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ABSTRACT

  1. Top of page
  2. ABSTRACT
  3. ANTHROPOLOGY AND THE LIMITS OF CONTROVERSY
  4. ORIENTATIONS
  5. EVIDENCE AS GOOD INTENTION: HISTORICIZING THE WILL TO KNOW
  6. AESTHETICS OF EVIDENCE
  7. ON THE EDGES OF SCIENCE
  8. CONCLUSION
  9. REFERENCES CITED

This article asks what anthropology can contribute to public and scholarly debates about politics of knowledge in global governance and argues that bringing together insights from aesthetics of governance, science and technology studies, and theories of performativity offers a productive reorientation to existing approaches. My specific question is: how did WHO research that was intended to counter alarmist discourses about female genital cutting end up legitimizing them? For anthropologists who participated in the scientific controversy, the answer was clear: the study was driven by ideology. To expand the range of analytical responses, I suggest, we need to understand the rearrangements of knowledge and power in neoliberal governance, as well as a conception of authorship that uncouples scientific statements from sovereign subjects. Deadly harms were not made certain by ideology, I argue, but by aesthetics of expertise, WHO bundling of governance by emergency and governance by evidence, and performative iterations at the cultural boundaries of science. To make this argument, I analyze the historical conditions of possibility for the WHO study, offer an ethnography of knowledge production, and trace the social and governmental lives of fact and meaning-making. [WHO, female genital cutting, science controversy, governance by evidence, anthropology in the public sphere, aesthetics, performativity]

If you want to say to our circumcised women “you might face complications,” at least tell them the real thing that might happen, rather than telling them “you're going to have hemorrhage, and pain, and possible death, and sexual dysfunction,” and all these sorts of things that you really don't have evidence for.

—WHO official

The history of science teaches that every great step in the direction toward demonstrating a final reality shows that this reality turns out to lead in a quite unexpected direction.

—Gaston Bachelard1

“New study shows female genital mutilation exposes women and babies to significant risk at childbirth,” announced the WHO in June of 2006 (WHO Study Group on Female Genital Mutilation and Obstetric Outcome 2006). A New York Times article, one of many commentaries that propelled the WHO mega study on obstetric consequences of cutting into the public sphere, put it more starkly: “Genital Cutting Raises by 50% Likelihood Mothers or Their Newborns Will Die” (Rosenthal 2006). The article's formulations about “reliable evidence” that cutting is a “killer of women and children” quickly entered both cultural and medical vocabularies, authorizing claims about cutting as a cause of death.

I first heard about the obstetrics study in the summer of 2002 from Dr. Adjei (a pseudonym), a Ghanaian researcher who was one of the WHO principal investigators (PIs). One of my key interlocutors, Dr. Adjei directed a private clinic and a reproductive health NGO and had spent many years trying to stop cutting in northern Ghana. Yet he was equally passionate about his research projects that debunked common myths about the practice and saw the WHO study as contributing to his quest for truth. “There is very little empirical data,” he told me, and “our methodology is designed to look at all the contaminating factors that can cause complications or that may be relevant, rather than just assuming that FGM is what caused complications.”

How did a study that was intended to tell women “the real thing” and counter alarmist discourses end up legitimizing them? For anthropologists who took issue with it, the answer was clear: the WHO research was driven by ideology and was meant to serve activist interests, rather than advance knowledge. The study came under fire in a public forum on the New York Times website and scholars became key actors in an ensuing controversy about the politics of knowledge. The most vociferous critic, Richard Schweder, stated that the WHO had become “a major site for lobbying by anti-‘fgm’ activist organizations; and the result is that identity politics has triumphed over science and critical reason” (2008). On the basis of ethnographic research of the WHO study, I suggest that the evidence of deadly harm was not produced by the scientists’ ideology but by shifts in aesthetics, governmental politics, and performative iterations at the cultural boundaries of science.

This article traces the coconstruction of science, aesthetics, and governmentality in contemporary configurations of global health, women's rights, and neoliberal governance, examining how an assemblage of passions, aspirations, and regulatory forms turned uncertain results into meaningful facts. It is based on a series of interviews and conversations with the scientists and bureaucrats in charge of the WHO study, my observations of the meetings at which they discussed the results and crafted the publication, and ethnographic and textual analysis of WHO documents and their social and governmental lives. I analyze these against the backdrop of my larger multisited fieldwork that spans a decade of research (incl. 16 months in Ghana and one year in the United States) on Ghanaian efforts to end cutting and their imbrications in domestic and transnational governmentality.

My analysis begins with the place of anthropology in public debates, and I point to current impasses. After outlining my theoretical orientations and contributions, I explore the historical shifts in the organization of knowledge, power, and capital that motivated the obstetrics study, showing that the WHO wanted to transform its technologies of governance. I then present an ethnography of knowledge in the making, looking at the role of aesthetics as a motivating force for WHO scientists. I suggest that they were compelled by formal rather than ideological concerns, and that the shift from objectivity to argument initiated the production of meanings. In the final section, I analyze the social life of the study and show that its meaning and authority were constructed and solidified as the institutional and cultural edges of science dissolved, and as the WHO bundled governance by emergency and governance by evidence. I conclude with a discussion of authorship and sovereignty.

ANTHROPOLOGY AND THE LIMITS OF CONTROVERSY

  1. Top of page
  2. ABSTRACT
  3. ANTHROPOLOGY AND THE LIMITS OF CONTROVERSY
  4. ORIENTATIONS
  5. EVIDENCE AS GOOD INTENTION: HISTORICIZING THE WILL TO KNOW
  6. AESTHETICS OF EVIDENCE
  7. ON THE EDGES OF SCIENCE
  8. CONCLUSION
  9. REFERENCES CITED

After attending an anthropological conference that challenged his understandings of cutting, a New York Times reporter John Tierney organized an online forum that transformed the otherwise sensationalist media (Piot 2007) into a site of radical and oppositional questions. This public forum gave a small group of scholars a platform to challenge the epistemological and political axioms of current debates. They were well positioned to do so, as this forum arrived on the wings of evidentiary debates in anthropology: over the last decade, anthropological journals had published numerous articles that contested assertions about the harms of cutting.2 Yet the anthropological alliance with the New York Times fell short of its radical aims because Tierney controlled the debate and molded it to fit the form of a controversy.

