(More recent items first)
Traditional circumcision raises risk of infection, study shows
By Ofri Ilani
Circumcision as performed by mohels, men whose profession is performing the Jewish ritual of brit milah, leads to a high rate of urinary tract infections among babies, according to a report released recently by physicians at Schneider Children's Medical Center in Petah Tikva.
The vast majority of Israeli Jews have their children circumcised by mohels. The religious obligation aside, many parents consider the ceremony of removing the foreskin to be hygienic and healthy. However, the study by the Schneider physicians, published in the pediatric journal the Archives of Disease in Childhood and headed by Prof. Yaakov Amir, found that circumcision conducted by a mohel leads in many cases to infections of the urinary tract that can significantly endanger the baby.
The researchers believe the infection is caused by the bandage left on the penis after circumcision. "For several years, we have noticed a wave of urinary tract infections among very young children - usually from the age of eight days on," Amir said. "We decided to investigate the phenomenon, and obtained figures from several hospitals."
Researchers identified 162 cases of babies under two months old undergoing hospitalization for urinary tract infections. Of these, 108 were boys and 54 girls. "We saw the same phenomenon in each hospital - a wave of urinary tract infections around the ninth day after pregnancy," he said.
"By contrast, among girls there was no such wave, but a gradual rise in cases over the first year of life. So it was clear to us that this issue is related to circumcision."
In addition, they found urinary tract infections to be far more common among babies who had undergone circumcision by a mohel rather than a physician. "There are children in Israel who undergo circumcision by a doctor. We saw that there is less infection among them than among those who had the procedure performed by a mohel," Amir said. "Without appropriate and intensive treatment, the bacteria could reach the blood, possibly even causing death."
"When the mohel finishes cutting, he takes a piece of dressing and wraps it around the member. That's the root of the problem - the bandage doesn't allow the baby to urinate completely. The baby sometimes stays for 15 or 20 hours with this bandage, and if the circumcision is performed before Shabbat, it is sometimes two days before the mohel removes the bandage," Amir added.
Menachem Fleischman, a mohel who supervises new members of the profession in the central region of the country, said they must be aware of the effect the bandage could have. "It is preferable that the bandage does not press too hard. One must pay attention, and a mohel who is adequately trained will make sure to surround the area with special cotton wool right after cutting."
To the abstract.
Chronogram (Hudson Valley, NY)
More than a snip
Re-examining Infant Circumcision
Being from England, I reached adulthood without even knowing that there was such a thing as the routine circumcision of newborn boys. In Europe it is rare, and it is estimated that between 80 and 95 percent of men worldwide are uncircumcised. But when I married an American and gave birth to a boy in the Hudson Valley, I learned that most boys are circumcised as a matter of course in the US. I informed my husband that I was against it for our child and he agreed. ...
... the fact that a baby cannot give his own informed consent bothers activists such as Georganne Chapin, a health care executive and attorney who has taught bioethics. She is leading the formation of Intact America (www.intactamerica.org), a new organization, based in Tarrytown, dedicated to abolishing infant circumcision. Ms. Chapin’s own prediction is that “it will only be a short time before we realize that circumcision cannot cure our ills, and coercing vulnerable people to give up a critical part of their anatomy is a bioethical travesty.”
Circumcision hype deludes young men.
The kindest cut: How circumcision is the secret weapon in the battle against HIV/Aids
In Zambia, an experiment in the battle with HIV/Aids is producing staggering results. If this were a vaccine trial, the medical world would be hailing it as a miracle. But instead of a wonder drug, the secret weapon is circumcision. Jeremy Laurance reports
After weeks of waiting, Michael Phiri decided to take matters into his own hands. The 16-year-old from George Compound, a township outside Lusaka, was so anxious to be rid of his foreskin, and so frustrated after being turned away from the circumcision clinic at the University Teaching Hospital for the third time, that he took a bread knife and did the job himself. The resulting bloody mess had one positive outcome; it sent him straight to the top of the queue for surgery, and he got his operation performed, as an emergency, by the urology specialist Kasonde Bowa.
"He had made a good start, with a dorsal cut as far as the rim of the glans, but things had got difficult from there," a smiling Dr Bowa says, with admirable understatement.
As Zambia's leading expert on circumcision, Bowa tells this story (the patient's name has been changed) to illustrate the soaring demand for the procedure that is sweeping Lusaka and other towns across sub-Saharan Africa, as word spreads of its remarkable preventive power.
[Yes, and the panic at Orson Welles' 'War of the Worlds' proves there really WAS a Martian invasion.]
Circumcision, if rolled out across the continent, offers the first real prospect of saving lives by preventing infection on a significant scale. [The total number of cases supposedly prevented - or more accurately, deferred - in the three trials, involving 10,908 men, is - 73.]
Surveys have shown wide acceptance of the procedure and increasing interest among parents wanting the operation for their children. [Cutting parts off is easy when it's someone else's parts.]
... President Yoweri Museveni of Uganda dismissed the proposal as the West's latest "golden calf" which Africa was expected to worship and warned that it could suck resources from other preventive strategies (a concern shared by some of the charities I spoke to).
... In sub-Saharan Africa, the main driver of the epidemic is multiple concurrent relationships – the practice of taking several lovers at the same time. ... Critics fear that circumcision will encourage men to think they are immune and to ignore safe-sex advice, so increasing risks. ...
At the Society for Family Health's clinic, men are offered an HIV test before the operation, and more than 80 per cent accept the offer. Calls for the test to be made mandatory have been rejected because of concern that it could deter people from seeking the surgery. [And the ones who refuse to be tested are the ones most likely to be infected...]
If something goes wrong, can they sue him for practising medicine without a licence?
Christian parents seek out 'holistic circumcisions'
By NICOLE NEROULIAS Religion News Service
Mark Kushner pulled up to the Watson family’s suburban Philadelphia home a week after the birth of their first son, Colin. In the dining room, he unpacked the tools of his trade: sterilized surgical instruments, topical anesthetic, prayer shawls and a small bottle of kosher wine.
The shawls went back into his black bag. But to Megan and Christopher Watson’s happy surprise, the mohel — pronounced “moyle,” the title for a Jewish ritual circumciser — had copies of several prayers appropriate for the Presbyterian parents to read for the occasion.
“We thank you for the miracle of human experience in the birth of our child,” they recited, as Kushner gently rocked their infant before the procedure. [This part of the miracle of human experience the baby would probably rather go without if he had a choice.]
Kushner, who is based in Philadelphia, and Philip Sherman, a mohel in the New York City area, say they have performed more than 30,000 circumcisions since training together in Israel in the 1970s. Most of their business comes from traditional brit milah ceremonies for 8-day-old Jewish boys. But in recent years, they have increasingly catered to Christian families who eschew a hospital procedure in favor of a $300 to $800 house call — a trend Sherman has dubbed “holistic circumcision.” [Giving it a New Age woo-woo name makes no difference to the baby. They could call it "teddy bear circumcision" and it would still be the same old genital cutting.]
“They want their babies circumcised in the comfort of their homes surrounded by family and friends, and they want it performed by someone highly experienced, who brings spirituality and meaning to the practice,” he said. “And it’s over in 30 seconds, compared to what hospitals do, which can be from 20 to 45 minutes, with the baby strapped down.” [...waiting for the anaesthetic to take effect.]
Many Christian clients, including the Watsons, liked what they saw at a friend’s brit milah, also known as a bris. Others are conservative Christians who want to follow Old Testament tradition [rejecting the New Testament is generally considered radical in Christians...], or learned about holistic circumcisions from the Internet, their doctors or word-of-mouth, Kushner said.
Yet this anecdotal rise in Christians calling on mohels comes as the U.S. circumcision rate — historically much higher than in other parts of the world — is in decline. In contrast to the 85 percent reported in 1965, just 65 percent of all male newborns in American hospitals were circumcised in 1999, according to the most recent figures from the National Hospital Discharge Survey. Reliable data on religious circumcisions outside hospitals is hard to come by.
Medical studies suggest circumcision may reduce the risk of penile cancer, urinary tract infections and HIV transmission. [From what, to what? Other medical studies suggest it may not.] But since 1999, the American Academy of Pediatrics has stated there is “insufficient data to recommend routine neonatal circumcision.’’
Critics argue the procedure causes physical and psychological pain to a child and diminishes sexual pleasure for adults, regardless of whether the foreskin gets removed in a clinical setting by medical residents or during a brit milah among loved ones.
“It makes no difference to the child who does the cutting, or what is hanging on the wall,’’ said Ronald Goldman, executive director of the Circumcision Resource Center in Boston, and author of two books opposing the practice for Jews and non-Jews alike.
Goldman, who compares circumcision to removing a fingertip, believes “it’s still traumatic. It still removes a natural, healthy, functioning body part.’’ Many families continue the trend only because men want their sons to look like them, he added, and the women don’t feel that it’s their place to argue.
Megan Watson acknowledges that she had mixed feelings about having Colin circumcised, but deferred to her husband’s judgment. [Unfortunately, every child has two parents and it only takes one....] At least at home, she said, they could comfort their son throughout the process, and she could breast feed him soon afterwards.
As Christopher Watson held his screaming baby’s legs still on the tabletop pillow, Kushner snipped the foreskin off the tiny penis. The process took less than a minute. ...
[And there's nothing new under the sun].
Selective use of science
Circumcision in spotlight
A meeting in Johannesburg with a national Aids body and other concerned groups today will put the spotlight on the merits [and the demerits?] of male circumcision in preventing HIV infection.
