Friday, March 18, 2011

Why does infant circumcision still exist?

Culture is the one word that encapsulates why this practice still exists.  Culture covering the whole spectrum of social life including: religion, community, tribal practices, belief systems, Scientific values, Cultural Myth making, Cultural taboos, & Cultural shaming practice.  These cultural reasons are reinforced by the practice iteslf which has components of trauma, pain and anxiety, which can manifest as obsessiveness in individuals. Look at the obsessive lengths people go to, including scientists and medico's to promote the practice.
1Culture Non-Religious = In this instance we have a cultural set of beliefs and practices, including institutions, high profile individuals from media to medicine, Friends, Family, & Community leaders who are Saying "circumcision is good and that natural anatomy (the foreskin) is bad."  Very difficult issue to deal with but predominantly extensive education is required, and a variety of persuasion strategies from predominantly gentle coaxing & education, to "rarely as a last resort" aggressive shaming tactics (Giving the Pro-Circers a smell and taste of their own medicine), Knowing your audience is important, in which persuasion strategy to use.
Cultural Belief Systems = "The foreskin is of no value, it is a useless flap of skin."  "Circumcision is a harmless procedure and the baby won’t feel a thing."  The new one: "Circumcision is like a surgical vaccine, and circumcision is the only way I can achieve these health benefits for my child."  While clearly false with strong evidence that disputes these cultural beliefs, many people still believe these strongly contested circumcision myths. The answer here, is to challenge these beliefs with education, such as healthiest longest lived people with lowest STI's/HIV are non-circumcision people.
2.       Obedience to Medical Authority = Medical personal have an esteemed position in most cultures and strongly influence people.  "If my doctor says I need to do it, then it must be right."  Some people have been bought up to defer to medical authority, and that the Doctor always knows best.  Doctors are human beings and are susceptible to personal bias, prejudice, errors, false beliefs, greed, ignorance, incompetence, medical negligence, unethical behaviour, and cultural conditioning.  In many ways doctors can be cultural ambassadors.  This belief in the infallibility of the medical profession needs to be challenged with opinions from the world-wide consesus of respected medical authorities that recommend against infant circumcision.
3.      Cultural Religious obligation = This is the most difficult one to deal with.  Ultimately it is from within the religious community that change needs to occur.  Some Jews have created an alternate ceremony that does not involve circumcision (Brit Shalom). Even a small minority of muslims are rejecting the practice.  Respect and dignity is required here no matter how much or how strongly we disagree.  When we go too hard on religion we usually get a severe backlash, however, I believe Scofield's San Francisco legislation proposal is a great way to highlight the ethical and legal issues of infant circumcision, and its connotations for religious circumcision.  Dont fall for or buy the anti-semetic tag, refer to the increasing numbers of Jews and Jewish groups that are anti-circumcision as well.
4.      Tribalism = The father who says “ I want him to look like me” is not really thinking about his son at this very moment, but instead his own need for his son to belong to the no-foreskin tribe.  Take a deep breath, and slowly educate and persuade.  What the father is not thinking about and needs to be reminded of, is that circumcision is harmful, there are risks in the procedure, the foreskin is functional anatomy and it is a human rights violation of his son. Tribalism constructs its own social reality and can be deconstructed and reconstructed to a higher moral level of functioning, particularly as we know more and know better.
5.       6.       Investment in the procedure = Some parents, having already circumcised feel very invested and defensive about the procedure, very difficult to change or persuade in this case, all of the above suggestions apply.     Many in the medical profession who have circumcised 100's if not 1,000's of babies are also very invested in the procedure and also very defensive.  Not easy to persuade here.
7. Scientific research = "The research from Africa says that circumcision will prevent males from getting HIV." This false belief arises out of the supposed infallibility of Scientific Research.  WE need to educate that All scientific research is culturally value laden, and not infallible.  The researcher can interpret data, & emphasise what he/she wants to find or publish, & ommisions can made of what the researcher doesnt want known about his/her research.  Again education is critical here.  Hints when discussing African Research = The research did not prove life-long protection only partial episodic protection. It is not absolute risk reduction only relative risk reduction.  A significant number of circumcised men in the study became infected with HIV, Participants were not treated equally with the circumcised group given more education about healing from surgery, abstained from sex longer, and were given greater time and emphasis about wearing condoms during the period of healing from surgery.  Nearly 10 times as many participants dropped out of the study as were infected, with HIV status unknown. The studies were ended early exagerrating effects. The vast majority of participants in the study were HIV free, therefore, why was no attempt made by researchers to identify the 100% condom users and compare these to the circumcised group, Was 100% condom use more effective than circumcision = Most probably yes!! but researchers did not want to find this and report it.  In another study, Women who had sex with circumcised men were 50% more likely to become infected with HIV.  The reseach is valid only for adult circumcision volunteers, and populations with high prevalence of HIV, not babies or low prevalence nations. Demographic studies in Africa have found many circumcised populations have higher HIV infection rates than non-cirumcised populations.  The USA which circumcises has much higher HIV than western Europe which doesnt circumcise. The strong message here needs to be safe sex and condoms can only prevent HIV, and a false belief in the protection of circumcision places men and women at greater risk of infection.

There are many other reasons and I would invite comments and discussion on the blog.

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