tag:theconversation.com,2011:/au/topics/circumcision-1081/articlesCircumcision – The Conversation2020-09-04T12:26:05Ztag:theconversation.com,2011:article/1443912020-09-04T12:26:05Z2020-09-04T12:26:05ZWhy masks are a religious issue<figure><img src="https://images.theconversation.com/files/355847/original/file-20200901-22-dytuaf.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C5108%2C2880&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Anti-mask protesters at a rally in Orem, Utah.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Virus-Outbreak-Utah/3f4cb6aa556e40ed8fd785631a41e3ba/71/0">AP Photo/Rick Bowmer</a></span></figcaption></figure><p>Seemingly everyone has an opinion on masks: when to wear them, how to wear them, which ones are best and even whether we should be wearing them at all.</p>
<p>For those in this last camp, a popular argument is that the coverings aren’t the problem, but <a href="https://www.indystar.com/story/news/local/2020/07/27/anti-mask-protesters-indianapolis-claim-governmental-overreach/5520232002/">being forced by a government entity to wear one</a> is. It’s the mandate, not the mask, some might say.</p>
<p>Some anti-maskers have claimed that being forced to wear a face covering <a href="https://www.washingtontimes.com/news/2020/may/1/forced-face-masking-civil-rights-offense/">violates their religious rights</a>. Back in May, Ohio State Rep. Nino Vitale, a Republican, publicly <a href="https://www.nbcnews.com/news/us-news/ohio-lawmaker-refuses-wear-mask-because-he-says-it-dishonors-n1201106">rejected</a> mask-wearing on the grounds that covering one’s face dishonors God. This view is echoed by some individual faith leaders, with churches <a href="https://khn.org/news/churches-mask-wearing-colorado-springs-congregations-flour-mask-orders/">flouting requirements</a> that congregants wear masks. Meanwhile, media-savvy pastors have put <a href="https://www.facebook.com/PastorLocke/videos/615824959335756/?v=615824959335756">anti-mask posts on Facebook</a> that have been viewed millions of times. </p>
<p>And a recent <a href="https://onlinelibrary.wiley.com/doi/10.1111/jssr.12677">study</a> revealed that the rejection of masks is higher in populations that associate with conservative politics and the idea that the United States is a divinely chosen nation.</p>
<p>Is it that masks are a religious matter, or is religion being used to suit people’s political agendas? Socially speaking, both things can be true.</p>
<h2>The function of religion</h2>
<p>As a <a href="https://www.avila.edu/academics/schools-colleges/college-of-liberal-arts-social-sciences/humanities/religious-studies-and-philosophy/faculty-3/faculty-dr-leslie-dorrough-smith">scholar who studies Christian conservatism and its impact on culture</a>, I believe society often adopts an overly narrow understanding of how religion works. </p>
<p>Using religion to support one’s political interests is generally viewed as a negative thing that represents the hijacking or twisting of religion. Such a view is echoed in the words of preacher and activist Rev. William Barber, <a href="https://www.theguardian.com/commentisfree/2020/jan/08/trump-religion-megachurch-american-tradition">who said</a> Donald Trump’s alliance with evangelical Christians was a “misuse of religion.” </p>
<p>From a scholarly perspective, though, all forms of religion affect society in some way – even if those outcomes are deemed undesirable or unethical by certain groups. Examining how religion operates in society can help us understand why the conversation over masks has recently turned religious.</p>
<p>In his landmark <a href="https://press.uchicago.edu/ucp/books/book/chicago/H/bo4038430.html">analysis</a> of the social impact of religion, <a href="https://divinity.uchicago.edu/directory/bruce-lincoln">scholar Bruce Lincoln</a> argued that there is no realm of life that cannot somehow be made religious. This is not because there are topics that are specific or unique to religion, but because of what happens to the authority of a claim when religious language is used. In other words, when people use religious speech, their authority is often perceived to be heightened.</p>
<p>For example, if someone plans to marry a partner they don’t appear to like very much, their claim that “we’ve been together a long time” may not come across as a convincing argument for a wedding. But what if that same person says that “God has brought this other person into my life”? That reason may be more readily accepted if the public hearing these words is already open to religious ideas. </p>
<p>Taking this approach to religion doesn’t mean that all religious claims are factually true or ethical. It also doesn’t mean that the people who use religious language are insincere or even wrong. Rather, the function of religious speech is to amplify the authority of an idea through appeals to seemingly unquestionable authorities, like deities and “ultimate truths.” If a statement does this, <a href="https://press.uchicago.edu/ucp/books/book/chicago/H/bo4038430.html">Lincoln concludes</a>, then it is religious. </p>
<h2>Special authority</h2>
<p>These are important considerations for the debate over masks. Using religious language to justify an anti-mask position is a move intended to amplify the voices of those who make this claim. And public health issues have long been a concern of American religious groups.</p>
<p>For example, when it comes to childhood vaccinations, arguing for <a href="https://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx">exemption on philosophical or moral grounds</a> will work in only 15 states. But arguing a religious objection will be <a href="https://www.pewresearch.org/fact-tank/2019/06/28/nearly-all-states-allow-religious-exemptions-for-vaccinations/">accepted in at least 44 of 50 states</a>. The difference is that, in the United States, religious claims are often granted a special type of authority.</p>
<p>Consider also that Americans generally <a href="https://www.nytimes.com/2020/04/17/parenting/guides/circumcision-baby-boy.html">accept</a> the circumcision of infant boys on religious grounds. This is true despite the fact that some <a href="https://www.doctorsopposingcircumcision.org/for-parents/reasons-to-keep-your-son-whole/">medical authorities and activists</a> have questioned both the ethics and health impact of performing this specific surgery, which is otherwise elective and cosmetic, on a newborn. </p>
<p>This does not mean, however, that if religion is involved, then anything goes. As recently as 2014, a faith-healing couple was sentenced to <a href="https://time.com/8750/faith-healing-parents-jailed-after-second-childs-death/">jail time</a> after the preventable deaths of two of their children. The couple claimed that seeking medical care was against their religion. </p>
<p>These examples provide some clarity on when religious rhetoric is successful and when it is not. Groups, beliefs or practices that are already popular or commonplace often appear to get a boost of authority when religious language is used to describe them. If the claim is unpopular or the group is not considered mainstream, then religious language may have little impact.</p>
<h2>Barometer of public opinion</h2>
<p>Masks are a religious issue because some people have described them that way. But this does not mean that such religious claims have successfully granted them authority. Despite an existing <a href="https://www.pewresearch.org/fact-tank/2020/06/23/most-americans-say-they-regularly-wore-a-mask-in-stores-in-the-past-month-fewer-see-others-doing-it/">partisan divide</a> on the matter, there is still no widespread sentiment among Americans that a government mask mandate is religiously problematic.</p>
<p>This means that those who rail against masks for religious reasons may not gain a lot of traction right now among the wider American public, when more than <a href="https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html">6 million Americans</a> have so far been infected with the virus. There is simply too much fear presently to make that a popular line of reasoning. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>But if that number wanes, I believe it is entirely possible that religious rationales against masking could receive renewed, and even broader, support as the culture’s interests change. </p>
<p>This is a good reminder that whether religious ideas take hold is not so much a matter of “truth” or ethics. Rather, the issue at hand is often the barometer of public opinion.</p>
<p><em>Editor’s note: This article has been updated to clarify that 6 million Americans have been infected with the coronavirus to date.</em></p><img src="https://counter.theconversation.com/content/144391/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leslie Dorrough Smith does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Are masks a religious matter, or is religion being used to suit people’s political agendas? A scholar of Christian conservatism and culture argues both can be true.Leslie Dorrough Smith, Associate Professor of Religious Studies and Director of the Women's and Gender Studies Program, Avila UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1251352019-12-09T01:11:07Z2019-12-09T01:11:07Z‘How do I clean my penis?’<figure><img src="https://images.theconversation.com/files/305101/original/file-20191204-70167-1dlj45h.png?ixlib=rb-1.1.0&rect=538%2C0%2C2958%2C2000&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Wes Mountain/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><blockquote>
<p>Growing up, no one ever gave me the rundown on how or what I should do to keep my penis clean […] I’ve never read any reliable answer beyond washing it with water. Do I use soap? Any soap? How normal is smegma? If my penis gets itchy from smegma should I go see a doctor? If so, my GP or a urologist? — Anonymous</p>
</blockquote>
<h2>Key points</h2>
<ul>
<li>clean under the foreskin, using soap, but not too much</li>
<li>smegma is normal</li>
<li>if you have any concerns, see your GP.</li>
</ul>
<p><a href="https://theconversation.com/au/topics/i-need-to-know-66587"><img src="https://images.theconversation.com/files/290837/original/file-20190904-175686-polw3q.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=90&fit=crop&dpr=2" width="100%"></a></p>
<p>It’s a shame some people think talking about cleaning and caring for our genitals is embarrassing or taboo. We probably know more about hair care than penis care.</p>
<p>The penis is simply another part of our anatomy, so cleaning should be relatively straight forward.</p>
<p>If you’ve been circumcised, where your foreskin was removed soon after birth, your penis will look something like the one in the diagram (below, right), with the head (or glans) always exposed.</p>
<p>But if you have a foreskin (below left and centre), there are some extra things to think about when washing, which we’ll get to soon.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Foreskin facts</h2>
<p>But first, some foreskin facts. From around the time you turn five, your foreskin <a href="http://www.cirp.org/library/hygiene/camille1/">separates</a> from the head of your penis, bit by bit. This allows you to pull back your foreskin (retract it). In some boys, the foreskin can stay partially stuck to the head of the penis until puberty.</p>
<p>You should <a href="https://www.berghahnjournals.com/view/journals/boyhood-studies/1/2/bhs010206.xml">never forcibly pull back</a> your foreskin. That’ll be painful, you could bleed, you could scar, or have other complications.</p>
<h2>OK, now for the washing part</h2>
<p><a href="http://www.cirp.org/library/hygiene/camille1/">Once your foreskin separates easily from the glans</a>, gently retract and clean underneath the foreskin with each bath or shower. Then, after washing, pull the foreskin forward to its normal position.</p>
<p>When it’s time to dry off, retract the foreskin again so you can dry the head of the penis with a towel. Then, you guessed it, pull the foreskin forward to its normal position.</p>
<p>It’s OK to clean with soap whether you have a foreskin or not. But generally, too much soap is worse than none at all. Excessive cleaning removes essential body oils that would normally keep our skin moist and reduce friction. If you have sensitive skin, you can use a soap-free wash from the chemist.</p>
<h2>What about smegma?</h2>
<p><a href="https://www.healthline.com/health/smegma">Smegma</a> is a thick, whitish discharge consisting of a build-up of dead skin cells, oil and other fluids under the foreskin. And it’s very useful. It protects and lubricates the penis. </p>
<p>Some people have oilier skin than others and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1464-410x.1999.0830s1034.x">tend to have more smegma</a>.
So some smegma is normal, but if you have too much or it becomes smelly, you may need to clean more.</p>
<h2>Things to watch out for (and when to see your GP)</h2>
<p>If the head of your penis becomes painful, red, itchy and has a discharge, you may have a treatable condition called <a href="https://www.mshc.org.au/SexualHealthInformation/SexualHealthFactSheets/BALANITIS/tabid/134/Default.aspx#.XcJiPfZuKUk">balanitis</a>.</p>
<p>It’s more common if you have a foreskin. And the bacteria and fungus that cause it like the warm and moist conditions under there.</p>
<p>Skin disorders, infection, poor hygiene, friction from sexual activity, and using too much soap all <a href="https://www.dermnetnz.org/topics/balanitis/">cause the condition</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-make-your-next-sexual-health-check-less-erm-awkward-72498">How to make your next sexual health check less, erm ... awkward</a>
</strong>
</em>
</p>
<hr>
<p>You can clear a mild case with good hygiene and simple treatments, such as an antiseptic or antifungal cream. You can buy these from any pharmacy. In addition to the medication, the cream itself helps protect and moisturise the inflammed skin. </p>
<p>If you have balanitis you may need to be more careful than usual to avoid urine irritating your inflamed skin. Retract your foreskin when you urinate. Dry the head of the penis gently after you finish.</p>
<p>If your penis is still inflamed after a week of these simple measures it’s <a href="https://www.aafp.org/afp/2018/0115/p102.html">best to see your GP</a>. They can then investigate other causes, such as <a href="https://www.ncbi.nlm.nih.gov/books/NBK537143/">psoriasis or an allergy</a>.</p><img src="https://counter.theconversation.com/content/125135/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s a surprisingly common question. Here’s what you need to know.David King, Senior Lecturer in General Practice, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1093112019-01-11T10:35:14Z2019-01-11T10:35:14ZNeonatal circumcision could increase the risk of sudden infant death syndrome in babies – new research<figure><img src="https://images.theconversation.com/files/252385/original/file-20190103-32145-kmeu2u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p><a href="https://www.nhs.uk/conditions/sudden-infant-death-syndrome-sids/">Sudden Infant Death Syndrome</a> (SIDS) or cot death remains the leading cause of infant death in many developed countries. There are around 2,700 babies <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083856/">who die from cot death every year</a> in the US – and around 300 in the UK. </p>
<p>Cot death occurs when a seemingly healthy infant – under 12 months of age – dies in their sleep with no cause of death established in a post-mortem investigation. Although many risk factors are known to increase the risk of cot death – such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1586150/">maternal smoking</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/24080961">bed sharing</a> – nobody is exactly sure why it happens. </p>
<p>Research, for example, indicates that cot death is more common in boys than girls – at a ratio of <a href="https://www.ncbi.nlm.nih.gov/pubmed/2926568">3:2</a>. <a href="https://www.cdc.gov/sids/data.htm">Studies</a> also show it is 39% lower among US Hispanic communities compared to non-Hispanic people. There is also a <a href="https://jamanetwork.com/journals/jama/article-abstract/348269">seasonal variation</a> – most cases occurring in winter. And 50% of cases occur between seven and 17 weeks after birth – with only 10% of cot deaths occurring after 24 weeks.</p>
<p><a href="http://journal.frontiersin.org/article/10.3389/fneur.2016.00180/full">My research from 2016</a>, suggested that exposure to chronic stress, such as that caused by maternal smoking, can put a baby at higher risk of cot death – and that early circumcision may also be one of the major risk factors in sudden infant death syndrome (SIDS) or cot death in boys. </p>
<p>In my <a href="https://www.jctres.com/en/04.201802.005/">latest study</a>, I analysed the data on SIDS and male neonatal circumcision across 15 countries – where post-mortem examination of infants is mandatory – which included 40 US states. The results show a strong correlation between early circumcision and cot death. So where male neonatal circumcision rates are high, higher rates of cot death occur. </p>
<h2>Bleeding, shock and sepsis</h2>
<p>Until the 19th century, neonatal circumcision was practised almost exclusively by Jews, some Muslims, and certain African cultures for religious or ritual reasons. <a href="https://books.google.co.uk/books/about/Circumcision.html?id=_tXfAAAAMAAJ&redir_esc=y">During this time</a>, British and US physicians increasingly came to see masturbation and the foreskin as disease inducing – and circumcision as a potential cure. </p>
<p>By 1940, <a href="https://www.press.uchicago.edu/ucp/books/book/chicago/S/bo3534612.html">40% of British boys</a> and <a href="https://jamanetwork.com/journals/jama/article-abstract/414922">80% of US boys</a> were circumcised as a preventive health measure. But after World War II, circumcision rapidly fell out of favour in Britain. In the US however, unnecessary surgery was promoted as “preventative” and “healthy” and reached a rate of about 95% in the late 1960s before declining to about 65% by 1999. Today in Europe, rates of circumcision are low – and mostly confined to the Jewish and Muslim communities – but in the US, circumcision is still the <a href="https://www.hcup-us.ahrq.gov/reports/statbriefs/sb187-Hospital-Stays-Children-2012.pdf">most common elective surgery</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/252373/original/file-20190103-32145-1oieokt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/252373/original/file-20190103-32145-1oieokt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/252373/original/file-20190103-32145-1oieokt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/252373/original/file-20190103-32145-1oieokt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/252373/original/file-20190103-32145-1oieokt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/252373/original/file-20190103-32145-1oieokt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/252373/original/file-20190103-32145-1oieokt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Circumcision is one of oldest surgical operations, dating back more than 4,000 years.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Male neonatal circumcision is usually performed in the first few days days after birth and is associated with many <a href="https://www.biorxiv.org/content/early/2018/06/07/339465">health risks</a>. These risks include bleeding, shock, sepsis, circulatory shock, haemorrhage, pain, and other long-term consequences – such as post traumatic stress disorder. </p>
<p><a href="https://europepmc.org/abstract/med/3627593">During circumcision</a> there is an increase in blood pressure, breathing rate and heart rate of the baby. And even with the most advanced techniques, bleeding occurs in <a href="https://www.ncbi.nlm.nih.gov/pubmed/25794628">more than 15% of cases</a>. Babies born early experience more than <a href="https://www.ncbi.nlm.nih.gov/pubmed/28412847">twice the rate of bleeding complications</a> than full-term babies.</p>
<p>With blood loss, there is also a danger that a lower blood volume could result in low blood pressure – reducing the amount of oxygen that reaches the tissues. Reduced blood pressure has also been associated with <a href="https://www.ncbi.nlm.nih.gov/pubmed/23768837">obstructive sleep apnea</a> – a condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing. <a href="https://www.ncbi.nlm.nih.gov/pubmed/11704597">Research shows</a> babies who have died from cot death are more likely to have experienced obstructive sleep apnea. </p>
<h2>What the data show</h2>
<p>My findings also show a correlation between the proportion of Hispanics in a US state and the SIDS rates. In other words, Hispanics lower the state’s SIDS rate. This is despite the fact Hispanics in the US tend to belong to a lower socioeconomic status – which is strongly associated with SIDS. </p>
<p>Not only that, but in US states with high proportions of Hispanics, the SIDS gender bias was closer to one – that is males and females died in even numbers. This could indicate neonatal circumcision accounts for the gender bias in SIDS. Babies born early were also found to be more at risk – circumcised boys born prematurely were at the highest risk.</p>
<p>Of course, male neonatal circumcision does not explain why all cot deaths occur, but it could go some way to explain why in the 16th century, Jews in Israel, where circumcision is prevalent, blamed the deaths on a <a href="https://www.jstor.org/stable/3651935">beautiful demoness</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/253043/original/file-20190109-32130-1x5e2bb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/253043/original/file-20190109-32130-1x5e2bb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/253043/original/file-20190109-32130-1x5e2bb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1144&fit=crop&dpr=1 600w, https://images.theconversation.com/files/253043/original/file-20190109-32130-1x5e2bb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1144&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/253043/original/file-20190109-32130-1x5e2bb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1144&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/253043/original/file-20190109-32130-1x5e2bb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1438&fit=crop&dpr=1 754w, https://images.theconversation.com/files/253043/original/file-20190109-32130-1x5e2bb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1438&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/253043/original/file-20190109-32130-1x5e2bb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1438&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A painting of Lilith from 1887.</span>
<span class="attribution"><span class="source">John Collier in Southport Atkinson Art Gallery</span></span>
</figcaption>
</figure>
<p>Lilith, a controversial figure within Jewish mythology, was said to rob children of life and was responsible for the deaths of still-born infants and cot deaths. Male children were said to be at risk of Lilith’s wrath for eight days after birth (until circumcision) and girls for 20 days. </p>
<p>Deceiving Lilith into believing newborn babies were a girl – letting the boy’s hair grow and even dressing him in girl clothes – were said to be the most effective means to avoid her harm – tricks that were also practiced by <a href="https://www.jstor.org/stable/3651935">some Muslims</a>. The Jewish practice is called “Halake” (haircut in Arabic). </p>
<p>The traditions that tie Lilith to the fear of death during the circumcision period could suggest ancient Jews had also drawn a link between cot death and early circumcision, so religious elders created the story of Lilith to explain away the deaths, and keep the practice alive for centuries to come.</p><img src="https://counter.theconversation.com/content/109311/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eran Elhaik consults the DNA Diagnostic Center (DDC), DNA Consultants, and MonDevices.
