If there’s been any elephant in any room, it’s been on MTV, since the launch of the network’s smash-success pair of reality series about teen pregnancy and motherhood. “For two seasons of ’16 and Pregnant’ and two seasons of ‘Teen Mom,’ we have never seen any pregnant teen seriously consider abortion,” media critic Jennifer L. Pozner, author of “Reality Bites Back,” has observed. While 27 percent of pregnant teens choose abortion, Pozner notes, “in MTV’s version of ‘reality,’ 100 percent of pregnant teens give birth.”

Late last night, that changed. MTV aired a 30-plus-minute interview special called “No Easy Decision,” in which three young women — including Markai Durham, who was featured last month on “16 and Pregnant” carrying her first pregnancy to term — spoke candidly about their decisions, as teenagers, to have abortions. Though MTV had not planned to promote the show, which appeared at the way-past-prime-time hour of 11:30 p.m., a leak by EW.com last week did just that — and had everyone prepared for the worst. Circling the wagons against nasty backlash, nonpartisan post-abortion support talkline Exhale, who partnered with MTV on the show, had already planned an online campaign called “16 and Loved” to act as sort of virtual clinic escorts for the young women outing themselves. Abortion-rights opponents smelled pro-choice conspiracy; abortion-rights supporters feared that the network — and especially “Dr. Drew” Pinsky — would tackle the subject with all the nuance and sensitivity of a Snooki Polizzi sucker punch.

But this member of the latter camp is relieved, delighted — and still amazed — to report that MTV got it right. Seriously, they nailed it. And by “nailed it,” I don’t mean they just did a great PSA for abortion. I mean they told the many-sided truth: that abortion is safe and common, that abortion has been made difficult to get, and, most importantly, that abortion is a complex decision made by complex human beings. (That thump you heard around 11:35 p.m. EST was the sound of 100 feminist media critics falling off our collective couches.)

Here’s Dr. Drew opening the show — and racking up stunned “FTW!”s (For The Win!) on Twitter right out of the gate: “About 750,000 girls in the U.S. get pregnant every year. And although nearly a third of these teen pregnancies result in abortion, we’ve never shown this choice on ’16 and Pregnant’ up until now. It can be a polarizing topic, and there’s quite frankly no way to talk about this and please everyone. Although controversial to some, abortion is one of the three viable options, and it’s among the safest, most common medical procedures in the U.S., so we thought it was important for us to discuss.”

In a wrenching produced segment, we then meet Markai and her partner, James, as they wrestle with their options for her unplanned second pregnancy, the result of a missed appointment for her shot of Depo-Provera. As a mother, Markai is tormented both by the prospect of terminating a pregnancy (or relinquishing a baby) and by the prospect of raising a child whose needs will splinter their already slim resources. Referring to her daughter, Zakaria — and reflecting the fact that 61 percent of women who have abortions already have children — she says, “I don’t want her to struggle because of my mistake.”

Through the rest of her segment, and in Dr. Drew’s follow-up interview with her and two other young women (Katie and Natalia), the show manages to include: medically accurate information about abortion procedures, the challenge of finding the birth control method that works for you, the positive presence of supportive family and friends, the compassionate voice of a clinic counselor (vs., for one, the cold depiction in “Juno”), the complex emotions of male partners, the cost of abortion ($750, in the case of Natalia, who sold her prom ticket back to school to help put together the funds), the cruelty of parental notification requirements (Natalie called the experience of securing an alternative judicial bypass “begging for permission to make your own decision”), the positive presence of supportive family and friends (in this case, African-American, a sadly rare portrayal), the normality of mixed feelings after the procedure (Markai says, insightfully, that she feels sadness but not regret), and the characterization of abortion as — in Katie’s words — “a parenting decision.” (In an extended interview available online, Natalia also describes the cruelty of being legally forced to view the pre-procedure ultrasound.)

All that in just over 30 minutes, all without scoldy shaming or down-our-noses voyeurism. Instead, this whoop-worthy kicker from Dr. Drew — “Hopefully this inspires us to be more compassionate when we think about abortions” — and, simply, three brave and articulate women who may have begun to raise the level of public, pop-culture conversation about abortion. Maybe it’s “just” MTV, but it matters (and God knows no one else is doing it).

