Guidelines recently reissued by the British National Health Service confirm the policies of most health authorities that circumcision is rarely needed, and that the risks and harms normally outweigh the potential benefits. The statement observes that while routine circumcision was common in Britain until the 1950s, the practice died out because the medical community came to realise that it “had no real medical benefit in the vast majority of cases.” While there is much media speculation on potential benefits (such as reduced risk of STIs), “most healthcare professionals now agree that the risks associated with routine circumcision, such as infection and excessive bleeding, outweigh any potential benefits. The NHS does not normally meet the costs of non-therapeutic circumcision, and funds therapeutic circumcision (when there is a penis-foreskin problem) only when medical (non-surgical) treatment has failed. “In such cases, circumcision is usually regarded as a "treatment of last resort” - as is the case with most other amputating surgeries.
This policy is in contrast to the new guidelines released for public comment by the United States Centers for Disease Control, which seems to be in the grip of the same illusion that led the American Academy of Pediatrics down the garden path. Although it did not recommend circumcision, the AAP’s 2012 policy statement has been widely criticised by child health experts for failing to substantiate its headline claim that the benefits of circumcision outweighed the risks, for failing to take the harm of circumcision and the value of the foreskin into account, and for completely ignoring bioethical and human rights issues. As early critiques suggest, the CDC guidelines are likely suffer from the same fatal flaws. What is it about these American circumcision obsessives?
Brian Earp, Proposed CDC guidelines on male circumcision: A critique (at Academia.edu)
A survey of recent medical literature on circumcision has concluded that many of the studies are of poor quality, are not sufficiently evidence-based, lack methodological rigour, and are often not applicable to developed countries. The paper, by J.A. Bossio and colleagues, concludes that more research is needed, particularly on the impact of circumcision on sexual experience and other harms and risks arising from the surgery. Parts of the abstract read as follows:
Introduction. Male circumcision is one of the most commonly performed surgical procedures worldwide and a subject that has been the center of considerable debate. Recently, the American Academy of Pediatrics released a statement affirming that the medical benefits of neonatal circumcision outweigh the risks. At present, however, the majority of the literature on circumcision is based on research that is not necessarily applicable to North American populations, as it fails to take into account factors likely to influence the interpretability and applicability of the results.
Results. This review highlights considerable gaps within the current literature on circumcision. The emphasis is on factors that should be addressed in order to influence research in becoming more applicable to North American populations. Such gaps include a need for rigorous, empirically based methodologies to address questions about circumcision and sexual functioning, penile sensitivity, the effect of circumcision on men’s sexual partners, and reasons for circumcision. Additional factors that should be addressed in future research include the effects of age at circumcision (with an emphasis on neonatal circumcision) and the need for objective research outcomes.
Conclusion. Further research is needed to inform policy makers, health-care professionals, and stakeholders (parents and individuals invested in this debate) with regard to the decision to perform routine circumcision on male neonates in North America.
CIA comment: For all it moderation of language, this paper, by three impartial observers, is a pretty devastating indictment of claims that the “benefits” of circumcision outweigh the risks. As the authors of the study point out, most of the research cited to back up this assertion was conducted in poverty-stricken Third World countries with poorly developed health services and high levels of sexually transmitted disease, especially HIV-AIDS. The results of this research is simply not applicable to developed countries such as north America, Canada and Australia. Just as serious is the study’s conclusion that much of the pro-circumcision literature is not based on sufficient evidence or conducted with sufficient methodological rigours to justify the sort of conclusions that the American Academy of Pediatrics came up with in 2012. As the authors of the survey point out, a great deal more research is needed before any firm conclusions about the balance of benefits, risks and harms can be reached.
Source: Bossio JA, Pukall CF, and Steele S. A review of the current state of the male circumcision literature. Journal of Sexual Medicine, Online first, 6 October 2014.
The sexual health of Australians continues to improve. Despite alarmist headlines about rising chlamydia and HIV incidence, the Second Australian Study of Health and Relationships (ASHR2) found that most Australians aged 16 to 69 years were living sexually fulfilling lives with a very low incidence of sexually transmitted infections (STIs) and other problems. Newspaper coverage of the survey focused on the news that Australians were becoming more permissive towards sexual behaviour and engaging in a greater variety of sexual activities, but more significant is the finding that more Australians are practising safe sex regularly and that the incidence of STIs has decreased since the previous study in 2001-02. Among the most important findings:
The authors of the study conclude that “the sexual health of the Australian population has improved” since the turn of the century, and that more Australians are having sex in ways that reduce the risk of STIs and unintended pregnancies. They report, however, that there is always room for improvement and suggest that the next step should be a comprehensive national sexual health strategy.
