Thursday, 24 May 2012

Irish Surgeon: Circumcision Should Never Be Performed

Routine circumcision in male infants is a potentially dangerous and unnecessary procedure, according to a Dublin surgeon, who has dismissed the rationale for the procedure as unproven and without medical justification.

Dublin consultant plastic surgeon Mr Matt McHugh – who has been speaking out against the practice for more than 30 years - said circumcision was a form of genital mutilation that exposed patients to a number of health risks according to

 Writing in the latest issue of Modern Medicine, the Irish journal of clinical medicine, Mr McHugh is reported to have said: "There is no rationale for carrying out this extremely painful, traumatic and potentially dangerous procedure on male infants
"While female genital mutilation (FGM) is banned in Ireland and regarded as a serious assault, circumcision, which is a form of male genital mutilation, is not illegal, with the procedure still undertaken by some doctors."

"Circumcision, like any other operation, is subject to the risk of haemorrhage and sepsis. Infection is also fairly common. Occasionally, infection may lead to more serious complications such as partial necrosis of the penis, or it may be a source of septicaemia."

Mr McHugh said the reasons put forward for circumcision are "unproven and have no scientific basis of fact". 

M McHugh has also spoken out against the practice of circumcision for medical conditions like “phimosis” stating that a "simple dorsal slit" in the foreskin is sufficient to cure the problem.

Most significantly he states that "circumcision is a procedure that should never be performed...It involves a general anaesthetic. It's disfiguring and basically you're removing something that shouldn't be removed".

Wednesday, 23 May 2012

New Statesman highlights Unnecessary Male Circumcision

It's great to see the New Statesman - Britain's weekly left-wing political and cultural magazine - highlighting the issue of Unnecessary Male Circumcision on its blog today.

The magazine is running a week of blog posts from contributors on the theme Let's Talk About Men and journalist Ally Fogg has today become the first reviewer of David Benatar's new book Second Sexism (subtitled Discrimination Against Men and Boys) to address the chapter on circumcision.

Though not looking at the issue in any depth he makes the point that women's rights activists who "campaign against ritual FGM find their argument easier to make if society expressed unequivocal condemnation of ritual genital mutilation of any infant".

For more on Female Genital Mutilation versus Male Circumcision click here.

Saturday, 19 May 2012

Rabbis speak out against circumcision

Circumcision is a “violent” and “barbaric custom”, “deaths and maiming have occurred”, it’s “unnecessary and painful” it’s  an “unimportant part of Jewish life”, there’s “no official place” for it in Judaism anymore and it should be replaced with a ceremony that’s “joyful” and “beautiful” and doesn’t “hurt little babies”.

These are the words of a growing number of Rabbis who are speaking out against Unnecessary Male Circumcision and encouraging members of different Jewish communities to give up the practice.

They include Rabbis in the Reform, Conservative, Reconstructionist and many other branches of Judaism, according to an excellent report at Intact News about Rabbis who are creating a Jewish covenant without circumcision

The quotes from the Rabbis (below) speak for themselves and demonstrate that the religious aspect of Unnecessary Male Circumcision is not the inevitable and impenetrable problem that some commentators would have us believe. 

For Jewish parents who choose not to have a 'brit milah' (circumcision ceremony) an increasing number of Rabbis are perfoming a 'brit shalom' which is a ceremony without the circumcision. 

Here are some of these Jewish leaders speaking about a covenant without circumcision in their own words:

"I believe circumcision is a major mistake……The code of the Jewish law is called "halacha" (the way). Within the Code, there is a provision that if a mother loses a son because of circumcision, she is NOT obligated to circumcise her next son. I extrapolate from this, the inter-connection of my human family, that enough deaths and maiming have occurred because of circumcision. Therefore - circumcision is no longer a requisite! Just as we no longer practice the animal sacrifices in the traditional temple, so let us not sacrifice an important piece of our mammal in the temple of tradition." 
Rabbi Nathan Segal

"When I see the babies crying……and I've spoken with neurosurgeons as well, and I know that babies undergo….a lot of pain. Our faith should be about healing and joy, not about inflicting more pain. And so from my perspective I'm very interested in performing brit shalom. You can do everything you do in that ceremony - except the violent part. Everything works….it's beautiful...that's the beauty of who we are today. We should be joyful and not hurt little babies. I too am rooted in tradition.I've led services in the Conservative synagogues and in the Reform synagogues."

