It is not at all usual that I find myself grinning at the result of medical research; I’ve been rather successful at maintaining equipoise on quite a range of research issues, but not on male circumcision. My first serious non-medical engagement with male circumcision occurred during an argument for the rights of a child. My contention was that piercing the ear of a girl child, indoctrinating children into the religion that their parents practice were instances of child abuse.
The retort was simple, a bit below the belt. Will you circumcise your male child? Growing up in southwestern Nigeria, and spending six years in boarding schools with common bathrooms, I never saw an uncircumcised penis. I had taken it for granted that it was normal to remove the prepuce. I did not even know what the prepuce looked like until I got to medical school!
Thankfully, there was at the time of the argument, very fresh evidence of the protective effect of male circumcision against heterosexual HIV transmission in sub-Saharan Africa. I replied in the affirmative. However, it got me thinking: what if this evidence had not existed? Much of the routine male circumcision I had been part would have been illegal, or would at least lack scientific merit.
In a BMJ feature article, Circumcision: Divided we fall, to be published in next week’s edition, Sophie Arie considers how recent research on the drawbacks of routine circumcision in boys is provoking medical bodies in different countries to review their position. I took some malicious pleasure in reading her report of a finding that may debunk the previous HIV protection claims for male circumcision:
“… the African trials are flawed in several ways and, if anything, they show that circumcision can delay infection for heterosexual men, not prevent it. ”
This was backed by evidence that have been largely ignored in the wake of the media frenzy about the new wonder solution to the HIV problem in sub-Saharan Africa: male circumcision. South Africa’s president, Jacob Zuma, recently made a point of getting circumcised to encourage others.
Here are further excerpts from the article:
“For a medically futile operation, not one complication can be justified. In the US and Israel, rates of complication in neonatal circumcisions have consistently been reported at between 0.2% and 0.4%. …research published in BMC Urology in February [2010]concluded that side effects such as bleeding and swelling occurred in roughly 1.5% of all procedures carried out by a medical professional on infants in 12 countries.
The Netherlands: “The Royal Dutch Medical Association became the first to decide that the procedure is not only medically unnecessary but also an abuse of the rights of the child in a similar way to female genital mutilation. Under the Dutch constitution, altering a child’s body without medical reasons is illegal, and the Dutch medical body therefore argues there are grounds for banning routine circumcision of babies and children. It has not, however, called for a legal ban on the procedure for fear that it would drive circumcision underground.”
The UK: “The British Medical Association’s guidance… states that the evidence on health benefits was “insufficient for this alone to be a justification,” but… “as a general rule, however, the BMA believes that parents should be entitled to make choices about how best to promote their children’s interests.””
Australia and New Zealand: “The Australasian Association of Paediatric Surgeons (AAPS) states that “it is considered to be inappropriate and unnecessary as a routine, “…but allows for elective circumcision in children over 6 months old when parents hold a very strong opinion.”
Sweden: “Sweden attempted to ban circumcision after the death of a child from complications in 2001. The initial ban was watered down, and the operation is illegal in Sweden in the first two months after birth.”
Nigeria: ???
If you were given the task of formulating the policy regarding male circumcision in Nigeria, what would you propose? My take on this is that indeed, divided we fall. There’s no reason why female circumcision should be any more frowned at or campaigned against. I like to think the foreskin may be almost as important as the clitoris.