“This isn’t just a television show. Media portrayals, real or fictional, don’t merely inform us — they form us,” as Gloria Feldt wrote in the Washington Post about “Friday Night Lights.” “And they miss the profound truth of women’s lives when they reduce broad issues such as sexual and childbearing choices to one word — abortion — and reduce abortion to a polarized, black-and-white debate.”

And as Dr. Drew himself said last night: “Having an abortion is not uncommon. But talking about it publicly is.” At this time, there are evidently no plans to repeat or extend the special, which was buried to begin with. So here’s a high-five to MTV for — finally, and so finely — getting this thing going.

But next time, how about prime time?

On the one hand, there’s the Gawker conclusion (shared by many), based on “in depth Internet research” revealing Cahoon on Facebook and her book on Amazon: She is “the world’s craziest dating expert” and the videos are “thrillingly real” (“please watch in splendid amazement”). On the other hand, there are those who say the videos — the costume changes! the cheesy soundtrack! the men! — are too thrilling, too splendid, too crazy to be real. Our appetite for irony is so voracious, our radar for hoaxes so sensitive, and (in some cases) satire has become so sophisticated, that indeed: These days, one could imagine Cahoon (or “Cahoon”) pulling off a head-spinningly elaborate pop-culture fake-persona long con: Joaquin Phoenix meets Stephen Colbert meets Tina Fey/Amy Poehler meets Carrie Bradshaw. (This was my take, initially. At least that’s what I was rooting for.) But the debate in the first place is a sign of our post-Blair Witch, post-reality TV, “I’m Still Here”/”Catfish“/”Jersey Shore”/YouTube times: We’ve become so jaded that it’s near impossible to distinguish between real life and a hoax — or a marketing strategy — and we’re always on the defensive for being duped. The argument over what’s real and what’s not has become, more than ever before, a major part of our reaction to art; the membrane between reality and imagination is getting more porous by the day. That mashup is what makes the Cahoon conundrum so captivating. She embodies an irresistible pop-culture zeitgeist two-fer: We thrill to a clueless train wreck; we smell a clever, clever rat.

But in all this investigation and vigorous discussion, one voice was missing: Katherine Chloé Cahoon’s. And so, I decided to call her up. Is Cahoon real or fake? The answer, at once disappointing and exhilarating: She is both.

“We meant to make the videos over the top,” she said from her home in Seattle. “I wanted to be like the travel hostess who says, ‘Come to Europe and all your dreams will come true!”" she says, still amazed that people seem to have thought otherwise. “The guys in the video called me and said, ‘They have to know we’re joking! I don’t really whip off my shirt in the gym and pose on the equipment!’” (On her website, Cahoon responded to the controversy by writing: “Of course they are parodies!”) But the videos — and the book — are also meant to be useful. These were tips the Vanderbilt grad gave to her friends upon returning to campus each fall with fabulous tales of being “manopolized” by suitors in Europe’s most “mantastic” hot spots. She explained one video tip to me about the festival of San Fermin: “If a woman wears red and white at the running of the bulls, it means you’re respecting Spanish culture, and men will want to meet you for that. And I really did have a friend who turned her sarong into a towel after spending the night on the beach!”

To some wiseass doubters, Cahoon’s claim that she meant to be funny would simply make her the Tommy Wiseau of dating advice. (Wiseau famously insisted — after his 2003 film, “The Room,” was cited as one of the worst films ever made — that it was, uh, supposed to be comedy.) But once you spend a little time with Cahoon and her Internet paper trail, it’s hard to do anything but take her at her honest, earnest word. Her ingenuousness, it turns out, is almost impossibly genuine. And that’s where she is totally for real.

The real vs. fake confusion, I think, arises from exactly what’s so beguiling about Cahoon: She actually has no idea how how funny she is. Because, really, her videos are reality magnified only about 1.3 times. In real life, she remains almost as guileless and dreams-come-true, unicorns-and-rainbows sincere as she is on-screen: Elle Woods, or Tracy Flick in a spun-sugar tutu, the über-achiever who, underneath all her cheerfulness, is actually cheerful.

