San Francisco to ban circumcision?

Jun 15, 11 San Francisco to ban circumcision?

It’s “vaccines-cause-autism” all over again A year or two back, an anti-vaccination campaign began urging mothers not to vaccinate their children because (in spite of all scientific evidence to the contrary) they believe that vaccines cause autism. Vaccines don’t cause autism but they would have prevented the recent measles outbreaks in countries that last saw epidemics of these diseases before widespread vaccinations were available. Now, a small group of nutcases activists in the US is campaigning (based on extremely-shaky evidence) to ban circumcision because it is supposedly hugely risky and psychologically damaging to infant boys. The scientific community has again been quick to point out that there is no real evidence to support these claims, but this appears not to matter to the anti-circumcision lobby. Proponents have now garnered enough support to get the issue on the November ballot in San Francisco.

In Africa, or at least in South Africa, circumcision has been a hot topic for years. There are those in South Africa who would like to see traditional circumcision practices outlawed, on the grounds that they sometimes prove fatal. Every year a number of young men die. Over the past decade or so, however, a lot of work has been done by the medical community working in partnership with traditional leaders to make traditional cultural practices safer. That seems to make sense: if the problem is that circumcision isn’t safe, make it safer.

Not so for anti-circumcision activists in the US. Their somewhat implausible claims of health risks not being strong enough to convince many people (or anyone, really, I’d imagine), they resort to a perverse sort of (religious) freedom argument. Religion is, of course, key to this debate in the US because the practice is fundamental to the religious beliefs of the Jewish and Muslim communities. The argument of the anti-circumcision lobby is that circumcision of a minor is imposing on a child who has no choice. Not an original argument, and not a particularly convincing one without real evidence of harm, although it does highlight what the anti-circumcision lobby clearly sees as a pertinent balance of rights – the rights of individuals to practice religion vs the right of the state to prevent a religion from being imposed on a child (often, somewhat pointedly, phrased as “protecting the child”). An awful lot of things can be justified in the name of “protecting the child”.

In reality, the campaign seems to be little more than an attack on the religious practices of particular groups and is certainly being viewed that way by the Jewish community, at least. And, as with the creationism-vs-evolution-in-science-class debate, much (perhaps most) of the rest of the world looks on in puzzlement ranging to mild exasperation.

As the vaccination-debacle has already shown, however, these flurries of irrationality in US politics can have an influence beyond the borders of the USA. This is bad. It is particularly bad for Africa. The long-standing tradition of male circumcision in some African cultures means that moves to ban the practice will probably not fly here, but any disincentive – such as of the perception of circumcision as an abhorrent, invasive, imposed or foreign – could have a serious impact on the uptake of male medical circumcision as part of HIV prevention.

Many people have been nervous about circumcision as an HIV prevention tool, not least because some of the practices associated with traditional circumcision rituals may in fact encourage unprotected sex and so drive the spread of HIV in certain communities. Male medical circumcision has now been shown, however, to lower the risk of infection for men. While this will not make HIV go away, any new development that can be added to the arsenal of tools to fight HIV is important; every single infection prevented is a positive step. Also, as males are most likely to have multiple concurrent partners in many of the most high-risk situations, fewer men infected means fewer women infected and fewer babies born infected, even where condom use is erratic. Not sleeping with an infected partner remains the most effective way to stay HIV negative.

Male medical circumcision also has the added advantage of being medically supervised and so far lower risk than other forms of circumcision. Infant circumcision is even lower risk. Individuals and groups in the USA are, of course, entitled to express their opinions – even if they are thinly veiled religious intolerance and the belief that everyone else’s religious freedoms stops short of actually practicing a religion – but wouldn’t it be nice if, just for once, the crazy beliefs of that take the US by storm could help and not hinder African development, public health and HIV prevention measures?

Image by Celine Nadeau

  • Joe Roussos

    Claire, I’m afraid that I think your rant has gone awry.

    1. A minor quibble: This isn’t like the vaccines-cause-autism saga, because that contained a medical inferrence which was simply false, based on poor data from a single bad study. The scientific evidence for circumcision being dangerous is much better than the evidence for vaccines causing autism. The chief piece of evidence used in that debate is a meta-analysis published in 1995. It combined the results of multiple studies and seemed to show that circumcision increases the risk of HIV infection. It was later shown to have made a mistake, but the error is far more subtle and the intention was good. This is an error in good science, not bad science. 