Rabbi Steven Blane

"We're all born into the world vulnerable and in need of people who love us and take care of us…  we depend upon each other for love and protection and that extends in this case I would say also to creating a covenant without circumcision….  There’s no official place in our movement’s philosophy for circumcision… the welcoming ceremony has no place for it… it’s really unimportant actually… most Jewish people who have any of covenant actually focus primarily on how we treat each other…   we’re all in this together folks… we all have to live some kind of ideas… not sacrifices of children’s bits. I think that’s completely absurd at this time in history. I will say that I would not circumcise a child. I think many Rabbis actually if they were going to be honest would say that circumcision is an unimportant part of Jewish life.”

Rabbi Binyamin Biber

"I have already written about my opposition to infant circumcision….. there is finally some momentum building among Jews to do away with this antiquated and barbaric custom.... I cannot imagine why any sane person would put their baby boy through an unnecessary and painful surgery without even the benefit of anesthesia.  Yet, until recently, no one in Jewish leadership has challenged this obsolete and primitive ritual."

Rabbi Jeffrey Falick

 "There is more emotion about eliminating circumcision than perhaps any other traditional practice. But it is time to find a different symbol of a boy's entrance into the community. Instead of cutting our sons, we might celebrate their masculinity. A more appropriate symbol would be a nurturing act, one that would affirm a boy's relationship to a loving father, both his own and that of his God. We might, for example, feed our sons, since a meal is also a traditional symbol of covenant. Indeed, in one text, Moses and Aaron and the elders go up to the top of the mountain, and when they see God, they eat and drink. Feeding our sons, rather than wounding them, would be a symbol of our nurturing relationship to them." 

Rabbi and Professor Howard Eilberg-Schwartz

To find out more about the Jewish community speaking out against circumcision see Jews Against Circumcision in the USA.

Friday, 18 May 2012

UK Atheists Speak Out On Circumcision

The Freethinker - a magazine and website that has been the "voice of atheism" in the UK since 1881, has reaffirmed its opposition to Unnecessary Male Circumcision.

Barry Duke, editor of The Freethinker, has posted an online article declaring his "horror' at news that the pro-circumcision lobby in Australia is calling for more boys to be circumcised. In the same article, Barry highlights the July 2012 mini-conference on preventing circumcision that this blog is supporting.

In his Freethinker article on unnecessary male circumcision Barry says:

"I was horrified to learn earlier this month that 'a group of senior medical experts' in Australia are advocating circumcision for infant boys......I now learn that a conference is to take place to explore how boys might be protected from being unnecessarily damaged by the practice."

The Freethinker has a good track record of featuring articles on Unnecessary Male Circumcision and has a comments section on each article where you can join in the debate.

Thanks to Barry and The Freethinker for highlighting this important issue if you want to visit The Freethinker and join the debate click on this link Freethinking Link now.

Wednesday, 16 May 2012

Male Circumcision and the UN Convention on Children's Rights

  • Article 2 States Parties shall respect and ensure the rights set forth in the Convention to each child within their jurisdiction without discrimination of any kind irrespective of the child’s or his or her parent’s or legal guardian’s race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status.
  • Article 19 The right to protection from all forms of violence, injury, abuse, neglect or exploitation.
  • Article 24 The right to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. Article 24 makes specific reference to the duty of governments to take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children.
  • Article 37 The duty of the government to prohibit torture, or other cruel, inhuman or degrading treatment or punishment.
  • Article 39 requires government to take measures to promote physical and psychological recovery and social reintegration of a child victim of neglect, exploitation or abuse, torture or other cruel, inhuman or degrading treatment or punishment, or armed conflict.
Viewing the issue of Unnecessary Male Circumcision through this filter it is clear that the practice is an imposed violation of a child’s physical integrity and as such could be categorised as child abuse.

