The Universal Periodic Review and the Ban on Intersex Genital Mutilation in an African Context

Comments Reviewer 1

My reply

This article engages with an important and under-researched issue of intersex genital surgeries in the African context. While there is an emerging critical literature about the human rights implications of current medical practices in the western world which promote early ‘normalising’ medical and surgical interventions based on parental consent, the literature on African practices and attitudes is comparatively scant. This article offers an important contribution to that body of literature.

Thank you for your appreciation, this is indeed a topic close to my heart.

I am very grateful for your constructive comments and suggestions. They prompted me to rewrite the entire article, aiming for a higher quality.

However, the article is poorly structured and lacks coherence. It suffers from a number of significant problems, including poor quality of written English.

I agree that it might have been sent too soon. I worked hard to integrate your comments.

The paper purports to be organised around the Universal Periodic Review process of the UN. However, the data and the conclusions to be drawn from the data provide little insight. The author suggests that, because Western countries issue most or all of the UPR recommendation concerning intersex genital mutilation, there is greater concern in Western countries about the human rights violations. This is simply incorrect. Most Western nations practice early IGM and there is little public or political opposition to the practices. Although there is a groundswell of support for prohibiting IGM, the reality, as outlined in the literature cited in the article, is that the West is responsible for practicing IGM and promoting it globally. Thus, the UPR does not provide a helpful frame for analysis.

I emphasized the importance of the UPR to better frame the analysis and integrated the data into the narrative for greater clarity, coherence, and support of the argument, which I have also clarified.

Similar confusions abound in the article. For example, in analyzing the available literature on intersex, the article fails to distinguish between critical analysis offered by, for example, Carpenter, Kessler, Travis and Fae, and Monroe, and the clinical literature authored by Warne and Raza, which provides strong support for early IGM. On page 2, it states that ‘medical publications underscore widely the experiences of intersex persons,’ which is incorrect. The footnote cites an article by critical intersex activists who oppose the medicalised perspective. The discussion flips between critical and clinical literature without commenting on or seeming to appreciate the different perspectives. The discussion on invisibility of intersex in Africa refers to lack of ‘medical management’ without seeming to acknowledge that this management is at the core of IGM.

This is an important point that I will consider much deeper in further writing. I have tried to clarify and distinguish the difference between the different strands. Parts of the literature were not opportune anymore, so I shortened the article, to increase clarity. I also corrected where indicated.

There is ongoing conflation between assigning gender and performing IGM. Assigning gender does not in itself require surgical intervention. Where early gender assignment is identified in African culture, it does not denote early medical and surgical interventions, but that distinction is not made.  

I have made this more clear. Thank you for highlighting this omission.

A good deal of the article discusses three aspects of consent – informed, voluntary and fully conscious. However, the significance of these three aspects is never spelt out, and indeed the reference to ‘conscious’ consent is often misspelled as ‘conscience’. These two words convey very different meanings. In any case, the significance of this framework is not explained or adequately argued. The author asserts that these aspects of consent are necessary but not sufficient. However, that argument is also unclear.

I have spelled out the three aspects and corrected where necessary. Although further reading provided many additional ideas, I could not integrate them into this article, but I plan to use them in future research.

Overall, the structure of the analysis is incoherent, particularly with respect to the three facets of consent and the data derived from the UPR. These frameworks fail to provide a coherent structure for the analysis and add very little to the discussion.

I have worked hard to restructure the article for greater clarity and coherence.

The discussion of epistemic violence is effective and would provide a sounder framework for analysis, though the author might consider how this ties into the discussion of invisibility of intersex in Africa on page 16 – there is an argument to be made that lack of medical management might inhibit epistemic violence. The concept of testimonial smothering is raised to good effect on p17 and I suggest the author should consider using these concepts of epistemic violence and testimonial suffering to organize the analysis.

I agree, this is a very adequate point. This will be the entry point for further writing. It was, however, given the timeframe, not possible for me to restructure the whole article around the analysis and discussion of epistemic violence.

Comments on the Quality of English Language

My academic coach have reviewed the article several times.

The quality of English expression in the article is poor. The writing is awkward and jarring. At times it conveys a meaning quite inconsistent with what seems to be intended. Much of the discussion is confusing and ambiguous because the wording is unclear and poorly chosen.

