Ok lets have some honesty here, and stop insulting everyone with half a brain. When you object to a German Court Ruling that found "non-therapuetic circumcision of children is a violation of children's individual human rights", by calling it a ridiculous ruling, you insult me and everyone that believes and fights for individual human rights.
The ruling is correct, it is intellectualy correct, it is correct in law, and because it is in accordance with the philosophy of individual human rights, it is therefore therefore morally correct from a human rights point of view. You have a right not to like it because it interferes with your Religious freedom, but that does not make the ruling ridiculous. Be honest, and show some guts and argue openly & publicly why you think religious freedom should take precedence over individual human rights.
Here's some clues for you = If you want to argue for religious freedom, then be intellectually honest about it. Tell the truth!! Say that you believe religious freedom is more important to you and your community than are individual human rights. Be totally honest and admit that circumcision of children male or female is a violation of their bodily integrity and their individual human rights, but that you belive that religious freedom should take precendence over these individual human rights. Be courageous, and ask for an exemption from law and human rights legislation, because your practices of circumcision of children are more important within your religion, than are individual human rights.
Just dont insult me and the rest of the world, and argue that calling the circumcision of children a violation of individual human rights is ridiculous. It is ridiculous that you expect to call such a ruling ridiculous and feel that it is somehow a valid statement and one that will go without challenge???
Friday, June 29, 2012
Friday, June 22, 2012
Imagine if it was a girl?
Imagine you have a new baby, she's a beautiful baby girl & she's your dream come true, she's healthy & fully formed, she's just 2 days old, but then the nurse comes and takes her away from you, she's led into a surgical room, she's strapped to a table, she beigins to cry from the restrainsts on her, her nappy is removed, she's dabbed in the genital area, then a doctor with a very sharp knife, starts to cut away at parts of her genitals, she bleeds, she screams in agony as loud as a 2 day old can scream, but her cries are ignored, She writhes but cant move, she struggles to breathe because of the pain, her heart pounds so hard it causes a severe stress reaction, & the screams go on and on and on .... until the cutting stops, then the surgery is over, she's quiet and in shock, she becomes catatonic, she's bought back to you, and the nurse tells you she slept thru the whole event, but she refuses to breastfeed, and she averts her gaze from you........ An unimaginable HORROR & What barbaric civilisation would allow this to happen?..... I'm sure at this point you;ve had enuff, and are saying this would never happen to a daughter of mine, and thank God it just doesnt happen (except in places like Malaysia), and we dont do that to our baby girls, .......Phew.......... what a horrible read........
But Somehow I imagine even if you are an intactivist, If I'd replaced the word girl with the word boy, you wouldnt have had such a vile reaction or thought it was an unimaginable horror......... Even I, an avid intactivist felt horrible writing it, trying to comfort myself that it doesnt happen in the real world. Thats what cultural/tribal conditioning does to humans, it allows u to accept an Unimaginable horror committed to a 2 day old infant male child....its why its so hard to convince those who are in favor of infant male circumcision to see that it is WRONG..... Its why babies dying from circumcision are tolerated, its why sucking the penis of a baby is tolerated, its why doctors make money from the procedure and dont want to give it up, its why the medical community looks for ways to justify the procedure, and conduct research on adults to justify cutting babies.......
So whats the message in all this?
WE need to work very hard and very long, & maybe for generations and we must never ever give up, & yes there'll be times of exhaustion, frustration and doubt, then you have a rest, you rest as long as you need, & then you come back because baby boys need you to help change a culture! And Never Forget = This also applies to ending FGM, because what I described above UNIMAGINABLE HORROR happens to little girls in Africa Asia & the Middle east and to baby girls in Malaysia!!!!!
But Somehow I imagine even if you are an intactivist, If I'd replaced the word girl with the word boy, you wouldnt have had such a vile reaction or thought it was an unimaginable horror......... Even I, an avid intactivist felt horrible writing it, trying to comfort myself that it doesnt happen in the real world. Thats what cultural/tribal conditioning does to humans, it allows u to accept an Unimaginable horror committed to a 2 day old infant male child....its why its so hard to convince those who are in favor of infant male circumcision to see that it is WRONG..... Its why babies dying from circumcision are tolerated, its why sucking the penis of a baby is tolerated, its why doctors make money from the procedure and dont want to give it up, its why the medical community looks for ways to justify the procedure, and conduct research on adults to justify cutting babies.......
So whats the message in all this?
WE need to work very hard and very long, & maybe for generations and we must never ever give up, & yes there'll be times of exhaustion, frustration and doubt, then you have a rest, you rest as long as you need, & then you come back because baby boys need you to help change a culture! And Never Forget = This also applies to ending FGM, because what I described above UNIMAGINABLE HORROR happens to little girls in Africa Asia & the Middle east and to baby girls in Malaysia!!!!!
AN ESTIMATE OF U.S. CIRCUMCISION-RELATED INFANT DEATHS
AS we seem to lose access to a lot of journal articles, I thought I'd copy this to make sure we always have a copy of this impt one!
LOST BOYS: AN ESTIMATE OF U.S. CIRCUMCISION-RELATED INFANT DEATHS
Baby boys can and do succumb as a result of having their foreskin removed. Circumcision-related mortality rates are not known with certainty; this study estimates the scale of this problem. This study finds that approximately 117 neonatal circumcision-related deaths (9.01/100,000) occur annually in the United States, about 1.3% of male neonatal deaths from all causes. Because infant circumcision is elective, all of these deaths are avoidable. This study also identifies reasons why accurate data on these deaths are not available, some of the obstacles to preventing these deaths, and some solutions to overcome them. Keywords: male, infant, death, mortality, neonatal, circumcision, penis, foreskin, United States.
Publication: Thymos
Author: Bollinger, Dan
Date published: April 1, 2010
"The life of man is., nasty, brutish, and short."
-Thomas Hobbes
Circumcision is a surgical procedure performed upon newborn baby boys in the United States once every seven seconds,1 three thousand times a day, over a million times a year. The practice is so deeply rooted in American childbirth and medical culture that the public is largely unaware of two facts: first, that infant circumcision is not medically necessary in almost all instances, and second, that it carries serious medical risks, including the risk of death. For some parents, circumcising their son will mean losing their baby boy to what they have been told is a harmless procedure.
Medical associations fail to warn parents of the very real risk of death from circumcision. Neither the American Academy of Pediatrics (AAP, 1999), nor the American College of Obstetricians and Gynecologists (ACOG, 2001), nor the American Medical Association (AMA, 1999) mentions death as a possible outcome of the surgery in their policy statements on circumcision. The American Academy of Family Physicians (AAFP, 2002) statement says death is possible, but (according to this study's findings) significantly underreports the risk as 1/500,000.
Parenting and baby books are equally culpable in failing to mention death as a possible, if rare, outcome of circumcision. A survey of ten popular infant-care books found that none warn that circumcision could result in a baby's death.2 Most websites and literature on circumcision also minimize or ignore the risk of death, and no contemporary study has attempted to learn the magnitude of this problem. Perhaps this is due to the peculiar place occupied by circumcision in American medicine- an elective, almost incidental, procedure carried out on babies, behind closed doors, and mostly by residents and obstetricians rather than by the baby's own doctor (Stang & Snellman, 1998).
This study reviews the few sources that have reported on deaths occurring as a result of circumcision and attempts to provide a rough estimate for neonatal (first 28 days after birth) circumcision-related mortality in the United States. Since infant circumcision is elective, this study will consider all circumcision sequelae, not just the procedure itself. Its goal is to promote discussion, encourage solutions, and- most importantly- save children's lives.
Background
About 1 .3 million boys are circumcised each year in the United States (HCUP, 2007); however, the number of boys who died from those surgeries has not been reported or estimated in any credible way. Some reasons include record-keeping practices, indifference, and- no doubt- concerns about liability.
Death certificates typically do not list circumcision as the immediate or leading cause of death and rarely list circumcision as an underlying cause. Incomplete and inaccurate death certificates for children are a common phenomenon (Cunniff , Carmack, Kirby, & Fiser, 1995). Thus, many circumcision-related deaths are more often reported as surgical mishap, infection, hemorrhage, cardiac arrest, stroke, reaction to anesthesia, or even parental neglect.
In recent years, U.S. infant deaths have been infrequently reported in the media (Rachter, 1982; The State, 1992; Miami Herald, 1993; Lum & Sorelle, 1995; NewsNet5, 1998; Proctor, 2002; Cohen, 2005; Verges, 2009). Reports of circumcision-related deaths have sporadically appeared in the medical literature beginning in the early 1900s (Holt, 1913; Reuben, 1916; Sauer, 1943; Scurlock & Pemberton, 1977; GeIUs, 1978; Baker, 1979; Hiss, Horowitz, & Kahana, 2000). In Africa, dozens of deaths from circumcision initiation rites are reported every year, but, as in America, are often treated with indifference (Ncayiyana, 2003).
Lost Boys
Boys have been lost to circumcision in the United States from the time it was first practiced to the present day, for a variety of reasons, as the following examples illustrate. The first known reported circumcision-related deaths were in New York City, where circumcision was introduced. The first was Julius Katzenstein in 1856 (New York Times) and the second was one -week-old Myer Jacob Levy in 1858 (New York Times). Both boys were circumcised by a Dr. Abrahams, and the same coroner reviewed both deaths. The coroner found that Abrahams had performed the surgeries properly, and that the boys died from blood loss as a result of parental neglect. Neither boy had received a follow-up examination.
Allen Ervin, born 1985, was in a coma for more than six years before he died. He had been on life support after his brain was damaged from oxygen deprivation during his circumcision (The State, 1992).
Demetrius Manker was born in 1993 and died soon thereafter from blood loss. The coroner's examination found a large, gaping wound on the underside of the boy's penis extending almost to the scrotum. The coroner listed cause of death as blood loss due to penile circumcision (Welti, 1993); however, there is no mention of further action being taken.
A West Virginia child, whose name was withheld, was born in 1996 without incidence and circumcised prior to hospital release. A few days later, the parents rushed him to the emergency room because he was having seizures and his penis had turned green in color. He died the next day from septicemia (Ballad, 1997).
Death sometimes occurs following repair of a circumcision complication. Dustin Evans, Jr., was circumcised soon after being born in 1998. The surgeon took so much shaft skin that the scar healed as a tight "collar" around his penis, preventing him from urinating. When he was later given an anesthetic in order to repair the damage, he immediately died of cardiopulmonary arrest (Giannetti, 2000). His father lamented, "You think, 'What could go wrong with a circumcision?' The next thing I know, he's dead."
In a 2004 Vancouver, Canada, incident, one-month-old Ryleigh McWillis was sent home from the hospital immediately following his circumcision. He later bled to death, his disposable diapers absorbing the small amount of blood from his circumcision wound necessary to send him into hypovolemic shock (Newell, 2004).
Because the penis is highly vascularized, blood-loss is a risk even for boys circumcised past the neonatal period. In 2008, 6- week-old Native American Eric Keefe died from massive blood loss. Hospital officials claimed his circumcision was not to blame, but instead faulted the parents because they had administered over-the-counter pain medication that, they also claimed, thinned his blood. The parents were not told about this possible complication (Verges, 2009). Since then the hospital has stopped performing infant circumcisions.3
Nor are ritual circumcisions without risk, either. In 2004, an infant twin born to Jewish parents was circumcised by a mohel, a ritual circumciser who was infected with Herpes simplex virus 1 . He practiced the orthodox version of circumcision called metzitzah b'peh (in which the circumciser sucks blood from the wound with his mouth), thereby transmitting herpes to the boy via his saliva. The baby boy died a few days later (Cohen, 2005).
Previous Death Estimates
The widely varying results from the handful of researchers that have attempted to estimate circumcision-related deaths can be explained by their choice of survey criteria. A study by Dr. Douglas Gairdner in 1949 included deaths due both to surgery and to ensuing complications. He reviewed case histories of 90,000 circumcisions for boys under five years old from 1942 to 1947 in England and Wales, identifying 95 deaths attributable to circumcision. Of these, he found 16 deaths per 100,000 annually for boys less than one year old, including postoperative, postrelease deaths. Some of these were due to reactions to anesthesia; Gairdner nevertheless classified these as circumcisionrelated since the boy would not have been administered anesthesia except for circumcision. This was considered a definitive study in the United Kingdom, and led the British government to deem infant circumcision an unnecessary and nonreimbursable medical procedure. When extrapolated to the present-day United States, Gairdner's findings represent an estimated 230 deaths annually. Children's-rights activists in the United States often claim this death toll (Baker, 1979), rather than underreport the risk using lower estimates, in an attempt to portray the gravity of the problem. However, this rate is misleading because it does not allow for improvements in healthcare from postwar, pre-penicillin Britain to the present day United States. Thus, this figure is likely overstated. The question is, How much is it overstated?
In a 1953 letter to the editor of Obstetrics and Gynecology, Dr. H. Speert states that of 566,483 circumcisions performed between 1939 and 1951 , there was one operative death. Applied to the present U.S. incidence that would equal 2.4 operative deaths per year. Circumcisionists cite this ratio in order to minimize the death risk. But this estimate reports only those who died on the operating table- it ignores the much larger number of postoperative deaths both inside and outside the hospital.
Inexplicably, no deaths at all were reported from any cause in a population of 100,157 circumcised, neonatal boys in a survey of U.S. Army hospital records (Wiswell & Geschke, 1989). However, the national male neonatal death rate from just two causes- hemorrhage and sepsis- is 30.2 per 100,000 (NCHS, 2004), leaving us unsure what to make of this discrepancy.
Hospital discharge records reveal that, during the 1991-2000 decade, on average 35.9 boys died from all causes each year during their stay (average 2.4 days) in the hospital in which both their birth and circumcision occurred (Thompson Reuters, 2004). These were among the average of 1,243,392 boys circumcised annually during the same period, but this number is limited to deaths inside the hospital, some of which are undoubtedly due to circumcision.
Complications from circumcision are as high as 55%, according to Patel's (1966) circumcised-infant cohort study, which reviewed case histories, examined infants in the home, and questioned parents on outcomes, making it the most thorough circumcision-complication study performed to date. Eight percent of boys in the cohort became infected after being circumcised, and they were 700% more likely to have become infected after hospital release than before. Bacterial sepsis and hemorrhage are both frequent fatal complications of circumcision, and circumcised boys are at a higher risk for streptococcus infection (Cleary & Kohl, 1979). Gairdner reported that one in fifty circumcised boys returned to the hospital for treatment of excessive bleeding, some requiring transfusions.
Infection has become even more of a factor recently with the epidemic of methicillin-resistant Staphylococcus aureus (MRSA) now under way in the United States. The medical literature is replete with reports of MRSA infections occurring first in hospitals and now in the community (Rabin, 2003; Klevens et al., 2007). Circumcised boys are at a higher risk for this "superbug" than intact (not circumcised) boys (Enzenauer et al., 1985), most likely because of the open circumcision wound. A 2003 outbreak of MRSA in a Long Island, New York, hospital maternity ward resulted in three newborns' being infected: all were boys; all had been circumcised (Rabin). Circumcision is a double whammy when it comes to MRSA: the American Medical Association identified both surgery and young age as risk factors (Zeller, 2007). The mortality rate for neonates once subcutaneous tissue becomes infected is more than 70% (Sawin, Schaller, Tapper, Morgan, & Canili, 1994). The risk from MRSA alone would seem to dictate ceasing the practice of unnecessary surgery such as infant circumcision.
Mortality Estimation
Though the data previously cited are insufficient to establish a definitive death rate on their own, there is enough available information to calculate an estimate. Not all of the reported 35.9 deaths out of 1,243,392 circumcisions can be attributed to related causes. What portion, then, is circumcision- related and how may we extrapolate to the number of deaths after hospital release? What we can safely assume is that it is unlikely that any of these infants would have been subjected to the unnecessary trauma of circumcision if they had been in critical condition, or that they would have been circumcised after their death.
Gender-ratio data can help extrapolate a figure. Males have a 40.4% higher death rate than females from causes that are associated with male circumcision complications, such as infection and hemorrhage,4 during the period of one hour after birth to hospital release (day 2.4), the time frame in which circumcisions are typically performed (CDC, 2004). Assuming that the 59.6% portion is unrelated to gender, we can estimate that 40.4% of the 35.9 deaths were circumcision-related. This calculates to 14.5 deaths prior to hospital release.
But as is often the case with hemorrhage and infection, some circumcision-related deaths occur days, even weeks, after hospital release. The CDCs online searchable database, Mortality: Underlying cause of death, 2004 (CDC), lists causes by various age ranges and reveals that the percentage of deaths after release, compared with deaths before, is 772% greater. This ratio is comparable to Patel's (1966) 700% postrelease infection rate.