Her videos look and feel awkward in part because it’s actually her dad (a photographer with no video experience) behind the camera. (For her own part, Cahoon says, she drew on what she learned at Vanderbilt in one semester of Intro to Filmmaking.) Also at Vanderbilt, Cahoon sparkled up the gridiron as a member of Danceline, the school’s official dance team. (Amazing Flickr proof lives here.) As a child, though banished from her beloved trampoline by a back injury, Cahoon took ballet six days a week and became an avid — in fact, prizewinning — gardener by age 12. The elaborate garden she created at her parents’ home in Seattle was inspired by a childhood poem she wrote called “Rainbow Ranch,” about stuffed animals who come alive and gather for tea. (In between meetings with Hollywood producers about the in-the-works film based on her book, she still maintains the garden, having spruced it up just recently for some children to come over and act out her poem.) “I love gardening,” she told me. “It’s kind of like writing in a way. You get to create something out of nothing.”

Cahoon does get stopped by people on the street, she says, who compliment her book and ask to take a photo with her. “I try to get to know my readers so I ask about them and there is always some characteristic we have in common,” she says. “One girl was in law school and loved to travel. One man worked for a major film studio. He said his entire office stopped and watched my videos. I feel fortunate to have the opportunity to meet these people.”

To someone raised on rainbows, of course, that “entire office” could have had only the best, the most laughing-with, intentions. But Cahoon is not unaware that there’s also been some laughing-at. And that, indeed, has cost her a bit of her innocence — her Internet innocence, anyway. “All the critical comments I read about me, my videos and my book were inaccurate. For example, one person claimed to have read my book, but her description of it was the opposite of what the book states. She related her own tips for meeting Euro men. These were straight out of my book even though she claimed I had omitted them. For example, she suggested learning some of the native language. Tip No. 19 in my book, entitled ‘Break Through Language Barriers,’ covers exactly this,” Cahoon says, displaying a refreshingly dated belief in the magical power of demonstrable fact. “Also, someone who made several false statements about my videos and book received comments from those who refuted every one with direct references. This did not stop her. She continued to make statements that were so false and vicious they fit the legal description of libel. After learning this, I realized that there are people on the Internet who enjoy making crude, hateful statements. Even when they know these statements are false, they do not care.” (By the way, her book’s reviews on Amazon have taken on a grand satirical life of their own. “Miss Cahoon is kind to her ignorant reader like a Swedish hostel manager might be kind to a single American girl who thinks Sweden is a rustic province of Wales and can’t for the life of her remember if she thought to tell her family she’d be abroad for a few weeks,” reads one.)

Cahoon has also learned that she’s hardly the only victim of online asshattery. “Recently, I saw a video featuring a model from one of the premier agencies. She was absolutely gorgeous. Yet there were venomous comments saying she was overweight. Some went so far as to call her fat. If this girl is fat then heaven help the rest of us!” she says. “What should she do? Quit modeling because some cruel people want to bring her down? Absolutely not! Taylor Swift, who is hugely successful and one of the sweetest girls, would not have written a song called ‘Mean’ if this were not a problem in our society.” Seriously! Europe may be looking better and better.

The Portwood saga caps an intense season on “Teen Mom,” and an intense two years for examining the nuances of domestic violence through the lens of pop culture. Of course, there’s never been any shortage of male-on-female abuse on TV, especially with ever-scummier reality shows in the mix. But lately what we’re seeing, perhaps more than ever, is female-on-male violence. Before Amber vs. Gary, we also — obviously — had Chris vs. Rihanna, along with the common and supposedly exculpatory allegation that she hit him first. We had slapsticky reports that Elin Nordegren started the whole thing by clocking Tiger Woods with a nine-iron. There was Eminem’s smash “I Love the Way You Lie” featuring, of all people, Rihanna on vocals, which whipped up debate about whether the song offered a groundbreakingly complex tale of relationship hell (with which Eminem is also familiar) or reinforced that old idea that, hey, maybe Rihanna did like the way it hurt. But one thing largely unremarked upon throughout the whole “LTWYL” micro-saga is that the violence is presented as, essentially, equal. In the song’s follow-up, “I Love the Way You Lie (Pt. II),” the woman (Rihanna singing lead this time) is not just complicit in the abuse; she is also — almost blow by blow — as violent as the man. (Eminem: “Tell me I’ll be sorry that you pushed me into the coffee table last night so I can push you off me … You hit me twice, yeah, but who’s countin’ / I may have hit you three times.”)

Inherent in the above is some suggestion of perverse 21st century gender parity: Both partners are equally to blame, both partners are equally abusive; women are strong enough to punch, women are not — or no longer — the only victims. When we hear of a woman who hits, we hear rumblings that women are “becoming more violent,” that this is the dark price we pay for female empowerment. As in, hey, feminism, thanks a lot. But are women really becoming “as violent as men”? And is that even the question we should be asking in the first place?