He receives funding from MRC and DDC. </span></em></p>Circumcising newborn boys could increase their risk of cot death, here’s why.Eran Elhaik, Lecturer in population, medical and evolutionary genomics, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/948732018-04-13T09:13:18Z2018-04-13T09:13:18ZThe case that could end ritual male circumcision in the UK<figure><img src="https://images.theconversation.com/files/214332/original/file-20180411-587-1fjyvm2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/623492180?src=-_w5zSbJLanuGXxmtMOByw-1-35&size=medium_jpg">Stig Alenas/Shutterstock.com</a></span></figcaption></figure><p>A woman from Nottingham, England is <a href="https://www.thetimes.co.uk/article/mother-to-sue-over-son-s-circumcision-kh09k22p8">suing</a> the doctor who carried out a circumcision on her infant son without her permission. The circumcision took place during Eid festival when the infant was in the care of his biological father, a Muslim. After the operation, the child was in so much pain, he was unable to wear a nappy. </p>
<p>There is a stark contrast between female and male genital excision: the former is illegal, the other is permitted. There are mythical differences, too: one is seen as barbaric, the other as somehow beneficial. </p>
<p>I have actively contributed to the campaign to eradicate <a href="https://journals.rcni.com/doi/pdfplus/10.7748/ns.28.40.35.s46">female genital mutilation</a> (FGM), which varies in severity from the abhorrent radical destruction of outer genitalia (type I) to the most common, mildest form of clitoral excision (type IV). All types are forbidden, although not a single person has been convicted for this crime in Britain, despite <a href="https://www.trustforlondon.org.uk/publications/prevalence-female-genital-mutilation-england-and-wales-national-and-local-estimates/">estimates of 2.1%</a> of females in London having been cut. At least girls are protected in law, if not always in practice. </p>
<p>Shearing off parts of genital organs is no less unethical or abusive because the child is male. Yet the political and professional establishments don’t want to know. </p>
<p>Arguably, circumcision is on a par with FGM type IV in terms of harm. In the short term, there is often inflammation, soreness and bleeding, and the risk that the wound may become infected. There are also potential long-term psychological harms that may arise in adulthood, as self-consciousness detracts from sexual intimacy. Yet outdated justifications for circumcision are blithely accepted. </p>
<p>There are medical benefits, some say. In fact, as stated by the British Association of Paediatric Surgeons, it is <a href="http://www.baps.org.uk/resources/circumcision/">extremely rare</a> for removal of the foreskin to be medically necessary. </p>
<p>Another excuse is hygiene. When an academic colleague doubted my stance on circumcision of boys, arguing that it is necessary for cleanliness, I asked: “What’s wrong with soap?”</p>
<p>“But they don’t wash,” she replied with implausible certainty. </p>
<p>Another similarity with FGM is that incidence of male circumcision may be increasing, due to demographic change. Astonishingly, in some areas of the country, it is funded by the NHS. This could become more established as local commissioning bodies give in to cultural demands. </p>
<p>Circumcision is a Muslim and Jewish practice, and is also prevalent in some African Christian communities (it was also <a href="http://www.historyofcircumcision.net/index.php?option=com_content&task=category&sectionid=7&id=72&Itemid=51">fairly common</a> among the upper and middle classes in Britain until the 1950s). Happily, some parents are honouring the rite of passage with an adapted ceremony that relinquishes the scalpel. A boy or girl is no less a Jew or Muslim if their genitals remain intact. </p>
<h2>Cultural sensitivity</h2>
<p>As a healthcare lecturer, I am troubled by any medical practitioner performing this act for religious rather than clinical purpose. It breaks the Hippocratic Oath to “first, do no harm”. The operation, however proficiently completed, violates the healthy body. But, due to cultural sensitivities and moral relativism, few public figures are brave enough to call for circumcision to be outlawed, fearing charges of anti-Semitism or Islamophobia. However, Iceland has recently taken this bold step, and other countries may follow. </p>
<p>Should cultural sensitivity trump the rights of a child? From an egalitarian perspective, as guided by Immanuel Kant’s categorical imperative to afford everyone the same rational justice, the answer must be “no”. But society is hypocritical on equality. </p>
<figure>
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</figure>
<p>A situation where cutting girls is (rightly) illegal, but boys are fair game, is unconscionable. Sir James Munby, an English judge, criticised this inconsistency in a <a href="https://www.secularism.org.uk/news/2015/01/fgm-court-judgement-raises-questions-about-fgm-and-male-circumcision-in-the-uk">recent case</a> in which a local authority sought to remove a Muslim brother and sister from their home after the girl had been cut; the boy’s circumcision, by contrast, cannot be regarded as a safeguarding concern. </p>
<p>I’m not suggesting draconian intervention, but let the law treat children fairly and squarely, irrespective of gender. Perhaps a specific prohibition of male genital mutilation is needed, but this would not be necessary if the longstanding statute of the Offences Against the Person Act 1861 is applied. </p>
<p>The case reported in the Sunday Times is at least a promising sign that circumcision against a parent’s consent is prosecutable. A much-needed precedent would boost the cause against all forms of child genital cutting.</p><img src="https://counter.theconversation.com/content/94873/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Niall McCrae does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A mother is suing a doctor for circumcising her infant son without her consent.Niall McCrae, Lecturer in Mental Health, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/798512017-11-01T13:37:34Z2017-11-01T13:37:34ZWhy the law against female genital mutilation should be scrapped<figure><img src="https://images.theconversation.com/files/192483/original/file-20171030-18693-1f9mstt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/39771826?src=4NDjjhWWr_5REG48lGnR2w-1-1&size=medium_jpg">cristapper/Shutterstock</a></span></figcaption></figure><p>Causing grievous bodily harm, including mutilation, has been outlawed in the UK since time immemorial and has been a statutory offence for over 160 years. Despite this, a law banning female genital mutilation (<a href="http://www.who.int/mediacentre/factsheets/fs241/en/">FGM</a>) was <a href="http://www.legislation.gov.uk/ukpga/1985/38/contents">introduced</a> in the UK in 1985. Since then, only one FGM prosecution has been brought to trial, and both defendants were <a href="https://bererblog.wordpress.com/2015/02/10/acquittals-in-the-fgm-case-in-london-justice-was-done-and-was-seen-to-be-done-but-what-now/">acquitted</a>. There has yet to be a conviction under the FGM Act. </p>
<p>It is curious enough that the statute has hardly ever been used, but there are other reasons why the <a href="http://journals.sagepub.com/doi/abs/10.1177/1350506809350857">exception made for FGM</a> to have its own law now needs to be reconsidered. The problem of FGM was initially considered to be so extreme and so prevalent that it was thought that extra protection under the law was needed in a belt-and-braces approach, but we believe <a href="https://www.researchgate.net/publication/315757652_Ban_without_Prosecution_Conviction_without_Punishment_and_Circumcision_without_Cutting_A_Critical_Appraisal_of_Anti-FGM_Laws_in_Europe">this is no longer necessary</a>.</p>
<p><a href="https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg53/">FGM</a> is practised for a variety of cultural reasons and involves the ritual cutting or removal of some or all of the external female genitalia. It has no health benefits, but does have <a href="https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg53/">well-documented harms</a>. </p>
<p><a href="http://www.who.int/reproductivehealth/topics/fgm/prevalence/en/">One in 10</a> cases of FGM are the most severe form, known as type 3. This involves the greatest removal of tissue and sewing up of the vaginal entrance. An opening can be made in the scar tissue for childbirth (called “reversal”), but tissue cannot be restored. Doctors can attempt to reconstruct the clitoris, if it has been removed, but the procedure is not always possible, or <a href="http://www.sciencedirect.com/science/article/pii/S0140673612604000">successful</a>. </p>
<h2>Hypocrisy</h2>
<p>In children, FGM has parallels with the ritual circumcision of baby boys. Critics think it is inconsistent, if not hypocritical, that one practice is banned while the other is allowed. </p>
<p>In adults, FGM has parallels with cosmetic surgery. Under the FGM Act, it is illegal for a women in the UK to request having her vagina closed again (re-infibulation), following childbirth. It occurs in the few countries that practice type 3 FGM. In the UK, re-infibulation is always considered criminal, maybe protecting women from coercive cultural pressures, but potentially also denying their free choice. On the other hand, the Act specifically exempts those adults who choose to have female cosmetic genital surgery – operations largely performed in the private sector. </p>
<p>For instance, a plastic surgeon who removed a healthy 33-year-old woman’s clitoris, at her request, <a href="http://www.standard.co.uk/news/health/doctor-cleared-over-fgm-says-women-should-be-free-to-have-intimate-surgery-a3477941.html">wasn’t prosecuted under the FGM Act</a> and neither was the psychiatrist who cleared her for the surgery. Given these contradictory positions, opponents of the FGM Act are increasingly wondering whether this is an example of <a href="https://www.academia.edu/10197867/Between_moral_relativism_and_moral_hypocrisy_reframing_the_debate_on_FGM_">moral relativism</a> and <a href="http://www.shiftingsands.org.uk/fgm-legislation-is-too-weak-and-too-strong/">bad law</a>.</p>
<p>Generally, <a href="https://www.gov.uk/government/publications/female-genital-mutilation-resource-pack/female-genital-mutilation-resource-pack">criminal law</a> is intended to prevent or punish an outlawed behaviour. The existence of a law acts symbolically to prevent the outlawed acts. Prosecution is the means to punish them when they occur. The desired end, of having less (or no) FGM, especially of children, is achieved by the absence of FGM, not by the presence of prosecutions. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/192488/original/file-20171030-18735-103fyze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/192488/original/file-20171030-18735-103fyze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=329&fit=crop&dpr=1 600w, https://images.theconversation.com/files/192488/original/file-20171030-18735-103fyze.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=329&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/192488/original/file-20171030-18735-103fyze.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=329&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/192488/original/file-20171030-18735-103fyze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=414&fit=crop&dpr=1 754w, https://images.theconversation.com/files/192488/original/file-20171030-18735-103fyze.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=414&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/192488/original/file-20171030-18735-103fyze.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=414&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/653746102?src=d5Akuf4vrNDsA4sfhYOTZQ-1-4&size=huge_jpg">Fang-Chun Liu/Shutterstock</a></span>
</figcaption>
</figure>
<h2>No longer needed</h2>
<p>The demand for prosecutions is a “tough” approach taken by the authorities, but it is not a primary desired end in itself. It may appear counter-intuitive that we think that the lack of successful prosecutions may be supportive evidence that the law is functioning successfully (if not completely) by encouraging <a href="https://www.rcm.org.uk/sites/default/files/FGM%20Survey%20FINAL_0.pdf">positive changes in attitude</a>. We do not advocate scrapping the specific FGM law because it is too difficult to enforce, but because it is no longer needed. </p>
<p>Up to now, the law may have worked by drawing attention to the issue and by setting an expectation of acceptable behaviour for new migrants. But there are difficulties and <a href="http://www.bbc.co.uk/programmes/b094mnx3">unintended effects</a>, including concerns that the current law is <a href="http://journals.sagepub.com/doi/abs/10.1177/1477750916682671">discriminatory about race</a>. </p>
<p>It has proven difficult to prosecute FGM due to its familial and hidden nature, the shortage of experienced and <a href="https://www.researchgate.net/publication/307877960_B_and_G_Children_No_2_2015_EWFC_3_Family_Court_England_and_Wales_Sir_James_Munby_President_of_the_Family_Division_High_Court_of_England_Wales_14_January_2015">competent experts</a>, low numbers of reports, and a first <a href="https://www.theguardian.com/society/2015/feb/04/first-female-genital-mutilation-prosecution-dhanuson-dharmasena-fgm">failed prosecution</a> of a doctor. In any event, established law already includes FGM in its remit (<a href="http://www.legislation.gov.uk/ukpga/Vict/24-25/100/contents">Offences Against the Person Act 1861</a>) and also safeguards children (<a href="http://www.legislation.gov.uk/ukpga/2004/31/contents">Children Act</a>). </p>
<p>So, rather than concentrating on government pressure to achieve a successful prosecution with unnecessary law, we could instead divert scarce resources to continuing prevention – such as education, provision of specialist health clinics and community support services. Also, there is evidence that the communities who practice FGM are giving it up with <a href="https://www.unicef.org/media/files/FGMC_2016_brochure_final_UNICEF_SPREAD.pdf">falling prevalence worldwide</a>, though sadly numbers may still rise due to population growth.</p>
<p>Lastly, the involvement of doctors legitimises surgery. Globally, “medical reasons” are used to justify and perform male infant circumcision. Likewise, medicalisation is used to justify FGM in some countries (Egypt and Malaysia) where <a href="https://www.madamasr.com/en/2016/02/06/feature/society/when-its-the-doctors-carrying-out-female-circumcision/">doctors perform “female circumcision”</a> more safely under anaesthetic, but still without any therapeutic benefit. The law should bring consistency into medical practice: either by banning <a href="https://aeon.co/essays/are-male-and-female-circumcision-morally-equivalent">male infant circumcision</a> or by <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31807-X/fulltext">recognising the harms of this traditional practice</a>. </p>
<p>Doctors in the UK are faced with two <a href="https://aeon.co/essays/are-male-and-female-circumcision-morally-equivalent">discriminatory conundrums</a>: a consenting adult female with normal genitalia can have major genital modification, yet a new mother who had FGM as a child cannot be re-infibulated; girls cannot undergo genital modification as unconsenting <a href="http://www.bbc.co.uk/news/health-40410459">children</a>, but boys can. </p>
<p>Increasingly, bodies representing the professional interests of medical doctors, such as in <a href="http://www.dutchnews.nl/features/2017/06/male-circumcision-is-violation-of-bodily-integrity/">the Netherlands</a>, are cited as saying the health risks of infant male circumcision outweigh the benefits.</p>
<h2>Eroding trust</h2>
<p>Finally, in the efforts to prosecute FGM, <a href="http://blog.practicalethics.ox.ac.uk/2015/10/mandatory-submission-of-patient-information-about-fgm-a-pointless-damaging-discriminatory-mess/">mandatory reporting</a> and recording of all old and new FGM by doctors has been introduced – which raises <a href="http://www.bmj.com/content/351/bmj.h5146">concerns about confidentiality</a> and erosion of trust in the medical profession. Doctors do not have to ring the police about other criminal events reported by victims that occurred long ago and elsewhere. This extra reporting may cause a loss in trust, not only of individual patients, but of whole communities. </p>
<p>The UK could introduce consistency with a Child Genital Modification Act which would make any non-medical genital modifications of male and female infants illegal because the medical benefits are negligible, at best, and the risks great. Alternatively, given that we already have criminal law that would cover FGM and inappropriate surgical cuttings by doctors in the <a href="http://www.legislation.gov.uk/ukpga/Vict/24-25/100/contents">Offences Against the Person Act 1861</a>, why do we need the FGM Act at all? It is not <a href="http://www.shiftingsands.org.uk/fgm-legislation-is-too-weak-and-too-strong/">fit for purpose</a> and should go.</p><img src="https://counter.theconversation.com/content/79851/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lynne Townley is affiliated with Save Your Rights, a charity campaigning against forced marriage and a committee member of Association of Women Barristers (a voluntary organization campaigning for access to the Bar for women and other under-represented groups). She has lectured and published articles on FGM and was the Legal Advisor on NHS Health Education England E-learning for Health FGM Learning Programme.</span></em></p><p class="fine-print"><em><span>Susan Bewley was involved in setting up the UKs second FGM clinic as Director of Obstetrics at Guy’s & St Thomas’ Hospitals in 1996. She has a research interest in violence against women, and has published and lectured on FGM. She was a expert for the defence in R vs Dharmasena.