The forum will include the South African National Aids Council, traditional leaders and civil society organisations.
They will discuss how male circumcision can be implemented in HIV-Aids prevention and treatment policies.
However, Sanac's Sue Goldstein excludes "traditional" circumcision done during initiation ritual. With traditional circumcision, the entire foreskin is not removed, said Goldstein [text missing, perhaps ", and she"] warned that circumcised men were not immune to the virus. [text missing, perhaps "Nor does it offer"] protection to people in homosexual relationships.
[But the entire foreskin was not removed by the forceps-guided method used in the South African or Kenyan randomised controlled tests either - yet the "protection" it gave was as great as that in the other test, in Uganda - which throws the claim that circumcision caused the "protection" into considerable doubt.]
"We would like to help the public by providing empirical and tested information to help make educated choice on health issues, especially around HIV-Aids," said William Mapham of the Reproductive Health and HIV Research Unit. - Namhla Tshisela
Magic or sadism?
Science Versus Religion: Circumcision Debate
BALTIMORE (WJZ) -- A circumcision debate is pitting science against religion. It's the same basic procedure whether it's done in the hospital or the home but, as Sally Thorner explains, there is one major difference.
Two babies--both newborn boys--are having very different experiences. Like 70% of [US adult] males, they are circumcised, but their response is pitting science against religion. What's up for debate is the management of pain during their surgeries.
"The moment that we are waiting for," said Rabbi Moshe Rappaport. "It might be a little uncomfortable, and at the same time, it might be very magical." [And we all believe in magic, don't we?]
In the Jewish religion, a Mohel performs the ritual circumcision, called a bris. Rabbi Rappaport minimizes the baby's pain with a numbing solution and wine for the baby to suck on.
"There's something right when the baby has a natural reaction to a bris and cries for a short time," he said.
While the ritual circumcision typically happens in the home when the baby is eight days old, the medical circumcision happens in a hospital soon after the baby is born.
A baby in the hospital is given Tylenol and sucks on sugar water. The big difference is they receive an injection to numb the entire area.
"It's inconceivable to me that there are even questions about this anymore," said Dr. Myron Yaster.
Dr. Yaster is a pediatric anesthesiologist and an Orthodox Jew. As a physician, Yaster's views on babies and pain trump his religious beliefs.
"Historically, it was long believed that babies or newborns did not feel or remember pain to the same degree that older children and adults do," he said. "We now know that that's completely incorrect."
In a recent study, Canadian researchers found that boys who are circumcised without pain relief are more sensitive to pain later in life.
"The parents are the consumer here. [No, actually, someone else is - but "consumer" is hardly the word. "Victim" is.] Do they want their child to experience the pain or not? There are techniques that are available, very easy to do, very simple that will eliminate the pain," Dr. Yaster said.
"Pain is okay," Rabbi Rappaort said. "It's a ritual, a covenant, a connection." [Actually, it's a disconnection.]
It's religion vs. science and a debate over pain management that doesn't end here.
"Everybody looks at pain as being bad," Rabbi Rappaport said. "Pain demonstrates a connection to your well-being." [Translation: screaming shows he's not dead. Judaism prohibits causing unnecessary pain.]
"You have to separate belief from fact," Dr. Yaster said. "There is belief that my children need to be circumcised but there's also fact: I don't have to do it painfully." [Or could the fact be that they don't need to be circumcised?]
Methods even differ from doctor to doctor. Not every procedure includes a shot to block the pain. Some believe the pain from the shot is as bad as the circumcision itself, so if you decide to circumsize [Should you trust an article about circumcising by someone who can't spell it?] your son, you should ask the doctor or the Mohel how he or she plans to control your baby's pain.
Straining out a gnat, swallowing a camel
Mass testing plan to tackle Aids
• Radical WHO strategy aimed at halting epidemic
A radical new strategy to stop the Aids epidemic in its tracks was proposed yesterday by World Health Organisation scientists but ran into immediate controversy over its implications for human rights.
The plan involves testing everybody for HIV every year in hard-hit areas like sub-Saharan Africa and immediately putting those who are positive on Aids drugs. It could slash dramatically the number of new infections, because Aids drugs lower the levels of virus in the body, making HIV transmission through unprotected sex much less likely.
But the strategy, expounded in a paper published online today by the Lancet medical journal, raises major issues both over implementation and over ethics.
Currently people who are HIV positive are not put on treatment until they need it, because of the toxicity and side-effects of antiretroviral drugs. It raises the prospect of subjecting people to potential medical harm for the public good, rather than their individual benefit. "We wouldn't do that in the UK," said John Howson of the International HIV/Aids Alliance. "These are huge issues."
The authors of the paper include Kevin de Cock, HIV/Aids director at the WHO, who points out that this is a mathematical model for discussion, but says it offers hope at a time when other avenues appear to have closed. If this could be implemented in sub-Saharan Africa, he told the Guardian, "the proportion of people with HIV would run to under 1% in less than 50 years".
In an accompanying editorial in the Lancet, Geoffrey Garnett and Rebecca Baggaley, of the department of infectious disease epidemiology at Imperial College London, say the strategy would be "extremely radical, with medical intervention for public health benefits rather than individual patients' benefits".
It "would reflect public health at its best and at its worst", they say. Treating people earlier could benefit them and protect their partners [unlike you-know-what], but could also expose them to over-treatment and side-effects. "Challenges will rightly come from those concerned about individuals' rights and patient autonomy, as well as from those who moralistically fear an 'easy' solution to HIV rather than behavioural change."
Howson said more effort should be put into interventions known to work, such as circumcision, which can reduce transmission by 60%. "It is important and really interesting," he said. "Let's do some research, but look at the implementation of those other things first."
Women to [be persuaded to] promote male cut
By JOHN NGIRACHU
Spurred on by reports of a significant increase in HIV infections among married couples, health officials want to involve women in the drive to have more Kenyan men undergo circumcision.
Speaking at the launch of the voluntary male circumcision programme at Panafric Hotel, Nairobi on Monday, Public Health and Sanitation assistant minister James Gesami said the ministry would provide free counselling for couples on the benefits [but not the detriments] of male circumcision.
Counselling will be part of Government's strategy to promote the male cut in Kenya, partly funded by the Bill and Melinda Gates Foundation and the US Government.
This follows recent release of data from the Kenya Aids Indicator Survey that shows two-thirds of Kenyan adults infected with HIV are legally married or cohabiting and that in one of every 10 marital unions, at least one partner is living with HIV, forming what doctors call 'discordant couples'.
"There are cases where the husband sneaks out for circumcision and the wife interprets that to mean that he is preparing to become promiscuous, or that it will have an impact on their sexual relations [as it will]... Women have to be involved for the full benefits to be felt," Dr Cherutich said.
He said the one-month healing period may also create problems as women may not understand the need for prolonged abstention from sex.
Parents will also be advised on how to counsel their sons facing "the cut."
Research has also shown that the male cut markedly reduces chances of infection with the human papilloma virus that causes genital warts and cervical cancer - the leading cause of cancer-related deaths in Kenya - by between 60 and 70 per cent.
It also reduces chances of infection with venereal diseases. ...
Grey area? What grey area? | Grauzone? Welche Grauzone?
The foreskin is a grey area
Male circumcision is part of the religion of many Jews and Muslims. However, opponents of the practice claim that it is seldom legal. Now a controversy over discrimination has flared up.
By Cigdem Akyol
This little boy thinks that circumcision is stupid, too.
For some it is just a small cut, for many Jews and Muslims, it's an important procedure: The removal of the foreskin. Religious circumcision has now triggered a controversy between the Islamic community Milli Görüs (IGMG) and authors contributing to the German physicians' paper Ärzteblatt. Engin Karahan of IGMG, which represents 87.000 members, accuses the authors of an article, published in August, of severe discrimination and paternalism.
In the essay "Criminal consequences even when religiously founded", the physicians Maximilian Stehr, Hans-Georg Dietz and the lawyer Holm Putzke advice against religious circumcisions without medical necessity. They argue that the removal of the foreskin is "not just an insignificant physical loss, and it is therefore a violation of bodily integrity". By performing it, the operating surgeon could be commiting an offence of bodily injury. Whether a physician practicing in Germany is obliged to circumcise children for religious reasons hasn't been legally regulated yet. While critics refer to the endangerment of the children's physical integrity, proponents argue with the fundamental right to freedom of religion.
Because of this legal grey area, there is no uniform procedure in Germany. Karahan gives an account of desperate parents who are not able to find a specialist to perform the circumcision of their sons. In 2006, a Turkish pensioner was fined in Düsseldorf because he had circumcised small boys even though he didn't have a medical education. In his defense, the man said that he would be considered a respected circumciser in Turkey. There, it would not be the physicians' responsibility to perform these procedures.
Holm Putzke knows that his article has hit a nerve that is already frayed. "Freedom of religion is not unrestricted", Putzke says and warns about a legal vacuum in an area concerning fundamental rights. "We must be able to discuss a taboo topic, too. Because this is the only way integration [of immigrants] will work." Karahan doesn't understand this perspective, though. On the contrary: He accuses the lawyer of partiality and lack of understanding. "A similar article by Putzke was sent to many physicians without solicitation. What does he intend with this action?", Karahan asks. "If I wrote an article about livestock breeding, I wouldn't send it to all farmers." [If it warned that some methods of livestock breeding could be illegal, one might.]