Australian Department of Health. National strategies for blood borne viruses and sexually transmissible infections.
Sydney Local Health District. Sexual Health Strategy: Sexually Transmissible Infections
It is a matter of interest that none of these documents (not even the HIV-AIDS strategy), nor the ASHR2 papers, so much as mention the word “circumcision”. Yet the fact is that over the same decade in which the sexual health of Australians has improved, the proportion of uncircumcised men (i.e. men with foreskins!!) among the sexually active population has steadily increased. It is thus obvious that circumcision is irrelevant to favourable sexual heath outcomes.
World Health Organisation definition of sexual health
A state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.
Richard O. de Visser, Juliet Richters, Chris Rissel et al. Change and stasis in sexual health and relationships: Comparisons between the First and Second Australian Studies of Health and Relationships. Sexual Health 11 (5), November 2014.
In Kenya, circumcision and other forms of sexual violence and genital mutilation are being used to terrorise minority groups and political opponents of the dominant tribal elites. This is the alarming conclusion of a study published in Ethnicity and Health, which also reports that the US-led push for mass circumcision in Africa as a tactic against HIV-AIDS is producing major violations of human rights and doing little for health. In Kenya the majority of the population belong to tribal groups that traditionally practice circumcision as an initiation ritual in late childhood. There are, however, several minority ethnic groups that do not practise circumcision, and these have been subject to various forms of oppression and mistreatment by the majority, including forced circumcision, sometimes by mobs who kidnap men in the street, as Michael Glass reported in the Journal of Medical Ethics last year. These outrages are clearly a form of sexual violence and a blatant violation of both civil law and human rights principles, and further evidence that the US-funded campaign for mass circumcision in Africa is leading to shameful abuses and placing vulnerable minorities at the mercy of their traditional enemies: the law of unintended consequences at work. It is disgraceful that international human rights agencies have been silent on these developments.
In a related paper, Robert Darby considers the parallels between responses to syphilis in Victorian Britain and HIV-AIDS in contemporary Africa, and finds that circumcision was recommended in both cases for reasons that had little to do with an objective assessment of the value of the surgery, but everything to do with cultural prejudice. He points out that many African countries hit hard by AIDS already had high rates of circumcision and that the majorities in these places welcomed the US-sponsored circumcision campaign as an excuse to force their non-circumcising minorities into line.
A young Muslim in Singapore has condemned circumcision as a painful ordeal that violates a child’s body for no valid reason. He reports the pain and distress that he experienced at his own circumcision, and his subsequent search for information, soon learning that circumcision was neither medically necessary nor required by Islam. He concludes his moving account by explaining that he wanted “to share this story to show how so much misinformation have affected my parent’s decision to perform an irreversible act to their child. They have regretted this decision once I have shared all the things I’ve learnt and I have forgiven them as they did what they thought was in my best interest. But now, armed with new information, I believe continuing in this tradition is as barbaric as the old Chinese Foot binding tradition.
“Circumcision is not something to be encouraged let alone to be done to a child. A child is too young to give such a life altering consent and parents should not be allowed to make this decision of their child. Circumcision is simply genital mutilation that does not serve any medical, hygiene or religious purpose (maybe the Jews only) and should be considered as child abuse if done to a child under the age of consent. The only time circumcision should be allowed to a child if there is a legitimate medical reason to do so. … The circumcision tradition will end with me in my family line and I promised never to put my future son in the same position I was. And I hope other will also follow.”
A Young Singapore Muslim, I am now against circumcision. The Real Singapore, 31 October 2013.
Circumcision is losing favour in the place where it first began: among Jewish people in Israel. According to an article in the Jerusalem newspaper Haaretz, “the institution of circumcision has no real hold among the segment of the Israeli population that is not conservative and religiously observant.” The article, by prominent Israeli author and former politician Avraham Burg, notes that as Jewish people have become more secular, traditions such as “observance of the Sabbath, kashrut (Jewish dietary laws), mikveh (family purity laws), and the religious prohibitions against same-sex relations” have fallen away, and concludes that circumcision is likely to follow suit. Burg notes that most supporters of circumcision cite “hygiene” or uniformity rather than religious reasons, but comments that the only justification for harming a defenceless child is religious obligation: if those obligations are not recognised, circumcision becomes a meaningless act of violence that violates a child’s human rights.
Avraham Burg, Is this the generation that rejects circumcision? Haaretz, 29 August 2014. Registration (free) required.