</span></em></p>The UK’s FGM Act is discriminatory and inconsistent.Lynne Townley, Lecturer in Law, City, University of LondonSusan Bewley, Professor of Women's Health, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/743082017-04-17T08:34:02Z2017-04-17T08:34:02ZMaking circumcision safer for young men with bleeding disorders<figure><img src="https://images.theconversation.com/files/164798/original/image-20170411-31911-dw2quo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Haemophilia impairs the body's ability to make blood clots causing excessive bleeding.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>Circumcision is the <a href="http://www.medicalnewstoday.com/articles/302234.php">oldest and most frequent</a> surgical procedure in the world. In some cultures, it marks a clear break from childhood to adulthood. But, reports of young men <a href="https://www.theguardian.com/commentisfree/2014/aug/25/male-circumcision-ceremonies-death-deformity-africa">dying</a> during traditional initiation rites due to spontaneous bleeding are devastating. The Conversation Africa’s Health and Medicine Editor Joy Wanja Muraya asked Dr Peter Kibet Shikuku for his views on a safe circumcision programme in Kenya for boys with haemophilia – a bleeding disorder.</em></p>
<p><strong>How prevalent is haemophilia in Kenya?</strong></p>
<p>Most patients with haemophilia are born with it, <a href="https://www.rarebleedingdisorders.com/bleeding-disorders/congenital-hemophilia.html">congenital</a>, while others <a href="http://www.haemophiliacare.co.uk/acquired-haemophilia.html">acquire it</a>.</p>
<p>Patients must see a specialist, a haematologist, before any surgery to control their bleeding. While circumcision is not a major operation, it can lead to <a href="https://www.hemophilia.org/Bleeding-Disorders/History-of-Bleeding-Disorders">death</a> because the bleeding is slow, consistent, continuous and prolonged.</p>
<p>The prevalence of haemophilia is the same in all communities and remains at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181156/">1 per 10,000</a> in any population. As a country we have only reached awareness of the disease at 14% of those affected.</p>
<p><a href="http://www.hemophiliaprince.com/myths-about-hemophilia.html">Superstitions </a> are driven by lack of awareness in the communities forcing some parents to hide or lock away their children from the general public due to associations of the condition with bad omen.</p>
<p>During circumcision by traditional healers, the injured young men and those slow to heal are abandoned in the forest to die. Circumcision, they say, is not for weaklings.</p>
<p><strong>How different is circumcision for haemophiliacs?</strong> </p>
<p>Circumcision carries different meanings in Africa and globally. In most communities in Kenya, it’s a <a href="http://www.cirp.org/library/cultural/marck/">rite of passage</a> practiced by most communities on boys and/or girls.</p>
<p>It involves either the removal of certain <a href="https://kenyastockholm.files.wordpress.com/2008/08/luocircumcisionrites_03.pdf">teeth</a>, tattooing parts of the body, piercing of earlobes, removal of the <a href="http://www.medicalnewstoday.com/articles/302234.php">foreskin</a> or a combination of practices.</p>
<p>During these rites blood is lost, with a few complications occurring. But, some young men die due to lack of adequate testing for <a href="https://www.haemophilia.org.au/about-bleeding-disorders/haemophilia">haemophilia</a> - a genetic disorder that impairs the body’s ability to make blood clots.</p>
<p>This is complicated by <a href="http://www.who.int/bulletin/volumes/88/12/09-072975/en/">lack of information</a> within the circumcising communities on the bleeding disorder. The uninitiated are often <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0083998">stigmatised</a>, ridiculed and bullied by their peers.</p>
<p>Because of this, some young men do not disclose that they’re haemophiliac and undergo circumcision without the precautionary measures, leading to complications, and even death. </p>
<p>Blood clot elements that manage haemophilia during circumcision are not readily available and are <a href="http://www.hemophiliafed.org/bleeding-disorders/hemophilia/treatment/">expensive</a>. The missing factor protein is <a href="http://www.hemophiliafed.org/bleeding-disorders/hemophilia/treatment/">injected</a> into the affected person’s vein enabling the body to continue the clotting and hence stop the bleeding.</p>
<h2>First case study</h2>
<p>A 23 year old man in high school was under peer pressure to get circumcised. They threatened to forcibly circumcise him themselves. He knew he had haemophilia and needed the <a href="https://www.cdc.gov/ncbddd/hemophilia/treatment.html">factor concentrate</a>.</p>
<p>He travelled from one health facility to another to accumulate enough of the concentrate . But, it wasn’t enough and he was circumcised with these expired products in one of the health facilities. </p>
<p>He developed antibodies to factor eight on the fifth day after the operation and ended up with a by passing agent to overcome the antibodies till he healed. It’s not even possible to establish the reason behind antibody development in this patient.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/eO1HtS0Onbg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Dr Kibet Shikuku talks about the impact of working with the World Federation of Hemophilia.</span></figcaption>
</figure>
<h2>Second case study</h2>
<p>A young man in his 20’s with haemophilia had suicidal tendencies. Being “uncut” was unacceptable and demeaning in his community.</p>
<p>He got clinicians to take him through the procedure even though they had very limited resources. A group of consultants decided to use blood components, a few factor concentrates and tranexamic acid. This combination worked despite the shortcomings associated with it. He recovered and is now one of Kenya’s paralympic sportsmen. </p>
<p><strong>What strategies and technologies are used to ensure safer circumcision amongst haemophiliacs?</strong></p>
<p>There are 450 young men attending the haemophilia comprehensive care clinic at Kenyatta National Hospital and Moi Teaching and Referral Hospital. They make up about 10% of all haemophiliacs countrywide. </p>
<p>Most of them are not circumcised despite coming from circumcising communities, because of haemophilia. That is because of the lack of factor concentrates which are essential in <a href="http://www.businessdailyafrica.com/Special-circumcision-knife/539444-3437776-8odmfo/">preventing bleeding</a>.</p>
<p>At <a href="http://knh.or.ke/">Kenyatta National Hospital</a>, circumcision was the least of procedures to be offered to haemophiliacs due to lack of factor concentrates. The clinical team opted to use tranexamic acid alternating it with cryoprecipitate to stop heavy bleeding, commonly used in peripheral facilities by uninformed surgeons. </p>
<p>This seemed to have worked though in case of any inhibitor development, there were almost no alternative treatment and fatalities were almost the norm.</p>
<p>Towards the end of 2015, <a href="http://haemophilia-kenya.org/index.php">Kenya Hemophilia Association</a> initiated a “safe” circumcision programme in the two health facilities, that has led to circumcision of about 30 haemophilia patients. All the young men were prepared before the surgery by getting clotting factors and later followed up in the wards until they got fully healed.</p>
<p><strong>What challenges do you face running this safer circumcision programme? What lessons have you learnt?</strong></p>
<p>The lack of cost effective drugs to manage patients during circumcision is the most urgent concern.</p>
<p>The shortage of factor concentrates in public hospitals and clinics forces us to rely heavily on <a href="http://humanpathology.uonbi.ac.ke/node/4270">donations </a>from the World Federation of Haemophilia. The availability of the concentrates in select health facilities locks out families with haemophiliac young men from safe circumcision.</p>
<p>Since the safe circumcision programme started, parents are bringing <a href="https://www.standardmedia.co.ke/evewoman/article/2000120029/silent-medical-condition-that-kills-quietly">their sons </a> for registration. This has enabled the programme to schedule with the surgeons all procedures annually. </p>
<p>We are creating <a href="https://www.standardmedia.co.ke/health/article/2000209632/victim-of-blood-disorder-lends-hand-to-those-with-same-condition">public awareness </a> of the signs and symptoms associated with the disease so that people can seek help early, before the young men reach circumcision age.</p>
<p>For young men who wish to keep to their cultural initiation rites, we have trained nurses to deliver the clotting factors at the village during circumcision supported by the traditional surgeons, elders and other decision makers.</p>
<p>Overall, fewer cases are now being brought to the hospital as emergencies following circumcision as compared to before. The programme intends to determine the best protocol which is cost effective and easily implemented at the lower health facilities in the counties.</p><img src="https://counter.theconversation.com/content/74308/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kibet Peter Shikuku receives funding from.get funding from Novo Nordisk Hemophilia Foundation and world federation of hemophilia
</span></em></p>Circumcision is a rite of passage in various African communities. However, for initiates with haemophilia, extra caution needs to be taken to ensure their safety.Kibet Peter Shikuku, Lecturer, School of Medicine (SOM)University of Nairobi (UON) and Consultant Haematologist, University of NairobiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/692702016-12-04T18:20:04Z2016-12-04T18:20:04ZMale circumcision in Uganda will only improve if local beliefs are considered<figure><img src="https://images.theconversation.com/files/147947/original/image-20161129-10945-10lk4rv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Reuters/Simphiwe Sibeko</span></span></figcaption></figure><p>For the past 10 years voluntary medical male circumcision has been recommended as a way of reducing female-to-male transmission of HIV. Estimates show that it could <a href="http://dx.doi.org/10.1080/17441692.2014.989532">reduce infections by 60%</a>. Several sub-Saharan African countries with high rates of HIV prevalence but low rates of male circumcision have rolled out the procedure as part of their HIV prevention initiatives.</p>
<p>Since 2007 more than 9 million circumcisions have been performed in <a href="http://www.who.int/hiv/topics/malecircumcision/fact_sheet/en/">eastern and southern Africa</a>. But to cover more than 80% of men on the continent by 2025, about 20 million more men need to be circumcised. If this happens about <a href="http://dx.doi.org/10.1371/journal.pmed.1001132">3.4 million new HIV infections</a> could be averted, reducing the number of people who would need HIV treatment and care.</p>
<p>While circumcision has been encouraged there are <a href="http://dx.doi.org/10.1016/j.socscimed.2015.04.020">many places</a> where it has <a href="http://dx.doi.org/10.1080/13557858.2013.772326">faced challenges</a>. This is linked to misconceptions about the purpose of circumcision as well as religious and cultural concerns which prevent men from getting circumcised. </p>
<p>Uganda is a case in point. By the end of 2015 the country’s health ministry aimed to circumcise 80% – <a href="http://health.go.ug/docs/UAIS_2011_KEY_FINDINGS.pdf">or 4.2 million</a> – men aged between 15 and 49. But between 2008 to 2013 the country only managed to <a href="http://www.aidsuganda.org/resource-center/downloads/%20doc_download/3-consolidated-q-3-supervision-report-may-2014">circumcise 50% of this population</a>. Most of these were young boys.</p>
<p><a href="http://dx.doi.org/10.2989/16085906.2016.1179652">Our research</a> found that religious and cultural beliefs compete with the messages about the purpose of circumcision. We found that this got in the way of men deciding whether or not to be circumcised medically and also affected the way they behaved afterwards. </p>
<p>When medical circumcision is introduced in settings where there are high rates of HIV, it must take into account local beliefs about circumcision. And local religious and social group leaders and women must be involved in the roll-out.</p>
<h2>Conflicts of belief</h2>
<p><a href="http://dx.doi.org/10.1016/j.socscimed.2015.04.020">Several studies</a> have compared uptake of circumcision in societies where there is a tradition of circumcision and those where there are not. </p>
<p>When circumcision is not part of religious or cultural practices, introducing voluntary male circumcision can be problematic because it is associated with ethnic and religious identities. This is the case in <a href="http://dx.doi.org/10.1080/17441692.2015.1006241">Zimbabwe</a>, <a href="http://dx.doi.org/10.1080/09540120220097919">Kenya</a>, and parts of <a href="http://dx.doi.org/10.1080/13691058.2013.807519">South Africa</a> where there are both social and cultural barriers to circumcision. </p>
<p>In Uganda, only <a href="http://www.who.int/bulletin/volumes/88/12/09-072975/en/">20% of men practice traditional male circumcision</a> for cultural and religious reasons. This is considerably lower than Kenya (80%) or Tanzania (70%) but similar to many other southern African countries.</p>
<p>We conducted a study of the beliefs and perceptions about circumcision in fishing villages on the shores of Lake Victoria, Uganda. The villages were part of an HIV combination prevention pilot study. </p>
<p>The overall aim of the trial was to investigate factors limiting access to HIV prevention interventions and to determine the feasibility of conducting an HIV combination prevention effectiveness trial to reduce HIV incidence among fishing communities in Uganda. </p>
<p>HIV combination prevention packages would include male circumcision along with access to antiretrovirals, prevention of mother to child transmission, condom promotion, counselling and testing, and health education. </p>
<p>We looked at the influence that different understandings and beliefs about male circumcision may have on voluntary male circumcision in the fishing communities, which are ethnically mixed and have high HIV prevalence. </p>
<p>In Uganda just over <a href="http://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/uganda">7% of the population</a> is living with HIV. </p>
<h2>How the men felt</h2>
<p>We found that even when men opted for voluntary medical male circumcision, they followed practices afterwards that were informed by traditional beliefs. This at times involved engaging in unsafe sexual behaviour. While men understood the health benefits of medical circumcision, these messages were sometimes mixed with beliefs drawn from traditional circumcision practices. </p>
<p>For example, several respondents believed that vaginal fluids helped them heal after being circumcised. Some also believed that vaginal fluids could heal wounds from cuts and snake bites as a form of first aid. In these villages it was reported that women also used vaginal fluids to treat themselves and their children’s injuries. </p>
<p>They also believed that having sex with a non-regular partner could chase away spirits and that circumcision offered them protection from sexually transmitted infections. These encouraged unsafe sexual practices.</p>
<h2>Changing the mindset</h2>
<p>Both personal and community-wide misconceptions need to be improved if the uptake of male circumcision is going to be improved, and if post-procedure behaviour is going to be changed. This can only be done if local knowledge systems in the community are engaged. </p>
<p>Engagements must include local religious and community leaders and must involve both men and women. And this must happen during the roll out of the circumcision procedures but also afterwards.</p>
<p>Key local actors such as traditional and religious leaders from different ethnic groups could help provide support for an approach that takes into account local beliefs about circumcision.</p><img src="https://counter.theconversation.com/content/69270/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janet Seeley receives funding from British Medical Research Council </span></em></p><p class="fine-print"><em><span>Martin Mbonye and Monica Kuteesa do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Medical circumcision in settings where there are high rates of HIV will only be successful if these interventions take into account local beliefs about circumcision.Martin Mbonye, Social scientist, MRC/UVRI Uganda Research Unit on AIDSJanet Seeley, Professor of Anthropology and Health, London School of Hygiene & Tropical MedicineMonica Kuteesa, Senior scientist, MRC/UVRI Uganda Research Unit on AIDSLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/637872016-08-18T20:43:00Z2016-08-18T20:43:00ZCultural practices that affect children’s health must be revisited<figure><img src="https://images.theconversation.com/files/134138/original/image-20160815-14909-13ioora.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pokot girls in Kenya wait for an ceremony that marks their passage into womanhood -- and means they're ready for marriage.
