#genitalmodification

Morphological freedom, as described by transhumanist scholar Anders Sandberg, is “the right to modify oneself according to one’s desires”, a right which follows from “the right to freedom and the right to one’s own body”. Both of these rights ultimately derive from the right to life and the right to seek happiness. As Sandberg explains, “If my pursuit of happiness requires a bodily change – be it dying my hair or changing my sex – then my right to freedom requires a right to morphological freedom.”[2] Insofar as the distinction between negative and positive rights is useful, I contend unlike Sandberg that morphological freedom has both a negative aspect and a positive one. The negative aspect is straightforward: no one should be coerced into bodily modification or prevented from bodily modification in a way that interferes with their pursuit of happiness, or perhaps more expansively, their pursuit of self-actualization, a term introduced by psychologist Kurt Goldstein and popularized by Abraham Maslow to describe the desire to realize one’s full potential[3]. Simultaneously though, there is the positive aspect: if one’s wellbeing or pursuit of self-actualization[4] requires bodily modification, as in the case of genital reassignment surgery for some trans people, then society has a duty to enable access to and support such a change. In a sense, there is no real distinction between the negative aspect and the positive one, because if society refuses to grant access and resources to certain types of bodily modification, then it effectively prevents people who desire such modifications from undergoing them. Another conceptual distinction that is sometimes useful is, as was briefly mentioned above, between freedom from bodily modification and freedom to it, but again it is important to recognize that both are but aspects of the same right, for denying either to a person impedes their pursuit of self-actualization.

In recognizing these different aspects of morphological freedom, one tension that arises is between society’s duty to ensure the wellbeing of individuals, from which the positive aspect derives, and the freedom from the imposition of bodily modification, which is part of the negative aspect. There may be situations in which the wellbeing of an individual requires some form of bodily modification to which they may not be able to fully give consent, as in the case of life-saving surgeries for unconscious victims of traffic accidents. One response to this dilemma is to remember that morphological freedom is a derived principle that ultimately rests upon the rights to life and to self-actualization, and so under certain conditions morphological freedom may be superseded by concern for these fundamental rights. Just as important to remember is that the meaning of self-actualization is contingent upon culture and circumstance, and so what may seem to an observer as an inexcusable violation of morphological freedom may at least in part be justified by culturally specific ethical concerns of which the observer is unaware.

Morphological freedom in feminist discourse

Feminist discourse on genital modifications has, outside of discourse on transgender rights, predominantly focused upon the negative and “freedom from” aspects of morphological freedom. Garnering the most attention, to the extent that it is now considered an international human rights issue[5], is the concern that young girls in “Third World cultures”[6] are misled and coerced into having their clitorises excised (clitoridectomy) or external genitalia cut away (infibulation), practices often grouped together and denoted with the value-laden term “female genital mutilation”[7]. In response to mainstream Western perceptions, representations and denunciations of such practices, feminist and post-colonial scholars have criticized the reductive neo-colonial perspectives that underlie these perceptions and how such (mis)representations can serve to further imperialist agendas[8]. Others have demonstrated the hypocritical nature of such perceptions by pointing out how “harmful” practices of genital modification continue to exist in the “First World” as well, such as having intersex infants undergo surgical “normalization” of their genitals without their ability to give consent[9], and the late capitalist phenomenon of “cosmetic” genital surgeries, which women often undergo as a result of heteropatriarchal expectations and pressures[10].

All of these practices – clitoridectomy and infibulation in the “Third World”, pediatric genital surgeries on intersex children, and cosmetic genital surgeries – can to varying degrees be conceived as violations of negative morphological freedom, insofar as they involve the imposition of unwanted and “harmful” bodily modifications. Making comparisons between these practices serves to establish cross-cultural and transnational empathy, through which, even as we work towards reducing the “harmful” nature of such practices, we can avoid the dangers of “arrogant perception”, a term used by Marilyn Frye, Isabelle R. Gunning and Stanlie M. James to describe the view that “one is the center of the universe, thus distancing [one]self from the other.”[11] As Gunning argues, “even if [feminists] do not abandon a paradigm of right versus wrong, we must develop a method of understanding culturally challenging practices, like female genital surgeries, that preserves the sense of respect and equality of various and different cultures.”[12] Yet, despite the progress made in engendering cross-cultural empathy, I contend that by focusing primarily on the negative and “freedom from” aspects of morphological freedom, we continue to risk the trap of arrogant perception by eliding the agency of the people(s) engaging in these practices and characterizing them as victims of “false consciousness”, a perspective which Gunning also cautions against.[13] Furthermore, we limit ourselves to the injustices associated with performing genital modifications, whilst neglecting or even reinforcing the injustice suffered by those who seek genital modifications but cannot access them safely or easily, as is the case for many trans people. By reframing our perspectives to include positive morphological freedom, and the freedom to modify one’s own body, we enhance our respect for the agency that may be involved in undergoing genital modification, whilst expanding our ethical vision to include those who desire genital modification but cannot obtain it. Also worth including in our perspectives is an awareness of the cultural contingency of contexts in which morphological freedom may be overridden, without which we risk characterizing other cultures as ethically backward for their failure to conform to Western liberal rights paradigms. In particular, I aim to demonstrate how notions of “harm” and “autonomy” figure into the designation of certain practices of genital modification as “harmful” and therefore as unwarranted violations of morphological freedom, and how by interrogating these notions and their cultural and historical contexts, we can come to understand the ways in which these practices might constitute either expressions of morphological freedom or the culturally specific supersession of morphological freedom by other ethical concerns.