The British Daily Telegraph recently (July 2014) hosted two opinion pieces that raised the question of whether male and female genital cutting were comparable. The first, by Neil Lyndon, expressed strong opposition to non-therapeutic circumcision of male infants and other minors, and showed many point of similarity between male circumcision and female genital cutting. In response, Simon Hochhauser insisted rather aggressively that there must never be comparisons between cutting a boy’s foreskin and “the abominable act of FGM” because the former is not harmful enough to pass beyond the bounds of the tolerable while the latter exceeds them. It is a remarkable sign of progress that a rather conservative newspaper should have published an article even suggesting that circumcision of boys might have some similarities with female genital mutilation, let alone arguing strongly that it is just as evil and wrong. No wonder the circumcision lobby is so worried.
Sithembile Mlotshwa, a senator in the Zimbabwe parliament, has urged that boys be legally protected from circumcision, warning that the circumcision campaign instituted as an HIV control measure was “creating a generation of useless men”. Mlotshwa moved the motion in Senate, arguing there were no benefits to infant male circumcision as children did not indulge in sexual activity. Infant circumcision could not mitigate the spread of HIV or cervical cancer. “I’m afraid we are creating a generation of useless men because if one of your limbs is not functioning properly after the mishaps of circumcision then you will be disabled. These children do not indulge in sexual activity anyway," she said. “After mutilating these children's sexual organs (in failed circumcision) the future generations will judge us and by the time these children need to taste how these organs should function we will be long dead and history will judge us on why we allowed the circumcision of children to continue.”
Mlotshwa said there was a side of the story that was not being told to the nation about male circumcision. “Circumcision of young boys is tantamount to genital mutilation and we are afraid that in the government will end up saying women’s clitorises should be cut because they are just taking everything that comes without doing proper research.” She said money meant for infant circumcision should instead go towards treatment centres for cervical cancer.
Veneranda Langa, Senators demand circumcision ban. Southern Eye (Zimbabwe), 18 July 2014.
Prominent circumcision advocate and leader of Gilgal Society, Vernon Quaintance, has pleaded guilty to nine offences against under-age boys and is likely to face a prison term when sentenced in September. As The Tablet reports, “Quaintance, 71, was a paedophile who also ran a pro-circumcision group. Southwark Crown Court heard that he accumulated images as recently as 2011. He was also a leader of the Gilgal Society, a group claiming to promote male circumcision and “its benefits in terms of health, sexual satisfaction and self-image.” In 2012, he was found guilty of possessing nine hours of child pornography on video tapes. This week he pleaded guilty to five counts of indecency with a child between 1966 and 1976 and four counts of possession of indecent images. An additional count of sexual assault alleged to have taken place in 2011 on a child was left to lie on file. Judge Anthony Leonard QC adjourned sentencing until September. He said there was a “very real likelihood” of a significant custodial sentence. Quaintance was released on conditional bail, with the requirement to have no unsupervised contact with anyone under 18.”
Former Knights of Malta member pleads guilty to abuse of boys. The Tablet, 17 July 2014.
Gilgal Society rebranded as Circumcision HelpDesk: In response to this embarrassing development, the pro-circumcision website run by the Gilgal Society has rebranded itself as the Circumcision HelpDesk, while retaining the same content. Further information. For links between Gilgal Society and other circumcision advocates, see Circwatch.
Close to 490 boys have died in initiation schools in three provinces in the past six years and a further 455 628 were hospitalised because of circumcision-related complications, an investigation has revealed. These findings are contained in a report, released by the Commission for the Protection and Promotion of the Rights of Cultural, Religious and Linguistic Communities in Joburg today. The report, titled Public Hearings on Initiation Schools in SA shows that boys as young as 12 died of dehydration, septicaemia, gangrene, kidney failure and assault during initiation. The investigation focused on three provinces – the Eastern Cape, Mpumalanga and Limpopo – where traditional circumcision is an important cultural practice. The Eastern Cape had the highest number of deaths between 2008 and 2013 – at 401. Mpumalanga followed, with 67 deaths and Limpopo recorded 18 deaths. Many of the deaths recorded in the Eastern Cape happened in 2009 (91) and last year, when 83 boys died. Mpumalanga also saw a spike during the same years. In 2009, the province recorded 15 deaths and last year the figure shot up to 42. Commission chairperson Thoko Mkhwanazi-Xaluva said the probe revealed a number of factors that led to the increase in the number of initiate deaths, but the biggest was the commercialisation of the practice by bogus surgeons.
