TL;DR
Jack Donnelly’s answer to the relativism-versus-universalism deadlock is “relative universality”: some kinds of universality — functional, international-legal, overlapping-consensus — are defensible, while anthropological and ontological universality are not, and properly understood universal rights leave real space for cultural particularity.1 Egypt is where that framework meets a measurable case. FGM affects more than 230 million girls and women alive today across 30 countries, usually carried out between infancy and age 15.2 Egypt reclassified it from misdemeanour to felony, with sentences of ten to fifteen years, professional disbarment and closure of facilities.3 Prevalence did decline, markedly, and more so among younger cohorts. But the share of procedures performed by health personnel rose to 83% by 2021, driven partly by a belief that medicalised cutting is the safer option and by parents deferring to providers’ expertise.3 The norm did not lose the argument. It found a more respectable venue.
An empty clinic corridor. The most consequential thing about a prohibition is often not whether it is obeyed but where it pushes the thing it prohibits. Photo: Tasha Kostyuk on Unsplash.4
The Deadlock, Stated Fairly
Two positions, both with something real behind them.
The relativist says moral practices are embedded in cultures and can only be understood from inside them, and that a confident outsider declaring a practice wrong is usually a powerful society instructing a weaker one — a pattern with a long and ugly history. The universalist says some things are wrong regardless of local meaning, that a child’s bodily integrity is not a matter of custom, and that the relativist position, pushed hard, licenses anything at all provided enough people locally endorse it.
Neither is stupid. The relativist is right that outside moral confidence has an appalling track record. The universalist is right that “their culture permits it” has been used to defend everything a culture happens to do.
Donnelly’s Way Through
Donnelly’s contribution is to stop treating universality as one thing.
He distinguishes several senses. Functional universality, international legal universality and overlapping consensus universality he defends. Anthropological universality — the claim that all societies have in fact recognised these rights — and ontological universality — the claim that they exist as moral facts prior to any human institution — he considers empirically, philosophically or politically indefensible.1 His central point is that universal human rights, properly understood, leave considerable space for national, regional and cultural particularity.1
That reframes the question usefully. It is not “are these standards universal, yes or no.” It is: universal in what sense, resting on what, and enforceable by whom.
Which turns an argument that can be had forever into one that can be checked.
The Case Where It Can Be Checked
FGM is the standing test case, because both sides say something concrete.
The WHO records more than 230 million girls and women alive today who have undergone it, across 30 countries in Africa, the Middle East and Asia, usually between infancy and age 15, with roughly four million girls at risk annually. The documented consequences run from immediate — severe pain, haemorrhage, infection, shock — to long-term urinary, obstetric, sexual and psychological harm.2 The WHO also opposes medicalised FGM specifically, urging health workers not to perform it.2
Note that last clause. It is there because the problem it addresses is real.
What Egypt Did, and What Happened
Egypt is the most-studied case, and it is not a story of external imposition. The prohibition is domestic law, tightened repeatedly: recent amendments reclassified FGM from a misdemeanour to a felony, carrying prison sentences of ten to fifteen years, professional disbarment for five years, and closure of the facilities involved.3
By the standard measure, this worked. A study analysing Egypt Demographic Health Survey data from 1995–2014 alongside the 2021 Egypt Family Health Survey found a marked decline in prevalence over time and among younger cohorts.3
Then look at the second measure.
The share of procedures performed by health personnel rose sharply, reaching 83% in 2021.3 The practice is now, overwhelmingly, a clinical one.
Why It Moved Rather Than Stopped
The drivers the researchers identify are the interesting part, because none of them is defiance.
They found persistent cultural beliefs framing medicalised FGM as the safer option and as a form of beautification; parents deferring to medical providers and relying on their expertise to judge whether the procedure was necessary; limited awareness of both the health consequences and the legal prohibition; and weak enforcement of penalties.3 They also found three distinct subnational patterns — governorates with high prevalence and high medicalisation, governorates where the practice persists with traditional cutters still common, and governorates with lower prevalence but high medicalisation among those still cut.3
Read that as a mechanism rather than a moral failure and it is almost predictable. Tell a population that a practice is dangerous, and you have given them a reason to seek a safer version rather than to abandon it. Give the medical profession authority over what is and isn’t safe, and some of its members will supply that version — and their involvement will itself read, to a parent, as evidence that the thing is legitimate.
The harm-reduction framing and the abolition framing point in opposite directions, and the health system sat at the junction.
What This Actually Shows About Universality
Three things, and the first is uncomfortable for the confident universalist.
Prohibition relocated the practice before it reduced it. A law can be correct, domestically enacted, severely penalised, and still produce a workaround rather than an abandonment. Being right about the norm does not tell you what enforcing it will do.
The “internal delegitimisation is better than external pressure” story is right about the mechanism and much too optimistic about the difficulty. Egypt’s is an internal campaign — its own legislature, its own courts, its own religious authorities, its own health ministry. It still produced 83% medicalisation. The problem was never only that the pressure came from outside.
And the relativist’s strongest point survives largely intact. Not the claim that the practice is defensible — the evidence on harm is not seriously contested. The surviving point is narrower and about authority: who decides, through what institutions, at what pace. Donnelly’s framework grants exactly this. Universality of the standard is compatible with enormous variation in how, and by whom, it is pursued.1 Egypt shows both halves at once: the standard held, and the implementation went somewhere nobody designed.
This is the same shape as an argument made here about food — that a moral ranking and a measurable-harm ranking are two different orderings, and confusing them produces confident conclusions in the wrong direction. Here the harm ranking is not in doubt. What was in doubt, and got answered, is what a prohibition does to a practice that a population still wants.
Where I’d Hold This Loosely
Four limits, and the first is a straightforward admission.
I could not reconcile the published prevalence series across the sources I read — the year-by-year figures for prevalence among girls aged 15–19 differed materially between reports of the same study. I have therefore avoided putting a prevalence trend line in the chart and have described the decline only in the terms the paper’s own abstract uses: marked, over time, and greater among younger cohorts. The medicalisation figures were consistent across sources; the prevalence figures were not, and I would want the primary tables before quoting a number.
Second, a rise in measured medicalisation can partly reflect changes in who is willing to report what. As a practice becomes illegal, families may be likelier to describe it as a medical procedure. Some of the 83% may be reclassification rather than relocation, and the study design cannot fully separate them.
Third, this is one country with an unusually high baseline and an unusually developed health system. Egypt is where medicalisation is most likely to be the available workaround. Elsewhere the failure mode of prohibition may look completely different.
Fourth, and against my own framing: none of this is an argument for doing nothing, and it should not be read as one. Prevalence fell. Younger cohorts are less affected than older ones. The honest conclusion is not that intervention failed but that it produced a second problem the original framing did not anticipate — which is what interventions in complex social systems generally do, and is an argument for measuring the second problem rather than for declining to act on the first.