People who support women’s rights, and who have worked for decades to get male-on-female domestic violence taken seriously, may find this conversation not just eye-rolling, but deeply troubling. As expert Jill Murray, author, most recently, of “But He Never Hit Me,” puts it: Equating the scope, incidence and danger of male vs. female domestic violence “stands to negate everything we’ve been trying to fight for, all the work we’ve done.”

How so? Because when not just played for man-bites-dog laughs, female violence against men — especially in cases of heterosexual domestic abuse — is invoked to diminish, even deny, the reality of male violence against women.

“We can’t ignore or deny that women can be violent to their partners, whether their partners are men or women,” says Jennifer L. Pozner, author of “Reality Bites Back: The Troubling Truth About Guilty Pleasure TV” and founder of Women in Media & News. “But by hyping inaccurate studies in news reports and creating salacious narratives on crime dramas, media have for decades tried to create a false equivalence, discussing the few women who have been violent and using those women’s stories as proof that A) there’s ‘just as much’ female-to-male domestic violence as male-to-female, and B) domestic violence isn’t a problem that women have to deal with as victims anymore.” (Men’s rights activists go even further, claiming that men are [as reporter Kathryn Joyce put it] “victims of an unrecognized epidemic of violence at the hands of abusive wives.”)

Let’s see what the stats really say, and what they mean in context. The DOJ’s numbers do contain this one perhaps surprising stat among many, many others: Males and females in violent relationships are “hit, slapped, or knocked down” by partners at almost exactly the same rate. Other research accumulating since at least 2000 suggests that, in fact, females are at least as likely as males to perpetrate intimate partner violence and that abusive relationships often involve mutual violence. So if you were cherry-picking, or very-broad-stroking, you could sort of call it even.

Except it’s not. Not at all. Experts say the raw, in-a-vacuum numbers don’t even start to tell the whole story of a given relationship, or of the complex dynamics of domestic violence. Other DOJ data shows men are more likely to be attacked with a knife or hit with a thrown object; women are more likely to be grabbed, held or tripped, raped, or sexually assaulted. Perhaps more to the point, females are more likely than males to sustain severe or injurious violence and to require medical treatment. “When you take the data out of context, in some cases, women come up as violent as men,” says Meda Chesney-Lind, Ph.D., a criminologist, professor of women’s studies at the University of Hawaii, and author, most recently, of “Fighting for Girls: New Perspectives on Gender and Violence.” “But men will often use the excuse ‘she hit me first’ to justify decking her or throwing her against a wall. She slaps him, and that’s used as a pretext to beat the crap out of her. She’s the one who winds up in the hospital.”

Research also shows that male victims do not take violence by their partners as seriously as females do and, conversely, that women are more likely to be frightened by future violence. Men, perhaps most significantly, are much more likely to commit the extended, continuing violence known as “battery.”

In other words, even where select data points appear to be equal, “shared rates are not shared problems,” says Jeff R. Temple, Ph.D., an assistant professor of obstetrics and gynecology at the University of Texas Medical Branch who specializes in intimate partner violence.

Temple also notes that — likely related to changing mandatory- and dual-arrest laws in cases of domestic violence — reporting of female domestic abuse has increased; that skews the numbers as well.

Another fallacy, says Chesney-Lind: the presumption that violent women are a new post-feminist breed, hitting because being “empowered” makes them more like men. In reality, male and female domestic violence tend to emerge from different places, and with different intentions. In the context of heterosexual domestic abuse, she says, “male violence is an expression of power and control over women; men are hitting to control and get things. Women’s violence is an expression of frustration and rage and exasperation.”

And that’s where we get to the bigger picture. Bottom line, says Chesney-Lind, “we are fascinated by girls’ and women’s violence.” For those who like to see women — Angelina Jolie, even Helen Mirren — wielding serious, even heretofore forbidden, power, it’s hot. For those who fear women in that role, it’s … not. “For all the increased tolerance, even celebration, of aggressive women in pop culture, in daily life there’s still a lot of disapproval of women even speaking up at meetings or asking for a raise, let alone committing a physically aggressive act,” says Maud Lavin, author of “Push Comes to Shove: New Images of Aggressive Women.”