Ulrich Hofmann, president of the German Society for Child Surgery, is familiar with the heated debate. "We are in Germany, and here German right is valid", he says. His recommendation for his colleagues is to cover themselves with contracts. Because one day, the circumcised might sue the physicians.
Streit wegen Beschneidung
Die männliche Beschneidung ist für viele Juden und Muslime Teil ihrer Religion. Rechtens aber, behaupten Gegner, sei sie selten. Jetzt ist ein Streit über Diskriminierung entbrannt.
VON CIGDEM AKYOL
Findet die Beschneidung auch doof: kleiner Junge. Foto: dpa
Für die einen ist es lediglich ein kleiner Schnitt, für viele Juden und Muslime ein wichtiger Eingriff: die Entfernung der Vorhaut. Diese religiöse Beschneidung hat nun einem Streit zwischen der islamischen Gemeinschaft Milli Görüs (IGMG) und Autoren des Deutschen Ärzteblattes ausgelöst. Massive Diskriminierung und Bevormundung wirft Engin Karahan von der IGMG, der 87.000 Mitglieder angehören, den Verfassern eines Artikels vor, der im August veröffentlich wurde.
In dem Aufsatz "Strafrechtliche Konsequenzen auch bei religiöser Begründung" raten die Ärzte Maximilian Stehr, Hans-Georg Dietz und der Jurist Holm Putzke von religiösen Beschneidungen ohne medizinische Notwendigkeit ab. Denn die Entfernung der Vorhaut stelle einen "nicht nur unerheblichen Substanzverlust dar, sie ist mithin eine Verletzung der körperlichen Unversehrtheit", bei der sich der Operateur wegen Körperverletzung strafbar machen könne. Ob ein Arzt hierzulande Kinder aus religiösen Gründen beschneiden muss, ist juristisch nicht eindeutig geregelt. Während Kritiker auf die Gefährdung der körperlichen Unversehrtheit der Kinder hinweisen, argumentieren Befürworter mit dem Grundrecht der Religionsfreiheit.
Wegen der rechtlichen Grauzone gibt es auch kein einheitliches Vorgehen in Deutschland. Karahan erzählt von verzweifelten Eltern, die keinen Fachmann finden, der eine Beschneidung ihrer Söhne durchführen will. So wurde 2006 ein türkischer Rentner in Düsseldorf zu einer Geldstrafe verurteilt, weil er als Nichtmediziner kleine Jungen beschnitten hatte. Der Mann verteidigte sich: In der Türkei gelte er als angesehener Beschneider, und es sei dort nicht die Aufgabe von Ärzten, diese Eingriffe durchzuführen.
Holm Putzke weiß, dass er mit seinem Artikel einen bloßliegenden Nerv getroffen hat. "Es gibt keine unbeschränkte Religionsfreiheit", so Putzke und warnt vor einem rechtsfreien Raum bei grundrechtlich geschützten Bereichen. "Ein Tabuthema muss auch besprochen werden können. Denn nur so kann Integration funktionieren." Eine Sichtweise, die Karahan nicht nachvollziehen kann, im Gegenteil: Er wirft dem Juristen Einseitigkeit und Verständnislosigkeit vor. "Ein ähnlicher Artikel von Putzke wurde unaufgefordert an viele Ärzte versendet. Welche Intention steckt dahinter?", fragt er. "Wenn ich einen Beitrag über die Tierhaltung schreibe, sende ich den auch nicht allen Bauern zu."
Ulrich Hofmann, Präsident der deutschen Gesellschaft für Kinderchirurgie, kennt die hitzige Debatte. "Wir sind in Deutschland, und hier gilt deutsches Recht", sagt er und empfiehlt seinen Kollegen, sich vertraglich abzusichern. Denn vielleicht klagen irgendwann mal die Beschnittenen gegen die Ärzte.
Iraq's Kurdish areas prepare to ban female circumcision
ARBIL, Iraq (AFP) — Parliament in Iraq's northern autonomous region of Kurdistan is preparing to outlaw female circumcision, according to a woman MP and doctor who has long battled to halt the widespread practice.
"A bill making circumcision illegal will be presented in parliament over the next few days," Dr Hala Suheil told AFP, saying it would impose jail terms and fines on offenders. ...
"This practice began in the region so long ago, and we have no idea where it comes from. But the ancients justified it by saying it would preserve a girl's chastity," said Dr Suheil, adding that no precise statistics are available.
"Old women circumcise young girls using barber's razors and even shards of glass, often causing terrible haemorrhaging and sometimes death," the MP said.
Sheikh Sayyed Ahmad Abdel Wahab al-Panjawini, imam of Arbil's Hajj Jamal mosque, said "iIt may be an old custom, but it has nothing to do with Islam.
"No religious text mentions this practice. It is a custom that some have introduced to the Muslim way of thinking."
In a recent article in the Kurdish daily newspaper Hawlati, the secretary general of the Islamic Women's Union, Bekhal Abu Bakr, wrote that "female genital mutilation is not a Muslim practice."
"Many of the problems experienced by women are the result of erroneous traditions, and Islam is not to blame," she said.
"Sharia (Islamic law) is a long way from such practices, and circumcision exists because some people interpret the Koran in a false manner," she said, alluding to obligatory male circumcision. [Male circumcision is not mentioned in the Qu'ran.]
Cracks in the ice....
Male circumcision should be cut
While there are laws preventing female genital mutilation in Denmark, there are none preventing male genital mutilation. Demands for action.
The Children's Council and the Chair of the Ethical Council say it is objectionable and ethically indefensible that while there is a law preventing female genital mutilation, no such law exists for males.
Both the Jewish, Muslim and other traditions call for the circumcision of males. In Denmark, the Chief Rabbi Bent Lexner carries out the circumcision of Jewish boys. Muslim circumcisions are often carried out in clinics or hospitals.
"There is a deep problem here. Society is in no doubt that the genital mutilation of girls is unacceptable - but we accept it with boys and have tolerated it for many years because it is linked to religion. It is gender discrimination from birth that we make a distinction between boys and girls," says Gulberg, who adds that circumcision should be banned for boys under 15 years of age. According to tradition, young Jewish boys are circumcised at the age of eight days.
"There is an ethical problem. I would prefer people to wait until the child is 15, thus respecting his right to choose and so that he knows what is going on. I believe that one should not undertake physical procedures that leave lasting scars or have lasting effect until a child is 15. And there should be some discussion as to whether the procedure should be ritualised in another way. In Denmark we have also stopped putting a child's head completely under water during baptism," says Agger. ...
Edited by Julian Isherwood
Flere kræver omskæring af drengebørn forbudt
Formanden for Det Etiske Råd, Børnerådet og en række fagfolk mener, omskæring af drenge under 15 år skal forbydes. Men hverken jøder eller muslimer vil sløjfe ritualet Debat (9)
Laura Elisabeth Schnabel
Det er dybt kritisabelt og etisk uforsvarligt at foretage religiøse omskæringer på små drengebørn, som det er tilfældet indenfor jødedommen og islam. Det mener blandt andre Børnerådet og Det Etiske Råds formand, der er forundret over, at der er en lov for pigeomskæring og ikke for drengeomskæring.
Herhjemme er det overrabbiner Bent Lexner fra Det Mosaiske Troessamfund, der fører kniven ved de jødiske drenge, og han har omskåret mere end 1000 drenge i en periode på godt 30 år. De bliver efter religiøse regler omskåret, når de er otte dage gamle. Men det bør ikke være lovligt, mener Børnerådets formand, Charlotte Guldberg.
- Det er dybt problematisk. Vi er fra samfundets side ikke i tvivl om, at omskæringer af piger er uacceptabelt, men ved drengene accepterer vi det og har tolereret det i mange år, fordi omskæringen knytter an til en religion. Det er kønsdiskrimenerende, at man allerede fra fødslen skelner mellem piger og drenge, siger Charlotte Guldberg, der mener, omskæring bør forbydes på drenge under 15 år.
Det Etiske Råd har ikke en samlet holdning til omskæring, men formand Peder Agger er ikke på forhånd afvisende overfor at lovgive på området.
- Det er et etisk problem. Jeg vil foretrække, at man ventede, til barnet er 15 år og dermed respekterede barnets selvbestemmelse, så drengen selv ved, hvad der foregår. Man bør, efter min mening, ikke foretage fysiske indgreb med blivende ar eller følger, før barnet er 15 år. Og man bør overveje, om det kunne ritualiseres på en anden måde. Vi er eksempelvis i Danmark også holdt op med at stikke hele barnet ned under vandet, når det skal døbes, siger han.
And he uses the m-word...
The Times (South Africa)
Listen, boys: the snip is just a false sense of superiority
Andile Mngxitama says initiation is not culture but a backward, useless tradition that should be broken
Our collective reaction to the abduction, frog-marching and mutilation of Fikile Mbalula into manhood calls for reflection on the national values that we want to cultivate and instil in our young men.
We fail to undertake such a process at our peril, especially now that our national political discourse is tainted with the “tribal” poison. When Mosiuoa Lekota says the “ANC is run by boys”, we know he is directing his message to the primordial Xhosa chauvinism which militates against being led by the uninitiated.
But therein lies the contradiction.
Although Lekota is railing against tribalism, he is at the same time saying that until a Xhosa male is initiated, he cannot be regarded as a man and therefore cannot be charged with the responsibility of running the ANC. He is, in other words, reinforcing a useless and dangerous throwback tradition that continues to pass as culture.