Tuesday, 15 May 2012

UK Professionals Gather To Tackle Male Circumcision

The tragedy of a baby boy from Oldham who bled to death after a ritual circumcision raises major concerns for everyone working to safeguard children.

Who is responsible for protecting children at risk of harm from Unnecessary Male Circumcision and what action can professionals take to avoid that risk?

A groundbreaking conference at Keele University in July will provide a space for professionals to engage with the complex issue of reducing the risks associated with Unnecessary Male Circumcision.

Delegates from child protection, health, equality and diversity, human rights, medical ethics and legal backgrounds will gather at the conference to explore how we can prevent more boys from being unnecessarily damaged by the practice.

The Oldham death which will now be the subject of a manslaughter trial later this year; an Oxford report revealing that 45% of circumcisions at an Islamic school led to complications; and research from the charity NORM-UK revealing that as many as 9 out of 10 therapeutic circumcisions could be avoided are just three reasons why the taboo subject of Unnecessary Male Circumcision is now receiving greater attention from the public and professionals alike.

In some areas, such as Bristol, the public sector is working with circumcising communities to increase the number of non-therapeutic procedures carried out in medical settings while in other areas, healthcare professionals have so far resisted calls to use local healthcare settings to provide a medically unnecessary service.

There are also growing concerns that the unequal rights of boys and girls in the UK to be protected from unnecessary genital cutting, could compromise local, national and international initiatives to work with circumcising communities to protect girls from female genital mutilation.

All of these complex issues will be addressed through a series of presentations, question and answer sessions, discussions and facilitated problem-solving workshops at the Keele conference.

The “How To Prevent Unnecessary Male Circumcision” one-day workshop and mini-conference is hosted by the charity Genital Autonomy on Thursday 26th July 2012 at Keele University, Staffordshire.

  • For more information on how to attend The Keele Conference click here
  • For more information on the case of the Oldham baby who bled to death click here
  • For more information on the Oxford report that uncovered a 45% complication rate click here

The Bristol Compromise Part 3: Promoting Male Circumcision

The City of Bristol is at the forefront of tackling Unnecessary Female Circumcision at a local level in the UK – at the same time the city actively promotes, encourages and supports Unnecessary Male Circumcision.

In this post we look at how the city, which takes a zero tolerance approach to any form of Unnecessary Female Circumcision, is at the same time actively supporting, promoting and encouraging Unnecessary Male Circumcision in Bristol. 

Rather than take a zero tolerance approach, its approach is to encourage more parents in the city to circumcise their boys in local health services. A similar approach was proposed by Somali parents in Seattle to support their culture of both circumcising boys and girls (note this compromise was proposed in 1996 not 1966 as the attached linked article suggests – for a much fuller analysis of the Seattle Compromise click here)

In the case of The Seattle Compromise, the idea of symbolically nicking the clitoral hood of Somali girls in medical settings was dismissed, whereas removing their brothers’ foreskins for non-medical reason is permitted.

The same is true in Bristol, in that there is no compromise for Somali girls whose parents cannot turn to health services to perform a small symbolic nick on the clitoral hood (the female prepuce) – and city workers are working to prevent anyone taking a girl living in the city to another country to have this procedure performed. However, parents are encouraged to bring their sons into the city’s health services to have their foreskin (the male prepuce) removed for no medical reason.

Whereas the City’s Leaders call Unnecessary Female Circumcision “Female Genital Mutilation” and take a “zero tolerance” approach to this practice – Unnecessary Male Circumcision has been renamed “Safe Circumcision” and is promoted to local communities by the NHS.

This process of offering to perform Unnecessary Male Circumcision on boys living in Bristol at NHS facilities for no medical reason and long before the child is able to consent to having part of their body unnecessarily removed, began five years ago.