Adds Chesney-Lind: “To take the longest possible view, one of the things you do when you want to discourage women from seeking social justice for their gender is show that there are terrible downsides to ‘mimicking maleness.’ That has been a motif since the first wave of feminism. If you demand to go into the public sphere you’re going to be corrupted, just like men — and the most recent version of that is that you’re going to get ‘out of control,’ even hyper violent.”

None of this is to say that domestic violence by women should be accepted, excused or cheered. But when it comes to pop culture and public discourse, it needs to be discussed on its own face and in its own context, with its own set of causes and implications, not as a game of one-upmanship — and certainly not as a consequence of liberation. “Once we became concerned about them, it was very easy to find violent girls, because they’d always been there,” says Chesney-Lind. That more enlightened, accurate conversation might be — among other things — one step toward “I Love the Way You Lie (Pt. III), in which both singers say, “… and that’s why I got out.”

Mr. and Mrs. Bird-Bee are actually “Neil and Karen,” who are actually two very funny deadpan actors in giant goofy costumes. They’re the stars of a series of five webisodes at the centerpiece of a new campaign designed to raise awareness about infertility, one that nails the experience so knowingly and wittily that it’s getting big love from the infertility community — which is especially notable considering that, in fact, it’s coming from big pharma. Sponsored, subtly (no, really), by EMD Serono — Massachusetts-based maker of fertility drugs used to stimulate ovulation — the “Increase Your Chances” campaign encourages couples to visit a specialist if they hit that fertility wall, and, more broadly, aims to change the way infertility is talked, or, more to the point, whispered about, in our culture. (Part of the campaign involves sending bird- and bee-clad actors onto the streets of small cities — two weeks ago, it was Austin — to “get couples talking about fertility issues.”) The Web spots also close with key facts about infertility: One in eight couples struggles with it; it’s about equally likely that fertility issues will stem from the male as the female partner; 85 to 90 percent of fertility issues are treatable; infertility — “just relax,” my ass — has no correlation with stress. While scattered dissenters find the humor trivializing, most bloggers and commenters became big fans on sight, sending the videos to each other and also (as one poster wrote) to “close (and fertile) friends who are trying to be supportive of me but who just don’t quite understand what living with infertility is like.”

“This ad campaign takes infertility out of the darkness,” says Barbara Collura, executive director of RESOLVE: the National Infertility Association, who has partnered with Serono as a resource for patients.

What’s it doing there in the first place? Thankfully, infertility is not like it was for my childless great-aunt Bess (for whom my daughter is named), born in 1898, who went through it even before it had a name (or books, or blogs, or support groups, or treatments). But for all the resources and help available, there somehow persists the old-fashioned, possibly sexist notion that women get pregnant because that’s what they do, that conceiving is the natural, default outcome — after all, we spent so many years trying not to, goddammit — such that failing to seems to mean there’s something wrong with you. Not your plumbing, you. Result: stigma, secrecy, shame. (For the, mercifully, relatively short time I subscribed to Conceive magazine, I felt like I had to slip it inside something respectable, like Us Weekly, when I read it on the subway.) The assumption persists that every (married) woman will have a child, even those who aren’t interested. So you can imagine how that might feel for those who are. But, then, articles about infertility online, for one, often elicit ungenerous commentary that basically boils down to “boo-fucking-hoo.” Our nation’s collective pop-culture “bump watch” being on permanent orange alert (what Rebecca Traister called “pregnancy porn”) doesn’t help, either.

Speaking of culture, it’s not overflowing with positive, nuanced or compassionate images of women struggling to conceive or seeking fertility treatment. (One word: “octo-mom.”) Also, if you totally forgot that there was a dramedy about a fertility clinic on NBC called “Inconceivable,” good. In “Increase Your Chances,” Neil and Karen do drift a bit toward the tired doofy-husband/testy wife (hey, it works in “Modern Family”), but they’re still pretty winning; they still ring real, right down to the rank wheat-grass snake oil and military-timed robosex (post-coital murmur: “Don’t forget the dry cleaning”). They’re tense, they’re tender: You root for them. “They’re note-perfect, an assessment that my commenters share,” says Julie Robichaux of ALittlePregnant.com. “They’re kind of Everyinfertile, in fact, stunningly typical. For people trying to conceive, that makes it easy to relate to the couple. For those not in that situation, it advances the notion that people who do seek fertility treatments aren’t quite as egomaniacal/selfish/not-like-us as they may previously have thought — a win for the infertile community. By humanizing the couple so unerringly, the ads make us receptive to the message.”