Multiplying the 772% adjustment factor for age-at-time-of-death by the 14.5 hospital-stay deaths calculated above, the result is approximately 112 circumcision-related deaths annually for the 1991-2000 decade, a 9.01/100,000 death-incidence ratio. Applying this ratio to the 1,299,000 circumcisions performed in 2007, the most recent year for which data are available (HCUP, 2007), the number of deaths is about 117. This is equivalent to one death for every 1 1 ,105 cases, which is not in substantial conflict with Patel's observation of zero deaths in 6,753 procedures. It is more than some other estimates (Speert, 1953; Wiswell, 1989), but less than the overstated 230 figure derived from Gairdner (1949). Breaking this statistic down further, about 40% of these deaths (47) would have been from hemorrhage, and the remainder (70) from sepsis, using a hemorrhage-to-sepsis ratio for infant mortality (NCHS, 2004).
In summary: through a thorough review of the literature and the application of common-sense calculations, this study has arrived at a reasoned estimate of circumcision-related neonatal deaths in the United States: approximately 117 per year.
Ulterior Motives
Many factors combine to explain the lack of reliable mortality data or why this problem has not received more attention. To ignore or hide the likely cause of so many infant deaths for so many years requires a significant amount of denial or obfuscation- by: parents, physicians, hospital staff, insurers, medical associations, and legislators. The silence of human-rights, men's-rights, women's-rights, and children's-rights groups concerning these deaths is shocking. It might indicate that they are unaware of the problem, or that they wish to appear politically correct in regard to religious circumcisions, even though more than 96.5% of those performed are not for religious reasons (US Census Bureau, 2008) .5 The explanation for such lack of concern and discussion is unknown, but one fundamental reason has to be a lack of information disseminated among people who can correct the situation.
Not only will parents of a dead boy be in shock, but also potentially embarrassed, by what seems now to have been a whimsical choice for their infant. Their understandable reaction is to withdraw into protective silence or to defend their choice despite their loss. They might insist, as parents of one deceased child did recently, that they would "make the same choice with their next boy" (Fournier, 2004). Parents are sometimes irrational concerning circumcision. Many quickly sign the consent form without first learning more about the physical, psychological, and sexual consequences of circumcision. Some sign because they take their physician's mention of the topic as a recommendation, or because they feel coerced by repeated inquires. Others sign because they fear being regarded bad parents, rather than considering what is in the best interests of their son. For instance, nine out of ten parents who chose circumcision did so knowing full well that the procedure was excruciatingly painful for their newborn boy (Ahaghotu, Okafor, Igiehon, & Gray, 2009).
To hospital residents, the birth of a boy is celebrated as an opportunity to practice surgery. A resident's first surgery upon a live human being does not always go as planned- especially when the patient is not a sedated, consenting adult, but a screaming, thrashing baby. The resident's mentor is likely to provide cover for any errors, lest they reflect poorly on him or her and their institution. Busy residents often have a quota of interventions to meet in order to qualify in their specialty, which means that they have a conflict of interest, potentially an unethical stake, in performing the procedure. Thus, most adult American males can be seen as having been child medical-training draftees, now sporting a "scalpel practice" penis, carved on by a twenty-something-year-old undertaking his or her first surgery.
The relative simplicity of circumcision means that a charge that it was done poorly is a glaring indictment of the clinician. The notion that a child died as a result is, of course, even more embarrassing to them and would call forth some sort of preemptive defense. This often takes the form of blaming the parents for inadequate postoperative care, or insisting that it was the child's fault for being too feeble to withstand the procedure, turning the medical phrase "failure to thrive" into a euphemism for these iatrogenic deaths.
Because of the inadequacies of the death-certificate system and the apparent lack of investigation, it is easy to see how the medical system could either unwittingly or intentionally obscure the true cause of these deaths. American courts aid the medical institution by sometimes ruling that the parents signed the circumcision consent form, and that the parents took their chances even if they were not informed of such a possible outcome. Thus, medical practitioners have a tactical choice. They can list on a lengthy consent form every conceivable risk of circumcision, including death, which might undersell the procedure, or, calculating that the danger of failure and detection is low, soft-pedal the risks in hopes that parents will sign anyway.
Few death cases are ever litigated in court because hospitals recognize that their defenses are few and expensive to plead, and that the publicity would prove harmful. Such cases usually result in an offer to the parents of a private, sealed settlement. Sadly, the death of a child is considered less of a liability than an injury case, and therefore compensation for a dead infant is rarely substantial. On the other hand, severe injury cases- loss of all or part of the glans, or, even worse, the entire penis- are intensely litigated and may produce substantial monetary damages in the millions of dollars. The crass logic of the law is that the injured male will have to bear his injury for a lifetime, whereas the dead infant barely sensed his own existence, and so would not even sense the loss of himself. Invariably such settlements include a confidentiality clause, intended, of course, to protect the reputation of both the individual medical practitioner and the institution.
Following a death, the coroner or the medical examiner, who is usually a physician, will rule whether the death was from suspicious causes. In the United States, that coroner (who, if male, is probably circumcised) is not likely to face squarely and on the record the fact that his or her colleague performed an unnecessary and nontherapeutic surgery that resulted in the death of an infant. This malfeasance could itself be cause for an investigation, could have serious repercussions for the circumcising physician and institution, and therefore seems an unlikely move for coroners, especially if they are elected officials.
Primary and secondary causes of death are all too easy to conceal because of the lack of healthcare oversight. There is remarkably little regulation of medical practice by the Federal government, and little coordination among states to regulate medical procedures. Ironically, circumcision devices (e.g., restraints and clamps) are more closely scrutinized than their application.
The American Academy of Pediatrics (AAP) was found to be partially liable in the death of Dustin Evans, Jr., according to the Iowa Law Review (Giannetti, 2000). It reached the conclusion that his death was attributable to his circumcision, and that the AAP should either have labeled circumcision as experimental or proved its worth through exhaustive scientific testing. Yet the AAP has continued over the past four decades to issue a string of policy statements regarding circumcision, each one carefully worded so as to increasingly shift liability from its membership to parents, thereby protecting their members' lucrative income stream.
Physicians are less likely to circumcise their sons than the general populace (Topp, 1978), suggesting that they know it is an unnecessary surgery, but don't relay this valuable information to parents. Many physicians say that they prefer not to perform circumcisions, but do them anyway, rationalizing that the boy will be in better hands with them than with a physician they might refer the parents to. This may seem a noble position at first, but there can be no pretending to be a conscientious objector to circumcision while simultaneously performing one.
Circumcision is a $2 billion healthcare market, which includes costs for the procedure itself, dealing with complications, and payment for repairs (Fauntleroy, 2001). A study of Medicaid records found that a greater number of circumcisions are performed in states where Medicaid pays more for the procedure (Craig & Bollinger, 2006). A busy delivery-room obstetrician will do as many as five circumcisions a week. Physician reimbursement is at about $167 each6 (Van Howe, 2004), which means that they can potentially make an extra $3 ,340 per month, or $40 ,080 per year. That is moie than an entire year's income for 45% of Americans (US Census Bureau, 2005). One physician brazenly admitted, "I love doing circumcisions- they make my Mercedes payments!"7
At the very heart of this problem is a lack of honesty about an entrenched medicalized ritual. Circumcisers are quick to sidestep ethics and put their real patient- the baby boy- at risk. But they are not likely to speak out, simply because calling attention to their unethical actions would likely jeopardize them or their peers, reduce their income, and, possibly, have dangerous legal consequences.
Implications
Risk assessment for an unnecessary surgery must be held to a higher standard than that for a life-saving surgery. We accept that a heart transplant carries with it a substantial risk of death, but without it there is a certainty of death. On the other hand, the risk from circumcision, which has no therapeutic value, needs to be zero for the infant's sake, all the more so because he is never consulted about whether he wishes to take his chances.
We hear very little in the media about circumcision-related deaths compared with other causes. For instance, compare the 1 17 annual deaths from circumcision with those from other causes for male infants: suffocation (44), mother's use of addictive drugs (27), HTV/ATDS (19), homicide (17), automobile accidents (8), drowning (2), and falls (1) (CDC, 2004). Sudden infant-death syndrome (SIDS) killed 1 ,216 boys under the age of one year in 2004; of those, 115 were under the age of 1 month (CDC), which is the same risk as from circumcision. Approximately 36 teen-aged boys are killed in schoolyard shootings each year (Donohue, Schiraldi, & Ziedenberg, 1998). But there is more publicity for the SIDS deaths and shootings than for the circumcision-related deaths.
Is male circumcision so ingrained in American masculinity that we are hardened to its consequences? Have we inherited the recurring theme in religion and mythology of offering our sons to the gods? Or do we stoically value it as a painful male initiation rite, requiring sacrifice of blood and a body part (Zoske, 1990)- and therefore believed to be worth the occasional death-cost?
If a similar number of children were dying from another optional body modification-say, tattooing or piercing- would the public be outraged at the people and institutions benefiting financially? If not, is it then due to gender bias? Imagine the uproar if a hundred girls were dying from female circumcision each year. Why are so many adults silent about this atrocity? Adults would be furious and highly vocal, to say the least, if someone were to forcibly cut their genitals.
Solutions
The problem is this: circumcision is a killer of baby boys. No one, except for some human-rights activists, is trying to save them. It is unlikely that improving circumcision techniques would eliminate these deaths. No matter how skilled the physician is, some deaths will always occur.
Improving the process of securing informed consent from parents by listing death as a possible outcome would, at first, seem to be a logical solution, but it would fail to save lives for two reasons. First, even well-informed parents will sometimes insist on circumcision (Binner, Mastrobattista, Day, Swaim, & Monga, 2002). Second, healthcare providers cannot be trusted to provide truthful disclosure of the risks involved. The fact that physicians and nurses are already willing to perform well over a million of these unnecessary surgeries a year is proof they are generally untrustworthy.
The overwhelming majority of infant circumcisions are nontherapeutic and therefore unnecessary; the simple solution is eliminating them. To start with, physicians and nurses should be prohibited from initiating a discussion with, or soliciting circumcision from, expectant parents. Circumcision should also be defunded, following the examples set by the sixteen states that have already eliminated Medicaid coverage.
Physicians regularly give parents information favoring circumcision, but rarely provide instructions on how to care for the intact penis. Furnishing parents with this knowledge would alleviate their anxiety concerning a body part unfamiliar to them (Bollinger, 2008). All medical textbooks and parenting guides should include intact-care information and mention death as a possible outcome.
Physicians who perform unnecessary surgeries that result in death must be held accountable for their actions in criminal and civil court. Professional associations that protect their members rather than their patients should be forced to change their policies. Physicians must talk with their peers about ceasing circumcision, or at the very least become conscientious objectors. Legislation to protect boys must be passed, beginning with demanding that Congress rewrite the 1996 Federal law prohibiting female circumcision to make it gender-neutral. A nationwide system that reports all infant deaths with all contributing factors rigorously listed must be established.
Few human emotions compare with the profound grief that results from the loss of a newborn child. Adding guilt to that grief- from the realization that you requested the optional surgery that caused his death- is beyond imagination. Most parents would likely refrain from talking about it publicly. People affected by a circumcision-related death must speak up. Parents must be encouraged to talk about why they chose circumcision, what happened to their son, what they are feeling, what they would advise other parents to do, and whether they would choose circumcision again. Family members and friends must also be involved in the discussion.
Conclusion
It is reasonable to conclude that about 117 circumcision-related deaths occur each year in the United States- approximately 1 out of every 77 male neonatal deaths- and that thousands of boys have died since this practice was first medicalized 160 years ago. These boys died because physicians have been either complicit or duplicitous, and because parents ignorantly said "Yes," or lacked the courage to say "No." Every one of these boys would have had a chance at life had he not been circumcised. Circumcision can no longer be called either a beneficial surgery or a beneficent rite of passage, but by its true designation: an unrecognized sacrifice of innocents.
1 Based on a workweek of five, 8-hour days.
2 Survey by author of the ten highest ranked books listed on Amazon.com, November 10, 2008.
3 Personal communication with author at the 2009 AAP national conference, Washington, DC.
4 Selected from ICD- 10 codes P21.9-22.9, 29.0-29.1, 29.8-29.9, 36.0-36.9, 37.5, 39.8-38.9, 50.9, 52.3, 54.3, 54.8-54.9, 55.9, 96.8-96.9
5 If all Jews, Muslims, and Coptic Christians in the United States circumcise.
6 Adjusted for medical inflation to year 2010, does not include hospital's portion of $136, or what they obtain from foreskin sales to laboratories and cosmetic companies.
7 Personal communication at the 2003 AAP national conference, New Orleans, Louisiana.
References
AAFP Commission on Science. (2002). Position paper on neonatal circumcision. American Academy of Family Physicians.
AAP, American Academy of Pediatrics Task Force on Circumcision. (1999). Circumcision policy statement. Pediatrics, 103(3), 686-693.
ACOG Committee Opinion Number 260: Circumcision. (2001). Obstetrics and Gynecology, 98(4), 707-708.
Ahaghotu, C, Okafor, H., Igiehon, E., & Gray, E. (2009). Psychosocial factors influence parental decision for circumcision in pediatric males of African American decent. Journal of National Medical Association, 101(4), 325-330.
AMA Council on Scientific Affairs. (1999) . Report 10: Neonatal circumcision. Chicago: American Medical Association.
Baker, R. L. (1979). Newborn male circumcision: Needless and dangerous. Sexual Medicine Today, 5(11), 35-36.
Ballad, R. (1997). Malpractice: Septicemia secondary to circumcision. Comtemporary OBIGYN Archive.
Binner, S.L., Mastrobattista, J.M., Day, M.C., Swaim, L.S., & Monga, M. (2002). Effect of parental education on decision-making about neonatal circumcision. South Med J. 95(4), 457-461.
Bollinger, D. (2008). The penis-care information gap: Preventing improper care of intact boys. Thymos: Journal of Boyhood Studies, 1(2), 205-219.
CDC. (2004). Mortality: Underlying cause of death, 2004. CDC online database search. Retrieved March 10, 2009, from http://wonder.cdc.gov/cmf-icdlOJitml
Cleary, T.G., & Kohl, S. (1979). Overwhelming infection with group B beta-hemolytic streptococcus associated with circumcision. Pediatrics, 64(3), 301-303.
Cohen, D.N. (2005, February 10). Should mohelim be supervised?: Baby's death from herpes virus sparks call for oversight. Jewish Week.
Craig, A., & Bollinger, D. (2006). Of waste and want: A nationwide survey of Medicaid funding for medically unnecessary, non-therapeutic circumcision. In G.C. Denniston, P.G. Gallo, FM. Hodges, & MF. Milos, (Eds.), Bodily integrity and the politics of circumcision: Culture, controversy, and change (pp. 233-246). New York: Springer.
Cunniff, C., Carmack, J.L., Kirby, R.S., & Fiser, DJH. (1995). Contribution of heritable disorders to mortality in the pediatric intensive care unit. Pediatrics, 95, 678-681.
Donohue, E., Schiraldi, V., & Ziedenberg, J. (1998). School house hype: School shootings and the real risks kids face in America. Washington, DC: Justice Policy Institute.
Enzenauer, R.W., Dotson, CJR., Leonard, T., Reuben, L., Bass, J.W., & Brown, J. 3rd. (1985). Male predominance in persistent staphylococcal colonization and infection of the newborn. Hawaii Medical Journal, 44(10), 389-390, 392, 394-396.
Fauntleroy, G. (2001 , July 30). Infant circumcision: The debate over parents' rights, human rights and the right to choose. The New Mexican.
Fournier, S. (2004, February 13). Lack of post-surgery info angers grieving parents. The Province, Vancouver, British Columbia.
Gairdner, D. ( 1949). The fate of the foreskin: A study of circumcision. British Medical Journal, 2, 1433-1437.
Gellis, S.S. (1978). Circumcision. American Journal of Diseases of Children, 132, 1168.
Giannetti, MJR.. (2000). Circumcision and the American Academy of Pediatrics: Should scientific misconduct result in trade association liability. Iowa Law Review, 85, 1507.
HCUP. (2006). Statistical Brief #56: Hospital stays for children, 2006. Retrieved March 10, 2009, from http://wwwJicup-us.ahrq.gov/reports/statbriefs/sb56.jsp
HCUP. (2007). HCUP facts and figures: Statistics on hospital-based care in the United States.
Hiss, J., Horowitz, A., & Kahana, T. (2000). Fatal haemorrhage following male ritual circumcision. Journal of Clinical Forensic Medicine, 7, 32-34.
