
Western critics of FGC to ‘take a hard second look’at the practice
and to be slow to judge the people and groups for whom it
remains important. It is an invitation to evaluate the cultural
practices and inherent biases of one’s own sociocultural context
and heritage that many scholars pursuing policy parity on child
genital cutting and modification have taken seriously [4,5]. Most
scholars working on the ethico-legal status of child genital
cutting in Western societies have come to agree on one thing:
policy inconsistency such as strict prohibition of so-called
‘cultural’FGC alongside legal permission of multiple forms of
medically unnecessary MGC and IGC cannot be reconciled with a
principle of policy parity for diverse groups, nor defended if
equal children’s rights to bodily integrity are taken seriously.
What remains to be agreed upon, however, is what Western
states ought to do about their inconsistent policies.
PURSUING POLICY PARITY
One way to ensure policy parity regarding child genital cutting
would be to permit some forms of FGC that are currently illegal.
Advocates of tolerance for what they regard as ‘minimal’forms of
child genital cutting (such as, nicking, pricking, or partial removal
of the clitoral prepuce or hood, and/or cutting or excision of
portions of the labia) argue as follows: parents are permitted to
authorise medically unnecessary intersex child genital modifica-
tion and male child prepuce removal (partial or total) in Western
societies whatever their justification –and on the condition that
all of the child’s parents agree in some societies, for instance in the
UK [9]. As such, justice requires that parents also be permitted to
authorise medically unnecessary FGC for their daughters, as
practised, for example, within various Muslim communities [21], so
long as the cutting is no more harmful than whatever is permitted
for male children.
Defenders of this position characterise it as a ‘harm reduction’
approach, the idea being that permitting these relatively minor
forms would dissuade community members from continuing
more intrusive forms of FGC that carry a greater risk of resulting in
lasting complications ([2]: p. 290). This position takes seriously the
fact that some forms of FGC are more materially harmful than
others, and that grouping all non-Western types under the
provocative and demonising title ‘Female Genital Mutilation’,asis
standard in Western law and policy, obscures these material
differences [7,8,18–20]. In recent work, Duivenbode and Padela
consider the question from a Muslim religious perspective,
arguing that rather than ‘decoupling’FGC from Islam, as is
common for opponents of the practice, it would be beneficial to
take guidance from Islamic ethical teachings that favour harm
reduction [2]. The authors argue that, despite protestations to the
contrary, there is a meaningful historico-religious association
between Islam and FGC in many communities that should be
acknowledged, rather than avoided, by people engaged in the
debate ([2]: p. 290).
Presenting child FGC in this way may well be successful for its
advocates. The argument that child MGC should be permitted has
been most effective in real-world contexts when framed as a
matter of religious freedom [8,22–24]. For instance, in Germany,
the decision to permit infant MGC for religious purposes was
made on the basis that prohibiting it would be a violation of
parents’religious freedom [24]. Similarly, Iceland recently shied
away from enforcing a ban on MGC after criticisms that it would
violate the religious freedom of some practising groups [23]. The
question of religious freedom is among the most difficult areas to
tread politically speaking, and so ‘recoupling’FGC with Islam is a
potentially powerful way to argue that some forms should be
permitted. However, the argument is unconvincing for several
reasons.
First, the idea that male child prepuce removal is ‘harmless’is
highly controversial [1,4,7–9,25,26]. The suggestion that the
practice should be used as a default standard for what is
acceptable when considering harm-reduction approaches to FGC
does not go unchallenged. Many authors have raised concern
about the moral and legal status of male genital cutting practices,
emphasising the material and psychological harms that they entail
[1,4,7–9,25,26]. The view that penile prepuce removal is
harmless assumes that the prepuce itself has no value, meaning
that the only real harm at stake in its removal is the risk of surgical
complications. But it is not standard to take this approach to other
functional body tissues which are attributed their own value. The
value given other body tissue means, for instance, that even when
surgery is medically necessary, there is a moral and legal
imperative to make every effort to preserve healthy tissue [27].
Many men whose genitals were cut as children, teens, or infants
express extreme discontent at having their sexual anatomy altered
before they were able to make the decision for themselves
[25–28]. This does not mean, of course, that every person whose
genitals were cut or modified in childhood experiences the same
negative consequences, but it does cast serous doubt on the
assertion that the harms of prepuce removal are minimal.