How did Serono (and mono, the agency they worked with) get it so right? Not rocket science: They talked to people. “What you see comes directly from conversations with patients,” confirms David Stern, executive vice president of endocrinology for EMD Serono. “We wanted to come up with an awareness campaign to help create less stigma around infertility. We looked at everything being done online by IVF clinics, patient advocacy groups, and competitors, and we saw very similar themes: flowers and soft colors and other warm, fuzzy things and babies. Lots of babies. It’s all done very softly. We said, ‘OK, a lot of people are doing this and there’s still this stigma. We want to do something different that will get a conversation started, in a way that’s humorous without making fun.” He adds: “We also want to get people to physicians who know how to treat them. If they use fertility drugs, that’s great, but we really want to motivate people to go in to see specialists because that’s the best route for them to become parents.”

That’s a welcome message, too, says Robichaux. “It undoubtedly serves the drug company, but it also serves anyone who’s been trying for a while with no success. Nothing frustrates me more than to hear a friend tell me, ‘Well my gynecologist said a year’s not that long, that we should just keep trying on our own.’ Lady. You’re 41. Your doctor has done you no favors.”

The ads, she notes, also don’t pander or patronize by promising success. “That’s huge,” she says. “Not only is it a truthful acknowledgment of the limitations of medicine — imagine that — it’s also a very respectful position to take with regard to the intended audience. Infertile people know that there’s no magic bullet, or silver needle, or pregnant rainbow Pegasus crop-dusting the world with glittery baby dust.” And now they also know that there are a few more people who understand.

So what if a U.S. doctor — while refusing to perform any other or more invasive sort of genital cutting — were authorized to offer one option: a tiny, symbolic, non-disfiguring pinprick or “nick” on a girl’s clitoral hood, under sanitary conditions and local anesthesia? What if her parents, resolved to do some form of ritual cutting, accepted this offer as an alternative? What if the doctor — though arguably perpetuating, in principle, a cruel and misogynist tradition — would therefore save this girl from an almost incomparably worse fate, whether on U.S. soil or abroad: perhaps a brutally invasive excision with rough tools and nothing to numb the pain, plus the possibility of serious lifelong health complications — or death?

Would that, then, be the right thing for this doctor to do?

For a few weeks in May, that question took a small — though immensely controversial — step out of the realm of “What if?” The trigger: The American Academy of Pediatrics (AAP) released a provocative update to its 1998 policy on FGM, which unambiguously condemned all forms of the procedure. In a revision published on April 26, the AAP — primarily out of stated “respect” for the “experience of the many women who have had their genitals altered and who do not perceive themselves as ‘mutilated’” — replaced the term “mutilation” with the more “neutral,” less “inflammatory” and, they suggest, dialogue-stifling term “cutting” (or FGC). Without explanation, the AAP removed a reference to FGM’s “cultural implications for the status of women.” And they advanced what proved to be an incendiary proposition: Let doctors offer the “nick.” Not to accommodate, endorse or encourage FGM, but to preclude it: to offer a lesser-evil strategy of “harm reduction” (analogous in some ways to, say, syringe exchange for drug users). “Such a compromise,” the policy suggested, could offer a physically harmless way to “build trust between hospitals and immigrant communities, save some girls from undergoing disfiguring and life-threatening procedures in their native countries, and play a role in the eventual eradication of FGC.”

The revised policy sent shock waves through the anti-FGM community worldwide — which is committed to eradicating FGM in all its forms, even when “medicalized” in the interest of harm reduction — and the sisterhood of anti-FGM advocates in the United States. Marianne Sarkis, founder and director of the Female Genital Mutilation Education and Networking Project and visiting faculty in the Clark University (Worcester, Mass.) international development department, called the statement “an insult to all the women who have put their lives on the line fighting these practices.” Her allies from FGM-practicing countries were “outraged” by it, she said. “Many of those who have decided not to force this practice on their daughters felt betrayed by the system that’s meant to protect them.”

Demands for a retraction came fast, including a joint response (PDF) from the World Health Organization and three United Nations agencies urging the AAP to re-revise its new policy so as to “be aligned with internationally agreed positions which are the result of in-depth analysis of FGM and of the approach that successfully leads to the abandonment of the practice.” And so, in a rare — though widely welcomed, and clearly wise — move, the AAP retracted the policy last Thursday.