Holt, LE. (1913). Tuberculosis acquired through ritual circumcision. Journal of American Medical Association, LXI(2), 99-102.
Klevens, R.M" Morrison, MA,, Nadle, J., Petit, S., Gershman, K., et al. (2007). Invasive methicillin-resistant Staphylococcus aureus infections in the United States. Journal of the American Medical Association, 298(15), 1763-1771.
Lum, L., & Sorelle, R. (1995, July 28). Boy's death to be probed. Houston Chronicle, 28A.
Miami Herald. (1993, June 26). Baby bleeds to death after circumcision. Miami Herald.
Ncayiyana D.J. (Ed.). (2003). Astonishing indifference to deaths due to botched ritual circumcision. South African Medical Journal, 95(8), 545.
NCHS. (2004). Deaths: Leading causes for 2001. National Center for Health Statistics, 52(9).
New York Times. (1856, December 16). Death from the operation of circumcision. New York Times.
New York Times. (1858, April 23). Death from circumcision. New York Times.
Newell, TJE.C. (2004, January 19). Judgement of inquiry into the death ofMcWillis, Ryleigh Roman Bryan. British Columbia Coroner's Service.
NewsNet5. (1998, October 20). Circumcision that didn't heal kills boy, NewsNet5.
Patel, H. (1966). The problem of routine infant circumcision. Canadian Medical Association Journal, 95, 576-581.
Proctor, J. (2002, August 29). 'Totally unexpected' death of baby probed. The Province.
Rabin, R. (2003, October 9). Mysterious crop of Staph: Newborns, moms infected after stay at St. Catherine's. Newsday.
Rachter, P (1982, November 20). Grand jury to probe death of baby after circumcision. The Des Moines Register.
Reuben, M.S. (1916). Tuberculosis from ritual circumcision. Proceedings of the New York Academy of Medicine, 333-334.
Sauer, L.W. (1943). Fatal staphylococcus bronchopneumonia following ritual circumcision. American Journal of Obstetrics and Gynecology, 46, 583.
Sawin, R.S., Schaller, R.T. Jr., Tapper, D., Morgan, A., & Canili, J. (1994). Early recognition of neonatal abdominal wall necrotizing fasciitis. American Journal of Surgery, 167, 481-484.
Scurlock, JM., & Pemberton, PJ. (1977). Neonatal meningitis and circumcision. The Medical Journal of Australia, 1(10), 332-334.
Speert, H. (1953). Letter to editor. Obstetrics and Gynecology, 2, 104.
Stang, H.J., & Snellman, L.W. (1998). Circumcision practice patterns in the United States. Pediatrics, 01(6):c5.
The State. (1992, July 10). Boy in coma most of his 6 years dies. The State, North Carolina, F21.
Thomson Reuters. (2004). InPatient view report for ICD-9 64.0. Thomson Reuters, Inc., New York, NY. (database search provided to the author)
Topp, S. (1978, January). Why not to circumcise your baby boy. Mothering, 6, 69-11.
US Census Bureau. (2005). Current population survey: 2005 annual social and economic supplement. Table HJNC-06.
US Census Bureau. (2008). Statistical abstract of the United States: Self-described religious identification of adult population (Edition 130), Table 75.
Van Howe, R.S . (2004) . A cost-utility analysis of neonatal circumcision. Medical Decision Making, 24, 584-601.
Verges, J. (2009, September 19). Parents sue over circumcision death. Argus Leader, Sioux Falls, SD.
Welti, C.V. (1993). The Dade County Medical Examiner Department, Miami, Florida, Case No. 93-1711.
Wiswell TJE., & Gesenke D.W. (1989). Risks from circumcision during the first month of life compared with those for uncircumcised boys. Pediatrics, 83, 1011-1015.
Zeller, JJL. (2007). JAMA patient page: MRSA infections. Journal of the American Medical Association, 298(15), 1826.
Zoske, J. (1990). Male circumcision: A gender perspective. Journal of Men's Studies, 6(2), 189-208.
Author affiliation:
Dan Bollinger*
Author affiliation:
* Boy's Health Advisory.
Correspondence concerning this article should be addressed to Dan Bollinger, Boy's Health Advisory, 1970 North River Road, West Lafayette, IN 47906. Email: danbollinger@comcast.net
Author: Bollinger, Dan
Date published: April 1, 2010
"The life of man is., nasty, brutish, and short."
-Thomas Hobbes
Circumcision is a surgical procedure performed upon newborn baby boys in the United States once every seven seconds,1 three thousand times a day, over a million times a year. The practice is so deeply rooted in American childbirth and medical culture that the public is largely unaware of two facts: first, that infant circumcision is not medically necessary in almost all instances, and second, that it carries serious medical risks, including the risk of death. For some parents, circumcising their son will mean losing their baby boy to what they have been told is a harmless procedure.
Medical associations fail to warn parents of the very real risk of death from circumcision. Neither the American Academy of Pediatrics (AAP, 1999), nor the American College of Obstetricians and Gynecologists (ACOG, 2001), nor the American Medical Association (AMA, 1999) mentions death as a possible outcome of the surgery in their policy statements on circumcision. The American Academy of Family Physicians (AAFP, 2002) statement says death is possible, but (according to this study's findings) significantly underreports the risk as 1/500,000.
Parenting and baby books are equally culpable in failing to mention death as a possible, if rare, outcome of circumcision. A survey of ten popular infant-care books found that none warn that circumcision could result in a baby's death.2 Most websites and literature on circumcision also minimize or ignore the risk of death, and no contemporary study has attempted to learn the magnitude of this problem. Perhaps this is due to the peculiar place occupied by circumcision in American medicine- an elective, almost incidental, procedure carried out on babies, behind closed doors, and mostly by residents and obstetricians rather than by the baby's own doctor (Stang & Snellman, 1998).
This study reviews the few sources that have reported on deaths occurring as a result of circumcision and attempts to provide a rough estimate for neonatal (first 28 days after birth) circumcision-related mortality in the United States. Since infant circumcision is elective, this study will consider all circumcision sequelae, not just the procedure itself. Its goal is to promote discussion, encourage solutions, and- most importantly- save children's lives.
Background
About 1 .3 million boys are circumcised each year in the United States (HCUP, 2007); however, the number of boys who died from those surgeries has not been reported or estimated in any credible way. Some reasons include record-keeping practices, indifference, and- no doubt- concerns about liability.
Death certificates typically do not list circumcision as the immediate or leading cause of death and rarely list circumcision as an underlying cause. Incomplete and inaccurate death certificates for children are a common phenomenon (Cunniff , Carmack, Kirby, & Fiser, 1995). Thus, many circumcision-related deaths are more often reported as surgical mishap, infection, hemorrhage, cardiac arrest, stroke, reaction to anesthesia, or even parental neglect.
In recent years, U.S. infant deaths have been infrequently reported in the media (Rachter, 1982; The State, 1992; Miami Herald, 1993; Lum & Sorelle, 1995; NewsNet5, 1998; Proctor, 2002; Cohen, 2005; Verges, 2009). Reports of circumcision-related deaths have sporadically appeared in the medical literature beginning in the early 1900s (Holt, 1913; Reuben, 1916; Sauer, 1943; Scurlock & Pemberton, 1977; GeIUs, 1978; Baker, 1979; Hiss, Horowitz, & Kahana, 2000). In Africa, dozens of deaths from circumcision initiation rites are reported every year, but, as in America, are often treated with indifference (Ncayiyana, 2003).
Lost Boys
Boys have been lost to circumcision in the United States from the time it was first practiced to the present day, for a variety of reasons, as the following examples illustrate. The first known reported circumcision-related deaths were in New York City, where circumcision was introduced. The first was Julius Katzenstein in 1856 (New York Times) and the second was one -week-old Myer Jacob Levy in 1858 (New York Times). Both boys were circumcised by a Dr. Abrahams, and the same coroner reviewed both deaths. The coroner found that Abrahams had performed the surgeries properly, and that the boys died from blood loss as a result of parental neglect. Neither boy had received a follow-up examination.
Allen Ervin, born 1985, was in a coma for more than six years before he died. He had been on life support after his brain was damaged from oxygen deprivation during his circumcision (The State, 1992).
Demetrius Manker was born in 1993 and died soon thereafter from blood loss. The coroner's examination found a large, gaping wound on the underside of the boy's penis extending almost to the scrotum. The coroner listed cause of death as blood loss due to penile circumcision (Welti, 1993); however, there is no mention of further action being taken.
A West Virginia child, whose name was withheld, was born in 1996 without incidence and circumcised prior to hospital release. A few days later, the parents rushed him to the emergency room because he was having seizures and his penis had turned green in color. He died the next day from septicemia (Ballad, 1997).
Death sometimes occurs following repair of a circumcision complication. Dustin Evans, Jr., was circumcised soon after being born in 1998. The surgeon took so much shaft skin that the scar healed as a tight "collar" around his penis, preventing him from urinating. When he was later given an anesthetic in order to repair the damage, he immediately died of cardiopulmonary arrest (Giannetti, 2000). His father lamented, "You think, 'What could go wrong with a circumcision?' The next thing I know, he's dead."
In a 2004 Vancouver, Canada, incident, one-month-old Ryleigh McWillis was sent home from the hospital immediately following his circumcision. He later bled to death, his disposable diapers absorbing the small amount of blood from his circumcision wound necessary to send him into hypovolemic shock (Newell, 2004).
Because the penis is highly vascularized, blood-loss is a risk even for boys circumcised past the neonatal period. In 2008, 6- week-old Native American Eric Keefe died from massive blood loss. Hospital officials claimed his circumcision was not to blame, but instead faulted the parents because they had administered over-the-counter pain medication that, they also claimed, thinned his blood. The parents were not told about this possible complication (Verges, 2009). Since then the hospital has stopped performing infant circumcisions.3
Nor are ritual circumcisions without risk, either. In 2004, an infant twin born to Jewish parents was circumcised by a mohel, a ritual circumciser who was infected with Herpes simplex virus 1 . He practiced the orthodox version of circumcision called metzitzah b'peh (in which the circumciser sucks blood from the wound with his mouth), thereby transmitting herpes to the boy via his saliva. The baby boy died a few days later (Cohen, 2005).
Previous Death Estimates
The widely varying results from the handful of researchers that have attempted to estimate circumcision-related deaths can be explained by their choice of survey criteria. A study by Dr. Douglas Gairdner in 1949 included deaths due both to surgery and to ensuing complications. He reviewed case histories of 90,000 circumcisions for boys under five years old from 1942 to 1947 in England and Wales, identifying 95 deaths attributable to circumcision. Of these, he found 16 deaths per 100,000 annually for boys less than one year old, including postoperative, postrelease deaths. Some of these were due to reactions to anesthesia; Gairdner nevertheless classified these as circumcisionrelated since the boy would not have been administered anesthesia except for circumcision. This was considered a definitive study in the United Kingdom, and led the British government to deem infant circumcision an unnecessary and nonreimbursable medical procedure. When extrapolated to the present-day United States, Gairdner's findings represent an estimated 230 deaths annually. Children's-rights activists in the United States often claim this death toll (Baker, 1979), rather than underreport the risk using lower estimates, in an attempt to portray the gravity of the problem. However, this rate is misleading because it does not allow for improvements in healthcare from postwar, pre-penicillin Britain to the present day United States. Thus, this figure is likely overstated. The question is, How much is it overstated?
In a 1953 letter to the editor of Obstetrics and Gynecology, Dr. H. Speert states that of 566,483 circumcisions performed between 1939 and 1951 , there was one operative death. Applied to the present U.S. incidence that would equal 2.4 operative deaths per year. Circumcisionists cite this ratio in order to minimize the death risk. But this estimate reports only those who died on the operating table- it ignores the much larger number of postoperative deaths both inside and outside the hospital.
Inexplicably, no deaths at all were reported from any cause in a population of 100,157 circumcised, neonatal boys in a survey of U.S. Army hospital records (Wiswell & Geschke, 1989). However, the national male neonatal death rate from just two causes- hemorrhage and sepsis- is 30.2 per 100,000 (NCHS, 2004), leaving us unsure what to make of this discrepancy.
Hospital discharge records reveal that, during the 1991-2000 decade, on average 35.9 boys died from all causes each year during their stay (average 2.4 days) in the hospital in which both their birth and circumcision occurred (Thompson Reuters, 2004). These were among the average of 1,243,392 boys circumcised annually during the same period, but this number is limited to deaths inside the hospital, some of which are undoubtedly due to circumcision.
Complications from circumcision are as high as 55%, according to Patel's (1966) circumcised-infant cohort study, which reviewed case histories, examined infants in the home, and questioned parents on outcomes, making it the most thorough circumcision-complication study performed to date. Eight percent of boys in the cohort became infected after being circumcised, and they were 700% more likely to have become infected after hospital release than before. Bacterial sepsis and hemorrhage are both frequent fatal complications of circumcision, and circumcised boys are at a higher risk for streptococcus infection (Cleary & Kohl, 1979). Gairdner reported that one in fifty circumcised boys returned to the hospital for treatment of excessive bleeding, some requiring transfusions.
Infection has become even more of a factor recently with the epidemic of methicillin-resistant Staphylococcus aureus (MRSA) now under way in the United States. The medical literature is replete with reports of MRSA infections occurring first in hospitals and now in the community (Rabin, 2003; Klevens et al., 2007). Circumcised boys are at a higher risk for this "superbug" than intact (not circumcised) boys (Enzenauer et al., 1985), most likely because of the open circumcision wound. A 2003 outbreak of MRSA in a Long Island, New York, hospital maternity ward resulted in three newborns' being infected: all were boys; all had been circumcised (Rabin). Circumcision is a double whammy when it comes to MRSA: the American Medical Association identified both surgery and young age as risk factors (Zeller, 2007). The mortality rate for neonates once subcutaneous tissue becomes infected is more than 70% (Sawin, Schaller, Tapper, Morgan, & Canili, 1994). The risk from MRSA alone would seem to dictate ceasing the practice of unnecessary surgery such as infant circumcision.
Mortality Estimation
Though the data previously cited are insufficient to establish a definitive death rate on their own, there is enough available information to calculate an estimate. Not all of the reported 35.9 deaths out of 1,243,392 circumcisions can be attributed to related causes. What portion, then, is circumcision- related and how may we extrapolate to the number of deaths after hospital release? What we can safely assume is that it is unlikely that any of these infants would have been subjected to the unnecessary trauma of circumcision if they had been in critical condition, or that they would have been circumcised after their death.
Gender-ratio data can help extrapolate a figure. Males have a 40.4% higher death rate than females from causes that are associated with male circumcision complications, such as infection and hemorrhage,4 during the period of one hour after birth to hospital release (day 2.4), the time frame in which circumcisions are typically performed (CDC, 2004). Assuming that the 59.6% portion is unrelated to gender, we can estimate that 40.4% of the 35.9 deaths were circumcision-related. This calculates to 14.5 deaths prior to hospital release.
But as is often the case with hemorrhage and infection, some circumcision-related deaths occur days, even weeks, after hospital release. The CDCs online searchable database, Mortality: Underlying cause of death, 2004 (CDC), lists causes by various age ranges and reveals that the percentage of deaths after release, compared with deaths before, is 772% greater. This ratio is comparable to Patel's (1966) 700% postrelease infection rate.
Multiplying the 772% adjustment factor for age-at-time-of-death by the 14.5 hospital-stay deaths calculated above, the result is approximately 112 circumcision-related deaths annually for the 1991-2000 decade, a 9.01/100,000 death-incidence ratio. Applying this ratio to the 1,299,000 circumcisions performed in 2007, the most recent year for which data are available (HCUP, 2007), the number of deaths is about 117. This is equivalent to one death for every 1 1 ,105 cases, which is not in substantial conflict with Patel's observation of zero deaths in 6,753 procedures. It is more than some other estimates (Speert, 1953; Wiswell, 1989), but less than the overstated 230 figure derived from Gairdner (1949). Breaking this statistic down further, about 40% of these deaths (47) would have been from hemorrhage, and the remainder (70) from sepsis, using a hemorrhage-to-sepsis ratio for infant mortality (NCHS, 2004).
In summary: through a thorough review of the literature and the application of common-sense calculations, this study has arrived at a reasoned estimate of circumcision-related neonatal deaths in the United States: approximately 117 per year.