In 2007-08 Bristol Primary Care Trust (PCT) facilitated a dialogue between representatives of the local Muslim community and health care providers around the development of affordable and safe male circumcision services in Bristol. 

Known as the “Bristol Male Circumcision Project”, this process was overseen by the PCTs Equality Lead, David Harris. The result of this process was the creation of an NHS-led health campaign promoting, supporting and encouraging local parents to bring their sons to the “Bristol Circumcision Service” for Unnecessary Male Circumcision which the health service locally now calls “safe circumcision”.

The Bristol Circumcision Service is promoted by NHS sponsored circumcision leaflets carrying pictures of happy, smiling babies, children with their mums and dads and is supported by:

Bristol Male Circumcision Campaign Group

The Bristol Circumcision Service is supported and promoted by the NHS and run by the local Eastville NHS Medical Practice with procedures paid for by the children’s families. A charged service for older boys is provided at the Bristol Children’s Hospital and promoted by NHS consultants at the hospital such as Dr Mark Woodward.

The ethical dilemma that health practitioners have wrestled with is that thousands of boys in the city are at risk of Unnecessary Male Circumcision which has traditionally been performed in synagogues, community centres, restaurants, private homes and other non-medical settings.

This non-medical approach causes complications – in 45% of cases in one study in Oxford – and in the worst cases death – such as the case of the baby boy who bled to death in Oldham.

As it is not illegal to circumcise boys, Bristol’s health bosses have come to the conclusion that the right action to take is not to campaign or advise against Unnecessary Male Circumcision, but to “strongly encourage” parents to use the NHS to circumcise their sons.

What is notable from this process is the absence of the police and the domestic violence partnership and the children’s safeguarding board and local schools – who are actively telling families that female circumcision is “wrong” whilst their NHS partners are “strongly encouraging” the same families to circumcise their sons for no medical reason other than it’s safer than doing it in a local restaurant.

The NHS locally also runs the 4YPBristol website which offers young people in the city information and advice and the issue of circumcision shows up in the advice given to boys about masturbation.

Here the City’s leaders tell young people that it’s “natural and healthy for both boys and girls to masturbate (and) it’s also totally ok if you don’t want to – it’s your body and your choice”.

It’s interesting to note that the same Bristol’s health bosses who are telling boys “it’s your body and your choice” are not applying the principle of “your body your choice” when it comes to removing a boys’ foreskin.

Even though the same health bosses are advising boys that removing their foreskin will have a negative impact on their sexual experience and inhibit their ability to masturbate in a “natural and healthy” way saying:

“The most common way guys masturbate….basically involves the hand ‘pumping’ the penis, making the foreskin go back and forth. This doesn’t mean that guys who have been circumcised can’t do it, but they need to be more careful in case the area gets sore. Lube can help with this.”

The other significant group missing from this process is Bristol's Jewish community which, it seems, continues to practice the ritual circumcision of baby boys in community settings without recourse to the NHS's "safe circumcision" service. 

Finally, in addition to Unnecessary Male Circumcision being performed in community settings and NHS facilities in Bristol, the procedure is also available for non-medical reasons in a private circumcision clinic.

The overall message that the City of Bristol's leaders are giving to parents who want to perform medically unnecessary rituals on their children's genitals is that for GIRLS we have a zero tolerance approach and for BOYS we strongly encourage you to use are tax-payer supported service.

Click on the links below to read to the two related posts:


Monday, 14 May 2012

UK trails Norway in moves to end circumcision after baby death

Leading authorities in Norway – where a 2-week-old baby boy has died from circumcision complications – are calling for a ban on Unnecessary Male Circumcision in Norway.

The state ombudsman for children, Reidar Hjermann, has proposed the introduction of a lower age limit for non-medical circumcisions of 16 or 18 which would effectively ban ritual circumcision.

In the UK, the authorities have been conspicuously silent about the need to tackle Unnecessary Male Circumcision despite the fact that a UK midwife was charged with the manslaughter last month after a  baby who bled to death

In Norway, Trond Markestad, a pediatrician and leader of the Norwegian Medical Association (NMA) ethical council, believes that circumcising a boy on non-medical grounds is unethical and “should not be a prioritized public responsibility.” 

