Dear Mr. Falk:

Thank you for your letter regarding circumcision. I appreciate the opportunity to help address the matters on which you are seeking clarification.

Attached is a copy of the definition of a child in need of protective services from the Alberta Child Welfare Act. You will note that the key to applying any of the definitions is that "the survival, security or development of the child is endangered because of any of the following"...actions or inactions of the guardian.

Female genital mutilation (FGM) is considered aggravated assault under s.268 of the Criminal Code of Canada. A criminal act against a child taken or allowed by a guardian would normally be considered placing the child in need of protective services.

Male circumcision by a qualified person would not be considered placing the child in need of protective services. The differences must be considered in both the cultural and family contexts. The culture has a role in defining acceptable behaviour and the Federal legislators have exercised that role in determining that FGM is an assault.

The family context of a behaviour is whether an action is taken in a context of a loving relationship, long-term planning and due attention to the child's survival, security and development. Within this context, the culture accepts many variations and a number of actions that could be considered "assaultive" outside the context.

The literature quite consistently considers female genital mutilation to be highly likely to inhibit female sexual response. In fact, some would question whether it has any other purpose. In this way, it would endanger a child's development. The same type of developmental danger has not been linked to actions such as male circumcision.

Alberta Children's Services does not keep records to the level of detail that would allow me to answer your questions regarding actions taken regarding FGM. Since this is a matter under a federal act, the federal Justice department might be able to help you.

Thank you again for the opportunity to respond to your questions.

Sincerely yours,
 
[signed]
 
Iris Evans
Minister

cc:  Denis Herard, MLA, Calgary-Egmont

Attachment:

DEFINITION OF A CHILD IN NEED OF PROTECTION
from section 1 of the Child Welfare Act [Alberta]

(2) For the purposes of this Act, a child is in need of protective services if there are reasonable and probable grounds to believe that the survival, security or development of the child is endangered because of any of the following:

[...]
 
(d) the child has been or there is substantial risk that the child will be physically injured or sexually abused by the guardian of the child;
 
(e) the guardian of the child is unable or unwilling to protect the child from physical injury or sexual abuse;
 
(f) the child has been emotionally injured by the guardian of the child;
 
(g) the guardian of the child is unable or unwilling to protect the child from emotional injury;
 
(h) the guardian of the child has subjected the child to or is unable or unwilling to protect the child from cruel and unusual treatment or punishment;
 
(i) the condition or behaviour of the child prevents the guardian of the child from providing the child with adequate care appropriate to meet the child's needs.

(a) a child is emotionally injured

(i) if there is substantial and observable impairment of the child's mental or emotional functioning that is evidenced by a mental or behavioural disorder, including anxiety, depression, withdrawal, aggression or delayed development, and
 
(ii) if there are reasonable and probable grounds to believe that the emotional injury is the result of

(A) rejection,
 
(B) deprivation of affection or cognitive stimulation,
 
(C) exposure to domestic violence or severe domestic disharmony,
 
(D) inappropriate criticism, threats, humiliation, accusations or expectations of or towards the child, or
 
(E) the mental or emotional condition of the guardian of the child or chronic alcohol or drug abuse by anyone living in the same residence as the child;

(b) a child is physically injured if there is substantial and observable injury to any part of the child's body as a result of the non-accidental application of force or an agent to the child's body that is evidenced by a laceration, a contusion, an abrasion, a scar, a fracture or other bony injury, a dislocation, a sprain, hemorrhaging, the rupture of viscus, a burn, a scald, frostbite, the loss or alteration of consciousness or physiological functioning or the loss of hair or teeth;
 
(c) a child is sexually abused if the child is inappropriately exposed or subjected to sexual contact, activity or behaviour including prostitution related activities.

Dear Minister:

Thank you for your letter of April 12th, in response to my questions concerning male circumcision. I would like to present additional information and ask further questions.