Ulterior Motives
Many factors combine to explain the lack of reliable mortality data or why this problem has not received more attention. To ignore or hide the likely cause of so many infant deaths for so many years requires a significant amount of denial or obfuscation- by: parents, physicians, hospital staff, insurers, medical associations, and legislators. The silence of human-rights, men's-rights, women's-rights, and children's-rights groups concerning these deaths is shocking. It might indicate that they are unaware of the problem, or that they wish to appear politically correct in regard to religious circumcisions, even though more than 96.5% of those performed are not for religious reasons (US Census Bureau, 2008) .5 The explanation for such lack of concern and discussion is unknown, but one fundamental reason has to be a lack of information disseminated among people who can correct the situation.
Not only will parents of a dead boy be in shock, but also potentially embarrassed, by what seems now to have been a whimsical choice for their infant. Their understandable reaction is to withdraw into protective silence or to defend their choice despite their loss. They might insist, as parents of one deceased child did recently, that they would "make the same choice with their next boy" (Fournier, 2004). Parents are sometimes irrational concerning circumcision. Many quickly sign the consent form without first learning more about the physical, psychological, and sexual consequences of circumcision. Some sign because they take their physician's mention of the topic as a recommendation, or because they feel coerced by repeated inquires. Others sign because they fear being regarded bad parents, rather than considering what is in the best interests of their son. For instance, nine out of ten parents who chose circumcision did so knowing full well that the procedure was excruciatingly painful for their newborn boy (Ahaghotu, Okafor, Igiehon, & Gray, 2009).
To hospital residents, the birth of a boy is celebrated as an opportunity to practice surgery. A resident's first surgery upon a live human being does not always go as planned- especially when the patient is not a sedated, consenting adult, but a screaming, thrashing baby. The resident's mentor is likely to provide cover for any errors, lest they reflect poorly on him or her and their institution. Busy residents often have a quota of interventions to meet in order to qualify in their specialty, which means that they have a conflict of interest, potentially an unethical stake, in performing the procedure. Thus, most adult American males can be seen as having been child medical-training draftees, now sporting a "scalpel practice" penis, carved on by a twenty-something-year-old undertaking his or her first surgery.
The relative simplicity of circumcision means that a charge that it was done poorly is a glaring indictment of the clinician. The notion that a child died as a result is, of course, even more embarrassing to them and would call forth some sort of preemptive defense. This often takes the form of blaming the parents for inadequate postoperative care, or insisting that it was the child's fault for being too feeble to withstand the procedure, turning the medical phrase "failure to thrive" into a euphemism for these iatrogenic deaths.
Because of the inadequacies of the death-certificate system and the apparent lack of investigation, it is easy to see how the medical system could either unwittingly or intentionally obscure the true cause of these deaths. American courts aid the medical institution by sometimes ruling that the parents signed the circumcision consent form, and that the parents took their chances even if they were not informed of such a possible outcome. Thus, medical practitioners have a tactical choice. They can list on a lengthy consent form every conceivable risk of circumcision, including death, which might undersell the procedure, or, calculating that the danger of failure and detection is low, soft-pedal the risks in hopes that parents will sign anyway.
Few death cases are ever litigated in court because hospitals recognize that their defenses are few and expensive to plead, and that the publicity would prove harmful. Such cases usually result in an offer to the parents of a private, sealed settlement. Sadly, the death of a child is considered less of a liability than an injury case, and therefore compensation for a dead infant is rarely substantial. On the other hand, severe injury cases- loss of all or part of the glans, or, even worse, the entire penis- are intensely litigated and may produce substantial monetary damages in the millions of dollars. The crass logic of the law is that the injured male will have to bear his injury for a lifetime, whereas the dead infant barely sensed his own existence, and so would not even sense the loss of himself. Invariably such settlements include a confidentiality clause, intended, of course, to protect the reputation of both the individual medical practitioner and the institution.
Following a death, the coroner or the medical examiner, who is usually a physician, will rule whether the death was from suspicious causes. In the United States, that coroner (who, if male, is probably circumcised) is not likely to face squarely and on the record the fact that his or her colleague performed an unnecessary and nontherapeutic surgery that resulted in the death of an infant. This malfeasance could itself be cause for an investigation, could have serious repercussions for the circumcising physician and institution, and therefore seems an unlikely move for coroners, especially if they are elected officials.
Primary and secondary causes of death are all too easy to conceal because of the lack of healthcare oversight. There is remarkably little regulation of medical practice by the Federal government, and little coordination among states to regulate medical procedures. Ironically, circumcision devices (e.g., restraints and clamps) are more closely scrutinized than their application.
The American Academy of Pediatrics (AAP) was found to be partially liable in the death of Dustin Evans, Jr., according to the Iowa Law Review (Giannetti, 2000). It reached the conclusion that his death was attributable to his circumcision, and that the AAP should either have labeled circumcision as experimental or proved its worth through exhaustive scientific testing. Yet the AAP has continued over the past four decades to issue a string of policy statements regarding circumcision, each one carefully worded so as to increasingly shift liability from its membership to parents, thereby protecting their members' lucrative income stream.
Physicians are less likely to circumcise their sons than the general populace (Topp, 1978), suggesting that they know it is an unnecessary surgery, but don't relay this valuable information to parents. Many physicians say that they prefer not to perform circumcisions, but do them anyway, rationalizing that the boy will be in better hands with them than with a physician they might refer the parents to. This may seem a noble position at first, but there can be no pretending to be a conscientious objector to circumcision while simultaneously performing one.
Circumcision is a $2 billion healthcare market, which includes costs for the procedure itself, dealing with complications, and payment for repairs (Fauntleroy, 2001). A study of Medicaid records found that a greater number of circumcisions are performed in states where Medicaid pays more for the procedure (Craig & Bollinger, 2006). A busy delivery-room obstetrician will do as many as five circumcisions a week. Physician reimbursement is at about $167 each6 (Van Howe, 2004), which means that they can potentially make an extra $3 ,340 per month, or $40 ,080 per year. That is moie than an entire year's income for 45% of Americans (US Census Bureau, 2005). One physician brazenly admitted, "I love doing circumcisions- they make my Mercedes payments!"7
At the very heart of this problem is a lack of honesty about an entrenched medicalized ritual. Circumcisers are quick to sidestep ethics and put their real patient- the baby boy- at risk. But they are not likely to speak out, simply because calling attention to their unethical actions would likely jeopardize them or their peers, reduce their income, and, possibly, have dangerous legal consequences.
Implications
Risk assessment for an unnecessary surgery must be held to a higher standard than that for a life-saving surgery. We accept that a heart transplant carries with it a substantial risk of death, but without it there is a certainty of death. On the other hand, the risk from circumcision, which has no therapeutic value, needs to be zero for the infant's sake, all the more so because he is never consulted about whether he wishes to take his chances.
We hear very little in the media about circumcision-related deaths compared with other causes. For instance, compare the 1 17 annual deaths from circumcision with those from other causes for male infants: suffocation (44), mother's use of addictive drugs (27), HTV/ATDS (19), homicide (17), automobile accidents (8), drowning (2), and falls (1) (CDC, 2004). Sudden infant-death syndrome (SIDS) killed 1 ,216 boys under the age of one year in 2004; of those, 115 were under the age of 1 month (CDC), which is the same risk as from circumcision. Approximately 36 teen-aged boys are killed in schoolyard shootings each year (Donohue, Schiraldi, & Ziedenberg, 1998). But there is more publicity for the SIDS deaths and shootings than for the circumcision-related deaths.
Is male circumcision so ingrained in American masculinity that we are hardened to its consequences? Have we inherited the recurring theme in religion and mythology of offering our sons to the gods? Or do we stoically value it as a painful male initiation rite, requiring sacrifice of blood and a body part (Zoske, 1990)- and therefore believed to be worth the occasional death-cost?
If a similar number of children were dying from another optional body modification-say, tattooing or piercing- would the public be outraged at the people and institutions benefiting financially? If not, is it then due to gender bias? Imagine the uproar if a hundred girls were dying from female circumcision each year. Why are so many adults silent about this atrocity? Adults would be furious and highly vocal, to say the least, if someone were to forcibly cut their genitals.
Solutions
The problem is this: circumcision is a killer of baby boys. No one, except for some human-rights activists, is trying to save them. It is unlikely that improving circumcision techniques would eliminate these deaths. No matter how skilled the physician is, some deaths will always occur.
Improving the process of securing informed consent from parents by listing death as a possible outcome would, at first, seem to be a logical solution, but it would fail to save lives for two reasons. First, even well-informed parents will sometimes insist on circumcision (Binner, Mastrobattista, Day, Swaim, & Monga, 2002). Second, healthcare providers cannot be trusted to provide truthful disclosure of the risks involved. The fact that physicians and nurses are already willing to perform well over a million of these unnecessary surgeries a year is proof they are generally untrustworthy.
The overwhelming majority of infant circumcisions are nontherapeutic and therefore unnecessary; the simple solution is eliminating them. To start with, physicians and nurses should be prohibited from initiating a discussion with, or soliciting circumcision from, expectant parents. Circumcision should also be defunded, following the examples set by the sixteen states that have already eliminated Medicaid coverage.
Physicians regularly give parents information favoring circumcision, but rarely provide instructions on how to care for the intact penis. Furnishing parents with this knowledge would alleviate their anxiety concerning a body part unfamiliar to them (Bollinger, 2008). All medical textbooks and parenting guides should include intact-care information and mention death as a possible outcome.
Physicians who perform unnecessary surgeries that result in death must be held accountable for their actions in criminal and civil court. Professional associations that protect their members rather than their patients should be forced to change their policies. Physicians must talk with their peers about ceasing circumcision, or at the very least become conscientious objectors. Legislation to protect boys must be passed, beginning with demanding that Congress rewrite the 1996 Federal law prohibiting female circumcision to make it gender-neutral. A nationwide system that reports all infant deaths with all contributing factors rigorously listed must be established.
Few human emotions compare with the profound grief that results from the loss of a newborn child. Adding guilt to that grief- from the realization that you requested the optional surgery that caused his death- is beyond imagination. Most parents would likely refrain from talking about it publicly. People affected by a circumcision-related death must speak up. Parents must be encouraged to talk about why they chose circumcision, what happened to their son, what they are feeling, what they would advise other parents to do, and whether they would choose circumcision again. Family members and friends must also be involved in the discussion.
Conclusion
It is reasonable to conclude that about 117 circumcision-related deaths occur each year in the United States- approximately 1 out of every 77 male neonatal deaths- and that thousands of boys have died since this practice was first medicalized 160 years ago. These boys died because physicians have been either complicit or duplicitous, and because parents ignorantly said "Yes," or lacked the courage to say "No." Every one of these boys would have had a chance at life had he not been circumcised. Circumcision can no longer be called either a beneficial surgery or a beneficent rite of passage, but by its true designation: an unrecognized sacrifice of innocents.
1 Based on a workweek of five, 8-hour days.
2 Survey by author of the ten highest ranked books listed on Amazon.com, November 10, 2008.
3 Personal communication with author at the 2009 AAP national conference, Washington, DC.
4 Selected from ICD- 10 codes P21.9-22.9, 29.0-29.1, 29.8-29.9, 36.0-36.9, 37.5, 39.8-38.9, 50.9, 52.3, 54.3, 54.8-54.9, 55.9, 96.8-96.9
5 If all Jews, Muslims, and Coptic Christians in the United States circumcise.
6 Adjusted for medical inflation to year 2010, does not include hospital's portion of $136, or what they obtain from foreskin sales to laboratories and cosmetic companies.
7 Personal communication at the 2003 AAP national conference, New Orleans, Louisiana.
References
AAFP Commission on Science. (2002). Position paper on neonatal circumcision. American Academy of Family Physicians.
AAP, American Academy of Pediatrics Task Force on Circumcision. (1999). Circumcision policy statement. Pediatrics, 103(3), 686-693.
ACOG Committee Opinion Number 260: Circumcision. (2001). Obstetrics and Gynecology, 98(4), 707-708.
Ahaghotu, C, Okafor, H., Igiehon, E., & Gray, E. (2009). Psychosocial factors influence parental decision for circumcision in pediatric males of African American decent. Journal of National Medical Association, 101(4), 325-330.
AMA Council on Scientific Affairs. (1999) . Report 10: Neonatal circumcision. Chicago: American Medical Association.
Baker, R. L. (1979). Newborn male circumcision: Needless and dangerous. Sexual Medicine Today, 5(11), 35-36.
Ballad, R. (1997). Malpractice: Septicemia secondary to circumcision. Comtemporary OBIGYN Archive.
Binner, S.L., Mastrobattista, J.M., Day, M.C., Swaim, L.S., & Monga, M. (2002). Effect of parental education on decision-making about neonatal circumcision. South Med J. 95(4), 457-461.
Bollinger, D. (2008). The penis-care information gap: Preventing improper care of intact boys. Thymos: Journal of Boyhood Studies, 1(2), 205-219.
CDC. (2004). Mortality: Underlying cause of death, 2004. CDC online database search. Retrieved March 10, 2009, from http://wonder.cdc.gov/cmf-icdlOJitml
Cleary, T.G., & Kohl, S. (1979). Overwhelming infection with group B beta-hemolytic streptococcus associated with circumcision. Pediatrics, 64(3), 301-303.
Cohen, D.N. (2005, February 10). Should mohelim be supervised?: Baby's death from herpes virus sparks call for oversight. Jewish Week.
Craig, A., & Bollinger, D. (2006). Of waste and want: A nationwide survey of Medicaid funding for medically unnecessary, non-therapeutic circumcision. In G.C. Denniston, P.G. Gallo, FM. Hodges, & MF. Milos, (Eds.), Bodily integrity and the politics of circumcision: Culture, controversy, and change (pp. 233-246). New York: Springer.
Cunniff, C., Carmack, J.L., Kirby, R.S., & Fiser, DJH. (1995). Contribution of heritable disorders to mortality in the pediatric intensive care unit. Pediatrics, 95, 678-681.
Donohue, E., Schiraldi, V., & Ziedenberg, J. (1998). School house hype: School shootings and the real risks kids face in America. Washington, DC: Justice Policy Institute.
Enzenauer, R.W., Dotson, CJR., Leonard, T., Reuben, L., Bass, J.W., & Brown, J. 3rd. (1985). Male predominance in persistent staphylococcal colonization and infection of the newborn. Hawaii Medical Journal, 44(10), 389-390, 392, 394-396.
Fauntleroy, G. (2001 , July 30). Infant circumcision: The debate over parents' rights, human rights and the right to choose. The New Mexican.
Fournier, S. (2004, February 13). Lack of post-surgery info angers grieving parents. The Province, Vancouver, British Columbia.
Gairdner, D. ( 1949). The fate of the foreskin: A study of circumcision. British Medical Journal, 2, 1433-1437.
Gellis, S.S. (1978). Circumcision. American Journal of Diseases of Children, 132, 1168.
Giannetti, MJR.. (2000). Circumcision and the American Academy of Pediatrics: Should scientific misconduct result in trade association liability. Iowa Law Review, 85, 1507.
HCUP. (2006). Statistical Brief #56: Hospital stays for children, 2006. Retrieved March 10, 2009, from http://wwwJicup-us.ahrq.gov/reports/statbriefs/sb56.jsp
HCUP. (2007). HCUP facts and figures: Statistics on hospital-based care in the United States.
Hiss, J., Horowitz, A., & Kahana, T. (2000). Fatal haemorrhage following male ritual circumcision. Journal of Clinical Forensic Medicine, 7, 32-34.
Holt, LE. (1913). Tuberculosis acquired through ritual circumcision. Journal of American Medical Association, LXI(2), 99-102.
Klevens, R.M" Morrison, MA,, Nadle, J., Petit, S., Gershman, K., et al. (2007). Invasive methicillin-resistant Staphylococcus aureus infections in the United States. Journal of the American Medical Association, 298(15), 1763-1771.
Lum, L., & Sorelle, R. (1995, July 28). Boy's death to be probed. Houston Chronicle, 28A.
Miami Herald. (1993, June 26). Baby bleeds to death after circumcision. Miami Herald.
Ncayiyana D.J. (Ed.). (2003). Astonishing indifference to deaths due to botched ritual circumcision. South African Medical Journal, 95(8), 545.
NCHS. (2004). Deaths: Leading causes for 2001. National Center for Health Statistics, 52(9).
New York Times. (1856, December 16). Death from the operation of circumcision. New York Times.
New York Times. (1858, April 23). Death from circumcision. New York Times.
Newell, TJE.C. (2004, January 19). Judgement of inquiry into the death ofMcWillis, Ryleigh Roman Bryan. British Columbia Coroner's Service.
NewsNet5. (1998, October 20). Circumcision that didn't heal kills boy, NewsNet5.
Patel, H. (1966). The problem of routine infant circumcision. Canadian Medical Association Journal, 95, 576-581.
Proctor, J. (2002, August 29). 'Totally unexpected' death of baby probed. The Province.