Second, from a practical point of view the argument has limited
applicability to real-world cases because a great many justifica-
tions given for continuing child genital cutting practices simply
are not religious. Routine secular child MGC in the US, for instance,
is practised for various reasons, from parental aesthetic prefer-
ences to the medically controversial belief that prepuce removal
promotes genital health or hygiene [1,7,8,22,24]. Intersex child
genital modification is defended on the assumption that children
have a psychosocial need for their genitals to fit a physical sex
binary [8,15,16,22]. Duivenbode argues that the blanket
prohibition of medically unnecessary child genital cutting would
further disadvantage marginalised minority religious groups [29],
but importantly, religion is seldom the only justification cited to
defend child genital cutting practices and is often not cited at all
[30]. If child genital cutting and modification practices were
prohibited out of respect for all children’s right to genital integrity
whatever their sex characteristics, then not only religious groups
would be affected. Parents and medics within dominant and
marginalised groups in Western states would have their value
preferences limited by prohibiting all child genital cutting and
modification.
Finally, the underlying claim that collective rights to engage in
other-affecting religious practices should take priority over the
individual’s right to bodily integrity is hard to reconcile with the
liberal commitments of Western states. While liberal thought and
policy are increasingly open to group differentiated rights within
culturally diverse societies, the individual remains normatively prior
to the collective when the group’s freedom would upset the rights
most prized by liberals; and bodily integrity is key for liberals of all
stripes [1,7–10]. Duivenbode argues that female and male child
prepuce removal should be permitted in liberal democracies within
an account of value pluralism whereby groups should be free to
practise traditions that cohere with their internal value structures.
Duivenbode is right to stress the importance of respect for all
groups within democratic political societies, but for value pluralism
to remain morally compatible with core liberal principles, there
must be limits to what is permitted when it comes to other-
affecting actions. Many children in democratic (and non-demo-
cratic) societies who are raised within religious value systems grow
up to reject certain aspects of those systems and may seek to leave
the group [31]. According to Möller, religious freedom properly
understood, ought to include the possibility for those raised within
a religious household to ‘distance’themselves from that religion
([32]: p. 470). This ‘freedom restraint’on what parents may
legitimately do to their children:
K.G. Townsend
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IJIR: Your Sexual Medicine Journal
‘prohibits irreversible religiously or culturally motivated
changes to the child’s body: precisely by virtue of being
irreversible, such changes make it impossible for the child to
ever to [dissociate] from them and to live …life free from a
religiously or culturally imposed physical mark’.([32]: p. 470)
Möller’s argument here is that the physical mark means that the
child will be permanently included in the group even if they come
to reject its values and practices. It goes without saying that the
child could still reject many of their parents’religious teachings
upon becoming an adult, and maybe endorse different religious
teachings or become an atheist [32]. But, Möller points out, the
physical mark would remain, and they may feel that their genital
and bodily integrity had been unjustifiably violated before they
could autonomously endorse or reject the associated values and
practices [32].
Priority rules are necessary within value plural political societies
to avoid slipping into a political space that permits people to do
anything to anybody on the grounds that the action is important
for their collective conception of the good life. When it comes to
liberal societies, the individual’s right to bodily integrity must be
prior to the group’s collective identity. Children’s rights to bodily
and genital integrity function as liberty-limiting principles if they
come into conflict with parental preferences that would violate
those rights. The role of liberty-limiting principles in value plural
liberal societies is to emphasise the limits of moral relativism, and
to stress priority rules that constrain the practices of all groups –
majority, minority, dominant, and marginalised.
THE RIGHT TO BODILY, INCLUDING GENITAL, INTEGRITY
The idea that people have a right to bodily integrity is common-
place and ‘now universally accepted’([33]: p. 569). It is enshrined
in human rights law representing political and institutional
commitments to respecting people’s bodies as sites of their
‘personal freedom’[7–9]. The right consolidates, politically, a moral
commitment to respecting the body as the point at which the
moral person encounters the empirical world. The moral and
political significance of the individual right to bodily and genital
integrity concerns the profoundly personal value that bodies and
genitals have for individuals’flourishing and experience through-
out life. Our (By ‘our’,‘we’, and ‘us’, I mean all embodied people.)
bodies are crucial to the most important events of our lives, ‘being
born, growing up, making love, having children, falling ill and
dying’([34]: p. 1). We use our bodies to express our thoughts and
feelings, to engage with the objective world, to hide from the
social world. In interfering with my body, you interfere with my
subjectivity in the most immediate, direct, and intimate way.
Violations of bodily integrity, then, are violations of a most serious
kind within a liberal normative framework.
