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