See above.

The written expression will need to be carefully overhauled. 

See above.

Comments Reviewer 2

My reply

Thank you for this opportunity to review the piece “The Universal Periodic Review and the ban on Intersex Genital Mutilation.” The piece offered important information on the efforts to eradicate IGM, looking both at the UPR as a platform as well as at specific context for IGM in Africa. The paper focused on consent as a way to understand the deficiencies of UPR recommendations in the context of non-Western countries. My recommendations are directed towards improving the legibility of the piece and its argument.

Thank you for your appreciation, this is indeed a topic close to my heart.

I am very grateful for your constructive comments and suggestions. They prompted me to rewrite the entire article, aiming for a higher quality.

1. The abstract and title do not well represent the discussion of the paper. I might recommend better integrating the argument around non-Western contexts into the abstract and title to clearly present the contributions made.

I have modified the title to better suit the content. I also reviewed the abstract for this purpose.

2. The introduction is nearly four pages long. I recommend a shorter introduction that briefly presents the paper and its arguments. Then a literature review could follow with discussions of the concepts and debates that the paper contributes to.

I followed your suggestion, integrating a shorter introduction and a clear contextualisation..

3. The argument of the paper and the goals of the paper are stated in different ways throughout the abstract and introduction. I find as follows:

·       Based on the analysis of 27 IGM-related recommendations from the Universal Human Rights Index1, this article extends the scope of the UPR as a platform for discussing the rights of intersex persons while integrating the ban on IGM into the dialogue.

·       This article centres around the consent to be given by the intersex person itself.

·       This article intends to shift the discussion on IGM from Western to African contexts, while providing insights on the meaning of informed consent.

·       This article emphasizes the risks emerging from issuing uniform UPR-recommendations on the ban on IGM without considering specifi-cally the context of the State Under Review (SUR).

·       I argue that the existing IGM-related UPR recommendations inhibit risks of flawed consent, and might even cause epistemic violence.

·       To avoid the risks of epistemic violence I argue that we reconsider the content of the IGM-related UPR-recommendations, based on contex-tualised analysis, rather than emitting recurring and duplicated formula-tions that mirror only one perspective of the global community.

·       This article focuses on the intersex individual, who might not have the autonomy to give their informed con-sent.

·       This article enriches the discourse of the effectiveness of the main hu-man rights dialogue platform, the Universal Periodic Review, (UPR) given the fact that only a portion of the global community expresses con-cern about a human rights infringement as severe as IGM.

I clarified the argument and goal of the article. Thank you for highlighting this important part.

4. For the introduction, I would recommend consolidating these lines into a clear argument that has two parts, related in part to the UPR and more specifically on ideas of consent and their relevance for non-Western countries to explain why the UPR has not been more effective. Then the context of Africa could be presented as a case study and the author could refer to plans to make recommendations to increase effectiveness in the conclusion.  

I emphasized the importance of the UPR to better frame the analysis and integrated the data into the narrative for greater clarity, coherence, and support of the argument, which I have also clarified. It was an excellent suggestion to present the African context as a case study. It gives me ideas for further research.

5. For the literature review, the lines related to the goals of the paper could reflect the gaps in the literature, as indicated already by the author. Here the necessary concepts could be discussed: intersex individuals, IGM, consent, epistemic violence, and the role of the UPR.

I have reviewed the literature. Parts of the literature were not opportune anymore, so I shortened the article, to increase clarity.

6. The material and methods section should be restricted to discussing the method and data used in the paper.  

I followed your suggestions.

7. This could be followed by a section on the necessary background for understanding the African context. Then the paper can move into the data analysis of the UPR recommendations and the deeper discussions on the application to the African context.

I followed your suggestion, by integrating the African context in the contextualisation, after the introduction. I did this to keep the flow in the sections, from introduction, to contextualisation, material and methods, results, discussion and conclusions.

8. The final discussion could be much shorter. And the conclusions could then focus on the ways in this research contributed to gaps in the literature and how its findings could inform future research.   

As mentioned above, the restructuring lade the discussion shorter.

9. The first mention of IGM is mentioned rather abruptly in the first sentence.  A bit more context to explain to issue would be helpful here.

I followed your suggestion.