</span> <span class="attribution"><span class="source">Reuters/Siegfried Modola</span></span></figcaption></figure><p>International broadcaster BBC has released a <a href="http://www.bbc.com/news/magazine-36843769">gripping exposé</a> about a Malawian man who explained how he initiates young girls into sexual activity as part of a rite of passage. </p>
<p>The man, informally known as a hyena, is alleged to be one of many in a southern Malawian community who are paid to perform the service. One of the most startling revelations is that, by his own admission, the man is living with HIV but does not use condoms when he has sex with these girls. </p>
<p>The report serves as a stark reminder of children’s extreme vulnerability.</p>
<p>Since the broadcast, Malawi’s President Peter Mutharika has <a href="http://www.nyasatimes.com/president-mutharika-orders-arrest-hiv-infected-man-paid-devirginise-girls-malawi-nonsense-hyena-culture-must-stop/">spoken out</a> against harmful cultural practices. The “hyena” has since been arrested. But the question remains: does taking on one hyena clean the ecosystem? What about the families, mothers, fathers and relatives who played a role?</p>
<p>The reality is that despite high levels of knowledge and information, communities still adhere to cultural practices which endanger their children. </p>
<h2>Persistent traditions and cultural practices</h2>
<p>The Malawian rite of passage is just one example where communal mores and norms are reinforced by communities. Several <a href="http://www.unicef.org/aids/files/Vulnerability_young-women-and-girlsSAfrica_2008_UNAIDS.pdf">studies</a> by UNICEF, UNAIDS and the Global Commission on HIV and the Law have shed light on African cultures and traditions associated with the human life cycle. These include initiation, birth and death rites; arranged marriages, female genital mutilation, circumcision and various iterations of cleansing rituals associated with the body and mind.</p>
<p>But some of these other cultural and ritual practices have come under scrutiny because they violate the health and rights of individuals. And in most cases it is children and women who bear the brunt.</p>
<p>This happens in many ways:</p>
<ul>
<li><p>young girls are forced into early sexual debut and unprotected sex and are at risk of contracting HIV;</p></li>
<li><p>female genital mutilation causes health complications for girls and women around sexual health and pregnancy;</p></li>
<li><p>child marriages result in childbearing which often has negative effects on their health and the child they carry;</p></li>
<li><p>In settings of poverty, many of these children suffer from malnutrition. This complicates maternal and child health; and,</p></li>
<li><p>In the long term, many of these women have poor physiological and mental health outcomes. </p></li>
</ul>
<p>In addition, these rituals are often transactional. Where there are high levels of poverty these children become a “resource”. They are transacted for money, food or other material goods. The main benefactors are adult males who seek to enhance their status or to get another wife. These men also look for labour or consider such girls a medical solution – some maladies are believed to need a young virgin “girl” for cleansing.</p>
<p>It has been shown that addressing the HIV epidemic in southern Africa is hampered by practices which place young people, particularly young women and girls, at risk of infection. </p>
<p>The question is why some of these cultural practices persist in the face of so much effort and interventions to highlight their negative impacts on individuals and communities. For example, three decades of HIV/AIDS and broader public health research has shown the link between unsafe ritual practices and human health and development. </p>
<h2>Legal instruments only go so far</h2>
<p>Several legal mechanisms have been put in place to tackle violence against children. </p>
<p>SADC leaders have approved a model law to ban child marriages and other forms of violence against children. They are also reviewing the SADC Gender Protocol which among other things prioritises the implementation of <a href="http://genderlinks.org.za/">gender equality</a>. <a href="http://www.girlsnotbrides.org/region/sub-saharan-africa">Female genital mutilation</a> and marriages involving children are banned in <a href="http://www.who.int/reproductivehealth/topics/fgm/prevalence/en/">several African countries</a>. But the practices continue.</p>
<p>At a regional level, the African Union has given significant attention to the issue of women’s empowerment. It has pronounced on gender based violence and child marriages as part of its Agenda 2063, the continental development road map. </p>
<p>There are also other international instruments like the UN Convention on the Rights of the Child, which most countries across the globe have signed up to. Several other high level international forums convened by United Nations agencies have similarly prioritised gender based violence and launched high profile <a href="http://wps.unwomen.org/en">initiatives</a> to promote the safety and security of women and girls. One of their most recent initiatives is the <a href="http://www.mckinsey.com/global-themes/women-matter">#womenmatter (Africa) McKinsey report</a>, launched by the Executive Director of UN Women Phumzile Mlambo-Ngcuka.</p>
<p>But the challenge is that none of these initiatives address the complicity and collusion of people, families and communities. Nor do they tackle how children and young people are silenced.</p>
<h2>What more can be done?</h2>
<p>Institutions that work with children and youth must be better equipped and protected in executing their mandate. Their work is too often hampered by <a href="http://www.girlsnotbrides.org/">mixed messages</a> from communities and leaders </p>
<p>More laws are needed because many countries have dual or multiple legal systems where these practices are not criminal. </p>
<p>Political leaders must be less ambivalent about legal reforms which they believe irk their largely rural voters in whose backyards most of these cultural practices thrive. </p>
<p>There are several groups that need to engaged to tackle culture related violence on children.</p>
<p>Working with elders who are gatekeepers of culture and tradition is critical in navigating for firm and purposeful action.</p>
<p>Tackling silences and rituals protecting patriarchal impunity must also involve engaging cultural experts and practitioners. </p>
<p>Finding ways to engage children is also important. Often children are not listened to until harm has been done. </p>
<p>Africa must prioritise its youth if the development aspirations of the global Sustainable Development Goals 2030 and Agenda 2063 are to to be realised. Preserving African cultures and traditions is important. But it should not translate into a license for murder.</p><img src="https://counter.theconversation.com/content/63787/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alinah Kelo Segobye received funding from the Rotary Peace Centre, Peace Studies Department as a visiting scholar at the University of Bradford in 2016. </span></em></p>Despite high levels of knowledge and information, communities still adhere to cultural practices which endanger their children.Alinah Kelo Segobye, Associate Professor (Archaeology), University of South AfricaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/464882015-10-07T04:10:42Z2015-10-07T04:10:42ZChanges in gender norms are making initiation safer for South African boys<figure><img src="https://images.theconversation.com/files/97434/original/image-20151006-7337-1g5gtvb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Initiates undergoing the traditional passage to manhood in Qunu, in the Eastern Cape, South Africa. Many either die or get maimed during the winter practice. </span> <span class="attribution"><span class="source">Reuters/Siegfried Modola</span></span></figcaption></figure><p>At least <a href="http://www.news24.com/SouthAfrica/News/Initiation-Government-wants-to-do-away-with-traditional-surgeons-20150909">30 initiates</a> are known to have died by the time the traditional male initiation season ended in South Africa this winter (2015). Most were from Xhosa communities in the Eastern Cape province. </p>
<p>Male initiation is a rite of passage from boyhood to manhood for some ethnic groups in South Africa. <a href="http://www.tandfonline.com/doi/pdf/10.1080/13691050701861447">Ritual male initiation</a> includes circumcision and the initiates spending about a month or longer in seclusion in the bush. </p>
<p><a href="http://tcn.sagepub.com/content/20/4/395.full.pdf+html">Initiation</a> is deemed a necessary rite of passage marking a developmental phase for boys to adulthood among the <a href="http://www.sahistory.org.za/people-south-africa/xhosa">amaXhosa</a>, <a href="http://www.bapedikingdom.co.za/history_bapedi.html">Bapedi</a>, <a href="http://countrystudies.us/south-africa/47.htm">Basotho</a>, <a href="http://www.gaabomotho.co.za/tswana.html">Batswana</a>, <a href="http://repository.up.ac.za/handle/2263/17089">amaNdebele</a>, <a href="https://intercontinentalcry.org/indigenous-peoples/vhavenda/">VhaVenda</a>, <a href="https://vatsonga.wordpress.com/about/">VaTsonga</a> and <a href="https://books.google.co.za/books?id=vRU9AAAAIAAJ&pg=PA7&dq=Amaswazi&hl=en&sa=X&ved=0CEQQ6AEwCTgKahUKEwj7zpuRsa3IAhVBohQKHW5gAUA#v=onepage&q=Amaswazi&f=false">amaSwazi</a> ethnic groups. The initiation process is typically run by the family, with the boy’s father directing proceedings.</p>
<p>Traditional initiation involving circumcision remains an important topic in South Africa for several reasons. At the top of the list is the public health discourse and debates around prevention of initiates’ deaths. But initiation is also important because the practise is still relevant and employed in a range of urbanising communities across the country.</p>
<p>Deaths of initiates resulting from botched circumcisions, related infections and dehydration during this rite of passage are <a href="http://dx.doi.org/10.1016/j.socscimed.2009.11.016">nothing new</a>. And there is some evidence that they may be <a href="http://www.dailymaverick.co.za/article/2015-07-30-sa-is-making-progress-on-making-initiation-schools-safer/#.Vb9jeE8w_4Y">declining</a>.</p>
<p>Deaths of initiates have attracted heightened attention from the government, civil society and the traditional custodians of the <a href="http://dx.doi.org/10.1016/j.socscimed.2009.11.016">practice</a>. </p>
<p>Save for girls, who are related to and who cook for the initiate, women are generally not involved in the traditional process. Women’s role could be described as that of cheer leaders. They participate significantly in the ceremonies to welcome the new men back home. Discussions around the meaningful involvement of women in the initiation process have been met with resistance from custodians of <a href="http://www.sciencedirect.com/science/article/pii/S0277953609008119">culture</a>.</p>
<p>But gender politics, changes in family formations and the high number of single mother households are increasingly pushing some of the traditional boundaries around initiations. </p>
<h2>Role of women</h2>
<p>South Africa has a higher rate of single, women-led families than households led by men. Most South African children under five live with <a href="http://www.statssa.gov.za/?p=2007">only their mothers</a>. </p>
<p>As a result, the practises around male initiation are changing and beginning to encompass women.</p>
<p>We conducted interviews in the Eastern Cape to understand people’s perceptions and experiences of sexual and reproductive health rights. </p>
<p>The study is conducted in collaboration with the AIDS Foundation of <a href="http://www.aids.org.za">South Africa</a>, a non-governmental organisation that supports community-based initiatives to strengthen men and women’s access to sexual and reproductive health rights. </p>
<p>We interviewed men and women of different ages, but older that 16, in single-sex focus group discussions. We also interviewed key stakeholders such as officials in the departments of health, education, social development, a traditional healer and a traditional leader in the Flagstaff district of the Eastern Cape. The people of Flagstaff identify as <a href="http://www.sahistory.org.za/places/pondoland">amaPondo</a> and their traditions slightly differ from those of amaXhosa in the Eastern Cape. </p>
<p>Our study (yet to be published) found people have mixed feelings about initiation. Some feel it is good but that the tradition has changed. Some felt as soon as an initiate required medical attention and went to hospital, they were no longer considered a traditional initiate. </p>
<p>They attributed the change and the undesirable outcomes to:</p>
<ul>
<li>underage initiates, </li>
<li>incompetent traditional nurses, and </li>
<li>substance use at the <em>Ibhoma</em>. The <em>Ibhoma</em> is a temporary hut built for the initiate in the <a href="http://tcn.sagepub.com/content/20/4/395.full.pdf+html">bush</a>. </li>
</ul>
<p>Some problems were related to what the community perceived to be uncanny behaviours by the new men. For example, engagement in violent behaviour, disrespect for adults and increased alcohol drinking and use of other substances. One of the major findings was a concern about the health impacts of the initiation, chief amongst these the death of the initiate.</p>
<h2>Dealing with the death</h2>
<p>Our study shows that men and women are demanding that the government protect the boys and curb the death of initiates. One of the participants explained: </p>
<blockquote>
<p>We are trying to end these deaths out there. I am saying everybody (should) start at (the) hospital and then go (their) separate … ways where a person is going to learn his own isiko (custom).</p>
</blockquote>
<p>The custodians of traditional practices are speaking out against distortions or misinterpretations of culture that threaten young men’s lives. </p>
<p>The House of Traditional Leaders in the Eastern Cape has started advocating for <a href="http://www.gov.za/speeches/leadership-visit-initiation-schools-lusikisiki-18-jun-2015-0000">safe initiation</a>. In one case, traditional leaders openly endorsed and supported women’s involvement in pre-initiation camps to educate and socialise boys and ensure stakeholder commitment to the legal and safe operation of initiation lodges.</p>
<p>Historically, boys who died at initiation lodges or camps were buried there. The boy’s father would take care of the burial ritual while his mother would find solace knowing her husband had buried their child. These deaths were less likely to be reported to the general community. </p>
<p>But as times have changed, so has this practice. As burial rituals, including funerals, have been modernised, bereaved families wish to see and bury their loved ones.</p>
<p>We found that in the event of a death, the mother now demands to know how her child died, to see his body and hold the funeral in the community. The circumstances surrounding his death are now disclosed, despite the fact that the custom stipulates that initiation should not be discussed with the female relatives. </p>
<p>Historically, a father would know what cultural instruction had been imparted to his son during initiation. He could sanction disrespectful behaviour towards women. Research shows that in the absence of male authority figures and role models, women are speaking out against this and demanding that boys are taught respectful and risk-reducing behaviour. </p>
<p>This study’s findings are important in crafting a way for more research to better understand the role of women and mothers in initiation. As society changes, so are there changes in our cultures. </p>
<p>Dialogues are needed at a community level to find ways to include women in the initiation process. These dialogues should involve men and women, children and parents and custodians of culture, in particular the duty bearers within the House of Traditional Leaders.</p><img src="https://counter.theconversation.com/content/46488/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mzi Nduna receives funding from the National Research Foundation and the COE-HUMAN</span></em></p><p class="fine-print"><em><span>Anele Siswana works for Dr George Mukhari Academic Hospital. He receives funding from the Canon Collins Legal Trust. He is affiliated with the Father Connections Study Team at Wits University.</span></em></p><p class="fine-print"><em><span>Deborah Lesley Ewing is affiliated with the AIDS Foundation of South Africa.</span></em></p><p class="fine-print"><em><span>Esmeralda Vilanculos is affiliated with the University of the Witwatersrand </span></em></p>The practices around the traditional passage to manhood in South Africa are changing and beginning to encompass women as family patterns change. But, there are mixed feelings about the changes.Mzi Nduna, Associate Professor in Psychology, University of the WitwatersrandAnele Siswana, Clinical Psychologist, University of the WitwatersrandDeborah Lesley Ewing, Visiting Scholar, School of Human and Community Development, University of the WitwatersrandEsmeralda Vilanculos, Research Assistant: Sexual and Reproductive Health rights, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/297142014-07-28T12:30:46Z2014-07-28T12:30:46ZISIS may not be enforcing FGM, but Iraqis still have to face the horrors of war<p>The July 24 <a href="http://www.theguardian.com/world/2014/jul/24/isis-women-girls-fgm-mosul-un">report</a> by UN official Jacqueline Badcock that <a href="https://theconversation.com/explainer-what-is-isis-and-where-did-it-come-from-27944">ISIS</a>, the militant Jihadist group now controlling areas of Syria and Iraq, had ordered all women between the ages <a href="http://www.bbc.co.uk/news/world-middle-east-28466434">of 11 and 46</a> to undergo female genital mutilation (FGM) was rightly met with both outrage <a href="http://i100.independent.co.uk/article/no-the-islamic-state-has-not-ordered-all-women-to-undergo-fgm--lyuebSA6Wl">and scepticism</a>. </p>
<p>Though certain Kurdish and other Iraqi sources maintain the <a href="http://basnews.com/en/News/Details/ISIS-enforces-female-circumcision-/27970">veracity of the story</a>, ISIS <a href="http://www.theguardian.com/world/2014/jul/24/isis-deny-ordering-fgm-girls-mosul">has denied</a> issuing the fatwa. The controversy comes at a time when FGM has been in the news as a result of the <a href="https://www.gov.uk/government/topical-events/girl-summit-2014">Girl Summit</a> and the British prime minister’s declaration that parents who allow FGM <a href="http://www.theguardian.com/society/2014/jul/22/parents-allow-female-genital-mutilation-prosecuted-cameron-law">will be prosecuted</a>.</p>
<p>ISIS and other jihadi groups <a href="http://www.news.com.au/world/isis-fanatics-hurl-public-execution-victims-into-deep-ravine-in-syria/story-fndir2ev-1226968737176">routinely</a> inflict physical, psychological and <a href="http://edition.cnn.com/2014/07/24/world/iraq-violence/">cultural</a> harm on conquered or subject people. It was this background that gave the UN report popular credence. </p>
<p>Their cause is abhorrent and their members psychopathic, and they recognise <a href="http://www.news.com.au/world/iraq-crisis-isis-rebels-hunting-for-wives-in-baiji/story-fndir2ev-1226963903347">no robust private sphere</a> of life in which diversity or freedom of thought can operate. They are keen to inflict an ascetic, heavily circumscribed life on their subjects – particularly with regard to <a href="http://www.theguardian.com/world/2014/jul/25/iraq-islamic-state-full-veil-warns-wear-women-punishment">female sexuality</a>.</p>
<p>Given that FGM is conducted by various groups which identify as Muslim and given that, unlike in Christian and Jewish scripture, there are <a href="http://www.unfpa.org/webdav/site/global/shared/documents/publications/2011/De-linking%20FGM%20from%20Islam%20final%20report.pdf">contestable</a> hadiths or teachings in Islam which <em>can</em> be interpreted as not explicitly prohibiting the practice or setting limits on its severity – even endorsing it – there was no reason to believe that ISIS would be incapable of issuing such an edict if it wished. Indeed, so pernicious and devoid of irony is ISIS that the fatwa, if a hoax, may even act as a policy proposal.</p>
<h2>Reality check</h2>
<p>The reality, however, is that there are great cultural and geographical differences in FGM practices. Most practising communities are found in Africa, with the notable exception in Iraq of certain Kurdish communities. It’s not a practice which is grounded primarily in scripture and is also found in groups that identify as Christian, animist and otherwise. </p>
<p>While the practice has little or no cultural traction in the vast majority of Iraqi communities, the fact that some of the most fervent ISIS members are from North Africa and other parts of the Islamic world may either mean that FGM is endorsed by some of their members or that the “hoax” was propagated as a means of highlighting the foreign nature of the conquest and occupation.</p>
<h2>Forced cutting as subjugation</h2>
<p>One of the problems that this topic highlights in the specific context of fanatical warfare and conquest is how bodily mutilation (and the word is appropriate here, though not necessarily in <a href="http://www.thehastingscenter.org/Publications/HCR/Detail.aspx?id=6059">other cases</a>, since the subject of the cutting is intended, in this circumstance, to feel mutilated and suppressed) has been as a means of humiliating, subjecting and “converting” conquered people. </p>
<p>While forced FGM would appear to be relatively rare, the practise of forced circumcisions of men is more common. Jewish groups in antiquity circumcised slaves and conquered groups. In recent times, Luo men in Kenya were <a href="http://articles.latimes.com/2008/jan/09/world/fg-circumcision9">forcibly circumcised</a> by the larger Kikuyu tribe and other circumcising groups. And there have been sporadic incidents of Muslim groups <a href="http://jme.bmj.com/content/suppl/2013/09/06/medethics-2013-101626.DC1/medethics-2013-101626supp.pdf">forcibly circumcising</a> non-Muslim people, including in Iraq, at various times in the history of Islam. </p>