“This is a medically unnecessary procedure, with the threat of complications, and is done to a person that can not give consent” he said. 

Other notable organisations calling for ban include the Norwegian Humanist Association and the Medical Faculty of Oslo Universitu. A spokeswoman for the Justice Policy Centre, Jenny Klinge, said ritual circumcision of young boys should be banned in line with the country’s laws protecting girls from circumcision.

The news from Norway places further pressure on leading organisations to speak out against the practice of Unnecessary Male Circumcision in the UK.

Sunday, 13 May 2012

The Bristol Compromise Part 2: Tackling Female Circumcision

The City of Bristol is at the forefront of tackling Unnecessary Female Circumcision at a local level in the UK – at the same time the city actively promotes, encourages and supports Unnecessary Male Circumcision.

We introduced this subject in our previous post The Bristol Compromise: An Unequal Approach To Tackling Genital Mutilation.

This post focuses on the groundbreaking work currently undertaken in Bristol to tackle Unnecessary Female Circumcision (also known as Female Genital Mutilation). There are two reasons for doing this. Firstly it enables us to contrast this work with the approach the city takes to tackling Unnecessary Male Circumcision. Secondly it gives us an understanding of the type of work we might want and expect the public and not-for-profit sector to be undertaking to tackle Unnecessary Male Circumcision in the future.

Bristol has come under the national spotlight recently after a local Muslim leader, the Imam Mohammed Abdul, was filmed advising members of his community to "take women and girls abroad so they can be circumcised legally" according to reports in the Daily Mail, the Sunday Times and local press

The city is committed to tackling what’s become known as Female Genital Mutilation (FGM) with “social workers and health professionals working together in Bristol to convince communities that female genital mutilation is abuse” – according to an excellent report on tackling FGM in Community Care magazine.

The breadth of activity is impressive. FGM has become an issue of international concern with the United Nations Population Fund (UNFPA) and UNICEF working together to end female gential mutilation/ cutting 

At a national level FGM is covered in the Home Office’s strategy to end violence against women and girls and is covered in legislations by the The Female Genital Mutilation Act which not only makes it illegal to carry out FGM in the UK, but also makes it illegal to support FGM happening in anyway. For example advising parents on where they can take their daughters to be circumcised abroad is illegal – even if the practice is lawful in that country. 

At a city level Female Genital Mutilation sits within Bristol’s definition of domestic violence and abuse and is tackled as part of a citywide Violence and Abuse Against Women and Girls Strategy which is overseen by the Bristol Domestic Abuse Forum (BDAF)
which involves a broad range of partners including the council, the NHS, the police, charities and community and voluntary organisations.

In addition to the work of the BDAF, the city’s Local Safeguarding Children Board (LSCB) is proactive in tackling FGM.

Every area of the country is required to set up and run a LCSB under the Children Act 2004 – the intention is that these boards co-ordinate and quality assure the activities of any local organisations involved in safeguarding children.

What this demonstrates is that when it comes to tackling Unnecessary Female Circumcision in Bristol – there is a huge weight of support from the UN, the UK government and the city’s leaders that enables that work to take place. 

Within this context people are empowered to speak out about this difficult issue. For example a small group of women staged an anti-FGM march, a local Labour MP has backed anti-FGM campaigns and so have Bristol Labour Students. Even groups as diverse as the South West Nationalists  and the Bristol Feminist Network have an opposition to FGM in common.

At the heart of the city’s drive to combat FGM is Jackie Mathers, NHS Bristol’s designated nurse for safeguarding children, who co-ordinated the development of the city's FGM prevention strategy which is overseen by Bristol's Female Genital Mutilation (FGM) safeguarding group (which is a subgroup of the Bristol Safeguarding Children Board).

A key plank of the strategy is to ensure that all practitioners working with children and families know how to spot FGM and if they become aware of a victim, make a child protection referral.