On harm and health

In surveying different practices of genital modification across times and spaces, Fiona Green observes how “a woman’s social and cultural value as a woman is frequently determined […] by her genitalia”[14] and how “[s]ocial and cultural customs, often supported by medical rationale and health explanations, justify the need for particular female genitalia”[15]. A closer reading of her work supports the idea that these “medical rationale” in fact arise out of sociocultural beliefs surrounding (female) sexuality and genitalia. For instance, in Victorian England and North America, “the medical profession ‘transformed the moral question of masturbation into a medical condition’” in order for women to “safeguard [their] energy to fulfill her primary role in life; that of wife and mother”[16], thereby constructing masturbation as not just immoral but also unhealthy. Similarly, normative ideas about genital size result in the constitution of “ambiguous” intersex genitalia as “an emergency that is viewed to be both social and medical” because “’people will be traumatized by their atypical anatomy’”[17], while heteronormative conceptions of sex result in the belief that a tighter vagina will enhance sexual health and pleasure[18]. Though the historical development of female genital cutting as practiced in some African cultures is largely unknown, there also seems to be an interplay between health/hygeine reasons and sociocultural ones, as in Sudan where “[m]en are so repulsed by [large uncut clitorises], according to Lightfoot-Klein, that ‘they would not under any circumstances consider marrying an uncircumcised or “unclean” girl’”.[19] Regardless of whether sociocultural beliefs or medical ones “came first”, it appears in all of these cases that there is positive feedback between the two: socially unacceptable genitalia are constructed as unhealthy, while unhealthy genitalia are viewed as socially unacceptable.

It is clear then that notions of “health”, and consequently those of “harm”, are socially constructed. Despite this, Green does not attempt to interrogate the presumably objective health claims of the Western medical establishment when she cites the “numerous physical ailments that accompany FGC”[20] and “the possibility of negative physical complications” that accompany genital cosmetic surgery[21]. In pointing this out, I do not mean to reject science as an epistemological framework – I am a firm believer in the scientific method – but to make note, as Saida Hodžić does in her analysis of the WHO study on the effect of FGC upon childbirth mortality[22], that the knowledge that the science produces and is asked to produce is dependent upon the social and political structures within which it is situated. Though I believe that many experiences of harm and pain are common to human beings across cultures, the range of physiological conditions that get designated as harmful by the scientific establishment or other authorities can vary by culture, and the relative severity and significance of various types of harm (what is bearable or endurable versus what is unacceptable) are also culturally mediated.

The relative valuation of harms plays an important role in what practices of genital modification ultimately get designated as “harmful”. There are social harms, psychological harms and physical harms, and the balance of all of these (along with their corresponding “healths”) given a specific cultural context and a specific position within that context results in the justification or prohibition of the practice in question. One result of this is that even when there is an awareness of the physical harms of a particular practice (scientifically informed or otherwise), people may continue justifying or participating in a practice because they believe the social or psychological benefits outweigh the physical harms. For example, Gunning describes how in some African cultures, “the value of women is tied almost exclusively to fertility”, and by de-emphasizing her sexuality through clitoridectomy, “[a] woman increases her power and value within the culture by being less like men, by being exclusively unique and invaluable creators of life.”[23] Western opponents of FGC, by failing to recognize or understand these benefits, or by insisting upon reading them as part of a patriarchal system of oppression (and so as necessarily harmful), end up making the opposite judgment, that is, the eradication of clitoridectomy. A similar analysis can be made for the case of intersex surgeries: doctors and parents of intersex children, whether aware or unaware of the physical and psychological harm that results from pediatric genital surgery and the secrecy surrounding it, continue to believe that the psychological and social harms that result from falling without the male/female binary take precedence, and thus support these surgeries. Intersex activists understand otherwise due to their embodied experiences, and hence oppose such surgeries.