Science and technology studies scholars understand scientific controversies as public and discursive battlefields that juxtapose sound science against junk science, whereby opposing groups make competing claims about what counts as science and attempt to make research more or less of a fact (Latour 1987:59). Yet controversies cannot explain how politics shapes the conduct of science because they reify science and politics in ideal-typic terms and insist on their separation. By positing that research is either sound or politically driven, controversies reduce politics to a dirty word and idealize science as pure and uncontaminated by social, governmental, and technological factors.

To mold the debate into a controversy, Tierney pitted the WHO that extolled the “robust scientific design” of its study (2008a) against the critics who accused the WHO of producing politically contaminated research aimed at confirming preexisting convictions. By juxtaposing the two sides of the debate, Tierney produced an illusion of an independent truth that stands above them. As Fortun argues, juxtaposition and aggregation of truth claims are modernist tropes that attempt to construct final judgments (2001:350). Tierney also gave prominent space to sensationalist statements and inflammatory, hot-button concepts such as identity politics, political correctness, and cultural imperialism. He sidelined contributions that challenged his paradigm (Shell-Duncan 2008a), and at times, also twisted the words of the participants—he still wanted to see blood, but of a different kind. The conclusion to be drawn is that the platforms for anthropological engagements in public debates about knowledge and policy matter, as does the ownership over the means of representation.

Assailing the objectivity of the WHO, the critics’ claims pivoted on one central accusation: this was an example of politically driven science in which the “roles of researchers and political activists often seem to be confused” (Johnsdotter and Essen 2008). Schweder stated that results “only became statistically significant in a negative direction through non-transparent statistical manipulation of the data” (2007). Certainly, any critical reader of the study will notice an uncanny discrepancy: although the raw numbers show almost identical outcomes for women who had experienced the three forms of cutting and those who had not, statistically adjusted data show that cutting increased the risk of harms. Schweder interpreted this discrepancy as a result of an illegitimate manipulation aimed at bringing study results into alignment with preexisting notions of cutting as a cause of harm.

The critics saw evidence of WHO's lack of objectivity in the article's nomenclature “female genital mutilation” and in the concluding sentence that states: “FGM remains a pressing human rights issue and reliable evidence about its harmful effects, especially the reproductive outcomes, should contribute to the abandonment of the practice” (WHO Study Group on Female Genital Mutilation and Obstetric Outcome 2006:1841). When I asked Dr. Adjei about this sentence, he surmised that it was a nod to WHO donors. But although he believes that science can maintain integrity despite such political gestures, the critics read “politics” into the conduct of the entire research process. “Activist politics,” best glossed as ideology, became a master narrative used to explain all of the WHO methodological and interpretive moves. The critics say: because of politics, raw and statistically adjusted data are too discrepant; because of politics, only aggregate data are presented; because of politics, a relevant risk factor is not taken into consideration; because of politics, the citations are selective; and so on.

In other words, the critics accused the WHO of anti-intellectual attempts to convert “blind passion” into knowledge and thus legitimize popular and activist sentiments (Gramsci 1971:418). Yet no form of knowledge is pure or outside of power relations, and, as Žižek reminds us, “when some procedure is denounced as ‘ideological par excellence,’ one can be sure that its inversion is no less ideological” (1994:3). By insisting that activist politics was the key to the mysteries of the entire research process, including WHO's motivations, methods, and rhetoric, the critics themselves turned to ideology (Arendt 1968:159).

ORIENTATIONS

  1. Top of page
  2. ABSTRACT
  3. ANTHROPOLOGY AND THE LIMITS OF CONTROVERSY
  4. ORIENTATIONS
  5. EVIDENCE AS GOOD INTENTION: HISTORICIZING THE WILL TO KNOW
  6. AESTHETICS OF EVIDENCE
  7. ON THE EDGES OF SCIENCE
  8. CONCLUSION
  9. REFERENCES CITED

In this article, I take a different approach. My aim is not to answer the question “Did the WHO scientists fudge the data?” but to expand the analytical and political reach of the debate. Rather than demarcating the lines between science and ideology, I situate science and governmental politics within the same analytical frame, tracing the mechanisms by which knowledge, power, and meaning are coconstructed. My theoretical orientation comes from considerations of aesthetics of governmental expertise and the science studies literature on the production of certainty at the cultural boundaries of science.

I will suggest that the WHO researchers were not moved by the instrumental functions of the study or its uses for governance but were invested in formal qualities of authoritative knowledge, or what Marilyn Strathern refers to as aesthetics—“the persuasiveness of form, the elicitation of a sense of appropriateness” (1991:10). Extending this concept, Annelise Riles has argued that transnational collaborations hinge on the sharing of aesthetic, rather than substantive, concerns (2001). Her work shows that the shared aesthetics of form and design enabled collaboration about international norms and platforms for action on women's rights. The production of information for purposes of governance is not necessarily driven by political convictions about the content and purpose of knowledge (Eggen 2012; Stirrat 2000). Rather, matters of form, design, and the presentation of information take precedence over its political uses and stir “collective passions” (Riles 2001:115).