In addition, a broad range of activities in the city are helping to support Bristol’s drive to end FGM:

The Bristol Healthy Schools Project - which is supported by the Department of Health, the Department of Education and the NHS runs Safeguarding Children and Female Genital Mutilation (FGM) awareness raising training and recommends that every school in the city send at least 2 members of staff on this training. The aim of the course is train staff how to spot children at risk of FGM and know how to make a referral to child protection agencies when they identify female genital mutilation or have concerns that female genital mutilation may be practiced.

The charity FORWARD (The Foundation for Women's Health, Research and Development) -  has been awarded a £30-40,000 contract for outreach work with community groups and hosted a conference Ending Female Genital Mutilation (FGM) Together in Bristol.

Sessions to encourage men to help stop FGM have been backed by Detective Chief Inspector Dave McCallum of Avon and Somerset Police backing the drive and calling on men to break their silence on FGM.

A local campaigner from the Somali Community, Nimco Ali, has co-founded a campaign group Daughters of Eve.

Another community initiative, the Somali Development Group was commissioned by the Government Office South West  and the Home Office to “produce a program to empower and protect young girls from FGM”.

Students in the city made a film aimed at raising awareness of female genital mutilation (FGM) and highlighting the myths surrounding the subject. The 12-minute drama-documentary, called Silent Scream, was been made by 27 Bristol students aged between 14-17. The film was screened locally and won the students a 'Chief Constable's Special Commendation for work to prevent FGM' which was presented by Chief Constable Colin Port, of Avon and Somerset Police.

In September last year BBC Radio 4's Woman's Hour aired a drama documentary on female genital mutilation (FGM) written by a group of Bristol teenage girls who had been affected.

Bristol CSB, Bristol NHS and Forward are running a series of "zero tolerance" events. The third, on 15 February, attracted 65 people, mostly from FGM-practising communities. 

Integrate Bristol, a charity formed to help with the integration and adaptation of young people and children who have arrived from other countries and cultures, has been awarded funding from Lankelly Chase Foundation to host the First National Conference on FGM in Bristol in July 2012. 

Collectively these actions are causing an increase in referrals of FGM cases, more openness with community groups and stronger multi-agency working. All of which demonstrates an extraordinary level of commitment from a broad range of individuals and organisations all taking action to tackle Unnecessary Female Circumcision in city.

Click on the links below to read the two related posts:

Saturday, 12 May 2012

The Bristol Compromise: An Unequal Approach To Tackling Genital Mutilation

The city of Bristol has been in the national spotlight recently after a local Muslim leader, the Imam Mohammed Abdul, was filmed advising his community to "take women and girls abroad so they can be circumcised legally" according to reports in the Daily Mail, the Sunday Times and local press

While it is in fact illegal to help and encourage anyone to carry out the procedure overseas it is perfectly legal for the authorities in Bristol and elsewhere to help and encourage anyone to carry out Unnecessary Male Circumcision without consent and for no medical reason in Bristol's health centres and hospitals. 

And so while Bristol is probably the UK’s most pro-active city in the fight against Unnecessary Female Circumcision (or Female Genital Mutilation) – it is also one the UK’s most proactive cities in promoting and legitimising Unnecessary Male Circumcision. When it comes to protecting boys and girls in Bristol from medically unnecessary circumcision, the City’s leaders have decided that genital cutting and mutilation is an issue that doesn’t cut both ways.

There are many cultures around the world where both male and female genital cutting are common practice. The number of women and girls affected is estimated at around 100-140 million. The number of men and boys affected is around the 1 billion mark. 

And while we are more aware of what is now called “Female Genital Mutilation” (FGM) than ever before in the UK – what most people don’t realise is that the definition FGM covers a broad range of cultural practices including rubbing the genitals with turmeric root, symbolically nicking the clitoris and extreme versions of the practice which involve both cutting and stitching.  

In countries like Indonesia the practice for boys and girls has become increasingly medicalised and sanitized and the majority of Indonesia's quarter of a billion inhabitants - male and female - have been circumcised. 