<p>All forms of non-medical genital cutting are grounded in identity, marking someone’s transition either from childhood to adulthood or from one cultural group to another. Forced circumcision not only means inflicting physical pain and suffering on victims, it also means cutting away their identity and marking permanently and irreversibly their subjection to another cultural group. </p>
<p>The alleged ISIS fatwa seems unlikely to be true, but it does remind us of the long tradition of extremists in various parts of the world using mutilation to subjugate people, with forced cutting as part of subjugation a long tradition with men. The horrors experienced by women, <a href="http://unu.edu/publications/articles/rape-and-hiv-as-weapons-of-war.html">through rape</a> (also <a href="http://www.irinnews.org/report/93960/health-rape-as-a-weapon-of-war-against-men">experienced by men</a>), forced marriage and forced conversion, among other things, are already significant enough. </p>
<p>We can but hope the ISIS fatwa is indeed a hoax, but the horrors perpetuated by these jihadi groups already demonstrate that their arbitrary and limitless power in the areas under their control is the very worst scenario for residents. If they want to inflict FGM or rape or forced conversion or murder on people, they have the capacity. </p><img src="https://counter.theconversation.com/content/29714/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew T. Johnson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The July 24 report by UN official Jacqueline Badcock that ISIS, the militant Jihadist group now controlling areas of Syria and Iraq, had ordered all women between the ages of 11 and 46 to undergo female…Matthew T. Johnson, Lecturer, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/191972013-10-22T03:30:13Z2013-10-22T03:30:13ZReligious freedom vs bodily integrity: another round of the foreskin wars<figure><img src="https://images.theconversation.com/files/33347/original/xjv8b9fj-1382327717.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Should we favour physical integrity over respect for cultural difference? </span> <span class="attribution"><span class="source">Image from shutterstock.com</span></span></figcaption></figure><p>The Council of Europe’s <a href="http://assembly.coe.int/nw/xml/XRef/Xref-DocDetails-EN.asp?FileID=20176&lang=EN">resolution</a> earlier this month to prohibit the circumcision of infant boys for religious reasons has ignited another round to the “foreskin wars”. This time it’s about the rights of religious freedom and autonomy versus the right of individuals to retain “physical integrity”. As usual, different groups are shouting that my human rights are more important than yours. </p>
<p>The Council’s new <a href="http://assembly.coe.int/nw/xml/XRef/X2H-Xref-ViewPDF.asp?FileID=20174">Childrens’s Right To Physical Integrity</a> notes the parliamentary assembly is</p>
<blockquote>
<p>… worried about a category of violation of the physical integrity of children, which supporters of the procedures tend to present as beneficial to the children themselves despite clear evidence to the contrary. This includes … the circumcision of young boys for religious reasons… </p>
</blockquote>
<p>The resolution is based on a <a href="http://assembly.coe.int/nw/xml/XRef/Xref-DocDetails-EN.asp?FileID=20057&lang=EN">report</a> by German MP Marlene Rupprecht who apparently wants to see Europe comprehensively ban the non-therapeutic circumcision of minors. That call is consistent with moves in <a href="https://theconversation.com/german-case-opens-up-another-battle-in-the-circumcision-war-7967">Germany</a> and <a href="http://www.news.com.au/world-news/childrens-ombudsman-calls-for-circumcision-ban-in-sweden/story-fndir2ev-1226729243733">Sweden</a> to criminalise that circumcision.</p>
<p>But while the <a href="http://hub.coe.int">Council of Europe</a> represents governments in regional policymaking, the resolution isn’t legally binding; nor is it recognised in the major international human rights agreements. The resolution has since been <a href="http://www.humanrightseurope.org/2013/10/jagalnd-male-circumcision-does-not-violate-human-rights/">disavowed</a> by the Council’s President and unsurprisingly <a href="http://www.theguardian.com/world/2013/oct/07/israel-council-of-europe-resolution-ritual-circumcision">condemned</a> by the governments of Israel and <a href="http://www.assembly.coe.int/nw/xml/XRef/Xref-AMDetails-EN.asp?fileid=20057&amid=20118&lang=EN">Turkey</a>, along with a range of human rights scholars.</p>
<p>So, how is the debate playing out in Australia? And are there likely to be any flow-on effects of the resolution? </p>
<h2>Local debate</h2>
<p>According to the <a href="http://www.abc.net.au/science/articles/2012/08/27/3576889.htm">Royal Australasian College of Physicians</a>, rates of male circumcision have fallen in Australia in recent decades, with 10% to 20% of newborn boys undergoing the procedure. </p>
<p>Locally, there’s disagreement among medical practitioners about the procedure, with some arguing that circumcision poses <a href="https://theconversation.com/unethical-and-harmful-the-case-against-circumcising-baby-boys-1543">unacceptable risks</a> to the newborn or adolescents, or <a href="https://theconversation.com/unethical-and-harmful-the-case-against-circumcising-baby-boys-1543">is unnecessary</a>. Contrary to hyperbole, we are not seeing many instances of death through infection or other problems.</p>
<p>Others argue it <a href="http://www.cdc.gov/hiv/prevention/research/malecircumcision/">reduces the incidence</a> of conditions such as herpes and HIV and should be seen as preventive surgery. Overall there’s no consensus, so we watch duelling professors making claims about risk, harm and benefit. </p>
<p>We’ve also seen recurrent and noisy expressions of “foreskin pride” or “intactivism”, often linked to rhetoric about physical integrity as a human right. </p>
<p>We don’t have definitive statistics, but circumcision appears to be a standard practice for many in the Jewish community and among Australia’s growing Islamic community. For those communities, the surgery is an important aspect of faith and belonging. </p>
<p>Circumcision of babies and minors on the basis of ethno-religious affinity (as a symbol of faith or culture) is legal in Australia. That was recognised in the Tasmanian Law Reform Institute’s three-year review which considered whether to change the law. The 2012 report <a href="http://www.utas.edu.au/__data/assets/pdf_file/0004/302836/Circ-Media-Release-2012.pdf">recommended</a>:</p>
<blockquote>
<p>A general prohibition on the circumcision of incapable minors with an exception for well-established religious or ethnicity motivated circumcisions. </p>
</blockquote>
<p>The report highlights that people often have very strong views and that there is debate about how we conceptualise conflicting claims regarding human rights.</p>
<h2>Balancing rights</h2>
<p>The circumcision debate raises questions about how we construe rights, responsibilities and Australia’s respect for cultural diversity. As a practice, non-therapeutic circumcision is of no concern to some people, is viscerally opposed by others, and fundamentally important to others as an embodiment of faith and belonging. </p>
<p>Understandably, some members of Australia’s Jewish and Islamic communities wonder whether proposed prohibition of circumcision signals both a profound disrespect for their faith and an attack on their cultural identity. They plausibly argue that a ban would disregard their human rights (and those of their children) – a disrespect of something that gives meaning to their lives.</p>
<p>The European resolution isn’t Australian law. It is interesting, however, as an illustration of tensions in thinking about rights and discrimination. It is likely to be invoked in Australia through local calls and support for a ban in infant circumcision.</p>
<p>Once the latest battles in the foreskin wars are over, we’re likely to see a regime in Australia where employees of public hospitals refuse to conduct non-therapeutic circumcisions. Administrative <a href="https://theconversation.com/male-circumcision-policy-ignores-research-showing-benefits-8395">guidelines</a> will act as a “soft” substitute for law. And parents will rely on private practitioners, particularly practitioners within their communities. Exclusion is discriminatory.</p>
<p>Meanwhile, bioethicists and lawyers will continue to disagree about therapeutic and non-therapeutic values because there is an inescapable tension in how we think about harm, autonomy, and competing claims for rights. What are the rights of children, including psychological well-being associated with “belonging”? Do we necessarily favour physical integrity over respect for cultural difference? </p>
<p>One conclusion is that we need to be wary about easy answers in relation to human flourishing, diversity and the “right to health”.</p><img src="https://counter.theconversation.com/content/19197/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Baer Arnold does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Council of Europe’s resolution earlier this month to prohibit the circumcision of infant boys for religious reasons has ignited another round to the “foreskin wars”. This time it’s about the rights…Bruce Baer Arnold, Assistant Professor, School of Law, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/148672013-06-13T05:46:20Z2013-06-13T05:46:20ZUK letting down victims of female genital mutilation<figure><img src="https://images.theconversation.com/files/25432/original/mpxhmkx9-1371058532.jpg?ixlib=rb-1.1.0&rect=1%2C3%2C1119%2C761&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Female genital mutilation is happening in the UK.</span> <span class="attribution"><span class="source">London Safeguarding Children Board</span></span></figcaption></figure><p>Female genital mutilation (FGM) is happening across the UK but despite being illegal for nearly 30 years, there have been no convictions. </p>
<p>Fortunately, politicians are beginning to pick up on the issue. A report from a committee of MPs <a href="http://www.parliament.uk/business/committees/committees-a-z/commons-select/international-development-committee/news/vawg-report-substantive/">warned that</a> the UK “is weakened by its failure to address [FGM] violence within its own borders”. They say it’s “unforgiveable” that there hasn’t been a single prosecution since the procedure was made illegal here in 1985. </p>
<p>FGM is a deep rooted traditional practice that has a huge impact on the health and well being of millions of girls and young women around the world. It’s a common practice in 28 African countries, as well as parts of the Middle East and Asia. In some countries such as Djibouti and Mali, <a href="http://www.who.int/bulletin/volumes/86/4/07-042093/en/">more than 90% of women</a> are believed to have undergone FGM. In Egypt it is illegal but the country still has one of the highest rates in the world. Only recently, <a href="http://www.huffingtonpost.com/2013/06/10/suhair-al-bataa-13-year-old-dies-circumcised_n_3417528.html">13-year-old Suhair al-Bata</a> died after undergoing the procedure in a village north of Cairo.</p>
<p>But FGM is not restricted to these countries. Globalisation and ease of travel means many Africans migrating to the EU and other developed regions - for economic reasons or asylum - has spread the practice. FGM is now taking place in EU countries and is <a href="http://www.europarl.europa.eu/sides/getDoc.do?type=TA&language=EN&reference=P7-TA-2012-261">on the increase</a>. </p>
<p>In England and Wales it’s estimated that 66,000 women are already living with FGM and a further 21,000 girls are <a href="http://www.nhs.uk/Conditions/female-genital-mutilation/Pages/Introduction.aspx">at risk of being cut</a>.</p>
<p>Anecdotal evidence collected as part of <a href="http://replacefgm.eu/sites/default/files/pressroom/REPLACE%20Toolkit.pdf">our research</a> suggests that some EU citizens are moving between member states to take advantage of differences in legislation - making the UK a destination for many families who want FGM for their daughters and believe the law isn’t applied here.</p>
<h2>What is FGM?</h2>
<p>FGM involves removing part or all of the external parts of a girl or woman’s genitalia but <a href="http://www.who.int/mediacentre/factsheets/fs241/en/">also includes procedures</a> that cause injury to that part of the body for cultural or other non-therapeutic reasons. The UN regards the practice of FGM as a violation of human and female reproductive health rights. Many <a href="http://www.unicef.org/protection/57929_58002.html">now recognise it</a> as a form of violence against girls and women and further, a form of torture. </p>
<p>The ritual is usually performed by traditional practitioners who have no formal medical training and perform the operation in non-sterile conditions. It can cause serious physical harm such as complications in childbirth, excessive bleeding, blood poisoning, death and HIV transmission, and psychological damage.</p>
<p>The World Health Organisation classifies FGM into four types. Type III is the most serious kind and often involves women <a href="http://www.who.int/mediacentre/factsheets/fs241/en/">having to be cut open</a> again to have sexual intercourse and for childbirth. It’s <a href="http://www.who.int/reproductivehealth/topics/fgm/prevalence/en/">estimated that globally</a> 90% of women affected by the practice have been subjected to full or partial removal of their clitoris and/or the removal of their inner labia and other “unclassified” procedures, including the use of cauterisation. </p>
<h2>Where did FGM come from?</h2>
<p>The <a href="http://www.unicef.org/protection/57929_58002.html">origins of FGM are unknown</a>; it doesn’t appear to be connected to any particular religion or culture, but perpetuated over generations by social dynamics. </p>
<p>It is often defended as a rite of passage from girlhood into womanhood and usually performed on girls from babyhood up until the age of 15. Support comes directly from mothers, mothers-in-law, and elder women. But FGM isn’t “women’s business” as it’s often seen. All the communities where it is common are highly patriarchal. And men wield a lot of influence - indirectly from fathers, religious and community leaders. </p>
<p>Pain is an important element of the ritual that it is said prepares girls for the pain of childbirth - even though it can cause later complications. Sometimes FGM is performed for “purity” or “hygiene” and some people also believe, wrongly, that FGM is just a female version of male circumcision.</p>
<h2>Overcoming cultural barriers</h2>
<p>At Coventry University we headed up <a href="http://www.replace%20fgm.eu">two European-funded projects</a>: one looking at Somali and Sudanese communities in the UK and Holland and another, which has just started, at different African FGM practising communities across six EU countries.</p>
<p>It’s clear that we need to get away from cloaking FGM in medical terminology. Many practising communities also have their own definitions and language for the procedure which are difficult to relate to the WHO’s “type” classifications. Various differences that individuals and communities place on certain terminology make it extremely difficult to work out the various types of genital cutting and how often it happens.</p>
<p>Many people in the communities that we worked with don’t regard FGM as “mutilation” so that can lead to confusion about what type of cutting is covered by legislation. Many find the term FGM offensive and equate it with the worst kind of procedures, which we’ve found many don’t support. Using the term “sunna”, which loosely equates with FGM types I and II, can be better. </p>
<h2>We need more information</h2>
<p>In the 1990s, 14 African countries including Ethiopia, Uganda, Ghana, Senegal and Togo, together with Egypt and Djibouti and six of the Federal States in Nigeria effectively banned FGM. But today, there is little evidence the situation is changing. Practising communities in the UK are from countries where FGM is common and include Somalian, Sudanese, Gambian and Nigerian communities.</p>
<p>But we still lack information. Only <a href="http://www.who.int/reproductivehealth/topics/fgm/fgm_prevalence_egypt/en/">in Egypt</a> and Sudan is some data available to properly work out trends. For example, we know that there was a decline in FGM from 96% of women in 1979 <a href="http://www.childinfo.org/files/fgmc_Coordinated_Strategy_to_Abandon_FGMC__in_One_Generation_eng.pdf">to 89% in 1990 in Sudan</a>. This was accompanied by a 10% shift from the worst type of FGM to a less drastic form.</p>
<p>In Egypt, surveys showed that <a href="http://measuredhs.com/Who-We-Are/News-Room/Female-circumcision-decreasing-among-young-women-in-Egypt.cfm">girls are now less likely</a> to be cut than their mothers. Some credit urbanisation and increased access to education for girls as partly responsible; others suggest that the high international profile of the practice and the criminalising of the practice in some countries have also played a role.</p>
<p>But elimination of FGM is proving very difficult. Despite campaigns to explain to communities the health implications of the rite and the criminalisation of the practice in many countries, FGM has continued. The link between social structures and gender power relations and sexuality mean it’s very resistant to change. The failure to conform can affect how well a girl marries and her family’s standing. Turning against it can lead to social exclusion, ostracism or even violence. </p>
<p>Family honour and social expectations play a powerful role in perpetuating FGM, making it extremely difficult for individual families, as well as individual girls and women, to stop the practice on their own.</p>
<p>This is also true of the UK; it’s clear that pressure from the community makes it hard for people to go against it. To tackle the problem we need not just to change the behaviour of individual people, for example those doing the cutting, but tackle wider issues concerning the beliefs held by the community that perpetuate the practice making it ‘normal’.</p>
<p>Ending FGM in the UK is going to take time, but understanding more about it and taking new approaches to change individual and community behaviour will push us towards the tipping point that we need - when communities accept that FGM is no longer necessary or acceptable and individuals (parents and children) have the power to say no.</p><img src="https://counter.theconversation.com/content/14867/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hazel Barrett receives funding from European Commission's Daphne III programme</span></em></p>Female genital mutilation (FGM) is happening across the UK but despite being illegal for nearly 30 years, there have been no convictions. Fortunately, politicians are beginning to pick up on the issue…Hazel Barrett, Associate Dean for Applied Research, Coventry UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/101992012-11-02T03:45:00Z2012-11-02T03:45:00ZTradition vs individual rights: the current debate on circumcision<figure><img src="https://images.theconversation.com/files/17023/original/5d365zhc-1351555342.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A protest against circumcision in the United States, where the debate about circumcision is still raging.</span> <span class="attribution"><span class="source">sigmaration/Flickr</span></span></figcaption></figure><p>Non-therapeutic circumcision of male infants and boys has always been a controversial issue – and never has opinion been more polarised. </p>
<p>In the United States, medical authorities have just <a href="http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1989">overturned</a> 40 years of sound science-based policy by deciding that the health benefits of circumcision — while not great enough to recommend the procedure as a routine — are sufficient to allow parental choice in the matter and coverage by medical insurance plans. </p>
<p>This move has been <a href="http://blog.practicalethics.ox.ac.uk/2012/08/the-aap-report-on-circumcision-bad-science-bad-ethics-bad-medicine/">heavily criticised</a> by medical ethicists in both the United States <a href="http://theeuropean-magazine.com/819-van-dijk-gert/820-medical-and-ethical-arguments-against-male-circumcision">and abroad</a>. They fault the new policy not only for downplaying the <a href="http://www.doctorsopposingcircumcision.org/pdf/Dalton_2007.pdf">risks and complications</a> of the procedure, but also for failing to take into account <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1733522/pdf/v028p00010.pdf">basic principles</a> from bioethics as well as human rights.</p>
<p>The rest of the world has moved on. In Europe and elsewhere, <a href="http://www.openforum.com.au/content/should-circumcision-be-illegal">the question is no longer</a> about whether there are any good “medical” justifications for routine circumcision — the consensus is that there are not. Instead, it’s about the much thornier issue of cultural and religious rationales. </p>
<p>In Germany, a court <a href="http://www.circinfo.org/Circumcision_and_law.html">recently found</a> that non-medically-indicated circumcision constitutes bodily harm and is thus unlawful. In Australia, the Tasmania Law Reform Institute has <a href="https://theconversation.com/tasmanian-report-calls-for-groundbreaking-reform-of-circumcision-law-9105">recommended</a> that it be legally prohibited in most cases, with limited exemptions for religious practice. </p>
<p>In Helsinki, an <a href="http://www.nocirc.org/symposia/twelfth/symposium12.pdf">international conference</a> heard many distinguished speakers criticise unnecessary genital surgeries of all types, whether performed for medical or cultural reasons, and whether on boys, girls or intersex children. The resultant <a href="http://www.genitalautonomy.eu/#/helsinki-declaration-2012/4569720986">declaration</a> formally defended the right of all children to bodily integrity.</p>