I use aesthetics as an organizing concept to indicate that focusing on the relationship between form and meaning helps us understand how knowledge becomes certain. I show that the WHO researchers’ passions were mobilized by the size and scale of their data, the striving for objectivity, and the prospect of a prestigious publication. As the study traveled toward publication, the apparatus that constitutes which forms of knowledge count as authoritative dominated instrumental considerations. However, these aesthetic concerns were not equally shared nor marked by formal unity. My analysis brings a new insight to the literature on aesthetics of governance by highlighting its shifting and performative aspects (Butler 1990, 1997).

My second orientation to the analysis of mechanisms that produce knowledge as authoritative is informed by interdisciplinary scholarship on science and technology studies. Knowledge becomes certain after scientific statements get taken up by others (Latour 1987; Latour and Woolgar 1986; Star 1985). Science, Latour argues, does not convince people when it is right, but becomes right when it convinces people (1987). More specifically, I build on literature showing that the certainty of knowledge is coconstructed at the “cultural boundaries of science,” as a historian of science Thomas Gieryn puts it (1999). Knowledge becomes authoritative when science meets its publics, especially when science is deemed crucial to solving sociopolitical problems or addressing moral concerns. Here, “the very contours of what is certain or uncertain in policy domains get established through intense and intimate science-society negotiations” (Jasanoff 2003:394). Using this approach, I explore forces that work “downstream” (Epstein 2008:166) and cross the imagined boundaries of science proper. As I show, the WHO researchers did not need to manipulate data to figure cutting as a “killer,” as an army of other actors readily constructed it as such.

However, by bringing science and technology studies scholarship in conversation with anthropology and critical theories of performativity, I want to shift the angle of analysis from the existing focus on certainty to its relationship to meaning-making (Lowe 2010; Svendsen 2011). By “untethering the speech act from the sovereign subject” (Butler 1997:15), I argue that facts acquire both certainty and meaning as the edges of science dissolve. Various institutions and publics produced the results as “irrefutable evidence” (FORWARD 2006) and thus authorized the facticity of the study, but were also the first to endow it with coded meanings. As the research traveled from the WHO headquarters to the global media stream, arriving at the doorsteps of households and computer screens, halting interpretations about infant and maternal mortality morphed into a narrative about evidence of death. The WHO bureaucratic apparatus, the news media, and NGOs constructed the study as scientific evidence that cutting is a killer of women and children. In doing so, they gave the study results their very meaning and purchase on the scientific, public, and governmental worlds.

EVIDENCE AS GOOD INTENTION: HISTORICIZING THE WILL TO KNOW

  1. Top of page
  2. ABSTRACT
  3. ANTHROPOLOGY AND THE LIMITS OF CONTROVERSY
  4. ORIENTATIONS
  5. EVIDENCE AS GOOD INTENTION: HISTORICIZING THE WILL TO KNOW
  6. AESTHETICS OF EVIDENCE
  7. ON THE EDGES OF SCIENCE
  8. CONCLUSION
  9. REFERENCES CITED

By the time I got to the WHO Geneva headquarters in 2004, the bureaucrats in charge of the obstetrics study were habituated to explaining its rationale, they told me, as they were often asked why they were producing knowledge about something “that people think they know.” Insisting that the WHO was interested in advancing knowledge, rather than confirming existing discourses, they represented the study as a critical response to the prevailing notion that there is “no reasonable doubt that FGC is harmful” (Mackie 2003:139). The WHO, I was told, wanted to counter the sensationalist discourses by developing “technically sound policies.” To examine how the hopes of rationalizing interventions were generated and betrayed, we need to understand the study's historical conditions of possibility.

To articulate cutting as an object of transnational epidemiological research, knowledge had to enter into new arrangements with power. The obstetrics study was made possible by the millennial realignments in international governance and global health. The WHO bureaucrats, another type of “situating” scientists (Caduff 2012:344), know this and adopt the voices of critical narrators who situate the production of knowledge in shifts of governance. They would agree with Foucault that the object of study “does not await in limbo the order that will free it … it exists under the positive conditions of a complex group of relations” (1972:45). Although they do not name these relations as liberal and neoliberal reconfigurations of global health, they do explain that the conjuncture of factors that motivated the study include the emergence of women's rights frameworks, WHO institutional crises and reforms, and the donors’ desire for evidence of risk coupled with their willingness to pay for it.

The Arrival of “Gender”

“FGM was not in the picture until the mid-1990s,” a bureaucrat in the WHO HRP office that produced the study told me, “when gender came to our office.”3 In the past, the WHO had refused UN demands for research on the “persistence of customs which subject girls to ritual operations” (Dorkenoo and Elworthy 1992:17), considering cutting a cultural practice outside its purview. The arrival of “gender” facilitated the problematization of cutting as an object of concern for the WHO. Gender indexes the paradigm shift from population control toward equity and rights. For most of its history, the HRP conducted research on safety and efficacy of contraception as well as on fertility and abortion. But when the WHO came to see “reproductive health equity as an area where we can make an impact,” cutting crystallized as a magnet for drawing public attention and signaling an institutional commitments to rights.4

The WHO hired Efua Dorkenoo, a Ghanaian-born nurse who had founded Great Britain's largest diasporic NGO that works on cutting, as its first “technical expert on FGM.” Dorkenoo's tenure at the WHO was brief, but consequential, as she helped place cutting on the HRP research agenda: “when there is a key person and a key idea, then things get pushed.” As a recognized activist, Dorkenoo was also able to showcase the WHO commitment to women's rights and opposition to medicalization (the performance of cutting in clinical settings). Accused of contributing to medicalization (see also Shell-Duncan 2008b), the WHO wanted to “settle the argument,” I was told, and establish the extent to which cutting was harmful no matter where it was performed.