“I cried and told them how grateful I am,” Soraya Mire, a Somali filmmaker and survivor of FGM, told CNN. “Thank you for understanding us survivors and hearing our voices.”

The new-new version of the policy retains the term “FGC,” but replaces the rest with a few blunt paragraphs reaffirming the group’s “strong opposition” to FGM in general and making clear that the AAP “does not endorse the practice of offering a ‘clitoral nick.’” Said AAP president Judith S. Palfrey, M.D.: “Our intention is not to endorse any form of female genital cutting or mutilation. We retracted the policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere else in the world.”

All told, this was a painful episode that everyone involved would probably like to forget. (Advocates privately called it “embarrassing,” the newly amended policy “lame.”) But to pretend it never happened — or dismiss the AAP’s intentions — would be to ignore the problems that the nearly stillborn policy revealed and legitimately, if maladroitly, sought to address.

As a nation of immigrants, we (in some ways like France, with its tensions over the burqa) continue to see tested the limits of liberties we hold dear; we continue to negotiate the tricky territory of embracing peoples while — in this case, rightly — rejecting their practices. And our doctors, evidently, are being asked to do exactly that in their own examining rooms. How can doctors address FGM in a way that makes sense to patients (why boys but not girls?) and educates without alienating, thus possibly helping protect that daughter from future harm? The above scenario with the Somali mother was a real one: It led to a comparable, and also rejected, “nicking” proposal in Seattle in 1996. So here we are again, revisiting the question at a national level, with doctors apparently still trying to figure out the most effective way to help protect the girls they encounter. What can we learn, this time around, about how to help them?

FGM refers to a variety of traditional rite-of-passage practices, widespread in parts of Africa, Asia and the Middle East, that involve the nicking, cutting or removal of parts of female genitals for reasons both non-medical and mythical (e.g., to make a woman “clean” and “reduce” her libido). Health consequences include severe pain and bleeding, hemorrhaging, chronic infection, infertility, painful intercourse, post-traumatic stress, pregnancy complications possibly fatal to the baby, and death of the victim herself. While remarkable steps have been taken toward abandonment of the practice — lawmakers from 27 African nations recently joined together to call for the U.N. to ban the practice as a human rights abuse — FGM, along with the misogynist belief and social systems it represents, remains deeply entrenched in numerous villages, regions and nations worldwide. “Uncut” girls may be shamed and considered unmarriageable, raising the prospect of severe economic consequences for her and her family. Coming to America does not mean abandoning the practice; in fact, according to some reports, some families here see FGM as an essential bulwark against the girls-gone-wildness of our culture. “Think of it as a genital burqa, designed to control female sexuality,” said Somali FGM survivor and opponent Ayaan Hirsi Ali, writing in the Daily Beast.

The revised AAP policy ignored the fundamentally anti-woman underpinnings of FGM, critics said. “Perpetuating any form of FGM, however seemingly innocuous, is denying girls their fundamental right to bodily integrity — and failing to recognize FGM as part of a system of violence and discrimination against them. One can’t violate just a little less or discriminate a little less. The AAP’s suggestions are the equivalent of advising doctors to agree to bind three toes instead of a girl’s whole foot, or supporting child marriage at age 13 instead of 8,” said Taina Bien-Aimé, executive director of Equality Now, a leading voice in the anti-FGM field.

The WHO/U.N. agency joint statement addressed to the AAP also outlined several concrete reasons why global anti-FGM consensus does not support “nicking” as a harm reduction approach. Among the concerns: The performance of any type of FGM by medical personnel confers a dangerous legitimacy on the practice; the lack of data confirming that a “nick” really would prevent worse; general lack of clarity about what a “nick” means in practice; and the concern that a “nick,” if ever established as an alternative, would be even harder to eradicate than harsher forms and would “thus result in greater overall harm.”

To be clear, the AAP was not about to start sending doctors out with nicking kits. Nor (as was erroneously implied and reported) was the group trying to be “culturally sensitive” for its own sake. The retracted statement urged doctors to “use all available educational and counseling resources to dissuade parents from seeking a ritual genital procedure for their daughter”; it acknowledged not only FGM’s harmful effects but also its status as a violation of human rights and a form of child abuse. Its intention was specifically, and only, to suggest that federal and state laws banning FGM in the U.S. should be tweaked to allow for the “nicking” possibility as a last resort. (Actually, and also contrary to reports, legal experts do not agree on whether federal law precludes a “nick” in the first place).