<p>Given its recent history, Germany is arguably the worst place in the world to see a decision in favour of child rights that could also be interpreted as directed against Jewish religious practice. Both Jewish and Muslim organisations have responded <a href="http://www.bbc.co.uk/news/magazine-18793842">with outrage</a>, attacking the ruling as an assault on <a href="http://blog.practicalethics.ox.ac.uk/2012/10/religious-vs-secular-ethics-and-a-note-about-respect/">religious freedom</a>, and hurling accusations of anti-Semitism and Islamophobia. </p>
<p>Problematically, as Lena Nyhus has <a href="http://www.jpost.com/Opinion/Op-EdContributors/Article.aspx?id=287950">argued</a> in The Jerusalem Post, when such serious charges are raised without adequate care and discretion, they risk losing their force.</p>
<p>“Outrage” is not an argument. But the claim that circumcision is “non-negotiable” for Jews because it is “divinely mandated” in Genesis does carry some weight. </p>
<p>Against this, <a href="http://www.beyondthebris.com/">a growing number of Jews</a> believe that circumcision is <a href="http://kazez.blogspot.de/2012/07/religious-circumcision.html">inconsistent with Jewish ethics</a> and has no place in contemporary religious practice. They point out that many things are “divinely mandated” in the Bible, but are happily “negotiated” by modern Jews — up to and including circumcision. </p>
<p>Biblical literalists will not find these arguments convincing, but they do not have a monopoly on the practice of Judaism.</p>
<p>What we are really witnessing is a <a href="http://blog.practicalethics.ox.ac.uk/2012/10/religious-vs-secular-ethics-and-a-note-about-respect/">clash between traditional patriarchal values</a>, emphasising group conformity, and those of secular modernity, emphasising individual autonomy. </p>
<p>The most honest defenders of circumcision acknowledge that it is a cruel disfigurement, permissible only because God commanded it – witness orthodox Rabbi Hershey Worch quoted in Eliyahu Ungar-Sargon’s <a href="http://www.cutthefilm.com/">documentary film Cut</a>:</p>
<blockquote>
<p>“It’s painful, it’s abusive. It’s traumatic, and if anybody who’s not in a covenant [with God] does it, I think they should be put in prison. I don’t think anybody has an excuse for mutilating a child. … Depriving them of [part of their] penis.” </p>
</blockquote>
<p>But still it must be done, because as the Rabbi concluded, “God owns my morals.”</p>
<p>Since <a href="http://www.historyofcircumcision.net/">at least</a> the mid-19th century, the question for Jewish people has been the extent to which they should relinquish traditional observances and integrate into the broader society. Jewish critics of circumcision first emerged in Germany in the 1840s, igniting a debate within the religion that has flared on and off right up to the present. </p>
<p>In response, their conservative opponents cited both traditional arguments (cultural and religious obligation), and the new discoveries of Anglo-American doctors that circumcision was helpful against such intractable health problems as masturbation, syphilis, epilepsy and tuberculosis. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/17024/original/4qjqs5w4-1351555357.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/17024/original/4qjqs5w4-1351555357.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/17024/original/4qjqs5w4-1351555357.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/17024/original/4qjqs5w4-1351555357.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/17024/original/4qjqs5w4-1351555357.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/17024/original/4qjqs5w4-1351555357.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/17024/original/4qjqs5w4-1351555357.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Arguments for circumcision on medical grounds are also used to justify religious-based reasoning.</span>
<span class="attribution"><span class="source">kityojames/Flickr.</span></span>
</figcaption>
</figure>
<p>We see the same tendency today: supporters of circumcision on health grounds cite religious requirements as a reason for why it shouldn’t be restricted, while those who support it for cultural reasons cite “health benefits” as a reason for why it should be expanded.</p>
<p>Regrettably, a number of analysts in the world of philosophical bioethics have been reluctant to take a public stand against this sort of vacillation. Discussion of circumcision is inhibited by the fear that objective analysis will incite accusations of intolerance. </p>
<p>Writing on the <a href="http://jme.bmj.com/">Journal of Medical Ethics</a> blog, the philosopher Iain Brassington <a href="http://blogs.bmj.com/medical-ethics/2012/07/17/more-on-circumcision-in-germany/">recently stated</a>, </p>
<blockquote>
<p>“Though I [have] mentioned the decision of the German court that ritual circumcision constituted assault, I’ve wanted to stay clear of saying more about it [because] it seemed too potentially toxic.” </p>
</blockquote>
<p>Likewise, the bioethicist Dan O’Connor from Johns Hopkins University <a href="http://bioethicsbulletin.org/archive/piece-i-didnt-want-to-write/">has said</a>, “When [a reporter] calls my work and ask[s] if there is a bioethicist in the house who will give the anti-circumcision viewpoint, I beg off.”</p>
<p>Lingering in the background is an unwritten rule that says critical discussion of certain ideas is automatically out of bounds. As Douglas Adams <a href="http://www.biota.org/people/douglasadams/">observed</a>, “If somebody votes for a party that you don’t agree with, you’re free to argue about it as much as you like.” But if somebody mentions something about their religious practices, “you say, ‘Fine, I respect that’.”</p>
<p>Adams’ point is that this avoidance is not really “respect” at all. It is about discomfort, or fear of ruffling too many feathers, being misunderstood, or being accused of harbouring prejudice. </p>
<p>Respect is something else entirely. Respect assumes that while someone may disagree with you, she will consider your points with an open mind, and judge your argument on its merits. </p>
<p>Respect assumes that we should be able to look at one another’s most cherished practices in light of the ethical advances of recent centuries without getting into a shouting match. </p>
<p>It’s time we took a critical look at the culturally-motivated cutting of the genitals of infant boys. And we call upon our colleagues, both religious and secular, to engage in this important dialogue. Respectfully. </p><img src="https://counter.theconversation.com/content/10199/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brian D. Earp has written and spoken critically about infant circumcision in academic contexts. He does not stand to profit financially or otherwise from the contents of this article.</span></em></p><p class="fine-print"><em><span>Robert Darby has written and published extensively on male and female circumcision from a critical perspective and has informal links with individuals and organisations that are opposed to circumcision.</span></em></p>Non-therapeutic circumcision of male infants and boys has always been a controversial issue – and never has opinion been more polarised. In the United States, medical authorities have just overturned 40…Brian D Earp, Research Associate, University of OxfordRobert Darby, Independent medical historianLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/91052012-09-05T04:43:27Z2012-09-05T04:43:27ZTasmanian report calls for groundbreaking reform of circumcision law<figure><img src="https://images.theconversation.com/files/14994/original/959bgc6f-1346723028.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A traditional circumcision set from the Jewish Museum of New York.</span> <span class="attribution"><span class="source">istolethetv/Flickr</span></span></figcaption></figure><p>Circumcision lies at the crossroads of religion, custom, human rights, health, commerce, harm, and ethics. From <a href="http://www.abc.net.au/news/2012-06-28/german-court-bans-circumcision-of-young-boys/4096998">high-profile court battles overseas</a> to its recent inclusion on <a href="http://ten.com.au/CanOfWorms-worm-25.htm">Channel Ten’s provocative <em>Can of Worms</em></a>, it’s clear that its regulation is a most divisive issue.</p>
<p>Male circumcision has many features attracting regulation and controversy. It’s invasive, involving blood loss, pain and the removal of genital tissue. It has an inherent risk of harmful complications and is performed in a variety of circumstances by medical professionals, trained ritual circumcisers, and laypersons alike. </p>
<p>Circumcisers usually profit from performing circumcision and often perform it on people too young to express an opinion on whether it’s in their interests. Individuals are also liable to request circumcision on the basis of <a href="https://www.mja.com.au/journal/2009/191/5/adequacy-consent-documentation-specialty-surgical-unit-time-community-debate">insufficient, inaccurate or inadequately contextualised information</a>.</p>
<h2>Grave complexities</h2>
<p>People can and do disagree about the merits of circumcising. Indeed, the circumcision debate is characterised by conflicts between claims that are equally absolute, and ends that are equally ultimate. </p>
<p>Legislatures and courts can’t frame the law to please both circumcision abolitionists and Orthodox Jewish <em>Mohels</em>. And they can’t promote every culturally significant way of circumcising while trying to maximise the health standards of every circumciser. This puts law reform bodies in an unenviable position.</p>
<p>Although it has the kind of features that give rise to the disputes brought before courts every day, circumcision has until recently avoided close legal scrutiny in Australia. There is no Circumcision Act. There has not been a significant test case. In many instances, it’s not clear how criminal and private law regulate circumcision. </p>
<p>Even the basic requirements of lawful authorisation to perform circumcision are uncertain. The shadow cast by the law’s uncertainty provides cover for questionable acts, and ominously follows those acting commendably. This uncertainty in the law provides ample impetus for reform.</p>
<h2>A way forward</h2>
<p>An attempt at reform has been made by the Tasmanian Law Reform Institute, which recently released a report titled <a href="http://www.law.utas.edu.au/reform/documents/CircumcisionFinal.pdf"><em>Non-Therapeutic Male Circumcision</em></a>. The report recommends reforming the legal framework governing circumcision in Tasmania, and provides the most comprehensive formal law reform analysis of circumcision ever undertaken.</p>
<p>The Institute outlined its approach to reform in the report to encourage critical consideration of its recommendations; it adopted a pluralistic path deeply concerned with legal, political, and evidential reality. </p>
<p>It recommended Tasmania provide a clear legislative basis for the legality of circumcision in some circumstances. But it didn’t consider each of the many rationales for circumcision to be equally deserving. </p>
<p>It recommended reform to allow adults and older minors the freedom to determine both their own circumcision status and the circumstances of the performance of their circumcision.</p>
<p>Due to the significant and entrenched acceptance of religious and ethnic circumcision globally, and the ardent support of its proponents, the Institute recommended reform to accommodate circumcision performed on young boys for established religious and ethnic circumcising reasons.</p>
<p>Because it assessed the secular social rationales for circumcising (such as improved appearance, family tradition and familiarity) as rightfully controversial, weakly established, and tenuously linked to the child’s interests, the Institute recommended the prohibition of circumcision performed on young children for the sake of secular social reasons.</p>
<p>Weighing the benefit of its putative <a href="http://www.racp.edu.au/index.cfm?objectid=65118B16-F145-8B74-236C86100E4E3E8E">prophylactic health effect</a> (offering potential benefits of <a href="http://www.theaustralian.com.au/news/health-science/circumcision-no-barrier-to-hiv/story-e6frg8y6-1111119114985">no real significance</a> to the vast majority of Australian males) against the harm of potentially significant costs (and the possibility of other costs with potential consequences ranging from negligible to truly dire), the Institute recommended the prohibition of circumcision performed on young children for preventative health reasons.</p>
<h2>Further reform</h2>
<p>The Institute made several supporting recommendations to:</p>
<p>• protect the interests of children by requiring court authorisation <a href="http://www.mycircumcisiondisgrace.org/How%20easy.html">when parents cannot agree</a> about the merits of circumcising their child;</p>
<p>• improve access to justice for those harmed by circumcision as a child by improving their access as an adult to legal remedies;</p>
<p>• ensure no minor be put at an <a href="http://www.ntnews.com.au/article/2010/01/11/114641_ntnews.html">unnecessarily high risk of suffering</a> from a circumcision by enacting clear minimum health standards for all circumcisers; and</p>
<p>• improve decision-making by requiring clear standards in regard to the quality of information about circumcision provided to the community.</p>
<p>Those who perform or instigate a circumcision do so without knowing the full extent of their exposure to civil and criminal liability. By reforming the law, Tasmania may spare itself the pain of hosting the kind of legal battles making headlines in Europe.</p><img src="https://counter.theconversation.com/content/9105/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Warwick Marshall is a former employee of the Tasmanian Law Reform Institute. He authored the Institute's final report on male circumcision.</span></em></p>Circumcision lies at the crossroads of religion, custom, human rights, health, commerce, harm, and ethics. From high-profile court battles overseas to its recent inclusion on Channel Ten’s provocative…Warwick Marshall, Honorary Associate, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/85172012-08-08T20:37:52Z2012-08-08T20:37:52ZInfant male circumcision: stop violating boys’ human rights<figure><img src="https://images.theconversation.com/files/13951/original/xdv4cyyd-1344315845.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Infant male circumcision violates aspects of international human rights law, which Australia is bound to uphold.</span> <span class="attribution"><span class="source">Chris Woods</span></span></figcaption></figure><p>In an article published recently on this site, “<a href="https://theconversation.com/male-circumcision-policy-ignores-research-showing-benefits-8395">Male circumcision policy ignores research showing benefits</a>”, the authors stated some alleged benefits of infant male circumcision and argued the Royal Australasian College of Physicians’ <a href="http://www.kids.vic.gov.au/downloads/male_circumcision.pdf">policy</a> (that infant male circumcision is not warranted in Australia and New Zealand) is misguided and not based on evidence. </p>
<p>The article itself ignores not just research and good policy, but also law – in particular, international human rights law, which Australia is bound to uphold.</p>
<h2>The importance of holistic policy</h2>
<p>Developing good public health policy is more than simply making conclusions based on risks and benefits to physical health. It requires consideration of what is meant by health. The World Health Organization <a href="http://www.who.int/governance/eb/who_constitution_en.pdf">defines</a> health as not only physical, but also mental and social well-being. Any debate about infant male circumcision should take into account the potential long-term trauma (conscious or subconscious) of such a procedure, as well as the sense of violation it engenders.</p>
<p>And if scientific research is used as justification for a medical procedure, it should be applicable to the context. The research cited as showing the utility and benefit of male circumcision for disease prevention is limited exclusively to developing countries, including HIV/AIDS-prevalent societies. This doesn’t make infant male circumcision a necessary procedure in Australia. </p>
<p>The <a href="http://www.kids.vic.gov.au/downloads/male_circumcision.pdf">Royal Australasian College of Physicians</a> (the policy paper of contention in the article in question), the <a href="http://www.kidshealth.org.nz/circumcision">Paediatric Society of New Zealand</a>, the <a href="http://bma.org.uk/-/media/Files/PDFs/Practical%20advice%20at%20work/Ethics/Circumcision.pdf">British Medical Association</a>, the <a href="https://www.cpsbc.ca/files/u6/Circumcision-Infant-Male.pdf">Canadian Paediatric Society</a>, <a href="http://pediatrics.aappublications.org/content/103/3/686.full.pdf+html">American Academy of Pediatrics</a> and the <a href="http://www.acog.org/%7E/media/For%20Patients/faq039.pdf?dmc=1&ts=20120803T0840172025">American College of Obstetricians and Gynecologists</a> all deem infant male circumcision for religious, appearance or even perceived preventative medical reasons as unnecessary medical procedure. They all consider it to be either elective or non-therapeutic surgery.</p>
<h2>Human rights</h2>
<p>Male circumcision and infant male circumcision both ultimately boil down to choice – and that is a human rights issue. At the heart of human rights is the concept of human dignity, and rights such as those <a href="http://www2.ohchr.org/english/law/ccpr.htm#art7">to physical integrity</a>, <a href="http://www2.ohchr.org/english/law/cescr.htm#art12">to the highest attainable standard of physical and mental health</a>, and, in the case of children, <a href="http://www2.ohchr.org/english/law/crc.htm#art3">the obligation to act in their best interests</a>. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/13949/original/32h4kbyn-1344315616.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/13949/original/32h4kbyn-1344315616.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/13949/original/32h4kbyn-1344315616.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/13949/original/32h4kbyn-1344315616.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/13949/original/32h4kbyn-1344315616.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/13949/original/32h4kbyn-1344315616.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/13949/original/32h4kbyn-1344315616.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Lack of informed consent makes infant male circumcision a violation of human rights.</span>
<span class="attribution"><span class="source">Matthew Kebbekus</span></span>
</figcaption>
</figure>
<p>These are not only protected under <a href="http://www2.ohchr.org/english/law/crc.htm">international human rights law</a>, but are entrenched in criminal law systems in various forms. Criminal laws consider interference with the physical integrity of another human being as the most serious of offences.</p>
<p>Human rights law reflects the importance placed on such violations and a forced medical procedure on an individual is in breach of a number of human rights. Circumcision without consent or any immediate medical necessity on a healthy adult male would clearly be in breach of his human rights. So how is infant male circumcision without consent any different? </p>
<p>Children are entitled to the same basic rights as adult individuals. Indeed, they have special protections that recognise their unique vulnerability, as made clear under the <a href="http://www2.ohchr.org/english/law/crc.htm">Convention on the Rights of the Child</a>, which Australia has <a href="http://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-11&chapter=4&lang=en">ratified</a>.</p>
<h2>The rights of parents?</h2>
<p>While parents and legal guardians provide consent on behalf of children for necessary medical procedures (such as immunisations) the removal of healthy, functioning genital tissue from an infant (many years before any purported protections from sexual disease are even relevant) is clearly not a necessary medical procedure. </p>
<p>Parental consent to infant male circumcision is insufficient justification in contemporary Australia. It also ignores doctors’ duties to the child to do no harm, is arguably an inconsistent interpretation of the limitations of parental consent and a breach of the child’s human rights. If the purported benefits are, on balance, enough to warrant a male circumcision, then this is a decision for which he, whether as an adolescent or an adult, is solely entitled to.</p>
<h2>Religious rights</h2>
<p>For some, the medical benefit debate is irrelevant. Infant male circumcision is seen as a fundamental ritual in the practise of religion, which is also a human right. While some may interpret the right to freedom of religion as including the right to practise infant male circumcision, it has clearly been accepted under international human rights law that one individual’s right to freedom of religion does not trump another’s right not to have their bodily integrity interfered with. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/13948/original/k5zf9gtq-1344315411.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/13948/original/k5zf9gtq-1344315411.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/13948/original/k5zf9gtq-1344315411.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/13948/original/k5zf9gtq-1344315411.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/13948/original/k5zf9gtq-1344315411.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/13948/original/k5zf9gtq-1344315411.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/13948/original/k5zf9gtq-1344315411.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Circumcision of Christ (1521), Chartres Cathedral France.</span>
<span class="attribution"><span class="source">Walwyn</span></span>
</figcaption>
</figure>