Emergency in Crisis

Next to performing its embrace of rights, the WHO charged the study with shifting its technologies of governance from emergency to evidence. Governance by emergency has caused an institutional crisis of knowledge and credibility, WHO staff told me:

In the 1990s, the WHO stated things like “pain, shock, hemorrhage, infertility.” And people started using the quote of “2 million girls are getting circumcised.” And this is what everybody starts repeating. If you look at the literature, everyone is saying exactly the same thing, without really thinking through: “Where is your evidence?” “Where are you getting your information from?” They are quoting the WHO.

The production of alarm and urgency has been called “the most striking feature of humanitarian interventions” (Rottenburg 2009:425). The stated purpose is to raise awareness and accelerate action, yet it detracts from careful conceptualizations of what constitutes a crisis. Potent constructions of urgency thus project gender problems onto the global South and often figure cutting as an exemplary form of women's suffering from “patriarchal” culture, largely obliterating structural and global forces that forge inequalities and make life precarious. Once constructed, emergencies self-legitimate (Fortun 2001). Alarmist WHO materials did circulate globally, finding traction with many African organizations. One of the Ghanaian NGOs I studied relied heavily on a WHO manual for nursing students to explain and illustrate the health consequences of cutting. Consonant with other WHO literature, the manual presents putative worst-case scenarios, but frames them as actual effects of cutting. Obstetric consequences form one of 33 clusters of harmful health consequences:

Problems in childbirth are common, particularly following severe forms of mutilation, because the tough scar tissue that forms causes partial or total occlusion of the vaginal opening. Difficulties in performing an examination during labour can lead to incorrect monitoring of the stage of labour and fetal presentation. Prolonged and obstructed labour can lead to tearing of the perineum, haemorrhage, fistula formation, and uterine inertia, rupture or prolapse. These complication [sic] can cause harm to the neonate (including stillbirth) and maternal death. In the event of miscarriage, the fetus may be retained in the uterus or birth canal. [WHO 2001:30, emphasis added]

Note that the manual uses the modifiers can and may to amplify the list of harms and their effects. Here, the WHO does not contextualize nor explain which problems were likely and which hypothetical—the aim was not to put the health effects of cutting into perspective. Instead, by constructing a list of all imaginable and ominous harms, the WHO helped produce an urgent cultural panic. This technology of governance, I was told, was no longer useful. The WHO concerns intensified after Carla Obermeyer's independent meta-analysis of medical literature on cutting showed that the consensus about harms was not supported (1999, 2003). Obermeyer was later hired by the WHO, and the bureaucrats I talked to referenced her publications to explain the importance of the study.

Evidence as a Neoliberal Remedy

The WHO imagined governance by evidence as a remedy and designed a research project that would be global and massive in scale. The obstetrics study enrolled over 28,000 women in six countries, including Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan. The goal was to “give a really credible and profound message … rather than coming up with nonsense without evidence.” The study was needed, another bureaucrat explained, “to provide tools for advocacy, campaigning, and management; medical school curricula had to be revised and needed evidence—we needed to provide it.”

That “evidence” emerged as a remedy is because of its status as the gold standard for neoliberal governance and medical knowledge (Goldenberg 2006:2621). The passion for evidence has transformed the norms that guide what knowledge is considered relevant for policy making and evaluation of interventions. Evidence has become “a lubricant for keeping resources flowing” (Nguyen 2009:209) between donors and policymakers.

The shifts toward neoliberal structures of funding made the production of global evidence thinkable and doable. Knowledge, power, and capital were coconstitutive here, and WHO bureaucrats understand this. An example of a “private–public partnership,” the study was funded by the UN Foundation (a nonprofit founded by Ted Turner), which one bureaucrat stated as the principal motivation for the study. “The money was there,” another said, and donors “asked for advice.”

WHO partners in the new international regime of interventions against cutting were also interested in evidence. Having rolled out interventions in 2008, this regime is a diffuse political formation comprised primarily of UN organizations (UNICEF, UNFPA, and the WHO), joined by the World Bank in the Donor Working Group. They saw global evidence as useful for problematizing cutting as an object of their globally coordinated, technocratic, and top-heavy interventions. As Fairhead and Leach put it, “in as much as the operation of international regimes depends on particular negotiated, scientifically authenticated truths, the politics of their operation is conducted through the practice of science” (Fairhead and Leach 2003:1).

Who Benefits? Risk, Ethics, and Liberal Empowerment

The WHO legitimized its quest for evidence as an ethical measure that would benefit African women. Dorkenoo wrote early on that knowledge “is most important for developing clinical support for girls and women who are suffering from health complications of female genital mutilation” (1996:145). The WHO staff echoed this sentiment but reframed the temporality of benefits, claiming that evidence of risk would prevent girls and women from getting cut in the first place. The study, they said, would “generate evidence, international and country-specific evidence to say: ‘that's really what you might risk in terms of health and obstetric sequelae if you're circumcised.’”

The WHO emphasis on risk is not incidental here, but represents a strategic deployment of a hallmark of medical modernity and technocratic governance. Alarmist discourses figure cutting as a “danger” that leads to “problems.” As we have seen in the WHO manual, dangers are ominous, evocative, and somewhat vague. Risk, in contrast, is measured and becomes “real” by virtue of being tangible, calculable, standardized, and proven (Douglas 2003; Lock 1998). In the WHO logic, science will provide access to information about the precise risks of cutting and women will be empowered to make calculated choices and become “ethical subjects” (Campbell and Shaw 2008:694). Meanwhile, the WHO argues, African states should invest in risk prevention by paying for interventions against cutting, as that will save them money in the long run (Adam et al. 2010:281). Two biopolitical aspirations meet here: the construction of informed liberal subjects who manage their risks and take care of themselves and the neoliberal primacy of cost cutting that shifts the burden of expenditure to African states.