What happened to Mbalula is a national disgrace and an act of sheer callousness, a vile manipulation of “culture” to serve narrow, provincial party-political ends.
We must ask earnestly: what does it mean to be a man? ...
Never mind the elephant in the room
Foreplay is overrated, researchers claim
EC to open private wards for botched circumcisions
By Gabi Khumalo
Eastern Cape - The Department of Health will soon provide private wards in hospitals throughout the Eastern Cape Province to accommodate patients who are admitted to hospital due to botched traditional circumcisions.
Health MEC Pemmy Majodina made the announcement to 4 000 residents in Lady Frere attending the National Council of Provinces (NCOP) Parliamentary seating in the Chris Hani District Municipality.
MEC Majodina told residents that the department wanted to separate the patients while giving dignity and upholding the customs and cultures of South Africans.
"We can no longer mix the people who are coming from circumcision schools with those that have not gone to the circumcision schools in our hospitals due to certain complications," she said.
Ms Majodina said the mandate of her department was to save the lives of people noting that her department could no longer afford any deaths during the circumcision period.
"The young people who undergo circumcision are the future of this province and if we want to grow the economy of this province, we need to make sure that they return from the circumcision schools healthy," she said.
In April, the department appealed to communities and parents in the province to report illegal initiation schools to the police and the department while ensuring that no more young boys.
This follows the death of four boys after being rescued from various initiation schools in the province.
Themed "Parliament Empowering Communities for Poverty Eradication", the NCOP is in Lady Frere for the week to listen to the people as part of its programme of taking parliamentary sessions to the people.
Over the next few weeks hundreds of young boys throughout the Eastern Cape are expected to flock to circumcision schools to seek passage to manhood.
Male circumcision and HIV infection
Clutching at straws to prevent the HIV/AIDS epidemic has included strident advocacy for male circumcision (MC) from some quarters, especially following three randomised controlled trials from South Africa, Kenya and Uganda in 2006 - 2007 that show a protective effect of MC. Three contributions in this SAMJ contest the value of MC in the prevention of HIV.
Connolly and colleagues1 analysed a sub-sample of men aged 15 years and older who participated in the first population-based survey on HIV/AIDS in 2002. Of the men 35.3% were circumcised. The factors strongly associated with circumcision were age >50, rural blacks and speaking SePedi or IsiXhosa. Blacks were significantly older (mean 18 years) compared with other race groups (3.5 years). Among blacks, circumcisions were mainly conducted outside hospital settings. Since they found that circumcision and HIV were not associated, they concluded that MC had no protective effect in the prevention of HIV transmission. They also noted that most circumcisions among indigenous ethnic groups in South Africa are conducted under unsterile conditions.
Non-therapeutic, non-religious circumcision is the surgical procedure most commonly published about. Sidler, Smith and Rode2 note that substantive indications for the procedure are lacking and review the evidence for the possible value of neonatal circumcision in reducing HIV infection rates. They cite reviews that question the necessity of non-therapeutic infant circumcision, showing that it has neither short- nor long-term benefits, and other reports that circumcision does not prevent sexually transmitted diseases. On this basis they conclude that neonatal non-therapeutic circumcision to combat the HIV crisis in Africa is neither medically nor ethically justifiable. Furthermore, promoting circumcision might worsen the problem by creating a false sense of security and therefore undermining safe sex practices. Education, female economic independence, safe sex practices and consistent condom use are proven effective measures against HIV transmission.
The accompanying editorial by the Myers team of father and son3 largely concurs with the findings of the two papers. They therefore suggest that the duty of parents may to be err on the side of caution, and defer the procedure until the child can make an autonomous decision. At a societal level MC may be unjust in so far as it could compete for resources with more effective and less costly interventions and disadvantage women.
Neonatal circumcision does not reduce HIV/AIDS infection rates
D Sidler, J Smith, H Rode Non-therapeutic, non-religious circumcision is the surgical procedure most commonly published about,1 but substantive indications are lacking. Since its introduction to the USA during the Victorian period, when it was thought that it prevented masturbation,2 medical justifications for the procedure progressed to prevention of various infective conditions (sexually transmitted diseases, penile and cervical cancer) and controlling of the sexual drive. ...
Finally, the WHO and UNAIDS appear to be basing these multi-million-dollar prevention programmes on limited and in some instances biased information. In order to prevent confusion and parents making misguided decisions on behalf of their infants, and to offer effective help in alleviating the suffering that is being created by HIV/AIDS, a much broader review process would be called for. Such a process would involve more objective scientific opinion, and the involvement of a representative panel of African experts, such as paediatric surgeons and neonatologists.
Rolling out male circumcision as a mass HIV/AIDS intervention seems neither justified nor practicable
Two articles1,2 published in this issue address male circumcision (MC).
Connolly et al.1 show in a national survey that MC, whether pre-pubertal or post-pubertal, has no protective effect on acquisition by males of HIV infection as measured by prevalence.
Sidler et al.2 state that neonatal MC continues to be promoted without adequate justification as a medicalised ritual, via an HIV prevention rationale. They caution that for MC to be a therapeutic as opposed to a non-therapeutic procedure, it is necessary to gather more corroborative and consistent evidence of its benefit, consider the potential harms (psychological, sexual, surgical and behavioural/disinhibition), examine the ethical implications, and examine effectiveness and efficiency (costs and benefits) at the population and societal levels. They point out that MC is not just a technical surgical intervention – it takes place in a social context that can radically alter the anticipated outcome. At the 2008 International AIDS Conference3 in Mexico cultural, political and educational issues raised by the intervention, such as decreased condom use and marginalisation of women, were hotly debated. Some cultural interpretations may view MC as a licence to have unprotected sex. A case in point is Swaziland, where men are flocking to be circumcised with the understanding that this means they no longer need to use other preventive methods (e.g. wear condoms or limit the number of sexual partners).4
The 2003 Cochrane review5 of observational studies of MC effectiveness concluded that there was insufficient evidence to support it as an anti-HIV intervention. Three randomised controlled trials (RCTs) from South Africa, Kenya and Uganda in 2006 - 2007 show a protective effect of MC. However, Garenne6 has subsequently shown from observational data that there is considerable heterogeneity [inconsistency] of the effect of MC across 14 African countries. Despite the South African RCT showing a protective effect, he reports for the nine South African provinces that ‘there is no evidence that HIV transmission over the period 1994 - 2004 was slower in those provinces with higher levels of circumcision’. Interestingly, in both Kenya and Uganda, where two of the RCTs were done, a protective effect of MC was observed, but a harmful effect was observed in Cameroon, Lesotho and Malawi. The other eight countries showed no significant effect of MC.
These somewhat discordant findings are difficult to interpret. While RCTs are theoretically strong designs, it is conceivable that their findings are not generalisable beyond their settings. Furthermore, there have been no trials of neonatal MC. Study flaws such as inability to obtain double blinding, and loss to follow-up in RCTs, may effectively degrade their quality to that of observational studies. Meanwhile other disturbing findings referred to by Sidler et al. are emerging, including the reported higher risk for women partners of circumcised HIVpositive men, disinhibition, urological complications, relatively small effect sizes of MC at the population level, and relative cost-inefficiency of MC.
Not all objections to MC as an HIV intervention have to do with evidence of effectiveness or cost. Sidler et al. raise ethical objections. Owing to the current climate of desperation with regard to the HIV epidemic, evidence in favour of MC frequently seems overstated. This reduces the scope for informed consent and autonomy for adult men considering the procedure. Further problems arise in the case of neonates whose parents may be considering the procedure. Whereas informed consent is at least possible for adult men, it is clearly not possible for neonates. Parents can only guess what the child’s wishes would be if he were presented with the information they have at their disposal. If it could be shown that circumcision was necessary in the neonatal period, parental consent on behalf of the neonate would be justified. But since no valid surgical indications for circumcision exist in this period, and the future benefit to the child in respect of HIV avoidance is not relevant before sexual debut, the duty of parents may well be to err on the side of caution, and defer the procedure until the child can make an autonomous decision. In the absence of compelling indications, a procedure such as circumcision could also be seen as a violation of the child’s right to bodily integrity. Furthermore, the ethical principle of non-maleficence cannot be upheld as there are clear harms attached to this practice, to which Sidler et al. refer in their article. Lastly, at a societal level MC may be unjust insofar as it could compete for resources with more effective and less costly interventions7 and disadvantage women.
Despite a strong pro-circumcision lobby driven by enthusiasts who have been promoting MC as an (HIV) intervention for many years, and impatience expressed by protagonists about the long delay after the 2006 - 2007 RCT results and the UNAIDS/WHO policy recommendations8 of March 2007, few mass campaigns have been launched in African countries.
Given the epidemiological uncertainties and the economic, cultural, ethical and logistical barriers, it seems neither justified nor practicable to roll out MC as a mass anti-HIV/AIDS intervention.
1. Connolly C, Simbayi LC, Shanmugam R, Nqeketo A. Male circumcision and its relationship to HIV infection in South Africa: Results from a national survey in 2002. S Afr Med J 2008; 98: 789-794.
2. Sidler D, Smith J, Rode H. Neonatal circumcision does not reduce HIV infection rates. S Afr Med J 2008; 98: 764-766.
3. Male Circumcision: To Cut or Not to Cut (dedicated session, 7 August). AIDS 2008 – Mexico City 3-8 August 2008 – XVII International AIDS Conference. http://www.aids2008.org/Pag/ PSession.aspx?s=41 (last accessed 8 August 2008).