Rabin, R. (2003, October 9). Mysterious crop of Staph: Newborns, moms infected after stay at St. Catherine's. Newsday.
Rachter, P (1982, November 20). Grand jury to probe death of baby after circumcision. The Des Moines Register.
Reuben, M.S. (1916). Tuberculosis from ritual circumcision. Proceedings of the New York Academy of Medicine, 333-334.
Sauer, L.W. (1943). Fatal staphylococcus bronchopneumonia following ritual circumcision. American Journal of Obstetrics and Gynecology, 46, 583.
Sawin, R.S., Schaller, R.T. Jr., Tapper, D., Morgan, A., & Canili, J. (1994). Early recognition of neonatal abdominal wall necrotizing fasciitis. American Journal of Surgery, 167, 481-484.
Scurlock, JM., & Pemberton, PJ. (1977). Neonatal meningitis and circumcision. The Medical Journal of Australia, 1(10), 332-334.
Speert, H. (1953). Letter to editor. Obstetrics and Gynecology, 2, 104.
Stang, H.J., & Snellman, L.W. (1998). Circumcision practice patterns in the United States. Pediatrics, 01(6):c5.
The State. (1992, July 10). Boy in coma most of his 6 years dies. The State, North Carolina, F21.
Thomson Reuters. (2004). InPatient view report for ICD-9 64.0. Thomson Reuters, Inc., New York, NY. (database search provided to the author)
Topp, S. (1978, January). Why not to circumcise your baby boy. Mothering, 6, 69-11.
US Census Bureau. (2005). Current population survey: 2005 annual social and economic supplement. Table HJNC-06.
US Census Bureau. (2008). Statistical abstract of the United States: Self-described religious identification of adult population (Edition 130), Table 75.
Van Howe, R.S . (2004) . A cost-utility analysis of neonatal circumcision. Medical Decision Making, 24, 584-601.
Verges, J. (2009, September 19). Parents sue over circumcision death. Argus Leader, Sioux Falls, SD.
Welti, C.V. (1993). The Dade County Medical Examiner Department, Miami, Florida, Case No. 93-1711.
Wiswell TJE., & Gesenke D.W. (1989). Risks from circumcision during the first month of life compared with those for uncircumcised boys. Pediatrics, 83, 1011-1015.
Zeller, JJL. (2007). JAMA patient page: MRSA infections. Journal of the American Medical Association, 298(15), 1826.
Zoske, J. (1990). Male circumcision: A gender perspective. Journal of Men's Studies, 6(2), 189-208.
Author affiliation:
Dan Bollinger*
Author affiliation:
* Boy's Health Advisory.
Correspondence concerning this article should be addressed to Dan Bollinger, Boy's Health Advisory, 1970 North River Road, West Lafayette, IN 47906. Email: danbollinger@comcast.net
Read more: http://www.readperiodicals.com/201004/2026622071.html#ixzz1yZOjGSt2
Friday, June 15, 2012
Penile Cancer & Fear Tactics by Pro-Circumcision Propaganda
Penile cancer is a rare disease which occurs in elderly men. It is the rarest of male cancers, occurring approximately in 1 in 100,000 men, A man is more likely to get breast cancer than he is to get penile cancer, and the greatest risk factor for it is wait for it...... smoking tobacco!! Even circumcised men get penile cancer and the most common site on the circumcised penis is the circumcision scar. Your son could choose circumcision for himself as an adult, if he wanted it.
Yet the incessant, misleading and unethical propaganda is cleverly framed in such a way by the Pro-Circumcision advocates that it would leave you to believe that "your precious baby" is at risk of penile cancer, if you dont have him circumcised as a baby! The truth is, Your Precious baby has a much greater chance of being wounded or experience a complication from circumcision (with average complications of infant circumcision being from 2 in 100 (and some say up to 10 in 100) than he would ever get penile cancer as an elderly man (1 in 100,000). Your precious baby will also be 100% deprived of a functional pleasure giving sex organ in the foreskin.
Here is the Cancer Council of Australia's response to recent propaganda about circumcsision and cancer rates in Australia:
"Given the lack of evidence to support circumcision as a cancer control measure in Australia, in the Cancer Council Australia’s view it is inappropriate to complicate the debate on circumcision by suggesting the procedure could contribute to reduced cancer burden in Australia."
Help Bust the Penile Cancer myth
Yet the incessant, misleading and unethical propaganda is cleverly framed in such a way by the Pro-Circumcision advocates that it would leave you to believe that "your precious baby" is at risk of penile cancer, if you dont have him circumcised as a baby! The truth is, Your Precious baby has a much greater chance of being wounded or experience a complication from circumcision (with average complications of infant circumcision being from 2 in 100 (and some say up to 10 in 100) than he would ever get penile cancer as an elderly man (1 in 100,000). Your precious baby will also be 100% deprived of a functional pleasure giving sex organ in the foreskin.
Here is the Cancer Council of Australia's response to recent propaganda about circumcsision and cancer rates in Australia:
"Given the lack of evidence to support circumcision as a cancer control measure in Australia, in the Cancer Council Australia’s view it is inappropriate to complicate the debate on circumcision by suggesting the procedure could contribute to reduced cancer burden in Australia."
Help Bust the Penile Cancer myth
Monday, June 11, 2012
Morten Frisch full rebuttal of Brian Morris
Author's Response to: Does sexual function survey in Denmark offer any support for male circumcision having an adverse effect?
+ Author Affiliations
Novel findings in our population-based survey, which had participation rates of 48% in men and 54% (not 40%, as wrongly mentioned by Morris et al.) in women, suggest, but by no means prove, the existence of non-trivial associations of male circumcision with frequent orgasm difficulties in men and with a range of frequent sexual difficulties in women, including orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment. Morris et al. should not be blamed for feeling unconvinced by our findings. However, as these critics repeatedly refer to Morris’ pro-circumcision manifesto1 as their source of knowledge, their objectivity must be questioned.
Morris et al. express concern over possible overfitting in our logistic regression models because we included a number of potentially confounding variables that differed between circumcised and uncircumcised men and between women with circumcised and uncircumcised spouses. However, as seen in Tables 3–6 of our paper, models with adjustment only for age provided odds ratios (ORs) similar to those obtained in the fully adjusted model, suggesting that this is mostly a theoretical concern. Next, Morris et al. suggest that we should have corrected for multiple testing even though such statistical manoeuvres are, at best, unnecessary and, at worst, deleterious to sound statistical inference in most epidemiological studies.2 Morris et al. also claim that prevalence ratios would have been more appropriate measures of association than ORs. However, despite Morris et al.’s firm statement to the contrary, there is nothing inherently inappropriate about using ORs in cross-sectional studies, even in situations with common outcomes. In such situations, however, ORs should not be misinterpreted as prevalence ratios. We would have been wrong to claim that our OR of 3.26 implied that frequent sexual difficulties were 3.26 times more common in women with circumcised spouses than in women with uncircumcised spouses. Nowhere in our paper did we interpret ORs in such a flawed manner. In accordance with the cited reference3 we simply noted that frequent sexual difficulties were more common in women with circumcised spouses and that the associated fully adjusted OR was 3.26.
Next, Morris et al. argue that our finding of considerably higher rates of frequent orgasm difficulties in (partially) circumcised than uncircumcised Danish men (11 vs 4%, OR = 3.26) may not apply in countries where circumcision means complete amputation of the foreskin. This may well be the case. If partial amputation of the foreskin truly entails frequent orgasm difficulties in a noticeable proportion of men (as experienced by 11% of circumcised men in our study), comparable proportions may well be larger and associated ORs even higher in countries where circumcised men experience greater tissue loss due to more extensive circumcision procedures. Obviously, more data are needed from rigorous studies using carefully constructed questionnaires. The questionnaires used to assess potential sexual problems in the two cited randomized controlled trials in Kenya and Uganda were not presented in detail in the original publications.4,5 Rather than blindly accepting such findings as any more trustworthy than other findings in the literature, it should be recalled that a strong study design, such as a randomized controlled trial, does not offset the need for high-quality questionnaires. Having obtained the questionnaires from the authors (RH Gray and RC Bailey, personal communication), I am not surprised that these studies provided little evidence of a link between circumcision and various sexual difficulties.4,5 Several questions were too vague to capture possible differences between circumcised and not-yet circumcised participants (e.g. lack of a clear distinction between intercourse and masturbation-related sexual problems and no distinction between premature ejaculation and trouble or inability to reach orgasm). Thus, non-differential misclassification of sexual outcomes in these African trials probably favoured the null hypothesis of no difference, whether an association was truly present or not.
Morris et al. should be commended for their creative attempt to dismiss the higher prevalence of frequent dyspareunia in women with circumcised (12%) than uncircumcised (4%) spouses (ORs between 4.17 and 9.00). They suggest that Danish women with circumcised spouses may be so psychologically troubled by the shape of their spouse’s penis that it might result in painful intercourse. A more plausible explanation would be that reduced penile sensitivity may raise the need among some circumcised men for more vigorous and, to some women, painful stimulation during intercourse in their pursuit of orgasm.
Two of the authors, Morris and Waskett, both internationally recognized circumcision activists,6,7 forget to declare their conflicts of interest. Even in situations that are out of context, Morris promotes himself as a neutral ‘authority on the extensive medical benefits of this simple surgical procedure’,8 whereas at the same time he argues that neonatal male circumcision ‘should be made compulsory’ and that ‘any parents not wanting their child circumcised really need good talking to’.9 In contrast, we conducted our survey without setting up any a priori hypotheses, because the limited and inconclusive literature on possible sexual consequences of circumcision would permit almost any imaginable a priori hypothesis. We had no intent to prove an already known ‘truth’ or disprove its contradiction. It is ironic that Morris et al. question the credibility of our findings, postulating that I have an ‘active involvement in opposition to male circumcision’. I have never expressed any objection, ethical, medical or other, against male circumcision as such. Unlike Morris, who believes that ‘circumcision is a biomedical imperative for the 21st century’,1 I could not care less whether fully informed, healthy adults choose to get circumcised or not. Likewise, when foreskin pathology is present (which does not include the physiological tightness of the foreskin experienced transiently by most boys), and the problem cannot be treated conservatively, preputioplasty or partial circumcision may be a relevant solution, even in minors and others who are unable to consent to the operation. However, because ethical discussions about ritual circumcision are sometimes distorted by strong personal views, I openly declared that I have participated in national debates over ethical issues surrounding male and female circumcision.
Like in critical letters to the editor following other recent studies that failed to support their agenda,10–12 Morris et al. air a series of harsh criticisms against our study. As seen, however, the points raised are not well founded. It seems that the main purpose, as with prior letters, is to be able in future writings to refer to our study as an ‘outlier study’ or one that has been ‘debunked’, ‘rejected by credible researchers’ or ‘shown wrong in subsequent proper statistical analysis’. This in spite of the fact that our study was carried out using conventional epidemiological and statistical methods, underwent peer-review and was published in an international top-ranking epidemiology journal.
I would like to thank the IJE editors for withstanding the pressure from one particularly discourteous and bullying reviewer who went to extremes to prevent our study from being published. After the paper's online publication, I have received emails from colleagues around the world who felt our contribution was useful and potentially important. One colleague informed me that the angry reviewer was the first author of the above letter to the editor. In an email, Morris had called people on his mailing list to arms against our study, openly admitting that he was the reviewer and that he had tried to get the paper rejected. To inspire his followers, Morris had attached his two exceedingly long and aggressive reviews of our paper (12 858 words and 5291 words, respectively), calling for critical letters in abundance to the IJE editors. Breaking unwritten confidentiality and courtesy rules of the peer-review process, Morris distributed his slandering criticism of our study to people working for the same cause. Rather than resorting to such selective distribution among friends, Morris should make both reviews freely available on the internet by posting them in their entirety on his pro circumcision homepage (www.circinfo.net). Alternatively, interested readers should feel free to request them from me at the e-mail address above.
Despite poorly founded criticisms and attempts at obstruction our findings suggest that male circumcision may be associated with hitherto unappreciated negative sexual consequences in a non-trivial proportion of men and women. Further carefully conducted studies are needed.
Sunday, June 10, 2012
Infant Circumcision & the Dreaded conversation w the Adult He Becomes
Son: Mum/Dad, why did you have me circumcised?
Mum/Dad: Well son, it was so you'd be protected from HIV!
Son: Does that mean I dont ever have to wear a condom?
Mum/Dad: No you still have to wear a condom!
Son: But Mum and dad, I just want to marry my girlfriend, neither of us is HIV infected, and we want to committ to a life of monogamy!!
Mum/Dad: .......But, we heard in the media that circumcision prevented HIV infections.
Son: But Mum/Dad, Circumcised men all over the world get infected with HIV and die from AIDS, So what was the point of circumcision?
Mum/Dad: Well we wanted you to look like your father!
Son: But I dont look anything like Dad, and I just wanted to look like me?
Mum/Dad: WEll, our Doctor recommended it!
Son: But I've researched it intensly and no medical organisation in the world recommends infant circumcision, what sort of a Doctor was he?
Mum/Dad: Its just better!!!!!!!
Son: But research has found the foreskin has 20,000 pleasure nerves, has anatomical structures, like the frenar band, the frenulum, and meisner corpuscles, and the foreskin both lubricates, and has a rolling mechanism which fascilitates masturbation, and sexual intercourse, and many women prefer being with intact men!
Mum/Dad: "Oh Son you've just turned into a foreskin fetishist, and we're not talking about this anymore!!" or " Son we are so sorry we took that away from you, i geuss we put our own interests first ahead of yours, and we deluded ourselves that we were doing best for you, because we wanted to believe what our culture and our doctors did was right and good, Please can you find it in your heart to forgive us and dont make the same mistake we did"
The converstaion will give you an opportunity to be defensive & dismissive, versus empathic and understanding, which way will it go for you, or better still if you have not circumcised a son or undecided, how about leaving it up to him?
The Conversation you have will further affect him emotionally! What will the SON be feeling at this stage? Rage? Violation? Dismissed? Cheated? Sadness? Forgiveness? And remember if you dont have him circumcised you never have to have this discussion!!!!!
Mum/Dad: Well son, it was so you'd be protected from HIV!
Son: Does that mean I dont ever have to wear a condom?
Mum/Dad: No you still have to wear a condom!
Son: But Mum and dad, I just want to marry my girlfriend, neither of us is HIV infected, and we want to committ to a life of monogamy!!
Mum/Dad: .......But, we heard in the media that circumcision prevented HIV infections.
Son: But Mum/Dad, Circumcised men all over the world get infected with HIV and die from AIDS, So what was the point of circumcision?
Mum/Dad: Well we wanted you to look like your father!
Son: But I dont look anything like Dad, and I just wanted to look like me?
Mum/Dad: WEll, our Doctor recommended it!
Son: But I've researched it intensly and no medical organisation in the world recommends infant circumcision, what sort of a Doctor was he?
Mum/Dad: Its just better!!!!!!!
Son: But research has found the foreskin has 20,000 pleasure nerves, has anatomical structures, like the frenar band, the frenulum, and meisner corpuscles, and the foreskin both lubricates, and has a rolling mechanism which fascilitates masturbation, and sexual intercourse, and many women prefer being with intact men!
Mum/Dad: "Oh Son you've just turned into a foreskin fetishist, and we're not talking about this anymore!!" or " Son we are so sorry we took that away from you, i geuss we put our own interests first ahead of yours, and we deluded ourselves that we were doing best for you, because we wanted to believe what our culture and our doctors did was right and good, Please can you find it in your heart to forgive us and dont make the same mistake we did"
The converstaion will give you an opportunity to be defensive & dismissive, versus empathic and understanding, which way will it go for you, or better still if you have not circumcised a son or undecided, how about leaving it up to him?
The Conversation you have will further affect him emotionally! What will the SON be feeling at this stage? Rage? Violation? Dismissed? Cheated? Sadness? Forgiveness? And remember if you dont have him circumcised you never have to have this discussion!!!!!
Latest Procirc LIES = A HIV Free Generation
Twitter Procircs are now quoting from a Procirc Website which makes the
dangerous public health claim that Circumcision will help create a generation free of HIV
AIDS, I mean what a dangerous and prepostorous statement that is!!!!
WE already have many African Nations where the circumcised populations have higher HIV rates than Non-Circumcised populations, and the USA which has the highest adult circ rates in the developed world, with also the highest HIV infections in the developed world.
This is just irresponsible propaganda!!!!!!!
WE already have many African Nations where the circumcised populations have higher HIV rates than Non-Circumcised populations, and the USA which has the highest adult circ rates in the developed world, with also the highest HIV infections in the developed world.