If you look carefully at the picture of the blade above you will see a small amount of skin cut from a baby girl in one such procedure. The picture  is taken from an eye-opening article comparing male and female circumcision in Indonesia.

The purpose of this post is not to defend female genital cutting but to shine a light on the contradictory approach that we are taking to the issue in the UK by highlighting what currently happens in Bristol.

At present mums, dads and community leaders in Bristol’s religious and cultural communities are told by the authorities that performing any form of genital ritual on their daughters – or taking them to other countries like Indonesia to be circumcised in sanitized conditions – is illegal.

At the same time, the same authorities are saying to the same mums and dads and community leaders that while it is perfectly legal for non-medical practitioners to perform medically Unnecessary Male Circumcision on non-consenting babies, you are “strongly encouraged to pay for our NHS service and to avoid using any service which is offered at a community centre, restaurant or private home”.

The justification the city's leaders give for supporting and encouraging Unnecessary Male Circumcision in Bristol's NHS facilities is that it helps local communities meet “religious and cultural requirements”.

The justification Bristol’s city leaders give for opposing Unnecessary Female Circumcision is that it is a “secretive practice” which is “illegal in many countries, including the UK” and that “it is a cultural practice NOT religious”.

So while it is perfectly legal for mums and dads to circumcise their sons in Bristol for cultural or religious reasons – and they are encouraged and supported by the authorities to do so in sanitized conditions; it is illegal for the same mums and dads to circumcise their daughters for cultural or religious reasons in Bristol, or to take them to another country where it is legal to have the procedure performed in sanitized conditions.

Regardless of whether you are for or against parents having the right to perform religious or cultural rituals on their children’s genitals, if you believe in equality then the double standard is obvious.

Bristol City’s leaders state in their Equality and Diversity Plan that their vision is to: “eliminate discrimination…..advance equality of opportunity between people from different groups and foster good relations between people from different groups”.

There is no question that permitting and supporting parents to perform medically unnecessary circumcision on boys but not girls in Bristol is a clear case of gender discrimination.

It is either gender discrimination against boys for failing to give them the same protection as girls, or it is gender discrimination against girls for failing to give them same opportunity to be part of their shared cultural tradition, such as the ritual circumcision of girls and boys from Indonesia.

In future posts we will look at the pioneering work that Bristol is undertaking to tackle unnecessary female circumcision in the city and - at the same time -  how the city promotes, supports and encourages Unnecessary Male Circumcision in Bristol.

Thursday, 10 May 2012

10 reasons to stop male circumcision in fight against AIDS

Unnecessary Male Circumcision is a serious problem in Africa with many young men being killed every year during ritual circumcisions and uncircumcised men being bullied, ostracized and forcibly circumcised.

While the international community condemns and campaigns against any type of female circumcision, far from working to end Unnecessary Male Circumcision, the international community is actively supporting, exporting and expanding the practice across the continent.

The key reason for giving international legitimacy to such a dangerous and barbaric practice is that the World Health Organization and UNAIDS are promoting Unnecessary Male Circumcision in the fight against HIV/AIDS as a result of 3 clinical trials which suggested that circumcision may reduce the number of heterosexual men contracting HIV.

Here we offer 10 reasons why we must stop the use of Unnecessary Male Circumcision in the fight against AIDS:
  1. It’s unethical
  2. It’s hypocritical
  3. It’s based on inconclusive evidence
  4. It ignores what’s happening in the real world
  5. It spreads dangerous myths about circumcision
  6. It puts women at greater risk
  7. It exposes men and boys to more risk
  8. It’s not as effective as other methods
  9. It's a waste of money
  10. It gives credibility to a dangerous practice that kills men and boys 

Most of the reasons listed above are addressed a report published in the American Journal of Preventative Health called : Male Circumcision and HIV Prevention (Insufficient Evidence and Neglected External Validity) by Green et al which you can read in full if you click here now.