4. Swaziland: Circumcision gives men an excuse not to use condoms. http://www.irinnews. org/Report.aspx?ReportId=79557 (last accessed 7 August 2008).
5. Siegfried N, Muller M, Volmink J, et al. Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD003362. DOI: 10.1002/14651858.CD003362.
6. Garenne M. Long-term population effect of male circumcision in generalised HIV epidemics in sub-Saharan Africa. African Journal of AIDS Research 2008; 7(1): 1-8.
7. New study shows condoms 95 times more cost-effective than circumcision in HIV battle. http://www.prweb.com/releases/2008/08/prweb1151894.htm (last accessed 7 August 2008).
8. WHO/UNAIDS Technical Consultation Male Circumcision and HIV Prevention: Research Implications for Policy and Programming. Montreux, 6 - 8 March 2007. Conclusions and Recommendations. http://data.unaids.org/pub/Report/2007/mc_recommendations_en.pdf (accessed 25 August 2008). October 2008, Vol. 98, No. 10 SAMJ
Uganda Health News: UCA to study male circumcision
The Executive Director of the Uganda Aids Commission (UCA) Dr. Kihumuro Apuuli has said that starting next month the organization will conduct research on the effectiveness of male circumcision on preventing the spread of HIV/AIDS in the country.
The disease is one of the leading causes of deaths in the country and the recent World Health Organization (WHO) report indicated that the prevalence rates have increased in the country despite government efforts to control it.
HIV/AIDS is mostly affecting women, children and the poor people especially in the rural areas which lack adequate medical facilities.
The UCA boss told journalists in Kampala yesterday that if the study is successful, it will help to compl[e]ment the existing ABC strategy.
Meanwhile, experts are skeptical on the new strategy recommended by WHO, they argue that HIV/AIDS prevalence rates is still high [in] Muslim dominated countries where the majority are circumcised.
The fight against HIV/AIDS in Uganda has been hampered by poverty, high illiteracy rates, bad cultural practices and corruption in the health sector.
The three former ministers of health Jim Muhwezi, Mike Mukula and Alex Kamugisha are still facing charges for mismanaging billions of Global and GAVI funds money meant for the treatment of HIV/AIDS, Tuberculosis, Malaria and Immunization.
The Secret World of Female Circumcision
- Juliet Torome
NAIROBI - As a child in rural Kenya, I was a secret admirer of female genital mutilation. I was swayed by talk of friends and elders about how once a girl undergoes "the cut," she gains respect and grown men consider her suitable for marriage. Perhaps these were the reasons why, as a girl of 13, I longed to be "circumcised" and become a "real woman."
My mother opposed the practice, however, because she was (and remains) a Christian and wanted me to become educated and to escape the fate of many girls in my community who are married off to older men and then lose their autonomy. I tried to persuade my mother to permit my circumcision, but she refused.
My mother's decision angered me. In frustration, I spoke with a few other schoolgirls. Each of them gave a different version of the process, but they held a common view: circumcision is intensely painful, and I must be prepared for much bleeding. And yet the friends to whom I spoke encouraged me to get circumcised.
So one August, during my school holidays, I decided to learn more about female genital circumcision. I decided to witness a girl undergoing the practice, and perhaps see her cry and bleed. If possible, I would talk to her later in order to gain a clearer picture of her experience. I
went ahead with my plan and witnessed a girl being circumcised. The experience changed my life, but not in the way I expected. Before the operation, traditional heroic songs were sung, while a few older women sharpened their knives, preparing for the task ahead. They also prepared special herbs for use as disinfectants. I paid little attention to their preparations, actually. My eyes were fixed on Lillian, a girlfriend who was waiting to be cut.
When the women began their work, Lillian's expression turned from giddy anticipation to fear and then panic. I thought she might change her mind and run for her life.
I was mistaken. She sat on a traditional stool and spread her legs wide apart. An old woman bent over her, knife in hand. I looked away and heard a sharp scream. The scream was swallowed by cheers from scores of women watching Lillian with me. They celebrated Lillian's mutilation, while I mourned her loss.
In my mind, Lillian was experiencing the worst moment of her life. In an instant, my view of female circumcision changed forever. While the women around me kept cheering, I resolved that from then on I would resist the practice with all my might.
Because of my mother's support, and my own determination, I succeeded in keeping my body intact. I went on to finish high school and then study journalism in a big city far from home. Today, living and working in cosmopolitan Nairobi, I look back with a mixture of horror and bemusement on my girlhood fascination with female circumcision.
I escaped mutilation, but other girls from my rural Kenyan community continue to receive "the cut" to this day. Only last month, in Narok, the town nearest my childhood village, a 13-year-old girl died after undergoing circumcision as a preparation for her marriage to a man who already had five wives. When the girl died, her father and fiancé conspired to have her body secretly buried in the bush. Kenya's police learned of the girl's death and legal action is being prepared against the men.
But punishment for the perpetrators of female circumcision remains rare. The practice persists, despite legal bans. As a child-welfare officer in Narok told me, "Unless attitudes are changed, efforts to stamp out the practice will be futile."
Parents' attitudes are changing, but slowly. Government can do more, of course. One new initiative calls for local leaders to be dismissed whenever high numbers of girls drop out of school.
The logic is compelling: if girls remain in school, they can avoid "the cut" and early marriage. Once educated, these girls may decide for themselves - as I did - to resist mistreatment at the hands of their family and neighbors.
At the same time, much more needs to be done to combat the practice, in Kenya and everywhere in Africa where it continues. International opposition helps. For decades, activists in the United States and Europe have brought attention to the problem and urged African governments to prosecute perpetrators.
Nevertheless, because female genital mutilation is tied to a wider set of traditional practices involving the control of girl's bodies and minds, and because these traditions have a powerful hold on some Africans, ultimately the practice can be halted only through concerted efforts by Africans themselves. Only if we change the views of our friends and neighbors can more girls escape "the cut" - and never long for it.
Juliet Torome is a staff writer and photographer at The Nairobi Star, a daily newspaper in Kenya.
Dispatch Now 24/7 (South Afirca)
Doc tells of circumcision trauma
A Port Elizabeth doctor has spoken out about her years of traumatic experience of treating botched circumcisions. Dr Mamisa Chabula-Nxiweni was speaking as a panelist during the Dispatch Dialogues at Hudson Park High School in East London on Tuesday night.
The panelists including Prince Zolile Burns-Ncamashe from the Eastern Cape House of Traditional Leaders, Pastor Nicholas Mcoteli from Faith Revival Christian Church, clinical psychologist Mthetho Tshemese and Health Department official Zweliphakamile Dweba.
They were asked to debate whether traditional circumcision was still relevant in the 21st century. [This assumes that it ever has been relevant.]
Burns-Ncamashe defended the old-age rite of passage to manhood, arguing that the misfortunes that have fallen the tradition should not be used as a measure to dismiss its relevance.
But Chabula-Nxiweni shocked the hall when she gave a personal account of seeing scores of initiates experiencing complications, which sometimes led to many of them losing their manhood.
The 61-year old mother of five men, who themselves went through the tradition, said in the past she had had to secretly treat initiates that experienced complications in Motherwell.
"These raised the alarm to me about what was going on. I have experienced so much trauma. Traditional circumcision has been embedded with complications and deaths which kill the original intention of making boys men," said Chabula-Mxiweni.
She recounted how in one incident at a provincial hospital an initiate had his private parts removed because of gangrene.
"He asked me what purpose would it serve if he continued living. I did not know what to tell him because that was his manhood being taken away. I just said God has a plan," she said.
Chabula-Mxiweni, whose personal accounts stirred many responses on how the tradition could be made safer, also related how a married man who had been amputated during circumcision earlier in his life went through a painful divorce because of the incident.
She constantly mentioned elders in Motherwell involved in circumcision who have managed to turn around the situation and that their knowledge should be utilised in the province.
Burns-Ncamashe argued that the deaths during traditional circumcision should not be a determining factor to end the custom.
He said the departure from indigenous wisdom has led to the norms and values of African society being distorted leading to reckless practices. [What makes cutting the most sensitive part of the penis off a "norm" or "value" of African society?]
Uganda: Community bans female circumcision
- By Bonny Apunyu
(SomaliNet) A local Ugandan official said on Wednesday that a community in eastern Uganda that has practiced female genital mutilation "since time immemorial" has banned the ritual.
Chairperson of Kapchorwa district Nelson Chelimo said: "The community decided that it was not useful, that women were not getting anything out of it, so the district council decided to establish an ordinance banning it"
Chelimo said that historically people in Kapchorwa believed that a woman who married without first being circumcised would be stricken for life with various illnesses, but that "those beliefs are really outmoded."
The district official said the campaign to end the practice has been alive in his community for several years, and that in the recent past, educated young women in Kapchorwa have shunned it.
The district council's ordinance will now be submitted to parliament so that it can become law, and subject to enforcement by the national police force.
The United Nations in 2007 passed a resolution that called female genital mutilation a violation of the rights of women and said it constituted "irreparable, irreversible abuse."
The resolution also said the practice increases the risk of HIV transmission [when performed under unhygienic conditions, as does male genital cutting - but at least one study suggests it reduces the risk of sexual transmission], as well as maternal and infant mortality. The UN estimates that between 100-million to 140-million worldwide have undergone the practice.-AFP
A voice of reason
Matters of manhood
The intiation ceremoney is not merely about circumcision, writes Mthetho Tshemese
ON THE weekend of September 6, Fikile Mbalula, former president of the African National Congress Youth League (ANCYL), was circumcised under controversial circumstances in Phillipi, Cape Town.