This is just irresponsible propaganda!!!!!!!
Thursday, June 7, 2012
Women Defending Female Circumcision
Statement by African Women Are Free to Choose (AWA-FC), Washington DC, USA
- Saturday 21 February 2009.
For Immediate Release
February 20, 2009
Statement by African Women Are Free to Choose (AWA-FC), Washington DC, USA.
It is with great concern that we, members of the newly formed African Women Are Free to Choose movement, regard recent situations in Sierra Leone, immediately stemming from the press release issued on Feb 6th by the U.S. Embassy in Freetown.
We are concerned about recent accusations of the Sierra Leone Association of Journalists (SLAJ) made against an important and valued female institution in Sierra Leone, the Bondo sodality of women. Though we do not condone the use of violence or intimidation we are also deeply affected by the inflammatory impact of language such as Female Genital Mutilation (FGM). We declare categorically that this language is offensive, demeaning and an assault against our identities as women, our prerogatives to uphold our cultural definitions of womanhood including determining for ourselves what bodily integrity means to us African women from ethnic groups that practice female and male initiation as parallel and mutually constitutive processes in our societies.
We declare that thus far the representation of female circumcision (FC) - its social and ideological meaning in terms of gender and female sexuality and impact, if any, on reproductive health and psychosexual wellbeing has been over the last thirty years dominated by a small but vocal number of African women that make up the Inter-African Committee (IAC) with the enormous backing, if not outright instigation of powerful western feminist organizations and media personalities. Through aggressive use of the media to portray African women as passive and powerless victims of barbaric, patriarchal African societies, their efforts have succeeded in influencing and tainting the objectivity of such institutions as WHO and UNICEF, among other international organizations that have taken the lead role in promulgating anti-FGM policies and legislation worldwide.
Through political pressure from first world countries on whose aid they continue to depend as well as internal political expediency, several African countries have introduced anti-FGM legislation over against the full knowledge, participation and desires of the majority of affected women. This will not happen in Sierra Leone.
Thus far, the negative medical or health claims about various forms of FC have been disputed as grossly exaggerated by several independent medical researchers and practitioners. The claims that various forms of FC reduce or eliminate sexual desire and feeling in women have also been disproven by affected women themselves, the researchers who relentlessly question them and medical doctors who examine and treat them. We can provide ample references for anyone who is interested in any of this work.
That FC was designed by men to control women’s sexuality is a western feminist myth constructed in a disturbing dismissal of African gender models of male and female complementarity and of our own creativity, power and agency as adult women in the social world. The assertion that FC violates the rights of children falters in the face of WHO’s promotion of routine neonatal male circumcision (MC) to protect against HIV infection in Southern African. Incidentally, circumcised African women also have some of the lowest rates of HIV infection among women in the world, so why the double standard?
We remind the world that all what is being said today about FC - barbaric, dangerous, reduces sexual pleasure, parochial - has also been said about male circumcision by its detractors, usually and conveniently, by those who are themselves uncircumcised. Just as racist remarks were made and aggressive legislation to criminalize practitioners (sometimes with the threat of capital punishment) were introduced by host countries or cultural outsiders to abolish MC with the support of some prominent male Jewish insiders, so too such negative actions are taken against practitioners of FC with the zealous support of some cultural insiders. Just as the bulk of Jewish men resisted and openly defied these edicts so too do the bulk of circumcised African women daily and openly resist global eradication policies and continue to define and celebrate their heritage. Just as MC has not ended and is even now seen as desirable with health and aesthetic benefits, so too FC has not ended and is even desired and being repackaged as vaginal cosmetic surgeries or “designer vaginas” by affluent segments of the very population of western women that today condemn us as “barbaric”.
We recognize the legitimacy of claims of the minority of circumcised African women who view their experiences in a negative light. Like the minority of circumcised men who have organized anti-circumcision campaigns, they emphasize their experiences of unnecessary pain and suffering and see their genital surgeries as an attack on their gender identities. We have no problem with these women, just as their male counterparts, organizing to seek change or even referring to their experiences and their own bodies as mutilated. However, these women, like their male counterparts, must take their case to the bulk of others who are circumcised and convince them of their worldview through peaceful, democratic and lawful means. If, where and whenever they fail to convince the majority, the minority must respect the choices and freedom of the bulk of practitioners to positively define their own experiences and bodies. This is a key cornerstone of any modern liberal, democratic and plural society. While we respect and do not support the coercion of the minority to uphold a tradition they find offensive, we certainly will not allow the minority to impose their will and worldview on the majority of women who are circumcised and their prerogatives as parents to make this decision for their children, both male and female. The minority of uncircumcised women in Sierra Leone, as elsewhere in Africa, must have the freedom to remain uncircumcised if they so wish (and many do request circumcision); and, for those already circumcised who wish to abandon the practice, we advocate for and stand with the Government in protecting their rights to not circumcise their own children. This is true, non-coercive abandonment.
As a newly formed association, Free to Choose will not accept attempts to delegitimize the positive experiences of most circumcised women and any attempts to deny African women, circumcised or not, our rights to self-determination. Further, most of us are not fooled by the substandard research evidence - anecdotal and those purporting to be objective science - to manipulate and coerce circumcised women into submission, that is, to give up a practice that is culturally meaningful to many African women. We question the appeal to a common sisterhood by our western feminist sisters who pretend they do not have a stake in seeing their own uncircumcised bodies as “normal”, “healthy”, and “whole” and therefore morally superior to our own supposedly “mutilated” African bodies.
Therefore, we call on restraint and respect on all sides. To the Soweis and Sokos of Bondo - you are mighty and need no other justification than that which we your daughters have just given you. No amount of western education and modernization can replace our ancestral rites and rights so we are with you. In that small place in Kenema you are showing the world that ours is not just about training women to be good wives and mothers (another myth constructed by our feminist critics and oft repeated from our own culturally ignorant western educated mouths) but that ours is a militant African feminist indigenous institution equipped with a hierarchy and election process that was set in place long before the very western feminist organizations that ridicule us now came into existence and won the right for their own women to vote in their male constructed and dominated social worlds. While our Bondo women warriors fought and died together with our Poro brothers in revolts against colonial injustices, where were our western feminist sisters who are today so interested in the intactness of our genitalia?
As we honor and carry on that militancy in our communal female spirit, let us seek ways to (re)educate our critics and to correct their misunderstandings and biases about female sexuality in particular and gender in general. We have ample intellectual, scientific and religiously grounded resources to do this. Let us also stand strong and united as our female ancestors have in the past against any attempts to allow the vilification of our own practices while our critics overlook or turn a blind eye to their own. Let us be united as African women to stand against any attempt to deny us our cultural rites and rights as adults equal to any other adult in the world whatever their religion, race, and country of origin. My sisters, mothers and grandmothers in Kenema, continue your peaceful protests, you are an exemplar to other so-called oppressed third world women who are portrayed as so passive and ignorant that they need western women to interpret their experiences and speak for them on the world scene. We stand with you in your resistance.
To SLAJ, while we support you in condemning any form of violence against journalists or any other civilians in Sierra Leone for that matter, we too are watching you. We will not allow the media in Sierra Leone to be hijacked and used to spread inflammatory language and messages in a country in which the bulk of women are members and strongly support Bondo. You do not need to use the term FGM, unless you state explicitly that the M refers to Modification and not Mutilation. You can use the term excision, which describes the procedure that can be associated with most women in the country. You can contact us and we will be happy to advise on culturally sensitive approaches. We can also provide you with lists of independent (i.e. non-activist) researchers and experts who are prepared to address any issues you have concerning FC as it pertains to health, human rights, cultural meanings and so on. We support the free flow of information so that women can be informed on both sides.
What we will not support and will expose is deliberate provocation by any member of the press of an international crisis to create a perception of Bondo as archaic, barbaric and unlawfully persecuting that very symbol of modernity, the innocent journalist in a truth-seeking mission to correct social injustice. If someone is itching to receive an international journalist of the year award and a free trip to the UN in New York, it will not be at the expense of our culture and our bodies.
To the U.S. Embassy, we recognize that you are following U.S. Policy. As Americans (some of us born, others naturalized) and permanent residents, we are proud of our great nation and commend your office. We are particularly thrilled that you represent the President of the United States, a man born to an African immigrant. Many of us are African immigrants or first generation African-Americans. We are also especially proud that the US President is of Kenyan descent, given the role of Jomo Kenyatta, the first President of Kenya and nationalist hero, who championed the practice of female circumcision among his ethnic group, the Kikuyu, in his stance against colonialism during the struggle for Kenyan independence from British rule. President Obama’s father was a Luo, as we are told, an ethnic group that does not practice either male or female circumcision whose members are sometimes persecuted by neighboring groups because of this as well as forcefully circumcised. Thus, this is perhaps an opportune moment for the US to lead the world in pausing for a moment to rethink the female (and male) circumcision controversy in global health policy: the homogenizing as well as hegemonic (and hypocritical) claims of western feminism over this issue; the cultural meanings FC and MC hold for the majority of practitioners and their right to self-determination; and importantly the internal ethnic politics of economically deprived African countries whose leaders often manipulate the female circumcision question, whether promoting or banning it, for political and economic expediency.
In the spirit of true diplomacy, we advise that the use of the term FGM is a slight to the very women you claim to support and speak for. Women in Sierra Leone do not form a homogenous group - most of us come from ethnic groups that practice female and male initiation, a section of the minority Krio who are descended from freed slaves do not. Most women support the continuation of FC and some are against it. We expect the US Ambassador, to show respect for all women of Sierra Leone and not use derogatory language that diminishes the majority of women over a minority. This would never happen in the United States where the public use of racist language can be viewed as an incitement to violence, and can be punishable by federal law. Prior to the civil rights movement, it was commonplace and uncontroversial for whites to refer to blacks by the n-word (and many blacks to refer to themselves as such, as some do today); the moral inferiority of blacks was not really in question. However, there is no doubt that the use of the n-word then (as it still does today) caused resentment and anger among many blacks. Similarly, the term FGM causes resentment and anger among circumcised women, even though the common perception of the day is that we are mutilated and hence morally inferior to so-called intact women.
In our local languages we too have vulgar terms for uncircumcised women, which is the marked category in our cultures. Even when used by circumcised women to refer to other circumcised women in a derogatory way it is an automatic provocation that spurs violence. In your proclamation against FGM you have given, albeit unwittingly, license to a minority group to use insulting language against the majority of women. If Bondo women were to respond by using their own vulgarities to refer to uncircumcised women there would be all out war among women in Sierra Leone eventually and inevitably - unknowingly or unintentionally triggered by the US Embassy. And, all Sierra Leoneans are tired of senseless war. Thus, we ask that the US Embassy and other western diplomats show due restraint and respect to all Sierra Leonean women, even as you, your NGOs and International Organizations advocate against our cultural practice.
To the Inter-African Committee (IAC) that has declared February 6 Zero-Tolerance to FGM Day, we do not know you, you have not made yourselves known to us, we have not elected you, you do not represent us and your organization has no legitimacy in the eyes of the masses of grassroots women across the sub-Sahara African belt. If the world does not know this, it will soon be made evident. Though you insult (and support the imprisonment of) our traditional female leaders as financially benefiting from the modest sums of money and basic goods they receive from families of initiates, you do not tell us the amounts of your own salaries, consultancy fees and per diems in the burgeoning anti-FGM global industry in which some African sisters (and brothers) are now fighting to outdo one another for international recognition. It is your leaders and your members (how many, 10, 20, 50 women?) who will need to start looking for alternate sources of income other than the horrific lies and images you have packaged and sold a world too ready to believe the worst of Africans. We will continue to celebrate and uphold our initiation practices and we will challenge whatever global international process that has given you official status to decide what happens to our bodies over against our knowledge and what name others should call us over against our will.
Finally, to our main judges, mostly otherwise liberal-minded uncircumcised women: please understand that the global feminist movement to eradicate female circumcision in Africa (and anywhere else) masks what is in fact a global movement to standardize and universalize the white European female body as the cultural, psychic and moral ideal. To the extent that many African and other third word women do not practice female circumcision within their own ethnic groups then these women’s bodies conform to the “healthy”, “normal”, “beautiful” and “desirable” European prototype for all women. We ask that you not ignore the blatant racism which underlies the zealousness of western feminists in abolishing FC but not MC, in marking African women’s bodies and sexuality as mutilated, while remaining quiet on other forms of women’s bodily and even similar genital surgeries. Their agenda is not really about our bodies, circumcised or not; it is about justifying theirs and thus resolving the uncomfortable dissonance that the existence and support of female excision by subversive African women poses for western feminist imperialism.
We ask that you consider what is happening to the minds of some of our immigrant daughters in western countries as they watch the sensationalist media spectacles of young circumcised African women who, in order to break into the modeling industry, accept invitations to publicly condemn their bodies as mutilated (as a couple of their infamous, albeit tragic predecessors did previously in bestselling tell-all books) on talk shows, reality TV, as well as magazine spreads where they exhibit their barely clothed bodies for the gaze and wonderment of the western world. We ask how different is the circulation and consumption of these images from that of South African “Hottentot” women paraded around Victorian circles; their photos eliciting feelings of sexual horror in a perturbing voyeurism engaged in by those (both European men and their wives) with the power to gaze as well as to define the “other”.
In that Victorian era, when white European women were defined as sexually repressed they projected their fears (in complicity with their husbands) onto African women who were viewed as sexually licentious and immoral. Today, to the extent that the descendants of these women view themselves as sexually liberated (calling attention to their external clitoris as the phallic symbol of theirs and so all women’s liberation and autonomy) they project their fears of past repression onto circumcised African women, who given their deliberate excision of the external clitoris, are conveniently marked as sexually repressed and passive. As circumcised women are already defined by white women and in comparison with them as mutilated, no one has bothered to ask what it is that circumcision symbolizes to African women. This would require a great leap of faith that Africans, not the least African women, have constructed, defined and continue to reproduce a meaningful social world, worthy of existence and defense, outside of dominant European socio-cultural and religious contexts and hence, moral control.
Thus, though we see that most of you are sincerely convinced of your concern about the health, sexuality and bodies of African women and girls, we suggest you remove first the plank in your own eyes: What are your own fears and concerns about your own bodies and how do these relate to your individual experiences of male oppression or violence in your lives as well as your societies’ historical experiences of patriarchy? What myths have your own cultures evolved about women’s sexuality including the relatively recent (re)discovery of the external clitoris as the supposed ultimate site of women’s pleasure and orgasm? How do you condone the routine circumcision of your sons, if this is the case in your own cultures, and react emotively to the idea of the circumcision of girls? Do you see no issue with the increasing popularity of Beverly Hills 90210 genital cosmetic surgeries among well to-do western women, including clitoral and labia reductions, vaginal rejuvenation or tightening and even restoration of the hymen?
And, to our formidable opponents, the radical few western imperial feminists who arrogantly say that multiculturalism is bad for women (and really mean only Euroamerican culture is good for all women), we suggest that in your self-righteous determination to draw the line at FC you reveal more about your hidden racism and xenophobia than you allow the world and yourselves to see. Whatever the case, my sisters, while we will not interfere with your rights to promulgate your steadfast beliefs in the superiority of western gender norms, cultural and aesthetic practices and pretend as if they are the same for women the world over, we will not allow you to deny us what is truly our own: our African cultural rites and our rights to uphold them. Your global power and financial resources, your attempts to divide and conquer us by handpicking, promoting and rewarding those of us who will do your dirty work on the ground in Africa, in the parliamentary and congressional halls of western countries and in secretive, exclusive UN meetings as well as your manipulation of the global media will never match our communal African feminist spirit of resistance, stretching from one end of the Sahara to the other, from the beginning of human history to this day.
We cannot end without acknowledging the sincere efforts of those circumcised and uncircumcised women, insiders and outsiders, activists, scholars, medical researchers and so on who believe in the equality of individuals and cultures and have tempered their individual beliefs with a commitment to evidence-based interventions and research that do not prejudge or stigmatize individuals, entire groups and cultures. We will continue to work with the growing number of such individuals in advocating for rigorous design, implementation, analysis and dissemination of scientific studies that look at the reproductive and sexual health outcomes of both circumcised and uncircumcised women in a wide range of geographic contexts and SES levels. We will continue to respect the rights of NGOs and other entities to try and convince women to abandon these cultural practices as long as their methods are culturally sensitive and respectful.