In order to make its case, the AAP’s revised policy made passing reference to what came to be known to some as “the Seattle Compromise.” In 1996, a group of Somali-born mothers approached doctors at Seattle’s Harborview Medical Center to open a radical conversation. They made clear that if some form of the procedure did not happen at the Center, they would send their girls to a local Somali “midwife” or even to Somalia, in which cases they’d be subject at least to clitoridectomy, if not complete “Pharaonic” infibulation — removal of all external genitalia and stitching together of the resulting wound. The Somalis’ proposal: allow Harborview doctors to perform only a symbolic “sunna,” a tiny nick. “Remember, these women were all infibulated, so it was a big step to not do anything for their daughters,” notes Leslie Miller, a Seattle OB/GYN formerly at Harborview who was a key player in the discussions and whose patients were among those who’d raised the question.

Harborview doctors and officials convened and came up with this counteroffer, one substantially more specific than the AAP’s proposal: a small cut to the clitoral hood, with no tissue excised, conducted under local anesthetic on children old enough to give consent. “Have you ever seen a male circumcision? Surely if we condone that then a simple nick of the prepuce is a tiny price to pay to prevent something more extreme,” says Miller of her colleagues’ rationale. (Comparisons between male circumcision and FGM are often disingenuous, ignoring the vast differences between the stated purposes of the practices and the belief systems from which they emerge. That said, the circumstances of the Seattle case, and “nicking” proposals in general, do invite limited areas of comparison, an interesting discussion of which — along with the full story of the Seattle Compromise — appears in this 1998 article in the Duke Law Journal.)

Did the “nicking” alternative save any Somali girls in Seattle from something worse? No: It was never put into place. Reaction against the proposed compromise — from the community, anti-FGM advocates, and Rep. Pat Schroeder, who’d worked for years to enact the federal FGM ban — was so swift and savage (though, according to the Duke Law Journal, probably based in part on inaccurate reports about Harborview’s motives and intentions) that Harborview dropped the idea without further discussion. (A similar proposal, also raised by Somalis, was rejected in Holland as well; it’s coming up right now in Australia. UPDATE: The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has clarified that it has no current plans to change its position against all forms of female genital mutilation.) Could it have made a difference? Would any given community actually accept such an alternative? We don’t have that kind of data, say experts, stressing that even “successful” harm reduction in the short term would come at too high a price.

By most accounts, the Seattle episode left such a bad taste that the primary lesson learned seems to have been “Don’t do that.” Can we do better this time around? Fourteen years later, it appears that many doctors here — like, metaphorically speaking, traditional FGM practitioners — are still equipped with only the roughest of tools. Flat-out refusal or condemnation of the procedure can backfire, driving patients away; the full weight of negotiation or education shouldn’t be left upon physicians, either. “The AAP should call for the local, state and federal authorities to educate, in a culturally sensitive way, the parents of at-risk girls about the harmful effects of FGM and how it is not necessary to secure a girl’s virginity until marriage or guarantee her chastity,” said Bien-Aimé of Equality Now.

In fact, that’s the law: The 1996 federal FGM ban called for funding for outreach efforts, but nothing ever happened. “The Department of State has dropped the ball on this issue,” confirms Marianne Sarkis of Clark University. In response to the AAP retraction, Rep. Joe Crowley, D-N.Y. (co-sponsor, with Rep. Mary Bono Mack, R-Calif., of proposed legislation that would make it a crime to take a girl out of the country for FGM), vowed to “continue pressing Congress to fund strong, comprehensive community-based outreach and education efforts to prevent this human rights abuse.”

Pediatricians are hardly the only, or the most influential, point of contact for immigrant groups, but they are potentially powerful allies in the fight against FGM in our country. The very clumsiness and cluelessness of the AAP’s retracted proposal — could the whole thing have been avoided with one call to the WHO? — makes one wonder why groups committed to the same goal were so out of touch in the first place. Now we see a clear chance for last week’s foes to join forces today: perhaps to improve and broaden the linking of doctors’ practices with community groups to whom they can refer families; to further educate doctors about the most effective way to respond when a girl seems to be at risk. And yes, to get money for that out of Congress. The real enemy is FGM, not the AAP. This is a chance, on behalf of our nation’s newest daughters, to turn outrage into opportunity.