About 30 per cent of the men in the world are circumcised – normally shortly after birth. This debate raises issues ranging from the purely ethical to the purely scientific; with quite a lot in between that is a hybrid of the two. Although defenders of the practice claim that there are medical benefits – up to and including the prevention of AIDS – opponents see it as an unnecessary procedure that causes pain to an infant for no apparent benefit.
Clearly there are also issues of the balance between religious freedom. 68 percent of the male circumcisions in the world are performed on Muslims, with members of the other Abrahamic faiths making up much to the rest. There is also an issue of whether parents have the right to make such a decision, one that is effectively irreversible, on behalf of their child when they are at an age when they are incapable of giving consent.
National and international medical bodies have mostly taken an agnostic position on the subject, acknowledging that there may be medical benefits but, ultimately, accepting that it is a matter of parental choice.
Circumcision became common practice in the US around 1900 and has been in relatively common practice for non-religious reasons in various countries. However, it is interesting that in situations where governments are required to pay for it, they tend not to.
The British Medical Association (BMA) has questioned the purported medical benefits but described the process as neutral in terms of its medical impact. National bodies in Canada and the Netherlands recommend against it as a standard procedure – a position backed up by the BMA. The American Academy of Pediatrics acknowledges the ‘potential benefits’ of the procedure but does not recommend it as a routine procedure for newborn boys.[i]
It seems fair to say that the jury is out on the question of the long term physical benefits or disadvantages of male circumcision. There is certainly no compelling argument in favor of circumcision as a default position. Studies on whether male circumcision has any impact on sexual performance or satisfaction in later life are equally mixed. Unlike female circumcision, where there is compelling evidence of harm in later life, this debate needs to focus far more clearly on whether there exists what the KNMG, the Dutch medical association[ii], called “a violation of children’s rights to autonomy and physical integrity.” This statement also suggests that the procedure is not as benign as is widely believed, but gives no extensive details. Unlike other medical associations, the KNMG has gone so far as to launch an advertising campaign to discourage the practice. In response to the campaign, Dutch Chief Rabbi Binyomin Jacobs has said that “We’re not ignoring the situation… we’ll see what happens and remain alert.”
Rabbi Jacobs explained that there are only about 50 Jewish boys are circumcised in the Netherlands every year, out of a total Jewish population of between 20,000 and 30,000[iii].
If this is simply a matter of performing a procedure with no apparent benefit to the patient – in most cases a young child – then it does rather raise the question of “Why”. If the procedure were, say, cutting off a toe or an earlobe then all involved would require a clear and compelling case for such a practice. There are grown adults that think that cutting off a finger is the next stage up from getting a tattoo or a piercing[i]. At best most people would consider such a practice odd, at worst unstable. However, these are grown adults who have made the decision to mutilate their bodies for themselves and as a statement they feel appropriate.
Consider society’s reaction if the fingers of unwilling adults were forcibly removed. What about unwilling children? What about the fingers of babies fresh out of the womb? The only sane response to such an action would be condemnation – and probably an arrest. The logic of this argument does not change if “finger” is replaced with “foreskin”.
Research undertaken by the World Health Organization found that the overwhelming determining factor in the decision as to whether a boy should be circumcised was whether the father had been[ii].
Although the report suggest a correlation with a reduction in the possibility in the spread of AIDS in sub-Saharan Africa it also comments, “If correctly planned, increased provision of accessible, safe adult male circumcision services could also increase opportunities to educate
men in areas of high HIV prevalence about a variety of sexual and reproductive health topics, including hygiene, sexuality, gender relations and the need for ongoing combination prevention strategies to further decrease risk of HIV acquisition and transmission.”
Out with this area the rate of adult male circumcision is very low, suggesting that when the individual is of an age to give consent, they chose not to. Performing an act on a child that would not be consented to by an adult except in extremis would seem a fairly reasonable definition of child abuse.
Neo-natal circumcision is an operation that has been performed, perhaps, more than any other. It is performed mostly for cultural or religious reasons but there is also a body of evidence that suggest health benefits. There is very little suggestion in any study of any harm to the child.
In all sorts of situations societies allow parents to make decisions on behalf of their child.
In the absence of proven harm and in the presence of possible benefits in terms of health and hygiene there is really no danger in allowing the parents this option.
Those problems that can arise from the surgery are both very rare and as a result of faulty surgery rather than any risks innate within the process itself[i].
This is mostly a religious or cultural decision that has survived within communities for thousands of years without howls of protest and with no proven harm. In the absence of a sizable body of opinion calling for it to be ended, why do so?
A report by the Royal Dutch Medical Association noted that there was not a single medical body in the world that could point, categorically to a medical need for circumcision of infants. It further concluded that “The fact that this practice is not medically necessary and entails a genuine risk of complications means that extra-stringent requirements must be established with regard to this type of information and advice.” Yet this is a practice that is performed around the world by people with little or no medical training and accepted by parents as an instruction from God.
Studies from the US suggest that around 230 baby boys die in America every year as a direct result of hemorrhaging following circumcision[i].