<p>In the seminal United States child rights case <a href="http://www.law.cornell.edu/supct/html/historics/USSC_CR_0321_0158_ZO.html"><em>Prince v Massachusetts</em></a>, the Court held that “[t]he right to practice religion freely does not include liberty to expose the… child to ill health or death… Parents may be free to become martyrs themselves. But they may not make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves”. </p>
<p>And in May this year, the regional court of Cologne in Germany applied the same reasoning in a case about infant male circumcision. It <a href="http://adam1cor.files.wordpress.com/2012/06/151-ns-169-11-beschneidung.pdf">said</a> “the right of the parents to raise their child in their religious faith does not take precedence over the right of the child’s bodily integrity and self-determination” (<em>translated from German</em>). </p>
<p>Restricting male circumcision to informed adolescents and adults is in no way a restriction on the freedom of religion. If anything, it’s upholding the child’s right to that freedom.</p>
<p>Whether for perceived medical benefit, religious or cultural reasons, until the informed consent of the individual can be freely given, infant male circumcision is plainly, and simply, a violation of human rights. It ignores the child’s rights to bodily integrity, to physical and mental health and to freedom of religion. </p>
<p>Advocates for infant male circumcision in Australia are failing to act in the best interests of Australian children.</p><img src="https://counter.theconversation.com/content/8517/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In an article published recently on this site, “Male circumcision policy ignores research showing benefits”, the authors stated some alleged benefits of infant male circumcision and argued the Royal Australasian…Claire Mahon, Adjunct Clinical Professor of Law, University of MichiganAlexandra Phelan, International Health and Human Rights Lawyer, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/83952012-07-26T20:09:15Z2012-07-26T20:09:15ZMale circumcision policy ignores research showing benefits<figure><img src="https://images.theconversation.com/files/13449/original/7jw44wr3-1343267006.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Circumcising boys in the neonatal period using local anaesthesia maximises benefits and safety.</span> <span class="attribution"><span class="source">TheGiantVermin/Flickr</span></span></figcaption></figure><p>For some time now, all the departments of health in Australia have based their policy on male circumcision on reviews of the scientific literature carried out periodically by the Royal Australasian College of Physicians (RACP). But the lack of a strong basis on evidence means the government should reconsider this reliance. </p>
<p>An RACP policy statement in 2004 argued that the available evidence didn’t justify infant male circumcision being carried out to prevent illness. But when a <a href="http://www.ncbi.nlm.nih.gov/pubmed/16502947">withering critique</a> of that 2004 policy was published in the Australia and New Zealand Journal of Public Health in 2006, the authors of the 2004 report didn’t even attempt to defend their work. This is generally considered an ominous sign in science.</p>
<p>In 2010, the RACP published its most recent policy <a href="http://www.racp.edu.au/page/paed-policy">Circumcision of infant males</a>. Again, the policy argued that the evidence didn’t justify infant male circumcision being carried out to prevent illness. But the 2010 policy statement was not quite as strongly opposed to infant circumcision as the 2004 policy had been.</p>
<p>We have just published <a href="http://www.ncbi.nlm.nih.gov/pubmed/22805686">a comprehensive evaluation</a> of the 2010 RACP policy in the College’s <a href="http://www.racp.edu.au/page/publications/internal-medicine-journal/">Internal Medicine Journal</a>. All nine co-authors of the paper, including ourselves, are public health and public policy experts. </p>
<p>Our critique concludes that the RACP policy is not a fair and balanced representation of the literature on male circumcision because it is not based on research evidence. Instead, the RACP policy ignores, downplays, obfuscates or misrepresents the considerable body of research that shows circumcising males offers strong protection against a number of diseases. </p>
<p>Benefits include reduced <a href="http://www.scirp.org/journal/PaperInformation.aspx?paperID=17415">childhood urinary tract infections</a>, which are common, painful and often cause permanent kidney damage. Male circumcision also provides some protection against many common, as well as not so common, <a href="http://rd.springer.com/chapter/10.1007/978-3-642-14663-3_54">sexually transmitted infections</a>, including the epidemic of cancer-causing types of human papillomavirus and genital herpes, <a href="http://www.scirp.org/journal/PaperInformation.aspx?paperID=17415">genital ulcer disease</a> and <a href="http://www.tandfonline.com/doi/abs/10.1080/09540121.2012.661836?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed">HIV</a>, among others.</p>
<p>Circumcision also helps protect against <a href="http://www.ncbi.nlm.nih.gov/pubmed/16925903">penile candidiasis</a> (thrush), <a href="http://circinfo.net/inflammatory_dermatatoses.html">inflammatory skin conditions</a> and <a href="http://circinfo.net/penile_hygiene.html">inferior penile hygiene</a>. It can help those with <a href="http://circinfo.net/physical_problems.html">physical problems</a>, such as a tight foreskin that interferes with passing urine, and an inability to return the foreskin after it is retracted. It virtually eliminates the risk of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113366/?tool=pubmed">penile cancer</a> that occurs in one in 1,000 uncircumcised males over their lifetime. And there may also be some reduction in the <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=morris%20bj%202012%20prostate">risk of prostate cancer</a>. </p>
<p>Women with circumcised male partners are protected to varying degrees against cancer-causing <a href="http://www.ncbi.nlm.nih.gov/pubmed/22734435">human papillomavirus infection</a>, <a href="http://rd.springer.com/chapter/10.1007/978-3-642-14663-3_54">genital herpes</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/18976733">bacterial vaginosis</a> (Gardneralla), and <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113366/?tool=pubmed">cervical cancer</a>. Although the RACP’s policy statement claims otherwise, complications of infant male circumcision <a href="http://www.ncbi.nlm.nih.gov/pubmed/20158883">are uncommon</a> and virtually all <a href="http://www.biomedcentral.com/1471-2431/12/20/abstract">minor and easily treated</a>.</p>
<p>The RACP policy statement claims that “the foreskin has a functional role” and “is a primary sensory part of the penis”. However, extensive <a href="http://circinfo.net/circumcision_sensitivity_sensation_sexual_function.html">high quality research</a>, including <a href="http://www.ncbi.nlm.nih.gov/pubmed/18761593">randomised controlled trials</a>, show no adverse effect on <a href="http://www.ncbi.nlm.nih.gov/pubmed/18761593">sexual function</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/17419812">sensitivity, sensation</a> or <a href="http://www.ncbi.nlm.nih.gov/pubmed/18761593">satisfaction</a>. </p>
<p>Instead of citing good research, such as large meta-analyses and randomised trials, the RACP policy selectively cites a <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=kim%20d%202007%20619%2099">poor quality study</a> that has been <a href="http://www.ncbi.nlm.nih.gov/pubmed/17437447">criticised</a>. The RACP’s claim – without support from a literature-based risk-benefit analysis – that the currently available evidence does “not warrant routine infant circumcision in Australia and New Zealand” is misleading. </p>
<p>A <a href="http://www.scirp.org/journal/PaperInformation.aspx?paperID=17415">risk-benefit analysis</a> by a number of us who also wrote the Internal Medicine Journal article was published recently in the <a href="http://www.scirp.org/journal/ojpm/">Open Journal of Preventive Medicine</a>. We found that the benefits of male circumcision were considerable and exceeded risks by a large margin; the risks are virtually all minor, while conditions prevented are often serious. </p>
<p>The RACP policy fails to explain that circumcising boys <a href="http://www.biomedcentral.com/1471-2431/12/20/abstract">in the neonatal period</a> using local anaesthesia maximises benefits and safety, is convenient and offers <a href="http://www.ncbi.nlm.nih.gov/pubmed/20090910">cost savings</a>.</p>
<p>Our Internal Medicine Journal article concludes that because the RACP’s policy “is not a fair and balanced representation of the current literature it should not be used to guide policy.” We recommend that an extensive, comprehensive, balanced review of the scientific literature and a risk-benefit analysis should be conducted to formulate policy, in the interests of public health and individual well-being. </p>
<p>Such a review was recently undertaken by the <a href="http://www.circumcisionaustralia.org/">Circumcision Foundation of Australia</a>. Health bodies, governments, doctors and the general public should use this evidence-based policy statement as a reliable guide to decision-making and health policy development.</p>
<p>Facing rising health costs, the federal government has recently increased its emphasis on prevention. Infant male circumcision is a good example of how difficult it can be to implement preventative measures. The process starts with basing policy fairly and squarely on evidence and continues with overcoming obstruction from groups opposed to policy based on evidence. Watch this space.</p><img src="https://counter.theconversation.com/content/8395/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For some time now, all the departments of health in Australia have based their policy on male circumcision on reviews of the scientific literature carried out periodically by the Royal Australasian College…Brian J. Morris, Professor of Molecular Medical Science, University of SydneyAlex Wodak, Emeritus Consultant, St Vincent's Hospital, DarlinghurstLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/79672012-06-28T05:31:06Z2012-06-28T05:31:06ZGerman case opens up another battle in the circumcision war<figure><img src="https://images.theconversation.com/files/12350/original/hvzyz4w9-1340861340.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For many, infant circumcision is contentious purely because it involves infants rather than because it involves pain.</span> <span class="attribution"><span class="source">Lars Plougmann</span></span></figcaption></figure><p>Bioethicists, human rights advocates and criminal lawyers are watching another outbreak of the “circumcision wars”, after yesterday’s decision by a provincial court in Cologne, Germany, that circumcision of male infants is illegal.</p>
<p>The decision resulted in expressions of concern from Germany’s Muslim and Jewish communities. It will almost certainly be appealed to Germany’s highest constitutional courts (and thence, if necessary) to the European Court of Justice, on the basis of human rights. </p>
<p>It will revive the debate in Australia and elsewhere about the legality of non-therapeutic surgery on minors – that is, people who cannot consent to a body modification that, in practice, is irreversible and not necessary immediately after birth in order to save their life.</p>
<p>In essence, non-therapeutic circumcision involves a conflict in human rights law.</p>
<p>Opponents of infant circumcision refer to the law about assault, characterising the surgery as something that would otherwise be dealt with as a crime. They also regard it as a denial of the infant’s human rights, a body modification that is akin to the female genital mutilation, which is criminalised in Australian law. </p>
<p>Previous articles about circumcision on this site demonstrate that <a href="https://theconversation.com/unethical-and-harmful-the-case-against-circumcising-baby-boys-1543">opponents</a> are often deeply committed to those views.</p>
<p>Proponents, on the other hand, claim that infant circumcision is a fundamental aspect of membership of ethno-religious communities, a practice that is ordained by God (evident, for example, in Genesis 17:1-27). And that underpins the person’s psychological well-being from childhood through to the grave. Criminalisation of non-therapeutic circumcision, in that view, is inconsistent with Australia’s respect for cultural diversity and religious belief.</p>
<p>It’s likely that around one in ten newborn Australian males are circumcised each year, typically outside public hospitals.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12343/original/9bjsw2sw-1340859814.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12343/original/9bjsw2sw-1340859814.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12343/original/9bjsw2sw-1340859814.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12343/original/9bjsw2sw-1340859814.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12343/original/9bjsw2sw-1340859814.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12343/original/9bjsw2sw-1340859814.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12343/original/9bjsw2sw-1340859814.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In principle, circumcising an infant could be regarded as assault.</span>
<span class="attribution"><span class="source">sean dreilinger</span></span>
</figcaption>
</figure>
<p>Australian law regarding non-therapeutic circumcision is unclear and likely to remain so, with governments proving reluctant to grasp the hot potato. The Tasmanian Parliament has not, for example, embraced the 2009 state Law Reform Institute’s <a href="http://www.law.utas.edu.au/reform/documents/CircumcisionIssuesPaperA4toPrint.pdf">issues paper</a> on <em>Non-Therapeutic Male Circumcision</em>. </p>
<p>Neither statute nor case law explicitly bans infant circumcision and it’s not prohibited by the leading international human rights agreements. In principle, circumcising an infant could be regarded as <a href="http://www.austlii.edu.au/au/legis/qld/consol_act/cc189994/s245.html">assault</a>, an offence under state or territory criminal law. Assault on an infant often carries a stronger penalty than that on an adult, reflecting the minor’s vulnerability.</p>
<p>Assault involves intentional application of force, and opponents of circumcision argue that the cutting can be construed as the offences “wounding” or “causing grievous bodily harm”. That harm is typically identified as a bodily injury that endangers, or is likely to endanger, life or cause serious injury to health. </p>
<p>Much medical treatment of course involves wounding and the infliction of pain; it is lawful to engage in surgery to remedy or treat an existing disease, illness or deformity of the body. </p>
<p>The law also permits some injury and pain in the course of sport, such as football and boxing, and body modification such as tattooing and piercings (in the genitals, nose, tongue or ears). And it’s increasingly grappling with questions about consensual sado-masochism that ranges from spanking through to stigmatized activity, such as branding.</p>
<p>For many people infant circumcision is contentious purely because it is non-therapeutic and involves infants rather than because it involves pain and the excision of flesh.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12349/original/vbnyqmdp-1340861101.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12349/original/vbnyqmdp-1340861101.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=615&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12349/original/vbnyqmdp-1340861101.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=615&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12349/original/vbnyqmdp-1340861101.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=615&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12349/original/vbnyqmdp-1340861101.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=773&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12349/original/vbnyqmdp-1340861101.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=773&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12349/original/vbnyqmdp-1340861101.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=773&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">As a society we expect parents to make decisions on behalf of their offspring.</span>
<span class="attribution"><span class="source">nanny snowflake/Flickr</span></span>
</figcaption>
</figure>
<p>An adult or teenager has autonomy in decision-making. They can consent and may well choose to modify their bodies, possibly in ways they’ll later regret (evident in the market for tattoo removal). An eight-day-old boy cannot consent. The decision has been made for the child. </p>
<p>Some communities consider that “belonging” requires the parents to act for the child. That action reflects a sense of the paramount interests of the child, a principle that underlies Australian family law.</p>
<p>From that perspective, debate about infant circumcision involves differing perspectives on what’s best for the child, for example, bodily integrity versus participation in a covenant that’s embedded in rich cultural and religious values. </p>
<p>There are no easy answers and it’s regrettable that much of the debate is so shrill. As a society we do allow – and even expect – parents to make decisions on behalf of their offspring. Is circumcision the right decision? Should the state intervene? Are we going to override the beliefs and values of Australia’s Muslim and Jewish communities?</p>
<p>One German jurist is <a href="http://www.theage.com.au/world/circumcision-on-boys-assault-court-rules-20120627-212rw.html">reported</a> as commenting, “After the knee-jerk outrage has faded away, hopefully a discussion will begin about how much religiously motivated violence against children a society is ready to tolerate.” </p>
<p>If we are going to have a principled discussion about “violence”, we might want to think about the violence inherent in the stigmatisation of ethno-religious groups and of gay people. The greatest harm experienced by many people is to be unloved, unwanted or marginalised rather than have to undergo surgery.</p><img src="https://counter.theconversation.com/content/7967/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Baer Arnold does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Bioethicists, human rights advocates and criminal lawyers are watching another outbreak of the “circumcision wars”, after yesterday’s decision by a provincial court in Cologne, Germany, that circumcision…Bruce Baer Arnold, Assistant Professor, School of Law, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/58072012-03-12T04:29:22Z2012-03-12T04:29:22ZCircumcision before first-time sex could help prevent prostate cancer<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/8541/original/m446vh3y-1331526030.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/8541/original/m446vh3y-1331526030.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/8541/original/m446vh3y-1331526030.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/8541/original/m446vh3y-1331526030.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/8541/original/m446vh3y-1331526030.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/8541/original/m446vh3y-1331526030.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/8541/original/m446vh3y-1331526030.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The supposed benefits of circumcision are hotly debated in the medical profession.</span>
<span class="attribution"><span class="source">Flickr/airosche5</span></span>
</figcaption>
</figure>
<p>Men who are circumcised before they have sex for the first time may be less likely to develop prostate cancer, a study has found.</p>
<p>Researchers who analysed medical information from 3,399 men (1,754 with prostate cancer and 1,645 without), found that those who had been circumcised before their first sexual intercourse were 12% less likely to develop non-aggressive prostate cancer and 18% less likely to develop aggressive prostate cancer.</p>
<p>The results of the study, by a team from the Fred Hutchinson Cancer Research Center in Seattle, are published in CANCER, a journal of the American Cancer Society.</p>
<p>The publication follows a <a href="http://www.scirp.org/journal/PaperInformation.aspx?paperID=17415">study</a> by a University of Sydney team, who found that infant male circumcision can reduce the risk of penile cancer, HIV, syphilis, kidney inflammation and other medical conditions.</p>
<p>Jonathan Wright, the lead author of the US study and an assistant professor of urology at the University of Washington School of Medicine, said the results suggested that circumcision may hinder infection and inflammation that can lead to prostate cancer.</p>
<p>“These data are in line with an infectious, inflammatory pathway which may be involved in the risk of prostate cancer in some men,” said Dr Wright. He cautioned that the data were purely observational, but said that they suggested a “biologically plausible mechanism through which circumcision may decrease the risk of prostate cancer”.</p>
<p>The authors wrote that “infections are known to cause cancer, and research suggests that sexually transmitted infections may contribute to the development of prostate cancer. Also, certain sexually transmitted infections can be prevented by circumcision.”</p>
<p>The authors of the University of Sydney-led study, published last week in the Open Journal of Preventive Medicine, said that a risk-benefit analysis showed benefits outweighed “minor risks by a factor of over 100 to 1”.</p>
<p>The research leader, Sydney University Professor of Medicine Brian Morris, said that “evidence in favour of infant circumcision is now so strong that advocating this simple, inexpensive procedure for baby boys is about as effective and safe as childhood vaccination”.</p>
<p>The study showed that in uncircumcised boys, the risk of urinary tract infection and kidney inflammation was 10 times higher. In later life the risk of prostate cancer, penile cancer, HIV and syphilis was higher. For the female partner of an uncircumcised male, the risk of cervical cancer was also higher.</p>