Newspaper reports suggested that Mbalula was not aware that he was going to be circumcised and that ANC national executive committee members, Nyami Booi and Tony Yengeni, together with ANC Western Cape provincial secretary Mcebisi Skwatsha, orchestrated the process. [i.e. They ambushed, hijacked, kidnapped and mutilated him.]
One newspaper identified Mbalula’s traditional surgeon as 73-year-old Maduna Nqabeni from Gugulethu. The paper quoted Nqabeni saying: “Laa ntwana (that boy) was not informed about the circumcision. But now he has accepted what has happened. He is going to graduate and become a man and is looking forward to that.”
Mbalula’s going to the bush got tongues wagging, including my own. We were shocked that he had not been to initiation school.
Considering that Mbalula got married a couple of years ago, one finds it difficult to believe Mbalula family spokesperson Goodenough Kodwa’s assertion that Mbalula wanted to go for initiation four years ago.
If anything, it would seem that Mbalula did not particularly embrace the notion of traditional male circumcision and initiation into manhood.
Interestingly, his older brother, Jabu, formerly chairperson of the National Youth Commission, is also reported not to have undergone initiation.
Following news of Mbalula’s circumcision I had a discussion with friends who had gone through the initiation process. I asked if indeed traditional male circumcision and the initiation of boys into manhood, as it is currently practised, adds any value to the development of healthy masculine identities in those who undergo the process.
I also asked if traditional male circumcision, in its current form, is of any relevance to the needs of our society. While the discussion was vibrant and interesting, it was marked by intolerance and irritation at my even asking these questions. [Yes, that is a typical response to any questioning of circumcision for any of the myriad reasons given for doing it.]
Some felt that such questions should not be asked. One friend told me off, saying:
“You should know better. Having gone through the process yourself, you know this is our culture. Why must people question our traditions and who we are, yet no one questions others about what they do?” [But they should, and do.]
By asking these questions my friends felt I was “betraying” our culture. I was also being “othered” – deemed to be like those outsiders who questioned and criticised our traditions.
Those who are pro the ritual almost always advance this argument, which is based on the view that those who have not personally gone through ritual should not be talking about it.
But silencing and labelling people is not going to solve the problems we face. I still believe that there is a need to critically engage on the subject.
In the past decade, botched circumcisions that have lead to hospitalisation, amputations, and an escalating death toll have tarnished the reputation of the ritual.
Delinquent behaviour by initiates at initiation schools has raised serious questions about what young boys get taught at the schools.
Two examples come to mind. In one an Eastern Cape initiate was arrested on a rape charge and had to appear in court before the ritual was completed. In the second, stolen items, including television sets and other electric appliances, were found inside an initiate’s hut.
The upshot of all these factors have been calls from certain quarters for the ritual to be abolished, with some labelling it as barbaric, backward, and unconstitutional.
Ironically Mbalula’s case – if he was indeed abducted and forced to go to the bush – may well raise questions on an issue of constitutionality.
But most of the negative publicity and the criticism centres around the circumcision aspect. Some people have wrongly reduced the entire initiation process to being only about circumcision.
To my understanding the initiation of boys into manhood is a process which involves, yet is much bigger, than circumcision. It is a process that aims to teach the young initiates about respect for self and others, their family responsibilities, community leadership, and about carrying their family names with integrity.
The outcomes are largely dependent on the initiate’s support structure.
That we see a lot of initiates and “new men” behaving in ways that are not consistent with what Xhosa culture (broadly speaking) expects of men, tells us that it is fallacious to think that going to the bush automatically translates into maturity.
Perhaps the question that should be asked is: Are the good, responsible and respectful Xhosa men that we have in our society like they are because they went through traditional male circumcision and initiation? Or even more generally: Are the kind of Xhosa men we have in society a reflection of what is taught during the initiation process?
In other words, when trying to understand the Xhosa masculine identity with all its complexities, fluidity and the consequent behaviours associated with it, how much can be attributed to what initiates are taught during the initiation process?
And the dreaded question – is traditional male circumcision and the initiation of boys into manhood still relevant today?
These are very tough questions which don’t have simple answers.
I am in no way suggesting that traditional male circumcision and the initiation process is unimportant. If anything I am arguing that given its importance to those who practise it, we should be trying to critically look at whether the manner in which it is being practised today is achieving that which it is designed to do.
Traditional male circumcision and the initiation of boys into manhood is an ancient cultural ritual still practised by many worldwide.
In South Africa amaXhosa, like the amaNdebele, baPedi and vhaVenda are among those practising the ritual.
While it is widely practised and accepted as the punctuation of one’s identity and status as a man, it should not be seen as a once-off event, but rather a process that is matched by actions that symbolise, in Xhosa culture, maturity and growth from a child to an adult.
It has also changed with time to suite different contexts and practical demands. For instance, in the Eastern Cape the ritual used to take place in winter, but we have seen the summer holidays becoming a very busy season for initiates .
The desired outcome of the entire process, one could argue, is psychological rebirth. It demands renouncing old, childish, irresponsible – boyish behaviour if you will – thinking and behaviour and embracing maturity and responsibility to become well-adjusted citizens.
To give a glimpse of how this psychological rebirth is conceptualised, framed, and articulated, one can look at how people responded to Mbalula’s initiation. As the news of his going to the bush surfaced people started linking his usually abrasive and sometimes reckless comments and actions, as the then ANCYL president, to the fact that he had not been to initiation school.
One commentator remarked: “Now we understand why he acted in the manner in which he did. It should be expected that a boy acts disrespectfully from time to time because he is a boy and is just being himself. Now that he is a man he will behave differently because of what he will learn from the bush.” It is clear that this particular commentator assumes that every initiate will be changed by the process and the learning in the bush, with the clear and undisputable results being a more respectful and mature man.
But the commentator’s remarks oversimplify the matter somewhat. The fact that Mbalula’s older brother, Jabu, is said never to have undergone initiation himself, yet has a calmer, more well-measured way of dealing with political issues, challenges his view.
It remains to be seen whether Fikile’s political tact and public commentary will change now that he has been to the bush. And should they do so and he becomes less confrontational, would it be correct to simply attribute this to him having gone to the bush?
I hold the view that traditional rituals, including male circumcision and initiation of boys into manhood, do play a meaningful role in the development and enhancement of those who practise them. However, sentiment should not be the dominant consideration for people to practise these rituals. Instead their relevance should be based on the desired positive contribution that the rituals are set out to achieve.
When there are serious problems with the rituals, as we have seen with traditional male circumcision, all those involved have a duty to demonstrate that the positive contribution to people’s lives outweighs any harm caused by practising the ritual.
In a country where social ills such as violent crime, violence against women and children, alcohol and drug abuse, absentee fathers, and HIV/Aids are rampant – any initiative aimed at making better men is welcome.
The question then, that those who are pro-traditional male circumcision should ask themselves, is whether the ritual contributes meaningfully to making better men? And more pointedly, is the ritual responsive to the challenges we face in today’s society?
# Mthetho Tshemese is a clinical psychologist who grew up in Mdantsane and is now based in Johannesburg
Scientists running first to the media - like the cold fusion research
Sunday Monitor (Uganda)
'Circumcision to prevent HIV' is giving people false information
There is research suggesting that circumcising men help reduce the chances to contract HIV. Dr. Francis Mwesigye Runumi, the acting Director of Health Policy Planning and Management in the Ministry of Health talked to Jennifer Bakyawa about the relevance of the medical male circumcision research results
In December 2006, the Rakai Health Sciences Programme released results of a clinical trial on medical male circumcision. Were these results relevant in terms of policy for Uganda?
We were highly interested given that our main task is to find several practical interventions that can curb the HIV/Aids pandemic. But here was someone claiming to have conducted a study in Rakai on male circumcision and found it to have protective chances. We wanted more details given that we didn’t discuss the proposal; didn’t know the methodology; how the results had been collected and analysed; and the confidence levels that led them to adduce their claims.
There was a social debate on how Aids has been killing Muslims who were circumcised. How come researchers went to a community and found circumcision to be a preventive measure. If it is preventive in any way, we would have seen Muslims dying less than other religions and tribes that don’t circumcise. The researchers were appealing to the Ministry to pursue this as one of the prevention policies.
Reactions were mixed: some people thought it was preventive. A strong side said the study was irrelevant because people have circumcised, still contracted the disease and died. Telling the whole population to circumcise is giving them false information. They would get multiple sexual partners and may die like any other Muslim and tribes that circumcise for religious and cultural practices have been dying. We wanted more information before the Ministry took it up as one of the prevention strategies.
What did the Ministry do when the results were released?
Still, questions came up: How many people have been circumcised for a long time but still die? That is when we went a little deeper to understand the possibility of not contracting the disease can be enhanced by being circumcised. Still, there are some doubts. When we look at the cohort of circumcised people that died, there isn’t much difference with the one Rakai is claiming.
You said the researchers released the results in the media. Could they have approached this issue of releasing the results differently?
With time, this picture was corrected. This was something very big. Even when the President (Museveni) heard about it, he wondered if this is something we should push forward. He demanded for an explanation that would convince people that this is a real strategy for recommendation. The President has been an activist in Aids prevention. This was going to interfere with his ABC drive.
Releasing results to the media excited debate about the research but questions were coming to us, yet we had not exchanged views with researchers.