A distinction: bodily integrity is complicated with, but distinct from
and irreducible to bodily autonomy [8,30,33,34]. A commitment to
the principle of bodily integrity requires others to respect
individuals’bodies, to leave them uncoerced, unpenetrated, and
uncut whether or not the individual is autonomous. The normative
thrust of a commitment to bodily integrity resides in the value and
significance of the body itself as commanding respectful treatment
by others –this value and significance is present whether or not the
person is autonomous and capable of consenting to interventions
into their body. This matters conceptually and with regards to the
argument against medically unnecessary child genital cutting,
because it means that the right to bodily integrity is not merely
about ensuring that the person is able to exercise rational control
over their body, and it acknowledges the fact that individuals are
seldom in complete control of their bodies. Understanding bodily
integrity as distinct from bodily autonomy appeals to and accounts
for the normative significance of the body itself as the point at
which a person’s integrated subjectivity –in all its rational and
irrational components –encounters the empirical world. Bodily
integrity as the ‘integrated body’helps ‘to explain the legal structure
of the right, the normative weight of the right, and the ambiguous
boundaries of the right’([33]: p. 567).
A body-oriented approach to understanding the right to bodily
integrity attributes to the body a value of its own as a site of
‘moral experience’([30]: p. 188), its moral value is distinct from the
person or people who exercise(s) control over it and it ‘cannot
(entirely) be owned or controlled’([30]: p. 183). When it comes to
the child, the right to bodily integrity has the character of
protecting their interest in having an intact body, so long as there
is not a medical need to interfere with the body, and carries with it
a duty in others to respect their bodies as the physical boundary
of their integrated subjectivity, and importantly, it emphasises the
idea that the individual’s body cannot and should not be owned
or controlled by others.
Dekkers et al. [30] identify a paradox in the moral outlook of
religious groups that are committed to the concept of bodily
integrity, but practise child genital cutting for religious purposes.
The authors found that there are different views of bodily
integrity, some of which contain the idea that child genital cutting
is permissible because it is thought of as contributing to male
children’s bodily integrity: without it, their bodies are viewed as
imperfect. In their analysis of different perspectives on MGC and
FGC of minors amongst people from Muslim and Jewish
communities, they observe that while many of the people they
interviewed did not consider bodily integrity to be violated by
MGC, they invariably considered FGC to be a violation of bodily
integrity ([30]: p. 188). The interviewees also reported a feeling of
unease and discomfort when witnessing MGC, despite the fact
that in their view ‘it definitely needs to be done’(p. 188). Dekkers
et al. claim that:
‘[t]his fact underscores that, although they rationally do not
speak in terms of bodily integrity or of a violation of the human
body, they intuitively express feelings of ambivalence and
hesitation that can be explained in terms of respect for the
integrity of the body’.([30]: p. 188)
This sense of unease is attributable to the moral value of the
body itself.
Dekkers et al. [30] acknowledge the difficulty in capturing the
moral significance of bodily integrity, and gesture towards the fact
that the concept is deployed and interpreted in different ways in
many real-world contexts. Nonetheless, the following is pro-
foundly important for how the right is conceptualised and
deployed: the right to bodily integrity is not reducible to bodily
autonomy, that is, a violation of the right to bodily integrity is not
only a violation of a person’s autonomy. This means that a person
who is not autonomous can have their bodily integrity violated. All
of this matters here, because it means that the child’s rights to
bodily and genital integrity are grounded in their interest in
having their bodily integrity respected irrespective of whether
they would or would not retrospectively endorse any cutting or
modification of their genitalia as adults. It may well be the case
that some adults who had their genitals cut or modified in
childhood would affirm it as something they are content with
because it coheres with the wider sociocultural values of their
group (majority or minority, dominant or marginalised); but the
practice would still be a violation of their bodily and genital
integrity and simply cannot be justified by appealing to group
rights to religious freedom within a liberal political framework.
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ACKNOWLEDGEMENTS
I would like to thank two anonymous reviewers for their comments and the associate
editor for numerous helpful suggestions. I am greatly indebted to Professor Clare
Chambers, Professor Catriona McKinnon, Professor Robert Lamb, Dr Andrew Schaap,
and Dr Sarah Drews Lucas for their feedback on and engagement with my work on
this subject.
AUTHOR CONTRIBUTIONS
KGT is the sole author.
COMPETING INTERESTS
The authors declare no competing interests.
ADDITIONAL INFORMATION
Correspondence and requests for materials should be addressed to Kate Goldie
Townsend.
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