You suggest that in contrast to male circumcision, female genital mutilation (FGM) does not take place in a loving, nurturing family context. But it is difficult to reconcile this point of view with the fact that FGM is virtually universal in some African countries. According to Amnesty International, the rates of FGM in Ethiopia, Egypt, and Somalia are 90%, 97% and 98% respectively. Is it possible that fully 98% of Somali parents do not love their daughters, or are not paying due attention to their daughters' survival, security and development? Surely a more likely explanation is that human cultures—our own included—do not see their own practices for what they are.

Both male and female circumcision remove specialized sexual tissue. It is difficult to see why removing specialized sexual tissue causes loss of sensation and function in females, but not in males. It is well documented that during the Victorian era, physicians viewed circumcision as an effective "treatment" for masturbation in both males and females.

I would like to draw your attention to an article entitled "Stronger campaign needed to end female genital mutilation," published in the current issue of the British Medical Journal.¹ The authors are five French medical practitioners. They argue not only that female genital mutilation and male circumcision are comparable practices, but also that tolerance of male circumcision hinders progress towards ending female genital mutilation. They write:

The women we interviewed considered their daughters' mutilation and their sons' circumcision to be similar. Male circumcision is also a form of genital mutilation since it involves removing a healthy part of an organ. How can we convince mothers that they should not mutilate their daughters while they could continue to have their sons circumcised? The dilemma is that male circumcision is widely spread, has a religious significance, has a low morbidity in developed countries, and is practised even in countries where female genital mutilation is unknown. Because of the fear of compromising the eradication of female genital mutilation, male circumcision is tolerated as doing less harm.

I would also like to draw your attention to a medical study undertaken by researchers at the University of Alberta for the purpose of measuring pain responses in male infants undergoing circumcision. The results of this study were published in the December 24, 1997 issue of the Journal of the Americal Medical Association.²

The researchers took the unusual step of halting the study prematurely after two of the 52 infants enrolled in the study were traumatized to the point of danger. One of the infants had an episode that included vomiting, abnormal posture (lack of tone in limbs), and several periods of apnea (cessation of breathing, one period lasting more than 25 seconds). The other infant had a choking episode with apnea. I understand that the episodes suffered by these infants met the criteria for what are known in paediatric medicine as ALTEs, or "apparent life threatening events."

According to the researchers themselves, the circumcisions were not medically required. As long ago as 1975, the Canadian Paediatric Society characterized newborn circumcision as a "mutilative operation of questionable benefit." The Alberta Health Care Insurance Program (AHCIP) dropped newborn circumcision from the list of insured services in 1987 because the procedure was not deemed medically necessary.

A medical study carried out at the Hospital for Sick Children in Toronto showed that even when anaesthetic cream is used, neonatal circumcision is traumatic enough to have long-lasting adverse effects on the developing nervous system.³

In light of the above information, I seek your professional opinion on the following:

1. Is FGM capable of endangering the survival, security or development of a child, within the meaning of the Child Welfare Act?
    
2. Is infant male circumcision capable of endangering the survival, security or development of a child, within the meaning of the Child Welfare Act? If not, please explain.
    
3. Does traumatizing a girl to the point of danger for the sake of an unnecessary and unadvised surgical operation on her sex organ constitute "cruel and unusual treatment" under the terms of the Child Welfare Act?
    
4. Does traumatizing a boy to the point of danger for the sake of an unnecessary and unadvised surgical operation on his sex organ constitute "cruel and unusual treatment" under the terms of the Child Welfare Act? If not, please explain.

I would appreciate your answers to the above additional questions. Please contact me at [phone no.] if you require further information or would like to speak to me about this request.

Sincerely yours,
 
[signed]
 
Geoffrey T. Falk
 
¹ Abboud P et al. Stronger campaign needed to end female genital mutilation. BMJ 2000;320:1153.
 
² Lander J et al. Comparison of Ring Block, Dorsal Penile Nerve Block, and Topical Anaesthesia for Neonatal Circumcision. JAMA 1997;278:2157-62.
 
³ Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997;349:599-603.

cc:  Denis Herard, MLA, Calgary-Egmont
 

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