You said that the Director General of Health Services (Dr. Sam Zaramba) invited the researchers to brief him about the study results. What ordinarily would be the ideal approach for communicating research findings?
As policy makers, we could advise the researchers to investigate something else based on their results so that everyone sees the final picture. It could lead to a strong policy that would solve some pertinent problems the country is grappling with. When researchers get results they should endeavour to look for people who move things and are likely to use the results. They should discuss the results with them before sharing them with the broad community through the media. ...
"carry out the operation" - this might aptly be called "circumrape"
East AZfrica, by Lucienne and Aaron
Circumcision and the wedding
... The Minister of Health here in Kenya (one of 40 ministers by the way) has recently encouraged men to go for ‘the cut’ to reduce the risks of HIV/AIDS. We have not been able to verify this claim yet, but health clinics all over Kenya are now overcrowded with young men wanting to undergo the operation. In some remote villages, young men in groups go around looking for uncircumcised men and if they manage to find one, they carry out the operation themselves ...
That's one step backward for a boy ...
Circumcision of Muslim boy not a crime - Finland's Supreme Court
A circumcision performed on a Muslim boy in Finland was not a penal offence, Finland's Supreme Court (KKO) decided Friday in a precedent setting case.
The Supreme Court decision concerned a Muslim mother who was charged with assault or incitement to assault for asking a doctor to circumcise her four-year-old son.
Previously the Tampere district court had ruled that the incident constituted assault, but did not issue a sentence for the mother.
The Turku intermediary court ruled that the mother's conduct did not constitute a penal offence.
However, according to the Supreme Court a circumcision done for religious reasons helped the son in the development of his identity. [This is a bizarre ruling: what does it mean?] The operation also helped him to become attached to his religious and social community. [So is this. He's four. How do they know if he will ever want to "become attached to his religious and social community"?]
The court decided that the child's parent was allowed to decide on the operation as it was not against the interests of the child. The boy's bodily integrity was violated only a little and as the operation was conducted under local anaesthetic, it did not cause the child unnecessary suffering.
Doctors know better
Etusivu » Finnish Medical Journal » English summaries
Circumcision of boys in Finland - a questionnaire to Finnish paediatric surgeons
We sent a questionare to surgeons treating children’s phimosis and performing circumcision in Finland. We received responses from 90% of the hospitals, including 39 surgeons. 74% of the responders were paediatric surgeons and 18% were resident paediatric surgeons. They came from all parts of Finland so that the whole country was well covered.
The incidence of operative treatment of phimosis has declined during the last ten years in Finland. The most common operation for adolescent balanitis xerotica obliterans is still circumcision. Preputial plasty is the most widely used method for prepubertal boys. Physiological phimosis is seldom an indication for operative treatment in patients under age of 5 years. Topical steroids are widely used in first line treatment of phimosis. The operation is selected on the basis of discussions with patients and parents. All operations are performed under general anesthesia.
Non-medical circumcision is not performed in Finland except in a few hospitals. The most important reason for not performing cultural circumcision is that the total usefulness of the operation is questionable and that it does not benefit the boy’s health. Circumcision does not belong to Finnish culture. The condition for performing a cultural circumcision is the informed consent of the boy himself. Over one third of the responders accept cultural circumcision only if it is performed by medical professionals, under general anaesthesia, and the costs are paid by the boy’s parents. One third of the respondents, however, demanded criminalization of cultural circumcision of boys.
Timo Hurme M.D., Paediatric Surgeon, Turku University Hospital
Finnish Medical Journal 2008;63:2781–6.
International Journal of Men's Health
New Study Shows Condoms 95 Times More Cost-Effective than Circumcision in HIV Battle
Results of a new study, “The Cost to Circumcise Africa,” published in the International Journal of Men’s Health, that compares the cost of male circumcision to the cost of lifetime distribution of free condoms in sub-Saharan Africa, found that condom distribution is 95 times more cost-effective in preventing the same number of infections.
“Some might call circumcision an ‘HIV vaccine,’ but its moderate, supposed-effectiveness, along with its very high cost and practical dangers, makes it a questionable and risky preventative,” said co-author Ryan McAllister, PhD, Biophysics, Georgetown University, Washington, DC. “Condoms succeed 99% of the time, while circumcision, at best, fails about half the time.”
“Male circumcision is too costly to justify in the HIV battle. Even if circumcision does offer some protection against heterosexually transmitted HIV, condoms clearly provide much more protection, at a much lower cost,” said study co-author and Wellness Associates founder, John Travis, MD, MPH. “It just doesn’t make sense to perform mass surgeries in a region of the world struggling to meet the most basic healthcare needs, especially when there are more cost-effective plans for achieving the same results.”
The study’s findings suggest that behavior change programs are more efficient and cost-effective than surgical procedures. In addition, condom usage provides protection for women as well as men. This is significant in an area where almost 61% of adults living with AIDS are women.
Featherbedding on the circumcision front
Elder says he never backed cut
By MAURICE K’ALUOCH
The chairman of the Luo Council of Elders, Ker Riaga Ogallo says that he was arm-twisted to endorse the male cut among the Luo community.
Ker Ogallo said that the whole affair had been turned into a cash cow by individuals and NGOs bent on enriching themselves.
He claimed that an NGO recently bought a fleet of vehicles and hired a few staff but did not have any structures.
“Our people are still languishing in poverty. No NGO is ready to offer practical assistance.
I am shocked that when it comes to circumcision of Luo youths, an organisation can import 24 new vehicles at once,” he said.
Ker Ogallo was reacting to accusations by elders from Homa Bay District that he had allowed “young politicians to turn our community into a laughing stock”.
Ker Ogallo assured the elders that at no time will he support the male cut, saying the choice was an individual’s.
“I want to tell you that I have weathered a lot of storms and arm-twisting to endorse male circumcision among our people.
I have however stood firm and will not accept it,” he said.
West African first ladies to join fight against female circumcision
OUAGADOUGOU (AFP) - First ladies from seven west African countries gather here Monday for a conference on ways to end female circumcision, a widespread practise in the region despite efforts to end it.
The three-day meeting will "discuss transboundary practices of circumcision in the region to better fight against the scourge," presidential spokesman Saidou Ouedraogo said.
First ladies from the west African countries of Benin, Ivory Coast, Ghana, Mali, Niger, Togo and Burkina Faso are due to participate, he said.
Female circumcision, or female genital mutilation (FGM), is common in some 30 African countries despite major awareness-raising campaigns and ever-tougher laws against the practise.
Burkina Faso is a case in point. Nearly half the country's women are circumcised according to a national committee on the issue.
The tradition continues despite new legislation stipulating prison sentences against FGM practitioners and their accomplices.
The Monitor (Kampala)
Uganda: Circumcision gone wrong
When the blowing of horns and playing of kadodi started in January through May to August announcing the arrival of the ritual of circumcision amongst the Bamasaba, Rogers Wareba, like many other boys, declared his intentions to be circumcised. He never imagined that getting circumcised would cause serious health consequences by damaging his urethra to the point of having to use a catheter to pass urine.
"I was set for Imbalu this year to initiate me into manhood, so the talk about the knife was not an issue. What I wanted was to get circumcised traditionally and not shame my parents and ancestors or be declared a misfit in society," Wareba recalls.
He says that during the ordeal, he felt unusual pain in the urethra and bled but that traditionalists told him that he would heal with traditional care using herbs like it is done amongst all Bamasaba. "But after sometime, there was no change and my parents opted for hospital when I failed to pass urine. The doctors then inserted the catheter.
It is very painful but I don't have a choice because I need to heal and pass urine normally," says Wareba. He is not the only victim though. Records by doctors at Mbale Regional and Bududa Referral hospitals have registered and treated many such cases.
Although the tradition of circumcision (Imbalu) has come a long way, it is still disturbing to think of how these boys brave the crude knife even when there are hospitals that carry out circumcision in more hygienic and modern conditions.
Wareba however says that traditionalists don't regard medically done circumcision highly, saying it is for cowards and social misfits and that once circumcised that way, one would never be a leader in the clan nor preside over clan meetings.
Although medical experts have long recognised that circumcision has health benefits, they condemn traditional circumcision especially amongst the Bamasaba as an easy way of contracting diseases like HIV/Aids and that it is partly responsible for urethral complications amongst boys. [Partly? What else is responsible?]
A surgeon at Mbale Regional Hospital, Dr Peter Wakalyembe says that on many occasions, the traditional surgeons use one unsterilised knife to circumcise many candidates besides not using of gloves and failure to wash hands that put the candidates at risk of not only septic wounds but also transmission of new infections.
"There are already three cases admitted at Mbale Regional Hospital due to this traditional careless crude circumcision. One of them has had his urethra destroyed and he can't urinate. There could be many others ignorantly rotting in the villages," said Dr Wakalyembe.
He said that although there are research findings that male circumcision can protect men from contracting HIV by about 60 per cent, use of unsterilised knives for circumcision exposes candidates to risks of wound contamination, infection and spread of HIV/Aids, adding that research done by Communication Partnership revealed that although actively involved in circumcising, about 80 per cent of the surgeons lack training in the basics of circumcision, hygiene and health risks involved in the crude practice which explains why many children like Wareba are suffering the consequences.
A senior consultant surgeon at Mbale Regional Hospital, Dr Jaffer Balyejjusa said whereas under medical circumcision which he has been doing for the last 16 years great emphasis is put on hygiene, treatment, management of bleeding and treatment of the wound, they are all lacking in traditional circumcision.