<p>The benefits of circumcision have been hotly debated in the medical profession and beyond for decades.</p>
<p>Bond University Professor of Psychology Greg Boyle, an opponent of the procedure, <a href="http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1041&context=hss_pubs">has said</a> there are “substantial adverse sexual effects of male circumcision, including significantly reduced penile sensitivity and significantly increased ejaculatory problems.</p>
<p>"As compared with genitally intact men, circumcised men reported significantly elevated levels of negative feelings and emotions related to being circumcised. Circumcised men also expressed significantly greater dissatisfaction with their sex lives than did genitally intact men.”</p>
<p>Professor Boyle has also <a href="http://works.bepress.com/greg_boyle/34/">argued</a> that involuntary circumcision of healthy boys should be considered an assault causing grievous bodily harm.</p><img src="https://counter.theconversation.com/content/5807/count.gif" alt="The Conversation" width="1" height="1" />
Men who are circumcised before they have sex for the first time may be less likely to develop prostate cancer, a study has found. Researchers who analysed medical information from 3,399 men (1,754 with…Justin Norrie, EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/15432011-08-16T20:40:05Z2011-08-16T20:40:05Z‘Unethical and harmful’: the case against circumcising baby boys<figure><img src="https://images.theconversation.com/files/2526/original/NoVa_Hokie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The foreskin is the most sensitive part of the penis. </span> <span class="attribution"><span class="source">Flickr/NoVa Hokie</span></span></figcaption></figure><p>For centuries, children have been subjected to cultural and medicalised practices that were ultimately proven harmful and a violation of basic bodily integrity. Such practices have included foot binding, forehead flattening, scarification and genital cutting. </p>
<p>In English-speaking countries, the practice of cutting the genitals of male children was <a href="http://www.jstor.org/pss/3788341">gradually medicalised</a> over a period of 150 years with the benign-sounding label “circumcision.” </p>
<p>Today, there is increasing awareness that infant male circumcision – once deemed a “parental choice” – is really an unnecessary, irreversible and harmful bodily modification. </p>
<p>With the recently discovered <a href="http://www.ncbi.nlm.nih.gov/pubmed/17378847">functions of the foreskin</a> and a growth in awareness, we’re fortunately beginning to see the rights and experience of the child become the paramount consideration in discussions about circumcision.</p>
<h2>The foreskin</h2>
<p>The <a href="http://video.google.com/videoplay?docid=1482347046642439341">human foreskin</a> is a contiguous part of the skin system of the clitoris or penis. </p>
<p>In infant males, the foreskin is attached to the head of the penis (glans). The outer foreskin protects the more sensitive inner foreskin and the glans from abrasion and injury. </p>
<p>The <a href="http://www.youtube.com/watch?v=c8voOaGouDM&feature=related">moveable skin</a> facilitates sexual pleasure. In fact, the foreskin is typically the <a href="http://www.ncbi.nlm.nih.gov/pubmed/17378847">most sensitive area of the penis</a>. </p>
<p>When circumcised males lose sensitivity and skin mobility, it’s likely to significantly alter their <a href="http://www.youtube.com/watch?v=BgoTRMKrJo4">sexual experience</a>. </p>
<p>One recent <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=21672947">Danish cross-sectional study</a> concluded that male circumcision was associated with sexual difficulties for men and their female partners.</p>
<h2>Bioethics of a non-treatment surgery on minors</h2>
<p>Surgery without consent is ethical only in cases for: </p>
<p>1) incapacitated patients, in order to save their life</p>
<p>2) minors, with proxy consent from a parent or guardian, but only for surgery that addresses an underlying condition. </p>
<p>Excision of an infant’s foreskin for dubious medical or cultural purposes is an anomaly. Because it removes healthy, typically-developed tissue, the procedure fails to meet either of the above conditions.</p>
<p><a href="http://video.google.com/videoplay?docid=-6584757516627632617">Circumcision</a> of minors also stands in contradiction to other medical ethics principles, including:</p>
<ul>
<li><p>Avoiding causing needless harm</p></li>
<li><p>Promoting the patient’s medical well-being</p></li>
<li><p>Providing information on a procedure that a reasonable person would deem significant.</p></li>
</ul>
<h2>Complications</h2>
<p>Circumcision can cause <a href="http://www.circlist.com/glossarymale/m-anatdetail/skinbridge.html">skin bridges</a>, haemorrhaging, infection, as well as major penile damage.</p>
<p><a href="http://www.cirp.org/library/complications/">Dozens of case studies</a> describe severe complications, including penile amputations and death; several <a href="http://www.cirp.org/news/abc2011-05-06/">infant deaths</a> have been reported in the past few years. </p>
<p>A Canadian <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528673/">Coroner’s report</a>, issued in 2007 following the death of a baby in Ontario, recommended the Canadian Paediatric Society conduct a surveillance study on complications.</p>
<p>The most detailed <a href="http://www.ncbi.nlm.nih.gov/pubmed/6623741">assessment</a> of circumcision complications cites <a href="http://medical-dictionary.thefreedictionary.com/meatitis">meatitis</a> (affecting 8% to 31% of those circumcised), infection (affecting between 0.4% and 10%, age varying) and many other severe complications. </p>
<p>A more recent <a href="http://www.ncbi.nlm.nih.gov/pubmed/8242285">British literature survey</a> estimates complications, including infection and hemorrhage, at rates as high as 10%. </p>
<p>Paediatric urologist David M. Gibbons, commented on MensHealth.com:
“in a two year period, I was referred [more than] 275 newborns and toddlers with complications of neonatal circumcision … 45% required corrective surgery (minor as well as major, especially for amputative injury) …”</p>
<p>Another <a href="http://www.wtvr.com/wtvr-botched-circumcisions-20110517,0,4411553.story">urologist reported</a> repairing over 1,600 botched circumcisions over a three-year period.</p>
<p>Official rates of complications are likely to be under reported. But regardless of the actual complication rate, it is unethical to subject a child to these risks.</p>
<h2>Insignificant benefits</h2>
<p>While some use medical benefits to justify male circumcision, those gains rarely materialise in the real world, and the damage outweighs any gain.</p>
<p>For example, circumcision is purported to reduce female-to-male HIV transmission by 50% to 60%. But studies of the general population have failed to find <a href="http://www.hsrc.ac.za/Research_Publication-20839.phtml">any decrease in HIV infection rates</a> among circumcised men compared with uncircumcised men. </p>
<p>HIV rates are three to four times higher in American men (mostly circumcised) than in Europe (rarely circumcised). But factors far more significant than circumcision status determine HIV transmission. </p>
<p>While proponents claim circumcision reduces other sexually-transmitted infections (STIs), a 2008 <a href="http://www.ncbi.nlm.nih.gov/pubmed/18280846">New Zealand birth cohort study</a> did not find any such evidence.</p>
<h2>Misleading portrayal</h2>
<p>Despite potentially severe complications, hospital websites generally portray circumcision as values-neutral and safe.</p>
<p>Because most hospitals don’t give parents adequate information on the risks of circumcision to allow for true informed consent, few parents understand the effects their choice will have on their child and the adult he will become. </p>
<h2>Parental regret and survivor perspectives</h2>
<p>In blogs, <a href="http://www.youtube.com/watch?v=i1ZECchLIHo&feature=related">vlogs</a> and other online forums, <a href="http://www.drmomma.org/2009/09/ask-experts-circumcision-regret.html">many parents</a> have shared concerns about their child’s circumcision. </p>
<p>Experiences range from “If I knew what I know now, I wouldn’t have done it,” to “I will die hearing my baby’s screams”. </p>
<p>Many men have also expressed dissatisfaction with their circumcision, including a sense of “being violated,” “being sexually maimed,” and having feelings of anger toward parents or the medico who performed their circumcision. </p>
<p>On thousands of websites, Facebook groups and blogs, circumcised men go to <a href="http://www.foreskin-restoration.net/forum/">share their experiences and support one another</a>.</p>
<h2>Society’s role</h2>
<p>A cultural framework that considers circumcision ethically neutral and the foreskin “a useless flap of skin” omits important considerations. </p>
<p>Before debating supposed benefits, we need to ask why would we ever even consider cutting our children’s genitals.</p>
<p>The medical benefits of male circumcision are insignificant: no evidence to date justifies irreversible surgery on children unable to give consent.</p>
<p>Society has recognised the inherent right of minor females to be free from unnecessary genital cutting. </p>
<p>In the twenty-first century it is time to recognise the same rights of male children.</p>
<p><br></p>
<p><strong>Is infant male circumcision unethical and harmful? Have your say below.</strong></p>
<p>Read Brian Morris’ article <a href="http://theconversation.com/male-infant-circumcision-safe-convenient-cheap-and-fast-1541">Male infant circumcision: ‘safe, convenient, cheap and fast’</a></p>
<p><br></p>
<p><em><strong>For more of Ryan McAllister’s research in infant male circumcision, watch his recent university lecture: <a href="http://www.youtube.com/watch?v=Ceht-3xu84I">Circumcision, an Elephant in the Hospital</a>.</strong></em></p>
<p><em><strong>Watch John W. Travis’ video on infant wellness and circumcision <a href="http://www.youtube.com/watch?v=kN0rxo8y6WM">here</a>.</strong></em></p><img src="https://counter.theconversation.com/content/1543/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ryan McAllister does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.</span></em></p><p class="fine-print"><em><span>John W. Travis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For centuries, children have been subjected to cultural and medicalised practices that were ultimately proven harmful and a violation of basic bodily integrity. Such practices have included foot binding…Ryan McAllister, Research Assistant Professor of Physics and Oncology, Georgetown UniversityJohn W. Travis, Adjunct Professor of Wellbeing, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/15412011-08-16T20:39:56Z2011-08-16T20:39:56ZMale infant circumcision: ‘safe, convenient, cheap and fast’<figure><img src="https://images.theconversation.com/files/2492/original/Jeff_Dickerson.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The benefits of circumcision outweigh the risks by 100 to one. </span> <span class="attribution"><span class="source">Jeff Dickerson</span></span></figcaption></figure><p>Medical circumcision of baby boys has plummeted in Australia, with only 20% of male infants now undergoing the procedure, down from 90% in the 1970s. </p>
<p>Meanwhile, HIV infections <a href="http://www.med.unsw.edu.au/NCHECRweb.nsf/resources/SurvRep07/$file/ASR2010-rev1.pdf">continue to rise</a> in the broader community, with heterosexual contact now accounting for 23% of new HIV diagnoses. </p>
<p>To protect Australians against the spread of HIV and other sexually transmissible infections, we need to <a href="http://www.mja.com.au/public/issues/193_06_200910/coo10571_fm.html">increase male circumcision rates</a>. And the safest, most convenient and cost-effective time to do this is shortly after birth. </p>
<p>But in recent years, short-sighted measures by state health departments (except Queensland) have restricted access to publicly-funded circumcision, meaning parents need to go beyond the public hospital system to procure a circumcision for their baby. And they’re left with the bill.</p>
<p>If they can’t afford it, their son misses out. </p>
<p>Parents love their children and strive to do the best for them in all aspects of life – and this should include the ability to have their baby boys circumcised in the public hospital system. </p>
<p>Adverse outcomes of circumcision are extremely rare but opponents of circumcision ensure they make the headlines. It’s important to keep it all in perspective: the benefits of circumcision <a href="http://www.circinfo.net/pdfs/CircBioEssays07.pdf">outweigh the risks by around 100 to one</a>.</p>
<h2>Minimal risks</h2>
<p>The circumcision of boys in infancy is <a href="http://circinfo.net/circumcision_why_you_should_not_delay.html">safe, convenient</a> and performed under local anaesthetic. <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=russell%20ct%20circumcision">Pain can be zero</a> and healing is quick. </p>
<p>The risks of serious complications are <a href="http://circinfo.net/risks_of_circumcision.html">extremely low</a>, affecting only one in a million boys. </p>
<p>Inflated statistics of harm are sometimes used by opponents to intimidate parents but these are based on <a href="http://circinfo.net/risks_of_circumcision.html">“kitchen table” circumcision outcomes</a> or the use, against advice, of general anaesthetics.</p>
<p>There’s no credible evidence of any adverse effects later in life on <a href="http://circinfo.net/circumcision_sensitivity_sensation_sexual_function.html">sexual function, sensitivity or satisfaction</a>. </p>
<p>The widely-cited adult penis <a href="http://www.nocirc.org/touch-test/bju_6685.pdf">“sensitivity study”</a> – which claimed the foreskin was the most sensitive part of the penis – <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2007.06970_6.x/full">has been outed</a> in medical literature as being statistically flawed. </p>
<p>I was the reviewer for a <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=frisch%20m%202011%20circumcision">recent Danish study</a> by circumcision opponents that, despite their best efforts, failed to find any major effect on sexual function. </p>
<p>I recommended the paper be rejected because of statistical flaws in their finding – that a small number of men (10) circumcised after experiencing penile problems were slightly less likely to reach orgasm during intercourse. </p>
<p>In fact, data from large, high quality <a href="http://www.ncbi.nlm.nih.gov/pubmed/18761593">randomised controlled trials</a> show circumcision enhances the sexual experience of men and their female partners. </p>
<h2>Benefits</h2>
<p><a href="http://circinfo.net/socio_sexual_aspects.html">Studies</a> show both men and women believe circumcision improves the appearance of the penis. </p>
<p>But beyond the cosmetic, parents who make this choice for their baby boy can be reassured that he now has a lifetime of protection against certain diseases and could have <a href="http://www.ncbi.nlm.nih.gov/pubmed/16925903">improved penile function later in life</a>.</p>
<p>Their infant son will be 10-times less likely to get a <a href="http://circinfo.net/urinary_tract_infections.html">urinary tract infection</a>, which affects <a href="http://circinfo.net/urinary_tract_infections.html">one in four males</a> over their lifetime. (UTIs also damage the kidneys of half of all infants who contract them). </p>
<p>The circumcised boy will be immediately protected against <a href="http://www.andrologyaustralia.org/pageContent.asp?pageCode=FSSEXPENIS#WHATSNEW1519">phimosis</a>, which <a href="http://www.circinfo.net/pdfs/CircBioEssays07.pdf">affects</a> one in ten teenage boys and men. This is when the orifice of the foreskin is too small for urine to pass, resulting in ballooning of the foreskin. Phimosis also means painful and difficult erections, and frenulum tearing.</p>
<p>Steroid treatment can’t cure phimosis; only circumcision can. But circumcision later is inconvenient, expensive, higher risk, and can involve a general anaesthetic. It’s <a href="http://www.ncbi.nlm.nih.gov/pubmed/21687572">better to remove the foreskin in infancy</a> rather than risk <a href="http://www.ncbi.nlm.nih.gov/pubmed/21791719">complications</a> later in life. </p>
<p>Phimosis is the <a href="http://www.hindawi.com/journals/au/2011/812368/">biggest risk factor for penile cancer</a>, which affects around one in 1,000 males over their lifetime, virtually all of whom are uncircumcised. </p>
<p>Other foreskin-related complaints include <a href="http://circinfo.net/inflammatory_dermatatoses.html">inflammation</a>, <a href="http://circinfo.net/penile_hygiene.html">malodorous smegma</a> and itching.</p>
<h2>Sexually-transmitted infections (STIs) </h2>
<p>STIs are <a href="http://www.ncbi.nlm.nih.gov/pubmed/17935209">more common in uncircumcised men</a> but it’s <a href="http://circinfo.net/hiv_the_aids_virus.html">circumcision’s ability to protect against HIV</a> that gets the headlines. </p>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pubmed/20048246">epidemic</a> of cancer-causing types of <a href="http://www.ncbi.nlm.nih.gov/pubmed/17484617">human papillomavirus</a> (HPV) in Australia also has authorities worried.</p>
<p>Not only are HPVs responsible for some penile cancers, when passed on to women during sex they cause more than <a href="http://www.ncbi.nlm.nih.gov/pubmed/17484617">99% of cervical cancers</a>. </p>
<p>Circumcision <a href="http://circinfo.net/sexually_transmitted_infections.html">reduces the likelihood</a> of contracting syphilis and other ulcerative STIs such as genital herpes. Thrush is also <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=richters%20j%202006%20547">less common in circumcised men</a>.</p>
<p>Not only will a circumcised boy’s future sexual partner(s) be less likely to get cervical cancer, they will be at lower risk of developing <a href="http://www.ncbi.nlm.nih.gov/pubmed/16177149">Chlamydia</a>, a bacterial infection that <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/chlamydia">can cause</a> pelvic inflammatory disease, ectopic pregnancy and infertility. </p>
<p>Herpes, trichomonas, genital ulcer disease and bacterial vaginosis (gardneralla) are also more common in women who have sex with uncircumcised men.</p>
<p>The evidence that infant male circumcision protects against the spread of disease is so compelling the procedure is now regarded by <a href="http://www.circinfo.net/pdfs/CircBioEssays07.pdf">academic</a> and <a href="http://www.iywg.org/ar/popline/circumcision-lifetime-vaccination-many-benefits">clinical experts</a> as a “surgical vaccine”. </p>
<p>Just as conventional vaccinations are recommended for populations of children, circumcision should be universally available for all boys.</p>
<p>Condoms should, of course, be used to reduce the risk of infection, but their effectiveness against different STIs is variable and <a href="http://www.ncbi.nlm.nih.gov/pubmed/11687062">falls well short of 100%</a>. And despite public health campaigns, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.2010.00593.x/abstract">condom use has failed to increase</a>. </p>
<p>Circumcision is a sensible precaution to reduce the spread of infection, but condoms must be worn each time a person has sex outside a stable, zero-risk relationship.</p>
<h2>The anti-circ movement</h2>
<p>Up to half of all uncircumcised men are likely to suffer from a condition <a href="http://www.ncbi.nlm.nih.gov/pubmed/17935209">caused by their foreskin</a> over their lifetime. But despite the protective benefits of circumcision, <a href="http://circinfo.net/anti_circumcision_lobby_groups.html">anti-circ campaigners</a> continue to overlook the evidence and perpetuate a raft of myths. </p>
<p>More than one in ten men have problems with impotence or other sexual dysfunction. Many will go to the internet, type in a few keywords and, hey presto, they come across an anti-circ website that tells them their infant circumcision is to blame. </p>
<p>Et voila … a new convert is signed up! This poor gullible chap then perpetuates the anti-circ myths. </p>
<p>Some even use devices purchased over the Internet to stretch the skin on the shaft in an attempt to grow a (pseudo) foreskin. But this doesn’t improve their erection problems and can instead cause tragic complications, as for a <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=walter%20g%201990%20125">case</a> at the Royal North Shore Hospital in Sydney.</p>
<h2>Greater availability</h2>
<p>Given the <a href="http://www.ncbi.nlm.nih.gov/pubmed/17935209">enormous amount of medical information</a> supporting infant male circumcision, governments have a responsibility to promote the benefits of this “surgical vaccine”, just as it did the HPV vaccine. </p>
<p>Elective circumcision should be subsidised and offered in public hospitals. </p>
<p><br></p>
<p><strong>Should circumcision be subsidised and offered in public hospitals? Have your say below.</strong></p>
<p><strong>Read Ryan McAllister & John W.Travis’ article <a href="http://theconversation.com/unethical-and-harmful-the-case-against-circumcising-baby-boys-1543">‘Unethical and harmful’: the case against circumcising baby boys</a></strong></p>
<p><br></p>
<p><em><strong>For more of Brian Morris’ research on the health benefits of circumcision, visit his website <a href="http://www.circinfo.net/">Male circumcision guide for doctors, parents, adults and teens</a>.</strong></em></p><img src="https://counter.theconversation.com/content/1541/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brian J. Morris does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.</span></em></p>Medical circumcision of baby boys has plummeted in Australia, with only 20% of male infants now undergoing the procedure, down from 90% in the 1970s. Meanwhile, HIV infections continue to rise in the broader…Brian J. Morris, Professor of Molecular Medical Science, University of SydneyLicensed as Creative Commons – attribution, no derivatives.