Truth as a Gap

What form of knowledge does the quest for evidence of risk generate? Dorkenoo provided a clue early on, writing that “there are still major gaps in knowledge about the extent and nature of the problem” (1996:142). But what is a gap in knowledge? “It is known that the physical and psychological effects of the practice are very extensive and irreversible,” Dorkenoo wrote (1996:142) and clarified: “What is unclear, however, is the actual prevalence of complications and their long term sequelae in relation to gynaecological and obstetric morbidity and their impact on maternal and childhood mortality” (1996:145). This framework maps harms as known but in need of specification, and the desired knowledge takes the form of filling gaps with evidence.

A gap, then, is an aesthetic form with instrumental consequences. The WHO assertions that it was agnostic about the obstetric consequences of cutting apply to results of the study, but not to its categories of analysis. Death in form of infant and maternal mortality was constructed as a category that would frame what counts as a “gap” and what questions can be asked of the data. That evidence would fill gaps about mortality was thus inscribed in the study.

I suggest that the WHO desire to specify gaps about mortality began to carve the fissure between the drive to “tell the real thing” and the construction of deadly harms. By mapping the effects of cutting as a field of known harms, the WHO as an institution could not conceive that their research might question this framework. In other words, the institutional desire was to rationalize governance by reforming knowledge about cutting, not by revolutionizing it. Reform works within the terms of given axiomatics while revolution refuses them (Scott 2008). The operating axiom here was that cutting is generally harmful, and might even be deadly, but that gaps in knowledge need to be specified.

Examining the coconstitutive character of knowledge, power, and capital, I suggest that WHO governmental politics, not ideology, shaped the study from the inception. The WHO aspired to reframe its governance, moving away from population control, medicalization, and production of alarm toward governance by evidence, rights, and risk in the context of neoliberal global health. These interests shaped what questions were asked and when and how the research was conducted. In the ethnography that follows, I show how formal considerations haunted the study and how the competing aesthetics of evidence set the stage for construction of deadly harms.

AESTHETICS OF EVIDENCE

  1. Top of page
  2. ABSTRACT
  3. ANTHROPOLOGY AND THE LIMITS OF CONTROVERSY
  4. ORIENTATIONS
  5. EVIDENCE AS GOOD INTENTION: HISTORICIZING THE WILL TO KNOW
  6. AESTHETICS OF EVIDENCE
  7. ON THE EDGES OF SCIENCE
  8. CONCLUSION
  9. REFERENCES CITED

In November of 2004, the WHO convened a three-day meeting to discuss the results of the study and solidify the objectivity of the article draft. Gathered in Geneva were WHO bureaucrats in charge of the study (a biostatistician, a statistician, and a medical doctor), consultant epidemiologists and doctors, bureaucrats from regional offices, and the PIs from each study country, all of whom were medical doctors and many of whom were professors of medicine. I followed Dr. Adjei to Geneva to observe these discussions.

The WHO saw the prospect of the article being accepted to the prestigious Lancet journal as quite good—they had “big” data and a novel research design. As the meetings unfolded, the confidence in the prospect of a prestigious publication grew but so did confusion about the meanings of the study. As graph after graph of data analysis was presented and discussed, it seemed that the study that was supposed to provide clear answers produced questions instead. By the end of the meeting, the air was permeated by uncertainty and nobody was able to fully make sense of just what it was that the study showed. In other words, the data were analyzed but did not yield a “consensus narrative” (Lowe 2010). To the question “What is the take-home message?” there was no clear answer.

If the WHO researchers were ideologically driven and interested in constructing cutting as a “killer of women and children” at the expense of scientific integrity, they did not reveal it. The discussions were dominated by sober, painstaking deliberations about data quality, rather than moralizing outcries against cutting. I suggest that the researchers were moved by aesthetic and formal concerns and passions. The content, purpose, and instrumental functions of information were secondary to the “activating power of unnoticed forms” (Riles 2001:181): the aesthetics of evidence and objectivity.

The Pendulum: Objectivity and Its Performance

Objectivity has an aesthetic form, and it looks like a pendulum. The draft article swings back and forth between data interpretations and qualifying statements that acknowledge the limitations of the study. Before concluding that women with clitoridectomies and infibulated women were more likely to require more invasive medical procedures, the draft stresses that this result has to be interpreted with caution. At the meeting, there was also much discussion about how some physicians routinely performed C-sections and episiotomies and that these procedures therefore index clinical habitus.

The draft also constructs objectivity by aiming at complete and balanced conclusions that give equal weight to competing results. It presents a range of inconclusive data and complicating factors, from challenges of generalizing from multisited research and methodological inconsistencies to insufficient numbers. Notably, the researchers agreed that the numbers of maternal deaths were too small for a meaningful analysis and that the study had nothing to say about them. Yet, the very mention of maternal mortality in the text allows it to continue to function as a gap that needed to be filled.

Although all researchers joined in the construction of objectivity, the epidemiologists were aware that what was at stake was not objectivity itself, but its performance. They openly discussed the need to represent themselves as impartial scientists to have their interpretations trusted. Anticipating accusations of “favoring negative outcomes” and “hiding” others, one epidemiologist argued for keeping an analysis of the second stage of labor in the text, despite serious problems with data quality. “Let's keep it and hope it will be deleted,” he said. He believed that not including these results would signal a lack of neutrality and leave them vulnerable to accusations of bias while including them would perform an appropriate measure of objectivity.

By invoking the notion of performance, I do not imply that the researchers took the construction of objectivity lightly or masked some hidden truth. Rather, I understand the performative as the regulatory apparatus that guides the production of norms (Butler 1990:25) and, in this case, constitutes what kind of knowledge counts as authoritative. The epidemiologists aimed at an objective text when they thought that objectivity was asked for. The notion of performativity also reminds us that some of the scientists were aware of the work with which their writing gestures were charged and of the likelihood that their results would be scrutinized, and that they adjusted their actions accordingly.