There are, of course, risks in any medical procedure. However circumcision remains astonishingly safe. Furthermore, denying the parents of a child the right to raise that child in accordance with their own beliefs would represent an unacceptable intrusion by the state into its citizens’ private and religious lives.
By implementing the resolution, a western liberal democratic state is obliging, say, orthodox Jewish parents, to compromise some of their most important moral and cultural beliefs. Ultra-orthodox Jewish groups believe, literally and without equivocation, that whoever breaks the covenant with God by not submitting to circumcision will be condemned for all eternity. The state should not compel parents (and children) to endure the moral, psychological and ideological turmoil associated with such a compromise; ultra-orthodox Jewish parents will see the state as forcing infinite harm upon their children.
There are risks to giving a child a bike or taking them on a plane. Parents are aware of this but act in what they consider to be the best interests of their child.
If we were to prevent parents from every taking a decision that might be risky for their children, they would never cross the street, eat a Big Mac or take up sports.
Any risk needs to be justified against some benefit. In the absence of any demonstrable benefit then there is no need to tolerate any risk, particularly in the case of a newborn baby who cannot express his opinion one way or another and will not be able to do so for years to come.
The risks of circumcision have been repeatedly demonstrated. Though they may be rare, they run from septicemia through to blood hemorrhage and heart attacks. There is little research conducted on the long term effects of the procedure; however there is a growing body of evidence that a surgical complication rate is about 1 in 500 and the post-surgical rate of attrition is believed by many to be higher[i].
The precautionary principle is alive and well but risks are inevitable in any procedure. There is no reliable data on fatalities directly related to circumcision.
The causes of the 10 million or so neonatal deaths that occur around the world each year are closely linked to the income and educational level of the mother, with diarrhea and malnutrition being the leading causes.
By contrast children that are born with access to modern surgery and informed parents are likely to do well.
Circumcision is akin, in many ways, to vaccination; a routine and simple procedure with miniscule risks and compelling probable benefits. We acknowledge the right of parents to take these decisions on the behalf of their children, even if the benefits in question are primarily cultural and spiritual, and relativistic in character.
Parents routinely make decisions with far greater implications for their children’s futures in terms of their education and general welfare on a regular basis and this should really be seen as no different[i].
As has been established, even in the most impromptu settings, male circumcision, unlike FGM, runs almost no risk of causing severe injury or infection. MGM does not endanger or restrict a child's development, or his ability to living and normal, fulfilled adult life. Parents make much more damaging choices for their children all the time - choices that do not involve modification of a child's body.
The cost of raising a child as a junior rugby player is an increased risk that the child may sustain life changing injuries. The cost of sending a child to a Montessori nursery as opposed to a curriculum-based institution is the possibility that they may lack personal discipline or respect for authority later in life.
Parents are still permitted to make these decisions, despite the impact they may have on a child’s development. Why not allow them to submit their children to a relatively minor and inconsequential aesthetic procedure?
Parents do not have the right to presume their children’s consent for procedures that are medically unnecessary, as in the case of circumcision.
Ultimately this is a choice that has more to do with culture than with medical need. The purported benefits are, at best, questionable and the results are irreversible.
The medical benefits of vaccination, by contrast, are undisputed and widely publicized. In those interests where the balance of risk is even remotely questioned, as in the case of the MMR vaccine, there is significant public debate and many parents have chosen to avoid the practice all together[i].
Where there compelling evidence from medical science that a process that predates it had some proven harm then there might be good reason to restrict it but that evidence simply isn’t there. What is known is that circumcisions have been performed for millennia without causing widespread difficulties. In addition, historically, the procedure has been performed in circumstances far less safe than the confines of a modern, well-equipped hospital where it usually takes place now, and to no apparent ill effect.
Even using the term ‘abuse’ to describe such a practice shows a lack of respect for those people who are genuinely victims of abuse.
Just because a practice is old doesn’t make it right. In addition to which societies’ attitudes, especially in the West, have changed radically in relationship to how we view both the body and childhood.
There is no other area where the physical violation of a child’s body would be tolerated, regardless of how old the process is. Indeed society tends now to reject ancient traditions as they relate to children, specifically because they are archaic, as is the case with corporal punishment. There is good reason to suspect that what may have been appropriate, possibly even beneficial, for semi-nomadic desert tribes is of little use in modern society.
There is compelling evidence that shortly after birth is the best time to perform this operation and that the rate of complications at this age is generally agreed to be between 0.2 and 0.4 percent. When performed later in life the risk of complications increases ten-fold to between two and four percent. In the light of this it is appropriate to recognize the rights of parents to approve a procedure that would be riskier if elected later in life on behalf of their child[i].
It is possible to perform this operation at any time during a person’s life and there is no compelling need to perform it on extremely young children. Doing so violates the child’s right to be free from pain. Indeed the deliberate and unnecessary infliction of pain on a minor in any other circumstance would be considered abusive, it is clearly illogical not to consider it so in this instance. The only reason why circumcision is not considered abusive is that it is so commonplace. However, only a couple of generations ago (and to this day in many nations) so was the routine use of physical punishment in schools, which many now consider abusive and repugnant.