We will, however, also insist on the rights of African women to continue their traditions if they so choose and will challenge and protest any unjust laws and policies that unfairly discriminate against them. We will step up to organize and sensitize affected girls and women to the full range of their human rights and not just the ones anti-FGM activists choose to share with them. Our new movement includes both circumcised and uncircumcised African women, those who are for and some who are against the continuation of FC as a personal and family decision. We believe that it is in such open and honest woman to woman dialogue and collaboration that we can come up with policies and interventions that protect the rights of minorities to dissent and the rights of the majority to rule as well as the dignity of the individual to choose what happens to her (or his) own body. This is not a subversive idea or a radical one, it is the principle of pro-choice and respect for privacy applied to African women; it is the same principle that supports a woman’s right to abortion, though critics view this as the killing (read: worse than mutilating) of an innocent child; it is the same principle that supports the right of a sixteen year old to opt for genital and bodily piercings, though others may see this as mutilating and repulsive; it is the same principle that invokes sympathy for gender confused individuals and supports their right to radical surgery to change their genitalia and gender.
As for those girls too young to give consent, we must accord to their parents the same rights we accord to the parents of boys in neonatal male circumcision and not discriminate on the basis of gender, religion, ethnicity or country of origin. We will work with willing stakeholders on all sides to determine appropriate ages of consent in varying socio-cultural contexts depending on how majority is determined for decision-making in other important life-crises or stages of development. None of this will be easy and western feminist opposition seems daunting, but from today we, African feminists, educated and illiterate, professionals and rural rice farmers, Christian, Muslim and followers of traditional religion, take the important step to begin speaking up for ourselves in local, national and international contexts in support of our global rights.
The AWA-FC is announcing a press-conference on March 6th 2009, in the Washington DC Metropolitan area, specific time and location to be announced shortly.
Contact Persons:
Fuambai Ahmadu, PhD cell (202)904-0023; email: fahmadu@hotmail.com
Sunju Ahmadu cell (202) 446-7280; email: dimadim18@hotmail.com
Sia Finoh (301) 213-5639; email: fefainc@hotmail.com
February 20, 2009
Statement by African Women Are Free to Choose (AWA-FC), Washington DC, USA.
It is with great concern that we, members of the newly formed African Women Are Free to Choose movement, regard recent situations in Sierra Leone, immediately stemming from the press release issued on Feb 6th by the U.S. Embassy in Freetown.
We are concerned about recent accusations of the Sierra Leone Association of Journalists (SLAJ) made against an important and valued female institution in Sierra Leone, the Bondo sodality of women. Though we do not condone the use of violence or intimidation we are also deeply affected by the inflammatory impact of language such as Female Genital Mutilation (FGM). We declare categorically that this language is offensive, demeaning and an assault against our identities as women, our prerogatives to uphold our cultural definitions of womanhood including determining for ourselves what bodily integrity means to us African women from ethnic groups that practice female and male initiation as parallel and mutually constitutive processes in our societies.
We declare that thus far the representation of female circumcision (FC) - its social and ideological meaning in terms of gender and female sexuality and impact, if any, on reproductive health and psychosexual wellbeing has been over the last thirty years dominated by a small but vocal number of African women that make up the Inter-African Committee (IAC) with the enormous backing, if not outright instigation of powerful western feminist organizations and media personalities. Through aggressive use of the media to portray African women as passive and powerless victims of barbaric, patriarchal African societies, their efforts have succeeded in influencing and tainting the objectivity of such institutions as WHO and UNICEF, among other international organizations that have taken the lead role in promulgating anti-FGM policies and legislation worldwide.
Through political pressure from first world countries on whose aid they continue to depend as well as internal political expediency, several African countries have introduced anti-FGM legislation over against the full knowledge, participation and desires of the majority of affected women. This will not happen in Sierra Leone.
Thus far, the negative medical or health claims about various forms of FC have been disputed as grossly exaggerated by several independent medical researchers and practitioners. The claims that various forms of FC reduce or eliminate sexual desire and feeling in women have also been disproven by affected women themselves, the researchers who relentlessly question them and medical doctors who examine and treat them. We can provide ample references for anyone who is interested in any of this work.
That FC was designed by men to control women’s sexuality is a western feminist myth constructed in a disturbing dismissal of African gender models of male and female complementarity and of our own creativity, power and agency as adult women in the social world. The assertion that FC violates the rights of children falters in the face of WHO’s promotion of routine neonatal male circumcision (MC) to protect against HIV infection in Southern African. Incidentally, circumcised African women also have some of the lowest rates of HIV infection among women in the world, so why the double standard?
We remind the world that all what is being said today about FC - barbaric, dangerous, reduces sexual pleasure, parochial - has also been said about male circumcision by its detractors, usually and conveniently, by those who are themselves uncircumcised. Just as racist remarks were made and aggressive legislation to criminalize practitioners (sometimes with the threat of capital punishment) were introduced by host countries or cultural outsiders to abolish MC with the support of some prominent male Jewish insiders, so too such negative actions are taken against practitioners of FC with the zealous support of some cultural insiders. Just as the bulk of Jewish men resisted and openly defied these edicts so too do the bulk of circumcised African women daily and openly resist global eradication policies and continue to define and celebrate their heritage. Just as MC has not ended and is even now seen as desirable with health and aesthetic benefits, so too FC has not ended and is even desired and being repackaged as vaginal cosmetic surgeries or “designer vaginas” by affluent segments of the very population of western women that today condemn us as “barbaric”.
We recognize the legitimacy of claims of the minority of circumcised African women who view their experiences in a negative light. Like the minority of circumcised men who have organized anti-circumcision campaigns, they emphasize their experiences of unnecessary pain and suffering and see their genital surgeries as an attack on their gender identities. We have no problem with these women, just as their male counterparts, organizing to seek change or even referring to their experiences and their own bodies as mutilated. However, these women, like their male counterparts, must take their case to the bulk of others who are circumcised and convince them of their worldview through peaceful, democratic and lawful means. If, where and whenever they fail to convince the majority, the minority must respect the choices and freedom of the bulk of practitioners to positively define their own experiences and bodies. This is a key cornerstone of any modern liberal, democratic and plural society. While we respect and do not support the coercion of the minority to uphold a tradition they find offensive, we certainly will not allow the minority to impose their will and worldview on the majority of women who are circumcised and their prerogatives as parents to make this decision for their children, both male and female. The minority of uncircumcised women in Sierra Leone, as elsewhere in Africa, must have the freedom to remain uncircumcised if they so wish (and many do request circumcision); and, for those already circumcised who wish to abandon the practice, we advocate for and stand with the Government in protecting their rights to not circumcise their own children. This is true, non-coercive abandonment.
As a newly formed association, Free to Choose will not accept attempts to delegitimize the positive experiences of most circumcised women and any attempts to deny African women, circumcised or not, our rights to self-determination. Further, most of us are not fooled by the substandard research evidence - anecdotal and those purporting to be objective science - to manipulate and coerce circumcised women into submission, that is, to give up a practice that is culturally meaningful to many African women. We question the appeal to a common sisterhood by our western feminist sisters who pretend they do not have a stake in seeing their own uncircumcised bodies as “normal”, “healthy”, and “whole” and therefore morally superior to our own supposedly “mutilated” African bodies.
Therefore, we call on restraint and respect on all sides. To the Soweis and Sokos of Bondo - you are mighty and need no other justification than that which we your daughters have just given you. No amount of western education and modernization can replace our ancestral rites and rights so we are with you. In that small place in Kenema you are showing the world that ours is not just about training women to be good wives and mothers (another myth constructed by our feminist critics and oft repeated from our own culturally ignorant western educated mouths) but that ours is a militant African feminist indigenous institution equipped with a hierarchy and election process that was set in place long before the very western feminist organizations that ridicule us now came into existence and won the right for their own women to vote in their male constructed and dominated social worlds. While our Bondo women warriors fought and died together with our Poro brothers in revolts against colonial injustices, where were our western feminist sisters who are today so interested in the intactness of our genitalia?
As we honor and carry on that militancy in our communal female spirit, let us seek ways to (re)educate our critics and to correct their misunderstandings and biases about female sexuality in particular and gender in general. We have ample intellectual, scientific and religiously grounded resources to do this. Let us also stand strong and united as our female ancestors have in the past against any attempts to allow the vilification of our own practices while our critics overlook or turn a blind eye to their own. Let us be united as African women to stand against any attempt to deny us our cultural rites and rights as adults equal to any other adult in the world whatever their religion, race, and country of origin. My sisters, mothers and grandmothers in Kenema, continue your peaceful protests, you are an exemplar to other so-called oppressed third world women who are portrayed as so passive and ignorant that they need western women to interpret their experiences and speak for them on the world scene. We stand with you in your resistance.
To SLAJ, while we support you in condemning any form of violence against journalists or any other civilians in Sierra Leone for that matter, we too are watching you. We will not allow the media in Sierra Leone to be hijacked and used to spread inflammatory language and messages in a country in which the bulk of women are members and strongly support Bondo. You do not need to use the term FGM, unless you state explicitly that the M refers to Modification and not Mutilation. You can use the term excision, which describes the procedure that can be associated with most women in the country. You can contact us and we will be happy to advise on culturally sensitive approaches. We can also provide you with lists of independent (i.e. non-activist) researchers and experts who are prepared to address any issues you have concerning FC as it pertains to health, human rights, cultural meanings and so on. We support the free flow of information so that women can be informed on both sides.
What we will not support and will expose is deliberate provocation by any member of the press of an international crisis to create a perception of Bondo as archaic, barbaric and unlawfully persecuting that very symbol of modernity, the innocent journalist in a truth-seeking mission to correct social injustice. If someone is itching to receive an international journalist of the year award and a free trip to the UN in New York, it will not be at the expense of our culture and our bodies.
To the U.S. Embassy, we recognize that you are following U.S. Policy. As Americans (some of us born, others naturalized) and permanent residents, we are proud of our great nation and commend your office. We are particularly thrilled that you represent the President of the United States, a man born to an African immigrant. Many of us are African immigrants or first generation African-Americans. We are also especially proud that the US President is of Kenyan descent, given the role of Jomo Kenyatta, the first President of Kenya and nationalist hero, who championed the practice of female circumcision among his ethnic group, the Kikuyu, in his stance against colonialism during the struggle for Kenyan independence from British rule. President Obama’s father was a Luo, as we are told, an ethnic group that does not practice either male or female circumcision whose members are sometimes persecuted by neighboring groups because of this as well as forcefully circumcised. Thus, this is perhaps an opportune moment for the US to lead the world in pausing for a moment to rethink the female (and male) circumcision controversy in global health policy: the homogenizing as well as hegemonic (and hypocritical) claims of western feminism over this issue; the cultural meanings FC and MC hold for the majority of practitioners and their right to self-determination; and importantly the internal ethnic politics of economically deprived African countries whose leaders often manipulate the female circumcision question, whether promoting or banning it, for political and economic expediency.
In the spirit of true diplomacy, we advise that the use of the term FGM is a slight to the very women you claim to support and speak for. Women in Sierra Leone do not form a homogenous group - most of us come from ethnic groups that practice female and male initiation, a section of the minority Krio who are descended from freed slaves do not. Most women support the continuation of FC and some are against it. We expect the US Ambassador, to show respect for all women of Sierra Leone and not use derogatory language that diminishes the majority of women over a minority. This would never happen in the United States where the public use of racist language can be viewed as an incitement to violence, and can be punishable by federal law. Prior to the civil rights movement, it was commonplace and uncontroversial for whites to refer to blacks by the n-word (and many blacks to refer to themselves as such, as some do today); the moral inferiority of blacks was not really in question. However, there is no doubt that the use of the n-word then (as it still does today) caused resentment and anger among many blacks. Similarly, the term FGM causes resentment and anger among circumcised women, even though the common perception of the day is that we are mutilated and hence morally inferior to so-called intact women.
In our local languages we too have vulgar terms for uncircumcised women, which is the marked category in our cultures. Even when used by circumcised women to refer to other circumcised women in a derogatory way it is an automatic provocation that spurs violence. In your proclamation against FGM you have given, albeit unwittingly, license to a minority group to use insulting language against the majority of women. If Bondo women were to respond by using their own vulgarities to refer to uncircumcised women there would be all out war among women in Sierra Leone eventually and inevitably - unknowingly or unintentionally triggered by the US Embassy. And, all Sierra Leoneans are tired of senseless war. Thus, we ask that the US Embassy and other western diplomats show due restraint and respect to all Sierra Leonean women, even as you, your NGOs and International Organizations advocate against our cultural practice.
To the Inter-African Committee (IAC) that has declared February 6 Zero-Tolerance to FGM Day, we do not know you, you have not made yourselves known to us, we have not elected you, you do not represent us and your organization has no legitimacy in the eyes of the masses of grassroots women across the sub-Sahara African belt. If the world does not know this, it will soon be made evident. Though you insult (and support the imprisonment of) our traditional female leaders as financially benefiting from the modest sums of money and basic goods they receive from families of initiates, you do not tell us the amounts of your own salaries, consultancy fees and per diems in the burgeoning anti-FGM global industry in which some African sisters (and brothers) are now fighting to outdo one another for international recognition. It is your leaders and your members (how many, 10, 20, 50 women?) who will need to start looking for alternate sources of income other than the horrific lies and images you have packaged and sold a world too ready to believe the worst of Africans. We will continue to celebrate and uphold our initiation practices and we will challenge whatever global international process that has given you official status to decide what happens to our bodies over against our knowledge and what name others should call us over against our will.
Finally, to our main judges, mostly otherwise liberal-minded uncircumcised women: please understand that the global feminist movement to eradicate female circumcision in Africa (and anywhere else) masks what is in fact a global movement to standardize and universalize the white European female body as the cultural, psychic and moral ideal. To the extent that many African and other third word women do not practice female circumcision within their own ethnic groups then these women’s bodies conform to the “healthy”, “normal”, “beautiful” and “desirable” European prototype for all women. We ask that you not ignore the blatant racism which underlies the zealousness of western feminists in abolishing FC but not MC, in marking African women’s bodies and sexuality as mutilated, while remaining quiet on other forms of women’s bodily and even similar genital surgeries. Their agenda is not really about our bodies, circumcised or not; it is about justifying theirs and thus resolving the uncomfortable dissonance that the existence and support of female excision by subversive African women poses for western feminist imperialism.
We ask that you consider what is happening to the minds of some of our immigrant daughters in western countries as they watch the sensationalist media spectacles of young circumcised African women who, in order to break into the modeling industry, accept invitations to publicly condemn their bodies as mutilated (as a couple of their infamous, albeit tragic predecessors did previously in bestselling tell-all books) on talk shows, reality TV, as well as magazine spreads where they exhibit their barely clothed bodies for the gaze and wonderment of the western world. We ask how different is the circulation and consumption of these images from that of South African “Hottentot” women paraded around Victorian circles; their photos eliciting feelings of sexual horror in a perturbing voyeurism engaged in by those (both European men and their wives) with the power to gaze as well as to define the “other”.
In that Victorian era, when white European women were defined as sexually repressed they projected their fears (in complicity with their husbands) onto African women who were viewed as sexually licentious and immoral. Today, to the extent that the descendants of these women view themselves as sexually liberated (calling attention to their external clitoris as the phallic symbol of theirs and so all women’s liberation and autonomy) they project their fears of past repression onto circumcised African women, who given their deliberate excision of the external clitoris, are conveniently marked as sexually repressed and passive. As circumcised women are already defined by white women and in comparison with them as mutilated, no one has bothered to ask what it is that circumcision symbolizes to African women. This would require a great leap of faith that Africans, not the least African women, have constructed, defined and continue to reproduce a meaningful social world, worthy of existence and defense, outside of dominant European socio-cultural and religious contexts and hence, moral control.
Thus, though we see that most of you are sincerely convinced of your concern about the health, sexuality and bodies of African women and girls, we suggest you remove first the plank in your own eyes: What are your own fears and concerns about your own bodies and how do these relate to your individual experiences of male oppression or violence in your lives as well as your societies’ historical experiences of patriarchy? What myths have your own cultures evolved about women’s sexuality including the relatively recent (re)discovery of the external clitoris as the supposed ultimate site of women’s pleasure and orgasm? How do you condone the routine circumcision of your sons, if this is the case in your own cultures, and react emotively to the idea of the circumcision of girls? Do you see no issue with the increasing popularity of Beverly Hills 90210 genital cosmetic surgeries among well to-do western women, including clitoral and labia reductions, vaginal rejuvenation or tightening and even restoration of the hymen?