From these analyses, we can see that non-consensual genital modification is potentially compatible with the supersession of morphological freedom by other ethical concerns – in this case the concern with avoiding harm and ensuring wellbeing, where the understanding of both harm and wellbeing is mediated by culture. To determine whether such practices are “truly right” or “truly wrong” then depends on whether such understandings of harm are “truly right” or “truly wrong”. In other words, the ethical validity of such practices is dependent upon the empirical or logical validity of the underlying beliefs about wellbeing. Recognizing this fact enables us to realize that the practices we find unethical may not represent moral failures so much as epistemological ones – that is, that the people engaging in these practices are not “evil”, just possibly mistaken. This recognition thus opens up avenues for dialogue and change that are less oppositional and more empathic, beginning with an interrogation of one’s own epistemological bases for “harm” and “health” (because who’s to say we’re not the ones who are mistaken?), and progressing with the complex task of challenging pre-existing conceptions of harm and agreeing (at least partially) upon a shared understanding of wellbeing.

On agency and autonomy

Another important factor in evaluating the ethical status of genital modification is the autonomy of the person involved. The reason for this is fairly self-evident within the rights-based framework utilized thus far: if a person is not autonomous, then they are unable to give meaningful consent and are hence not even free, much less morphologically so. Given that, any modification of their genitals is essentially coercive and is a violation of their morphological freedom insofar as it fails to satisfy the conditions for the ethical supersession of such freedom. Along these lines, Martha Nussbaum has argued for distinguishing between practices of female genital cutting in the Third World and dieting in the First World, as the former is “carried out by force” and “is usually performed on children far too young to consent even were consent solicited”, while the latter is the result of social pressure and “involves, above all, adolescents and young adults.”[24] While there is little to disagree with Nussbaum over given this account of the facts[25], it is important to remember that FGC is not a monolithic practice, and that clitoridectomy is sometimes performed on older teenage girls, as is the case in the village of Kikhome in Western Kenya. Following Christine Walley’s “search for voices” during her time as an English teacher in the village, we see shades of autonomy often missing from mainstream representations of FGC in Africa. Particularly poignant is the reply of several female Sabaot students to Walley’s surreptitious inquiry about the sexual consequences of excision: “But we are already regretting it!” At some level, the students were aware of what excision would entail, and were willing to undergo it.[26]

In light of this, it is reasonable to assume without establishing a precise account of autonomy that one can possess autonomy to varying degrees – rarely are agents completely autonomous, but rarely also are they completely enslaved. Recognizing this spectrum of possibilities, Green writes that “women who engage in cosmetic surgery may do so to comply with cultural constraints of femininity while simultaneously not agreeing with them” and are not “‘cultural dupes’” or “‘unwitting victims of ideological manipulation’”[27], while Gunning describes how “in thinking of the choices left to women within [cultures that practice FGC], supporting the surgeries can be viewed as rational and empowering in the context within which they find themselves.”[28] Acknowledging the cultural contingency of self-actualization is useful here for advancing our empathic understanding. Women, by pursuing or supporting these surgeries, are acting with what freedom they have in order to actualize themselves. In this sense, they are not being denied morphological freedom, but are instead exercising it. By advancing this perspective, I do not intend to deny the existence of the oppressive structures within which these women are situated. Rather, I hope to reinscribe the agency which is often written out of women’s lives by non-feminists and feminists alike, thereby guarding against the trap of arrogant perception.

From freedom from, to freedom to

The focus thus far has been on genital modifications that (at least nominally) infringe upon the negative aspect of morphological freedom. The positive aspect of morphological freedom also deserves attention, however, because there are many communities who suffer due to the lack of it. In particular, many trans people require genital reassignment surgery in order to alleviate their gender dysphoria and lead better lives. Indeed, failure to provide such procedures to trans patients, along with associated treatments like hormone replacement therapy, can result in self-surgery, self-harm and suicide.[29] Given that many of the procedures involved in pediatric and cosmetic genital surgeries are similar to procedures involved in genital reassignment surgery, we must be wary not to call for elimination of the technical skills and technologies that enable such surgeries, even as we express our concerns over their nonconsensual use on intersex infants and their problematic usage as cosmetic enhancements. Cosmetic enhancement in general represents a tricky intersection of trans issues with more mainstream feminist concerns – many of the cosmetic procedures associated with beauty culture, such as breast implants, hair removal and facial plastic surgery, are essential to ensuring the health (lack of dysphoria) and safety (ability to “pass”) of trans individuals. Engaging with these issues hence requires caution, lest the blind pursuit of eradicating beauty culture results in the curtailment of trans people’s freedom to bodily modification.

