Introduction
The removal of skin for cultural, social or medical reasons, commonly known as skin excision, is practiced around the world. While the exact prevalence of skin excision is difficult to determine, it is estimated that millions undergo some form of the procedure each year. In this article, we will explore the global prevalence of skin excision, the different types practiced, associated health risks, and arguments for and against its continuance as a cultural tradition.
Types of Skin Excision
There are various forms of skin excision practiced globally with different levels of invasiveness. Some of the major types include:
Female Genital Mutilation (FGM): One of the most widely known types, FGM involves the partial or total removal of the external female genitalia. It is predominantly practiced in parts of Africa and the Middle East for cultural or religious reasons. FGM has no health benefits and causes both immediate and long-term physical and psychological harm.
Breast Ironing: Practiced primarily in parts of West and Central Africa to delay the physical signs of puberty and prevent unwanted sexual attention, breast ironing involves firmly massaging hot stones or other hard objects against breasts of prepubescent girls. It causes immense pain and can damage breast tissue and lead to infections.
Neck Rings: The Padaung and Global Skin Excision Kayan ethnic groups from northern Myanmar and western Thailand tighten brass rings around the necks of young girls to elongate their necks. This causes vertebrae and spinal discs to compress over time, weakening the neck muscles and giving the illusion of an elongated neck. The health impacts of this procedure are severe and can restrict breathing and movement.
Scarification: The scarification practice involves incising or branding skin and leaving permanent raised scars for cultural or symbolic purposes. Common in parts of Africa, Asia, and South America, it carries risks of keloid formation, hypertrophic scarring, and potential transmission of infectious diseases if unsterilized tools are used.
Health Risks of Skin Excision Procedures
While cultural traditions are deeply meaningful, many skin excision practices unfortunately pose serious risks to health and human rights. Some of the major health risks associated include:
Severe Pain and Trauma: Many of these procedures are carried out without anesthesia and appropriate medical oversight, causing excruciating pain and psychological trauma, especially in children.
Bleeding and Infection: Unsafe practices increase chances of excessive bleeding, shock from blood loss, tetanus, gangrene of tissues, septicemia and sepsis.
Sexual Health Impacts: FGM often causes difficulties during birth, urination, menstruation, and sexual intercourse. It can also lead to complications in pregnancy and childbirth like excessive bleeding, difficult/prolonged labor, obstetric fistula, and newborn deaths.
Long-term Damage: Procedures like neck rings, breast ironing, and some scarification methods can lead to permanent physical deformities, nerve damage, restricted mobility, and other chronic health issues.
Mental Health Issues: In addition to pain, skin excision practices are associated with greater risks of post-traumatic stress disorder, anxiety, depression, low self-esteem and psychosocial problems.
Arguments For and Against Continuance
Proponents of cultural practices argue that skin excision holds deep religious, social, and cultural meaning for communities and is an important rite of passage. Banning them could infringe on cultural rights. However, human rights activists have raised serious concerns regarding physical and psychological harm caused to children and violation of rights to health, bodily integrity, and freedom from inhuman treatment.
Many factors influence decisions around banning or modifying cultural practices: preserving cultural identity versus safeguarding health and rights of individuals, lack of credible alternatives within communities, inadequate understanding of risks, perceived social norms. Most experts agree that safety, consent and empowerment of individuals should be prioritized over cultural rationalizations that undermine human dignity. Progressive attitudes within communities, education, engagement and empowerment of women are more effective than forced bans. Some countries have compromised by regulating instead of prohibiting practices or supporting modified symbolic alternatives within traditions. Overall, a nuanced culturally-sensitive approach seems best to tackle this multidimensional issue.
While skin excision holds cultural value for communities worldwide, available evidence strongly indicates several procedures often violate rights and norms of informed consent, especially involving children. With globalization and awareness, attitudes are gradually changing. More work is still needed through education, empowerment and community engagement to eliminate unsafe practices or modify them to remove health risks while respecting cultural identity. A cooperative approach respecting human rights seems most effective for addressing this complex issue.
Global Skin Excision: A Cultural Practice That Needs Rethinking