And, to our formidable opponents, the radical few western imperial feminists who arrogantly say that multiculturalism is bad for women (and really mean only Euroamerican culture is good for all women), we suggest that in your self-righteous determination to draw the line at FC you reveal more about your hidden racism and xenophobia than you allow the world and yourselves to see. Whatever the case, my sisters, while we will not interfere with your rights to promulgate your steadfast beliefs in the superiority of western gender norms, cultural and aesthetic practices and pretend as if they are the same for women the world over, we will not allow you to deny us what is truly our own: our African cultural rites and our rights to uphold them. Your global power and financial resources, your attempts to divide and conquer us by handpicking, promoting and rewarding those of us who will do your dirty work on the ground in Africa, in the parliamentary and congressional halls of western countries and in secretive, exclusive UN meetings as well as your manipulation of the global media will never match our communal African feminist spirit of resistance, stretching from one end of the Sahara to the other, from the beginning of human history to this day.
We cannot end without acknowledging the sincere efforts of those circumcised and uncircumcised women, insiders and outsiders, activists, scholars, medical researchers and so on who believe in the equality of individuals and cultures and have tempered their individual beliefs with a commitment to evidence-based interventions and research that do not prejudge or stigmatize individuals, entire groups and cultures. We will continue to work with the growing number of such individuals in advocating for rigorous design, implementation, analysis and dissemination of scientific studies that look at the reproductive and sexual health outcomes of both circumcised and uncircumcised women in a wide range of geographic contexts and SES levels. We will continue to respect the rights of NGOs and other entities to try and convince women to abandon these cultural practices as long as their methods are culturally sensitive and respectful.
We will, however, also insist on the rights of African women to continue their traditions if they so choose and will challenge and protest any unjust laws and policies that unfairly discriminate against them. We will step up to organize and sensitize affected girls and women to the full range of their human rights and not just the ones anti-FGM activists choose to share with them. Our new movement includes both circumcised and uncircumcised African women, those who are for and some who are against the continuation of FC as a personal and family decision. We believe that it is in such open and honest woman to woman dialogue and collaboration that we can come up with policies and interventions that protect the rights of minorities to dissent and the rights of the majority to rule as well as the dignity of the individual to choose what happens to her (or his) own body. This is not a subversive idea or a radical one, it is the principle of pro-choice and respect for privacy applied to African women; it is the same principle that supports a woman’s right to abortion, though critics view this as the killing (read: worse than mutilating) of an innocent child; it is the same principle that supports the right of a sixteen year old to opt for genital and bodily piercings, though others may see this as mutilating and repulsive; it is the same principle that invokes sympathy for gender confused individuals and supports their right to radical surgery to change their genitalia and gender.
As for those girls too young to give consent, we must accord to their parents the same rights we accord to the parents of boys in neonatal male circumcision and not discriminate on the basis of gender, religion, ethnicity or country of origin. We will work with willing stakeholders on all sides to determine appropriate ages of consent in varying socio-cultural contexts depending on how majority is determined for decision-making in other important life-crises or stages of development. None of this will be easy and western feminist opposition seems daunting, but from today we, African feminists, educated and illiterate, professionals and rural rice farmers, Christian, Muslim and followers of traditional religion, take the important step to begin speaking up for ourselves in local, national and international contexts in support of our global rights.
The AWA-FC is announcing a press-conference on March 6th 2009, in the Washington DC Metropolitan area, specific time and location to be announced shortly.
Contact Persons:
Fuambai Ahmadu, PhD cell (202)904-0023; email: fahmadu@hotmail.com
Sunju Ahmadu cell (202) 446-7280; email: dimadim18@hotmail.com
Sia Finoh (301) 213-5639; email: fefainc@hotmail.com
Circumcision a Licence to Infect & Contract HIV
In 2010 the chairman of the Royal Australasian College of Physicians in
Press stated as a Response to pro-circumcision propaganda that circumcision was
like a "surgical vaccine" said that "this Message is a recipe for a public health
disaster"........... And he's right!!!!!!
Another report from Africa stating recently circumcision is increasing unsafe sex behaviours:
http://www.bnltimes.com/index.php/daily-times/headlines/features/12423-male-circumcision-a-ticking-bomb
In Malawi recently Circumcised men go on sexual rampage believing they are immune from HIV:
http://mondofown.blogspot.com.au/2012/06/circumcision-looming-public-health.html
Research from Carribbean shows circumcised men with higher HIV & STI's
http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2012.02871.x/abstract
The latest evidence from Zimbabwe (Wednesday, 11 July 2012 15:35 Source AfricaReport) shows higher infections in circumcised men who believe they are now protected from HIV:
http://www.theafricareport.com/index.php/20120711501815186/southern-africa/zimbabwe-concern-over-high-hiv-rates-among-circumcised-males-501815186.html#.T_5XIkR-OzI.twitter
From a USAID report: "There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher." http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms". http://www.info.gov.za/issues/hiv/survey_2009.htm
From the committee of the South African Medical Association Human Rights, Law & Ethics Committee : "the Committee expressed serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The Committee reiterated its view that it did not support circumcision to prevent HIV transmission."
The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/abstract
ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery seems likely to cost African lives rather than save them.Male circumcision offers zero protection from HIV to females, with one trial showing the opposite, that male circumcision increased infections to female partners by 54% compared to intact partners, when the male partner was already HIV positive. See here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2905212/ In the male trials a significant number of circumcised men became infected with HIV proving circumcision is at best only partially effective and therefore condoms are absolutely nevessary. (Why then get circumcised?)
The circumcision campaigns in Africa are targeting all men to be circumcised, and are not screening out those already HIV positive.
Reports in Press from Africa, are claiming recently circumcised men are stating they are now immunized against HIV and no longer need to use condoms. Because, Most of these men are not being screened for HIV, therefore if they are already HIV positive, their recent circumcision gives them a licence to infect!
In African Press recently:
Report says circumcision does not reduce chances of HIV and other STD infection
The American Medical Association, in its recent journal, stated that “behavioural factors were far more important risk factors for acquisition of HIV and other sexually transmissible diseases than circumcision status, which cannot be responsibly viewed as protecting against such infections”.
It further states promoting unnecessary surgery when much less-invasive, less-costly and more-effective methods such as condoms, were available, raised ethical concerns and conflicted with common sense.
“The cost of one circumcision in Africa can pay for 3000 condoms, which also have the advantage of protecting women without any surgical risks and complications,” the journal noted.
Other surveys have also condemned male circumcision as genital mutilation that decreased sexual sensitivity and caused wide-ranging psychological consequences.
HIV-prevention expert Mohlabi, meanwhile, appears to concur with those taking the circumcision advocacy apart.
“There were a lot of issues that researchers in trials held in Kenya, Uganda and Zambia, for instance, might not have known for sure when they were conducting their studies because in such a study, it is difficult to control the group. For instance, one needs to establish whether the circumcised men were not using any other protection,” Mohlabi said, adding the low-risk perception after circumcision had also contributed to some men indulging in risky sexual behaviour.
“The perception that I’m circumcised and therefore, not so much at risk of acquiring HIV, has caused some men to do away with the use of condoms. The procedure might have a bearing on reducing infection but our major battle is how to ensure consistency on the use of condoms after circumcision.”
What a public health disaster!!!!!!!!
Another report from Africa stating recently circumcision is increasing unsafe sex behaviours:
http://www.bnltimes.com/index.php/daily-times/headlines/features/12423-male-circumcision-a-ticking-bomb
In Malawi recently Circumcised men go on sexual rampage believing they are immune from HIV:
http://mondofown.blogspot.com.au/2012/06/circumcision-looming-public-health.html
Research from Carribbean shows circumcised men with higher HIV & STI's
http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2012.02871.x/abstract
The latest evidence from Zimbabwe (Wednesday, 11 July 2012 15:35 Source AfricaReport) shows higher infections in circumcised men who believe they are now protected from HIV:
http://www.theafricareport.com/index.php/20120711501815186/southern-africa/zimbabwe-concern-over-high-hiv-rates-among-circumcised-males-501815186.html#.T_5XIkR-OzI.twitter
From a USAID report: "There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher." http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms". http://www.info.gov.za/issues/hiv/survey_2009.htm
From the committee of the South African Medical Association Human Rights, Law & Ethics Committee : "the Committee expressed serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The Committee reiterated its view that it did not support circumcision to prevent HIV transmission."
The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/abstract
ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery seems likely to cost African lives rather than save them.Male circumcision offers zero protection from HIV to females, with one trial showing the opposite, that male circumcision increased infections to female partners by 54% compared to intact partners, when the male partner was already HIV positive. See here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2905212/ In the male trials a significant number of circumcised men became infected with HIV proving circumcision is at best only partially effective and therefore condoms are absolutely nevessary. (Why then get circumcised?)
The circumcision campaigns in Africa are targeting all men to be circumcised, and are not screening out those already HIV positive.
Reports in Press from Africa, are claiming recently circumcised men are stating they are now immunized against HIV and no longer need to use condoms. Because, Most of these men are not being screened for HIV, therefore if they are already HIV positive, their recent circumcision gives them a licence to infect!
In African Press recently:
Report says circumcision does not reduce chances of HIV and other STD infection
By Tsitsi Matope
However, with huge campaigns advocating male circumcision, the Circumcision Resource Centre researchers said there are possibilities that this could result in lower condom use, with some people mistakenly believing circumcision meant “a natural condom.” The American Medical Association, in its recent journal, stated that “behavioural factors were far more important risk factors for acquisition of HIV and other sexually transmissible diseases than circumcision status, which cannot be responsibly viewed as protecting against such infections”.
It further states promoting unnecessary surgery when much less-invasive, less-costly and more-effective methods such as condoms, were available, raised ethical concerns and conflicted with common sense.
“The cost of one circumcision in Africa can pay for 3000 condoms, which also have the advantage of protecting women without any surgical risks and complications,” the journal noted.
Other surveys have also condemned male circumcision as genital mutilation that decreased sexual sensitivity and caused wide-ranging psychological consequences.
HIV-prevention expert Mohlabi, meanwhile, appears to concur with those taking the circumcision advocacy apart.
“There were a lot of issues that researchers in trials held in Kenya, Uganda and Zambia, for instance, might not have known for sure when they were conducting their studies because in such a study, it is difficult to control the group. For instance, one needs to establish whether the circumcised men were not using any other protection,” Mohlabi said, adding the low-risk perception after circumcision had also contributed to some men indulging in risky sexual behaviour.
“The perception that I’m circumcised and therefore, not so much at risk of acquiring HIV, has caused some men to do away with the use of condoms. The procedure might have a bearing on reducing infection but our major battle is how to ensure consistency on the use of condoms after circumcision.”
What a public health disaster!!!!!!!!
Wednesday, June 6, 2012
Rebuttal of Dr. Carolyn Roy-Bornstein on Infant Circumcision
This is my response to Dr Roy-Bornstein (Dr RB) whom in my opinion mis-represents the data in recommending infant circumcision, my arguments will be in bold-italics.
Dr Roy-Bornstein :
The AAP's recommendations on circumcision are pretty neutral. Despite scientific evidence for a reduced risk of numerous infections and cancers, the Academy's 10-year-old policy claims that "the data are not sufficient to recommend routine neonatal circumcision" and concludes that "parents should determine what is in the best interest of the child."
In the 10 years since that policy statement was published, a growing body of scientific evidence bears out many health benefits of the procedure and many in the scientific community are calling for the AAP to modify its position. In my opinion this is a mis-representation of the data as there is no conclusive evidence that circumcision is necessary in infancy.
One medical benefit of circumcision that has been known for a long time is the decreased risk of urinary tract infection, especially during the first year of life. While the chance of getting a urinary tract infection is 1 in 1,000 for a circumcised boy, the risk increases to 1 in 100 for uncircumcised males. UTI's are a clear example of misrepresenting the data. Dr RB concedes the risks of getting a UTI are 1 in 100 which is a minor risk, UTI's are not an infectious disease, and UTI's are genrally easily treatable, female children have much higher rates of UTI's with no surgery indicated, and convential treatment is a course of anti-biotics, so to recommend surgical amputation of a functional body part is a radical departure from conventional medicine.
The other clear advantage that has been known for some time is the effect of circumcision on the prevention of cancer of the penis. Uncircumcised men carry a three-fold increased risk for this rare disease. Again Dr RB concedes penile cancer is a vary rare occurance, she omits it occurs in elderly men, and amputation of a functional body part of an infant for a rare disease in an elderly man is not recommended by any medical organisation in the world, and therefore another misrepresentation of the data.
There are also conditions that only uncircumcised males experience such as paraphimosis, a painful state where the foreskin, once retracted, becomes trapped, unable to be returned to its original position. Balanoposthitis or infection of the glans and foreskin, also only occurs in uncircumcised males. Usually rare and treat when occurs.
But the last five to 10 years have brought a number of very good studies looking at circumcision and risk of sexually transmitted infections including human immunodeficiency virus (HIV), human papilloma virus (HPV), and herpes simplex virus.
In 2007, two randomized controlled clinical trials — the gold standard for study design — in Kenya and Uganda found that male circumcision decreased male heterosexual HIV acquisition by 50 percent to 60 percent. This is a total misrepresentation of the data and has nothing to do with infants. Infants dont have sex, Africa is a continent with high-prevalence HIV, America is not Africa. The research applied to adult men who volunteered and made informed consent decisions, and there is no reason why adult men around the world cannot make the decision for themselves, once they have decided what lifestyle decisions and risks factors they face . DR RB makes no mention of human rights issues that exist when removing a functional body part from a minor that cannot consent, and may have zero risk of lifetime exposure..
Those numbers may not be directly applicable to males here in the United States, where many HIV infections are acquired through intravenous drug use and men having sex with men. But a US study of patients in an inner city sexually transimitted infections clinic found that HIV rates in uncircumcised males were 22 percent compared with 10 percent in circumcised men. The consistency between this observational study and the African trials suggests this concern may not have legs, and supports the long term protective effect of the practice. DR RB again misrepresents the data, as she selectively chooses data to argue her point and omits data which contradicts her arguments. Again infants dont have sex. Advocates for Youth research found the USA had much higher HIV & STI's than Non-Circumcision Europe, and found that behaviour and education differences were the main factors for differences found. Behaviour is found to be more important than Circumcision status, and WHY the USA has 1200% higher HIV infections than No-Circ Finland, 3300% higher Gonorreah infections, and 1900% higher infections than No-Circ Hilland.
Those numbers may not be directly applicable to males here in the United States, where many HIV infections are acquired through intravenous drug use and men having sex with men. But a US study of patients in an inner city sexually transimitted infections clinic found that HIV rates in uncircumcised males were 22 percent compared with 10 percent in circumcised men. The consistency between this observational study and the African trials suggests this concern may not have legs, and supports the long term protective effect of the practice. DR RB again misrepresents the data, as she selectively chooses data to argue her point and omits data which contradicts her arguments. Again infants dont have sex. Advocates for Youth research found the USA had much higher HIV & STI's than Non-Circumcision Europe, and found that behaviour and education differences were the main factors for differences found. Behaviour is found to be more important than Circumcision status, and WHY the USA has 1200% higher HIV infections than No-Circ Finland, 3300% higher Gonorreah infections, and 1900% higher infections than No-Circ Hilland.
Two other trials showed that male circumcision decreased the rate of herpes infection by about a third.
Circumcision also decreases penile infection with human papilloma virus (HPV), the leading cause of cervical cancer in women and genital warts in both sexes, again by about a third.
Female partners of circumcised males also enjoy some benefits. Bacterial vaginosis and Trichomonas vaginalis infections in these women were reduced by almost half compared with women whose male partners were uncircumcised. Again & as before, this is selectively biased, and a misrepresentation of the data, and nothing to do with infants who dont have sex.
The risks of neonatal circumcision are small, less than 1 percent. The most common complications are bleeding and infection. More serious outcomes are extremely rare. Again a selective misrepresentation of the data on circumcision complications. A Systematic review of complications from circumcision in the BMC Urology found the range of complications was between 0 to 16%, and the range of serious events was between 0 to 2%. Research found here http://www.biomedcentral.com/1471-2490/10/2
Dr RB does not concede the foreskin is a functional male sex organ, minimises human rights issues and that men might actually want a say over their own bodies, and argues that circumcision is required in infancy becuase of the risk of UTI's which is very small 1 in 100, and easily treatable by anti-biotics.
Dr RB does not concede the foreskin is a functional male sex organ, minimises human rights issues and that men might actually want a say over their own bodies, and argues that circumcision is required in infancy becuase of the risk of UTI's which is very small 1 in 100, and easily treatable by anti-biotics.
Dr. Carolyn Roy-Bornstein is a board certified pediatrician with Merrimack Valley Child and Adolescent Health and Merrimack Valley Hospital. Her office is at Merrimack Health Center, 62 Brown St. adjacent to the hospital. She can be reached at 978-521-8108. Parents are invited to e-mail questions to CRoy.MVCAH@comcast.net.
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