"Besides wound contamination, infection and spread of disease due to poor hygiene, traditional surgeons make many mistakes during circumcision which have left many boys bleeding, taking long to heal and getting deformed," he said.
The Ministry of Health is working with Makerere University School of Public Health and Health Communication Partnership and has already started education and sensitisation programmes in Bugisu through community meetings, debates and Signal Radio spots to address such problems.
A local radio station is putting emphasis on promoting safe medical male circumcision under good hygiene, but the traditionalists are yet to cooperate.
PNG man arrested over $5 circumcisions
By PNG correspondent Steve Marshall
A Papua New Guinea man has been arrested for performing circumcisions on young boys in the belief that the operation would reduce their chances of contracting HIV/AIDS.
Police arrested the elderly man after he recently performed 10 circumcisions on boys aged between 10 and 15 years old for $5 each.
The operations took place at the man's house using razor blades, no [an]aesthetic and leaves dipped in liquid to heal the wounds.
Traditional circumcision is used for manhood rituals in some areas in PNG, but not in Enga province where these procedures took place.
The young boys believed circumcision would greatly reduce their chances of contracting HIV/AIDS and other sexually transmitted diseases.
Police have charged the man with inflicting grievous bodily harm.
The truth starts to emerge
South African Medical Journal
Male circumcision and its relationship to HIV infection in South Africa: Results of a national survey in 2002
Catherine Connolly, Leickness C Simbayi, Rebecca Shanmugam, Ayanda Nqeketo
Objective. To investigate the nature of male circumcision and its relationship to HIV infection.
Methods. Analysis of a sub-sample of 3 025 men aged 15 years and older who participated in the first national populationbased survey on HIV/AIDS in 2002. Chi-square tests and Wilcoxon rank sum tests were used to identify factors associated with circumcision and HIV status, followed by a logistic regression model.
Results. One-third of the men (35.3%) were circumcised. The factors strongly associated with circumcision were age >50, black living in rural areas and speaking SePedi (71.2%) or IsiXhosa (64.3%). The median age was significantly older for blacks (18 years) compared with other racial groups (3.5 years), p <0.001. Among blacks, circumcisions were mainly conducted outside hospital settings. In 40.5% of subjects, circumcision took place after sexual debut; two-thirds of the men circumcised after their 17th birthday were already sexually active. HIV and circumcision were not associated (12.3% HIV positive in the circumcised group v. 12% HIV positive in the uncircumcised group). HIV was, however, significantly lower in men circumcised before 12 years of age (6.8%) than in those circumcised after 12 years of age (13.5%, p=0.02). When restricted to sexually active men, the difference that remained did not reach statistical significance (8.9% v. 13.6%, p=0.08.). There was no effect when adjusted for possible confounding.
Conclusion. Circumcision had no protective effect in the prevention of HIV transmission. This is a concern, and has implications for the possible adoption of the mass male circumcision strategy both as a public health policy and an HIV prevention strategy.
S Afr Med J 2008; 98: 789-794
Havnig been intact Jews all their lives, why change now?
Third of FSU immigrants avoid circumcision
By JUDY SIEGEL-ITZKOVICH
Almost a third of male immigrants from the former Soviet Union are uncircumcised, according to a survey by the Geocartography Institute commissioned by the Jerusalem AIDS Project.
The project encourages circumcision here and abroad to reduce the risk of AIDS/HIV transmission.
Of those who have undergone ritual circumcisions, 37.3 percent had the procedure here and 5% had it performed when they were over 50. One percent underwent circumcision while they were in the I[srael ]D[efence ]F[orces].
Fewer than half had a brit mila at the halachicly required age of eight days.
The survey also found that 2.2% of women who immigrated from the FSU "didn't know" whether their partner was circumcised, and 72.8% of female partners of uncircumcised new immigrants would prefer that they don't undergo ritual circumcision.
Since 1990, when the major wave of immigration from the FSU began, half a million adult males have made aliya [migrated to Israel].
The Jerusalem AIDS Project said Monday that some 80,000 adult immigrants from the FSU and Ethiopia had undergone circumcision with a local anesthetic in a surgical theater.
Oh admit it! It doesn't protect.
No proof circumcision cuts gay male HIV risk: study
By Will Dunham
WASHINGTON (Reuters) - There is not enough evidence to say circumcision protects men from getting the AIDS virus during sex with other men even as studies show it protects them when having sex with women, U.S. researchers said on Tuesday. [Look how they rush to undo the story and defend circumcision, without even the courtesy of a comma to give us breath. 37 words is long for an opening sentence.]
A review of 15 studies involving 53,567 gay and bisexual men in the United States, Britain, Canada, Australia, India, Taiwan, Peru and the Netherlands failed to show a clear benefit for those who were circumcised, researchers from the U.S. government's Centers for Disease Control and Prevention said.
Circumcised men were 14 percent less likely to be infected with the human immunodeficiency virus, or HIV, than those who were uncircumcised, but the finding was not statistically significant, the CDC researchers said.
"You can't necessarily say with confidence that we're seeing a true effect there," said the CDC's Gregorio Millett, who led the study that appeared in the Journal of the American Medical Association.
"Overall, we're not finding a protective effect associated with circumcision for gay and bisexual men," Millett said in a telephone interview.
Studies involving men in Africa, where the AIDS epidemic is primarily spread by sex between men and women [with multiple, concurrent partners], showed that male circumcision halved the risk of female-to-male HIV infection.
Experts say this reduced HIV risk may be because cells on the inside of the foreskin, the part of the penis cut off in circumcision, are especially susceptible to HIV infection. [Or because the studies were faulty and conducted by circumcision enthusiasts.] The virus also may survive better in a warm, wet environment like that found beneath the foreskin [or inside the vagina].
But whether circumcision might lower the risk of HIV infection in sex between men had remained unclear. Gay and bisexual men play a much larger role in AIDS in many countries outside of Africa, the epidemic's epicenter.
For example, the CDC last week said 48 percent of the 1.1 million Americans infected with HIV are men who have sex with men. More than three-quarters of U.S. men are circumcised.
"We really cannot recommend overall male circumcision as a strategy for men who have sex with men in the United States," Millett said.
The CDC's Dr. Peter Kilmarx, who was not involved in the research, said the agency is preparing formal recommendations on circumcision in the United States, with a draft due to be made public early next year.
Millett said there are signs circumcision might protect certain gay and bisexual men depending on sexual practices.
The virus can be transmitted through blood or semen.
Studies in Australia and Peru showed that men who engaged in insertive anal sex only and were not being penetrated by male sex partners got a significant protective effect from HIV infection from being circumcised, Millett said. [The Australian study involved seven insertive men - and how many circumcised men are there in Peru?]
"Of course, if you're being penetrated by a partner during sex, you being circumcised is not going to protect you from HIV infection," Millett said. [But him being circumcised might put you at greater risk. They didn't measure that.]
Millett said two U.S. studies and one in Peru conducted before the introduction in 1996 of combination drug treatment for HIV infections, called highly active antiretroviral therapy, or HAART, showed that circumcised men were 53 percent less likely to be infected with HIV than uncircumcised men.
That's one small step for a boy ...
Supreme court turns away Oregon circumcision case
The US Supreme Court has declined to hear the Boldt vs. Boldt case in Oregon confirming the Oregon Supreme Court's decision that the boy has a right to have a say about his penis and whether he is circumcised or not.
by Ashbel S. Green,
The U.S. Supreme Court today declined to take up an Oregon dispute between a father who wants to circumcise his 13-year-old son against the wishes of the boy's mother.
The case now goes back to an Oregon trial judge to determine whether the boy wants to undergo the procedure.
James Boldt, a former Southern Oregon resident who converted to Judaism, says his son wants to be circumcised for religious reasons.
Lia Boldt claims her son is afraid to tell his father that he does not want to undergo the procedure.
The Boldts married in the early 1990s. She filed for divorce in 1998.
The boy initially lived with his mother, but the father later gained custody. James Boldt started studying Judaism in 1999 and eventually converted.
James Boldt claims that as the custodial parent he has a constitutional right to raise his son in his religion.
The Oregon Supreme Court earlier this year did not rule on the substance of the dispute, but said the trial judge needed to determine the boy's wishes before deciding which parent to side with.
Tasmania Law Reform Institute
University Law Institute to review circumcision law
The project will review the current law regulating the circumcision of male children in Australia, with particular reference to Tasmania. The project will examine the criminal and civil responsibility of those who perform, aid or instigate the procedure.
In relation to civil responsibility, the project will examine the requirement of informed consent and the unique nature of the procedure (e.g. that it is most commonly performed on neonates; that it is rarely medically necessary; and that it is sometimes performed outside of a surgical setting by people without medical qualifications who vary on the degree of their recognition of the various recommended surgical techniques).
Questions of who may consent or authorise the procedure when children are involved will also be addressed. This will include a discussion of the Family Law Act and the common law upon the question of whether, and if so when, the authorisation of the courts may be required for the procedure. The role of the Child’s consent or otherwise to the procedure will also be discussed in light of ‘Gillick’s Case’  3 All ER 402 and recent High Court decisions.
The possible constitutional, equal protection from the law and discrimination issues that arise depending on whether circumcision is lawful or unlawful currently will also be investigated.
In examining these issues, the project will take account of the law in foreign jurisdictions and international law.
This topic for law reform was suggested by the Tasmanian Commissioner for Children.
An issues paper will be released in 2008.
Back to the Intactivism index page.