They were also aware that their enthusiasm for the scale of their data was tied to its signifying potential and value. They attributed great, meaning-producing powers to the number of research subjects (28,983). One epidemiologist exclaimed that this number was a “very impressive, amazing, major achievement!” Another said that the data was both bigger and better than any previous research: “ten times the information ever available on this topic, and all systematically collected.”5 “The size,” one exclaimed, “speaks for itself!”

The data size made the study meaningful, authoritative, and valuable, and for the epidemiologists, this was more important than substantive interpretations. A publication in the Lancet might suspend the need for repeating the number and showing off, they said: “If it gets in the Lancet, we don't need to brag.” The journal would lend them credibility, and they were excited about it, repeatedly uttering what became the mantra of the meeting: “This will be published in the Lancet!

Foucault has argued that “the function proper to knowledge is not seeing or demonstrating; it is interpreting” (1970:40). Interpretations matter because they produce meaning, interpretations transform data results into knowledge. Yet for the epidemiologists, the very data size was capable of signification and meaning. Substantive interpretations of results were secondary and not of much interest to them.

Awkward Collaborators

The epidemiologists did not anticipate the PIs’ enthusiasm for scientific critique and substantive meanings. Dr. Adjei and other PIs emerged as the main voices probing the results and questioning the conclusions. They reminded everyone about the contingencies of data gathering, challenged the quality and the interpretations of the data, and demanded more deliberate and careful conclusions. Unlike the epidemiologists, they were interested in interpreting the study and read the data and the results in light of their clinical practice as physicians and in reference to their prior research on cutting. They wanted the study to make sense to them, but the conclusions about mortality did not.

One PI challenged the assertion that infants born to cut mothers had an elevated risk of dying and asked that this result be reexamined and specified. The very category of “infant death” was misconstrued, she said, as it included deaths that were not related to delivery-caused complications of cutting: “We should take out macerated babies [those who died in the uterus at least 12 hours and up to several weeks prior to delivery] from numbers of deaths. This is not related to FGM.” Her intervention moved infant mortality down the facticity scale, making it acutely uncertain. The following day, the statistician showed the reanalyzed results showing that the critique was valid and that macerated still births were overrepresented. The epidemiologist set the issue aside: “A big forum is probably not the best place to make these decisions. We need to look at this very carefully.” The decision was to be made later by the epidemiologists, and the meeting ended with the results still “vague and moving” (De Laet and Mol 2000:225).

The Argument Form

As the study traveled toward publication, it acquired a new form and with it, a meaning, setting the stage for the narrative about deadly harm. I suggest that the very form of the Lancet article lead to the appearance of conclusive interpretations and produced cutting as a risk of death. Although the final article and the Geneva draft present almost the same data, they differ in how they frame their analyses and conclusions: the draft aims at objectivity and is shot through with uncertainty whereas the published article presents a confident argument (WHO Study Group on Female Genital Mutilation and Obstetric Outcome 2006).

The rhetorical structure is transformed from a pendulum to an arrow—a straight line leading toward a conclusion that cutting leads to delivery complications. The article no longer aims at getting the facts straight but eliminates all “useless facts” (Latour 1987:7). Gone are most of the qualifications, modifiers, and swings between different kinds of evidence. Much like infibulation itself has an aesthetic valence and is meant to produce smooth lines, clean surfaces, and pure bodies (Boddy 1982), the scientific cutting of contradictory statements is also guided by aesthetic and formal considerations. The Lancet article tells a linear and streamlined story, without introducing counterevidence. The formal clarity of the published article does the double work of convincing and producing meaningful interpretations.

In minimizing contradictions and erasing doubt, the article complies with the formal norms of publishing. As Susan Leigh Star puts it, “the published data reveal, rather than hint; articles state, rather than guess at; subjects line up and are counted—by the time they get to the journals, they don't run away and hide behind the lab equipment or try sabotaging experiments” (Star 1985:392). The production of many kinds of academic arguments hinges on performing only a certain gesture of humbleness about the scope of the text's authority. Although objectivity requires a “balanced” presentation, arguments are seen as strong when they perform a more refined gesture of uncertainty. When the Lancet article does mention contingencies or uncertainties, these are measured and meant to be reassuring. Rather than highlighting the insufficiency of data on maternal mortality, the article “fills the gap” with data and merely points to the “wide CIs [confidence intervals] around these estimates” (WHO Study Group on Female Genital Mutilation and Obstetric Outcome 2006:1838). The maternal deaths are then counted, adjusted, analyzed, translated into relative risks, and thus endowed with the ability to “speak” and produce the meaning of deadly harms.

The publication's construction of evidence of deadly harms is thus not a testament to the researchers’ desires to bend the results into predetermined meanings but to the shifts in textual structure from objectivity to argument. I suggest that there are limits to inferring the relationship of science and ideology from published texts. The WHO researchers’ writing strategies were driven by disciplinary conventions, aesthetic norms, and the institutional desire to specify gaps. Their performances of objectivity and argument do not tell us about the authors’ “real intentions” or commitments to either truth or politics. Instead, these performances primarily reveal shifts in regulatory frameworks that guide what knowledge counts as authoritative.