Towards cultural change

Having identified the ways in which peoples and cultures may disagree upon the right course of action due to differing conceptions of harm and autonomy, we are now better positioned to imagine possibilities for cultural change. Some of the underlying principles have already been mentioned, starting with the determination of what is “truly harmful”. This step is perhaps the most essential, for it decides the direction in which cultural change should take place, or whether it should take place at all. In the case of intersex surgeries in the West, the decision is straightforward. Nonetheless, I shall work through the details as a demonstration of principles. Undoubtedly, the embodied experiences of intersex individuals count for more than the theories and concerns of doctors and parents, and we are on epistemologically stable ground in asserting the physical and emotional harm and non-consensual nature of pediatric general surgeries. Cultural change should thus be directed towards eradication of pediatric general surgeries by challenging flawed beliefs held by the medical establishment about the psycho-social harm of having genitals that fall outside of the male/female binary.

The way forward is less clear when it comes to female genital cutting as practiced in parts of the Third World. Even if we are sure that our account of the physical harms of FGC is correct, the nebulous nature of the social and emotional harms that may result from the eradication of an age-worn tradition, along with the (partial) agency and investment participants have in continuing these practices, raises questions as to the ideal form of cultural change – should eradication be the goal? Or should change look like something else? These are similar questions to the ones which Gunning asks when considering the mindset of the “guardians of the status quo”: “Will women be better off socially and economically if change is allowed, or will they fall into a morass of instability, continued economic deprivation and violence?”[30] And given that historical attempts at intervention have been counter-effective[31], do we also run the risk of reinvigorating practices we wish to stop?

Fortunately, examples of success provide us models for envisioning viable future strategies. The Circumcision through Words program in Kenya, an alternative rite that replaces traditional female initiation ceremonies, demonstrates the possibility of eliminating the physical harms of clitoridectomy whilst preserving social health and respect for cultural autonomy by transforming pre-existing communal rites and celebrations.[32] The Tolstan program in Senegal also establishes that productive cross-cultural education on the harms of genital cutting is achievable by avoiding a confrontational or didactic approach. Even more importantly, it demonstrates the feasibility of teaching human rights, which is surely a step in the direction of developing a shared respect for morphological freedom.[33] Several principles in relation to harm and autonomy can perhaps be drawn from these two examples: that the social harm of eradicating a traditional practice like clitoridectomy is a real danger that should be accounted for, that it is possible to eliminate the physical harm of female genital cutting whilst respecting cultural autonomy and preserving social health through innovative solutions, that it is possible to build a shared understanding of wellbeing through education, and that it is possible to build shared understanding of human rights. These principles, simple as they are, could serve as a guiding framework for future interventions.

In focusing upon morphological freedom as a human right, an important aspect of these two models of success has been neglected, namely, that they address female genital cutting as part of a whole host other important concerns that contribute to the welfare of the individual and of the village they are part of.[34] In a similar vein, morphological freedom cannot be viewed as completely separate from other rights and freedoms. Its existence necessitates the existence of other rights, and is also necessitated by others. The spread of infibulation in the Horn of Africa due to lack of employment for women that increases their dependence on husbands, worsened by war and neocolonial exploitation[35], reminds us that morphological freedom cannot be ensured without also ensuring the right to fair employment, to education, to health, to adequate standards of living, and other civil, social, and economic rights. In imagining possibilities for cultural change, the importance of these rights cannot be ignored.

Conclusion

A universal conceptions of human rights is often pitted against multiculturalism due to seemingly irresolvable contradictions between the two practices – how can all cultures be afforded equal respect without descending into cultural and moral relativism? This essay presented a possible solution in the context of genital modifications. By utilizing the notion of morphological freedom, along with the provisions under which it can be superseded, liberal rights paradigms can be reconfigured into an ethical framework that is compatible with “culturally challenging” practices of genital modification under culturally specific notions of “harm” and “autonomy”, thereby displacing qualms over irresolvable ethical differences into resolvable epistemological ones. By demonstrating how the notions of harm are socially constructed and how autonomy exists even in limited circumstances, I have attempted to engender empathic understanding in the Western liberal subject, that is, in myself and the reader(s) of this essay, and to furthermore use such understanding to map out possibilities for cultural change.

I resist however the imperative to a “totalizing discourse”, through which I would simply reproduce the modes of arrogant perception I have been trying to avoid. The ethical framework proposed should not be read as an attempt to theorize Other(s’) modes of ethical reasoning, nor should it be considered an “objective” view of the world. Rather, it is presented as a means of providing ethical clarity on genital modifications to the Western liberal subject, and a way of understanding how, under the same epistemological and cultural constraints as the Other, they might end up endorsing practices of genital modification that initially seem unethical. Inasmuch as I believe that the ethical framework I have proposed is true, and inasmuch as I believe in the right to morphological freedom, I also believe that they are but some truths in a multitude of truthful ways to view and understand the world, some contradictory, some complementary, all paradoxically aiding the clarity of our vision. In sharing my truth, I hope to imbue the reader with some of that clarity.