It’s unethical because – as Green et al report “male circumcision constitutes the removal of healthy, functional and biologically unique tissue. For fully informed consent to occur, men must be educated about the risks and sensory losses from circumcision as well as made aware that circumcision does not offer full protection".

It’s hypocritical because condemning and seeking to eliminate female circumcision on the one hand whilst encouraging the increase of male circumcision on the other, deomstrates a distinct lack of equality, morality or integrity on behalf of the international community. 

It’s based on inconclusive evidence - according to Green et al, effectiveness levels found in controlled trials are rarely replicated in real-world settings. The three trials that the mass circumcision drive are based on were terminated early, many participants dropped out of the trial and a third of people who contracted HIV in one of the trials, caught it from a non-sexual source. Most importantly participants in the trials received continuous counseling, free condoms and monitoring for infection, which will not be available in real-world campaigns.

It ignores what actually happens in the real world and there is substantial evidence that contradicts the trial results and suggests that real-world population benefıts from male circumcision might be minimal. One analysis of HIV prevalence in sub-Saharan Africa concluded that male circumcision is not associated with reduced HIV prevalence. Another study in South Africa concluded  that “circumcision had no protective effect on HIV transmission.”

About 75% of U.S. men and about 70% of sub-Saharan African men are circumcised—higher percentages than in most other regions or countries with lower prevalence of HIV. In 10 out of 18 African countries surveyed circumcised men had higher rates of HIV than uncircumcised men. And while the trials did find 1.2 in a 100 circumcised men contracted AIDs compared with 2.5 in a 100 uncircumcised men – in Cameroon research has found that 5.1 in a 100 circumcised men have AIDS – three times more than uncircumcised men (1.5 in a hundred).

It spreads dangerous myths about circumcision ­– most notably that circumcision prevents HIV, which it does not. Reports from circumcision clinics have revealed that newly circumcised males are abandoning condoms or have a false sense of immunity from circumcision. Research in South Africa found that 15% of men and women now hold the mistaken belief that circumcision meant they did not need a condom. This belief has been further reinforced by public health officials recently distributing materials listing one advantage of circumcision as being “that men don’t have [to] use condoms”.

It puts women at greater risk – a recent trial has shown that male circumcision increases the risk to women of contracting AIDS – this is thought to because they resumed sex before their circumcised male partner’s open wound had healded. Women also are placed at greater risk from unsafe sex practices when they, or their circumcised male partners, wrongly believe that with circumcision they are immune to HIV and therefore they choose not to use condoms according to Green et al.

It exposes men and boys to more risk - A 2008 World Health Organization bulletin stated that more than 1 in 3 (35%) of traditional male circumcisions result in complications and nearly 1 in 5 (18%) clinical circumcisions result in complications. Men who participated in the HIV and Circumcision trial were 4 times more likely to suffer circumcision complications than they were to become infected with HIV/AIDS.

Most shockingly, circumcision can cause death and in South Africa 91 young men died in 2009 died as a result of Unnecessary Male Circumcision.

It’s not as effective as other methods – according to Green et al supplying free condoms is 95 times more cost effective than mass circumcision. A mathematical modeling analysis, presented at the 2009 International AIDS Society, revealed that in terms of cost effectiveness, the use of  condoms  and anti-retroviral treatments are way ahead of  male circumcision.

It’s a huge waste of money – as well as being less cost effective than giving our free condoms, from a public health perspective Green et al observe that it is diffıcult to justify promoting expenditures of scarce healthcare resources on a risky surgical procedure for HIV prevention in areas of the world that continue to lack clean water, adequate food supplies, and the most basic medical care, much less sanitary surgical conditions.

It gives credibility to a dangerous practice that kills men and boys – at a time when international opposition to female circumcision is growing stronger and louder, it seems only right that we should adopt a zero-tolerance approach to Unnecessary Male Circumcision.
Doing otherwise  - and worse still promoting the mass practice of male circumcision as a surgical prophylactic – gives credibility to a dangerous practice that damages and kills men and boys in Africa and can lead to those who choose to remain intact being brutally and forcibly circumcised.