ON THE EDGES OF SCIENCE

  1. Top of page
  2. ABSTRACT
  3. ANTHROPOLOGY AND THE LIMITS OF CONTROVERSY
  4. ORIENTATIONS
  5. EVIDENCE AS GOOD INTENTION: HISTORICIZING THE WILL TO KNOW
  6. AESTHETICS OF EVIDENCE
  7. ON THE EDGES OF SCIENCE
  8. CONCLUSION
  9. REFERENCES CITED

Rather than waiting for the public to make sense of the study and be convinced by it, the WHO promoted the interpretation of the study as evidence of deadly harms, coding the study results in the alarmist discourse. The WHO was particularly skillful at constructing interpretations, as it not only sponsored and managed the production of knowledge, but also formulated its meanings. Embarking on a speedy campaign, they invited a scientific commentary written by doctors known for their activism against cutting, issued a press release, and sponsored a “study launch” at Dorkenoo's NGO.6

The notion of “cultural boundaries of science” (Gieryn 1999) shifts the analysis of fact making from researchers to public actors (see also Epstein 2007). Gieryn and Epstein have argued that a “whole array of social actors … consume scientific knowledge” (Epstein 2008:173–174). My analysis suggests that publics do not merely consume knowledge, but are central to the production of meaning and certainty. The boundaries of science, we shall see, dissolve as authorship becomes “thickly mediated” (Cody 2009:365) and instantiated through performative iterations.

For the WHO, the study's value derives from its circulation and recognition in the public sphere, governance regimes, and scientific networks. With the press release, the WHO abandoned its original goal of shifting to governance by evidence, instead combining it with emergency. The release announced alarmingly: “A new study by the World Health Organization has shown that women who have had Female Genital Mutilation (FGM) are significantly more likely to experience difficulties during childbirth and that their babies are more likely to die as a result of the practice” (WHO 2006). Aligning itself with the prevailing discourses, the release gives the study socially familiar, that is, alarmist meanings.

To construct cutting as a cause of mortality, the release relies on a mix of scientific figures, rhetorical strategies, and popular discourses. In a rhetorical feat, it frames risks as “significant” by lifting the notion of significance from the realm of statistics to the realm of value and meaning. It translates a statistically significant outcome as socially significant—that is, as particularly harmful. In doing so, it hides the fact that epidemiologists would evaluate the associations between cutting and mortality as weak. It also transforms risk into substance by claiming that cutting leads to “substantial dangers.”

The press release bundles risk and “danger” throughout. A WHO official is quoted as saying, “As a result of this study we have, for the first time, evidence that deliveries among women who have been subject to FGM are significantly more likely to be complicated and dangerous.” Alarm is also drummed up by an arsenal of adjectives: “Serious complications during childbirth include the need to have a caesarean section, dangerously heavy bleeding after the birth of the baby and prolonged hospitalization following the birth.” To augment the deadly harm, the release singles out the most extensive and, according to the study, most harmful form of cutting (infibulation, or in the WHO typology, FGM III) as representative, and shifts seamlessly between specific results and decontextualized framings.

The WHO press release was the crucial technology of “rearrangement of meaning” (Svendsen 2011:422) in the transfer of knowledge and meaning-making from the institutional to the public domain. Both supporters and critics—including some anthropologists who criticized the WHO (Prazak and Coffman 2007:vii)—relied on the release, rather than the publication proper. Thus, the press release was not a secondary text, but one whose voice would stand above the Lancet article.

Of the media outlets that picked it up, the New York Times was most influential. Touting the study as “the first conclusive medical evidence of long-term physical harm,” Rosenthal wrote that cutting “has deadly consequences when the women give birth, raising by more than 50 percent the likelihood that the woman or her baby will die” (2006). To arrive at this formulation, the Times uses infibulation as representative of all cutting, collapses infant and maternal mortality, and misconstrues relative risks as percentages. It then extends the discourse of death, writing that cutting has “deadly consequences,” causes “serious medical complications,” and quotes the president of the International Women's Health Coalition as saying “finally we have data to prove what health workers have long known: that female genital mutilation is a health issue, a killer of women and children, as well as a human rights issue” (Rosenthal 2006).

Understanding the productive power of the press in shaping meanings about cutting as a “killer” is particularly important, as the Times article supplanted the original publication, becoming a reference point for various publics. Activist organizations reprinted it and revised their definitions in accordance with its claims of deadly harm (Tahirih Justice Center n.d.). The influential Journal of the American Medical Association repeated Rosenthal nearly verbatim, reporting that cutting “increases by 50% the likelihood that the woman or her baby will die during childbirth” (Stephenson 2006:272). Most surprisingly, these formulations circulated back to the WHO researchers and were repeated by Dr. Guyo Jaldesa, one of the study's PIs. He stated at a UNFPA event: “While human rights groups long campaigned against genital cutting as a rights issue, the study provided the first conclusive medical evidence of long-term physical harm. It proved beyond a reasonable doubt that FGM/C was a health issue, a killer of women and children, as well as a human rights issue” (UNFPA 2008:14).

Discourse, Judith Butler suggests, “accumulates the force of authority through the repetition or citation of a prior and authoritative set of practices” (1997:51). This performative production of meaning of deadly harms was a citation of a long-standing discourse that gained in truth value through the repeated utterances and references to science and evidence.

The Afterlife of Alarm and Evidence

At the study launch, FORWARD also took the study as “verifiable evidence for the severe health implications of FGM which we have long known of” (FORWARD 2006). We might say then that the obstetrics study ironically arrived exactly where the WHO wanted to depart from: the people's certainty that “they know” that cutting is harmful and have no doubts about it. Yet this ironic outcome was mediated and enabled by the WHO abandonment of its desires for a paradigm shift, and its subsequent gluing of evidence and alarm.

The bundling of activist and technocratic technologies of governance has continued in the aftermath of the controversy. The WHO has used the study to modify its policy briefs and fact sheets, toning down the alarm and using sober and measured language (2008b, 2010). No longer an endless laundry list, the fact sheet refrains from mentions of maternal mortality, and replaces invocations of danger with risk calculations. Yet the WHO also cited the study when condemning cutting as a matter of policy at the WHO General Assembly. Notably, the study has legitimized and transformed larger governance agendas. In concert with its partners, the WHO uses it as a standard point of reference and as “strongly-established evidence” (Cottingham and Kismodi 2009:129) of risk and deadly harm. In a recent cost-cutting argument, the WHO mixes evidence and alarm by interpreting the costs of cutting in reference to death and “immense psychological trauma” (Adam et al. 2010:6). Rather than disappearing from sight, alarm has morphed into an unmarked Doppelganger that thrives in the shadows of the technocratic performance.

