Last week, a UK government review of the French breast implants that have caused panic from Australia to Uruguay concluded that there is no evidence the implants should be removed. The Australian Medical Association thinks women should at least get their implants checked out. But neither the reviews nor the media coverage of the implant panic has dealt with the real question at stake: what makes women voluntarily cut open their bodies to permanently implant foreign objects to the potential detriment of their health?
The answer to this question is potentially uncomfortable. I have often asked the students in my health rights seminars to articulate the principles that make us distinguish between voluntary female genital mutilation in adult women and voluntary breast augmentation surgery. Apart from the fact that the former makes us queasy and the second doesn't, there really is none.
To be sure, female genital mutilation (FGM) is often performed on girls who are unable to consent to -- or, indeed, understand -- the violence asserted on their bodies. And, because FGM is prevalent mostly in places where health infrastructure is weak or non-existent, the intervention is often unsanitary and ultimately can be deadly.
But even if FGM were carried out in the best of clinical conditions on a consenting adult woman, we call it a human rights violation. Why? Because it is an intervention which is carried out solely to satisfy stereotyped notions of what a women could or should be, and which has:
1.no discernible health benefits;
2.a negative impact on women's sexual health; and
3.permanent effects on women's health more generally.
FGM is often justified with direct reference to fixed gender roles, in particular in the sexual realm. Women "should be" sexually passive and "should not" experience sexual pleasure. Or women who have not undergone FGM are "unclean" and cannot properly serve their husbands. In countries where many see marriage as a woman's only real possibility for financial security, the intervention is less of a choice, even when performed on adult women with their outward consent.
Breast augmentation surgery is carried out for similar reasons with similar risks and results. The intervention carries no discernible health benefits and potentially has a negative impact on women's sexual health, as well as a number of other potential serious health effects. As the panic in December 2011 has shown, it is, in fact, not entirely clear how great the chances for complications are. Moreover, breast augmentation surgery is carried out solely to satisfy stereotyped notions of what women could or should be: sexually available and attractive to men. And as with FGM, for some women the intervention might be linked to financial benefits: well-endowed women win out in dating (and marriage), and waitresses with larger breasts generally get better tips than those less well-endowed.
I am not suggesting that we deem breast implants and other selective and exclusively cosmetically motivated nipping and tucking as human rights violations. I am suggesting, however, that we question the underlying stereotypes that lead to unprecedented growth in cosmetic surgery procedures in the United States during the worst depression since the 1930s. If the only reason for an intervention is that others think that's what we "should" look like, and if the intervention is both semi-permanent and potentially damaging to our health, maybe what we "should" do is reconsider.
Of course, social motives and stereotypes are incredibly hard to both identify and change. When I was in Iraqi Kurdistan a couple of years back as part of a research team looking into the practice of FGM, I was struck by the individual sense of responsibility felt by the mothers, aunts, and sisters who had subjected their relatives to the practice. They were aware of the social connotations, but felt personally responsible for the consequences of the intervention on the girls in their charge. One mother said to us after her interview: "You must think we are monsters."
Not long after, I had to physically restrain my own daughter while her dentist extracted a rotten tooth. As I was holding down my scared child, both of us crying, I felt connected to that woman through the same absolute belief that what I was doing was for the best of my child, even if it hurt her.
And so I know that nothing is solved by directing guilt or shame at those who, in a specific social context, feel that FGM (or breast implants) is for the best of their child (or themselves) because it is the only way to be accepted by their group or society.
The government, however, can help to change such perceptions. In the case of FGM, much has been said about supporting criminal prosecutions with community action for change. In the case of breast augmentation surgery, the road might be less clear though it is discernible. Research has shown that where girls enjoy and like their bodies, they are more likely to postpone their sexual debut and less likely to be in abusive relationships. Presumably, when these self-aware girls grow into women they would also be less likely to want to alter their bodies, in particular in a way that would affect their sexual health.
So if a government wanted to avoid another silicone implant panic, mandating comprehensive sex education in all schools would be a good start. That, and ensuring that women don't depend on tips, dates, and marriage for their financial wellbeing. We are not there yet.
(Published first at RHRealityCheck.org)
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