    2. Pointing out that something is central to a religious or cultural practice does not make it correct. An awful lot of things can be justified in the name of “protecting religion/culture”.

     2.1. Similarly – and you don’t do this, but the article does – it is not the case that an assault on a practice is automatically an assault on a culture which employs it. 

     2.2. It would be absurd to circumscribe certain types of advocacy on that basis, or indeed on the basis of a potentially negative spill over effect elsewhere. To do so would be to prejudge the debate and suppress free speech. 

    3. While I recognise the danger you highlight, of US activism thoughtlessly spilling over to Africa, we should acknowledge that African circumcision is a different beast. Here the practice mostly occurs later, with explicit voluntary agreement by the boys in question. So long as this takes place prior to the commencement of a sexually active lifestyle, it is successful as an HIV prevention mechanism. 

    4. Most importantly: they have a point. You can’t just run roughshod over their central claim, it must be engaged with. Circumcision is the modification a baby’s body in a (often deliberately) painful manner. There can be no consent at that time, and it removes choice later on. It is often done for reasons that have nothing to do with health concerns. Therefore, it seems to be open to debate. 

    • C Hawkridge

      1. Fair enough but basing a campaign on an error (while not as bad as basing it on bad data from a single study), is still a problem. 

      2. True. So then “protecting religion/culture” must be weighed against “protecting the child”. Without clear harm to the child, what’s the justification for stopping people doing what they want? 

      2.2 True. I’d intended to lament, rather than advocate for the restriction of this kind of movement. Sometimes free speech really doesn’t help the ends of public health/development. Sigh.

      3. African circumcision is many different beasts and in fact infant circumcision is also practised in parts of the continent. The point is that perceptions might be a disincentives to medical circumcision uptake early enough for HIV prevention (which, as I’m sure you know, is way before 18). But not enough to limit free speech – see 2.2 above.

      4. Right. The engagement runs something like this: a) children are unable to make choices for themselves, so guardians are given the right, b) guardians are perfectly capable of weighing up risks and benefits, c) this is not a procedure which has obvious, inevitable harms or which has no clear benefits, d) most circumcisions in the US context take place under medical supervision and local anaesthetic, e) the risks associated with circumcision appear to increase with age,  so f) guardians should be allowed to make the call on behalf of their infant children. 

      Even without a clear health benefit motivating the choice, unless there is a clear health harm, why is body modification necessarily illegitimate? (I’m really asking)

      • Joe Roussos

        I think what might be most interesting here is for me to put together a review of the arguments against non-therapeutic male circumcision. I’ve thought about it a fair bit, and the resources Tim posted on  your Facebook lend themselves to just such a project. I’ll try submit it on AS later tonight. 

        • John

          As someone who is both editor and circumcised, I approve of this :)

      • I completely agree with point 4! I briefly looked at his response and I don’t think he adequately dealt with this point.

      • crew

        “why is body modification necessarily illegitimate? (I’m really asking)”
        UTIs are treatable. Penile cancer (rare) shouldn’t be the circumcision decider in an infant. Let’s just go ahead and remove some female mammary glands. Since breast cancer is so common. 
        The foreskin contains thousands of nerve endings, just like the clitoris. And we wonder why older american men can’t get things going down there. Most are circumcised and have lost sensitivity. 
        There IS harm in cutting off something good for no direct reason. Especially when there is a chance.. small as it may be.. of death or serious infection.. mutilation of the penis/damage. Ask the parents of THOSE harmed babies if it was really necessary to have their son’s circ’d. 
         Most people I know who have done it, have done it for social reasons. Because there just aren’t any justifiable medical reasons to do it routinely to boys who have nothing wrong with them. 

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  • crew

    I am against routine infant circumcision, and it has nothing…NOTHING to do with religion. Most Christians I know cut their sons. Foreskin has an important biological purpose. It’s healthy, not sick–not broken. And yes, it’s akin to female circumcision. Find an image of male and female sex organs around 12 weeks gestation. There is no difference.