The WHO reforms of the arrangements of knowledge and power are thus marked by an apparent contradiction: the simultaneous performance of technocratic rationality and the production of moral alarm. Rather than instigating an epistemic shift, the WHO has accommodated these seemingly contradictory technologies. The resulting nesting of sensationalism and detachment, danger and risk, and urgency and calculation, points to a phenomenon that may be larger than the obstetrics study: the entanglements of governance by evidence and the governance by emergency in contemporary global health and international governance.

CONCLUSION

  1. Top of page
  2. ABSTRACT
  3. ANTHROPOLOGY AND THE LIMITS OF CONTROVERSY
  4. ORIENTATIONS
  5. EVIDENCE AS GOOD INTENTION: HISTORICIZING THE WILL TO KNOW
  6. AESTHETICS OF EVIDENCE
  7. ON THE EDGES OF SCIENCE
  8. CONCLUSION
  9. REFERENCES CITED

“What is an author?” asks Foucault (1977:113). A function, a discourse, a mutable subject? Rather than attributing sovereignty over authorship to WHO scientists, I have shown that they did not have control over the making of facts and meanings: a “plurality of egos” (Foucault 1977:130) constructed cutting as “killer of women and children.” I have traced the interconnected and dispersed mechanisms of authorship by uncoupling the acts of writing and interpretation from sovereign subjects. In the WHO study, nonsovereign authors generated and circulated meanings about evidence of deadly harm.

These meanings were created collaboratively and performatively, as a plurality of actors joined in the interpretation of results and as the institutional and cultural boundaries of science dissolved. The collaborators, we have seen, are both friends and enemies. “Collaborators,” Anna Tsing writes, “are not positioned in equality or sameness, and their collaboration does not produce a communal good” (2005:246). But while their influence over the meaning-making was unequal, nobody was fully in control.

To say that the authors were a plurality of collaborators does not fully explain the extent of their lack of sovereignty. The writing subject is multiple, and it disappears (Foucault 1977:116). The study's formal shifts and their resulting instrumental consequences reveal that aesthetics is crucial to the production of evidence and meaning. To wit, the text acquired a consensus narrative as it morphed from the pendulum of objectivity into the streamlined argument form. The final publication filled the gaps left open by the draft, and, by cutting competing statements and “useless facts” (Latour 1987:7), converted results into interpretations.7

Given the primacy of aesthetics and the nonsovereignty of authors, it is perhaps not surprising that the question of authorship elicited controversy at the Geneva meeting. The discussion about who would be named and recognized as author of the Lancet publication was declared “the most contentious thing of the study.” As the PIs were invited to present their cases and the room became rowdy, it became clear that some people would be left out. Dr. Adjei turned to me and said, under his breath, “There is too much politics at the WHO.”

NOTES

Acknowledgments. The authorship of this article is less sovereign than it may appear. Vincanne Adams, Johanna Crane, Johanna Bockman, Sada Aksartova, Bianca Dahl, Becky Schulthies, and Benjamin Yost provided close readings and comments that greatly improved the argument. I would also like to thank an audience member at the 2008 meeting of the American Anthropological Association whose question prompted me to reanalyze my data, and the CA reviewers who encouraged me to produce a more certain conclusion. Versions of this paper have been presented at George Mason University and Uppsala University. This article could not have been written without Dr. Adjei's help securing access to the WHO, and I thank him and other WHO researchers and staff for granting interviews and engaging in conversation. The Harry Frank Guggenheim Foundation supported the writing of this paper.

  1. 1

    See Fischer 2007:543.

  2. 2

    They challenged claims about the negative effects of cutting on women's health, sexuality, and fertility (Ahmadu 2008; Obermeyer 1999, 2003; Yount and Carrera 2006), questioned the doxa that cutting is on the increase because of its medicalization (Christoffersen-Deb 2005), and showed the problems with framing cutting as a human rights violation (Shell-Duncan 2008b).

  3. 3

    HRP stands for the Special Programme of Research, Development, and Research Training in Human Reproduction.

  4. 4

    Although this narrow notion of what counts as a women's rights violation has been criticized extensively by both scholars and African activists, cutting enjoys a high-profile status at various UN agencies.

  5. 5

    The aesthetics of numbers elicited another kind of affect and the construction of authority was simultaneously a performance of gendered power. The epidemiologists, both men and women, performed scientific masculinity and proudly talked about “hard endpoints,” “hard measurements,” and the data's “strength” and “power” (see Cohn 1987).

  6. 6

    As Nigerian doctors who had previously published passionate calls for eradicating cutting (Eke and Nkanginieme 1999), they were ideally positioned as both “native” and scientific voices who would authorize and amplify the conclusions about deadly harms (Eke and Nkanginieme 2006).

  7. 7

    This apparatus, to be clear, is not inevitably reproduced or impervious to the agency and intentionality of subjects. Agency is possible when actors engage in positive struggles that aim to rupture performative regulatory frameworks. But the WHO researchers complied with disciplinary conventions, and the WHO bureaucracy ultimately mobilized the alarmist discourse of emergency. In the contested fields of knowledge and power, the absence of deliberate interventions against given aesthetics had a depoliticizing effect.

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  3. ANTHROPOLOGY AND THE LIMITS OF CONTROVERSY
  4. ORIENTATIONS
  5. EVIDENCE AS GOOD INTENTION: HISTORICIZING THE WILL TO KNOW
  6. AESTHETICS OF EVIDENCE
  7. ON THE EDGES OF SCIENCE
  8. CONCLUSION
  9. REFERENCES CITED
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