Source: 486 die as greedy traditional surgeons run initiate schools 'like spaza shops’. City News (South Africa), 24 June 2014
In a further development, Fezisa Mdibi has condemned the traditional Xhosa initiation rite as “butchery” and called for the practice to be stopped. “As the mother of an 11-year-old boy and responsible for his health, I have to question: is this practice justifiable in the 21st century? In a society that shuns those who are not circumcised, does my son really have a choice about keeping his penis intact or will he just have to submit to having part of himself amputated because ‘it is the way things are done here’.” She concludes that as cultures evolve, harmful practices can and should be left behind: “Can we really say that if we decided to stop the circumcision of our boys we would lose our essential sense of identity as black South Africans? If we have banned the genital butchery of girls, why do we allow it for boys?” Article 24 (3) of the United Nations Convention on the Rights of the Child states obliges signatories to “take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children.” The only countries that have not ratified the convention are the United States and Somalia.
Fezisa Mdibi, Circumcision: South Africans should stop allowing our boys to be butchered. Guardian, 28 August 2014.
Further comment: Ally Fogg, The death and deformity caused by male circumcision in Africa can’t be ignored. Guardian, 26 August 2014.
In a statement issued on 24 June 2014, the Danish Association of Medical Students states that non-therapeutic circumcision is a question human rights and ethics, and that boys have as much right as girls to protection from genital cutting.
Ritual circumcision of boys removes healthy and functional tissue from a helpless, healthy child, and the question of ritual circumcision of boys is therefore in its starting point not a health issue. The question of whether circumcision of boys should be legal or not, is rather an ethical issue and a question of rights. Therefore, physicians and medical students are on an equal footing with all others in the community, and take a stance on whether a person’s right to to their body should take precedence over religious and cultural traditions or not. FADL believes that individuals have the right to decide on ritual circumcision, and that the right to an intact body should be independent of the individual’s sex. As girls already are guaranteed legal protection against ritual circumcision in Denmark, boys should also be guaranteed the same rights. FADL wants this resolution to: express respect for children’s - both girls and boys - recognized constitutional right to safeguarding their bodily integrity; and will appeal to physicians and other health professionals to take an active stance on whether to respect children and thus boys’ constitutional rights to an intact body by making use of their right to refuse to perform the ritual circumcision of boys.
FADL would like to stress that our approach to ritual boys circumcision is rooted in neither anti-Semitism nor Islamophobia. Men who have reached the age of majority [18 years], may even choose to be circumcised for religious or cultural reasons, if they wish to do so. FADLs position is not about whether to circumcise or not. Our position is that each individual should have the choice.
Danish Association of Medical Students (FADL) Main Association, Statement on the Ritual Circumcision of Boys, 24 June 2014 (In Danish)
The latest issue of the Turkish Journal of Psychology includes a searching examination of non-therapeutic circumcision of boys and concludes that it is unethical because it privileges the claims of society over the rights of the individual. The article, by M. Cumhur, provides a brief survey of circumcision practices around the world, and observes that there is no medical consensus as to the balance between benefits and risks. He then points out that there are strong ethical objections to the practice because “circumcision is an unnecessary tampering of the child’s body, the child cannot make an informed consent, and the parents’ rights are [regarded as] more important than those of the child. In addition, the intervention is controversial … because it is an intervention into the private lives of children.” Writing specifically with reference to Turkey, Cumhur notes that circumcision of minors is in contradiction with the Turkish constitution, which states (Article 17) that “All are entitled to living, protection and development of material and spiritual existence. Except the medical necessities and circumstances provided by law, a person’s bodily integrity is inviolable.” The author concludes that “Circumcision is not a medically ethical procedure. It favors the rights of the society over those of the individual, which is highly important to human rights and goes against the goals of medicine.” In a nation such as Turkey, where circumcision of boys is deeply embedded for social, religious and traditional reasons, Cumhur’s daring article is sure to arouse controversy; but it is a sign of the increasingly embattled “case for circumcision” that the case against is now being heard in such regions.
Source: M. Cumhur. Ethical evaluation of non-therapeutic circumcision. Turkish Journal of Psychology, June 2014.
An article in the UK Skeptic Magazine takes a sceptical look at recent restatements about the benefits of circumcision and finds them to be extremist, implausible, and out of touch with the real world. Focusing on recent publications by the well-known anti-foreskin activist, Brian Morris, the article covers the limits of science, the medical evidence for health benefits, the impact of circumcision on sexual response, the positions of various health authorities, and the questionable claims made by Professor Morris and friends. The paper concludes that while non-therapeutic circumcision of minors might conceivably have some trivial benefits for some individuals in later life, the medical evidence is contradictory, and the benefits for children minimal or non-existent. They are certainly not great enough to outweigh the risk of surgical complications, the impact on bodily appearance and sexual function, and the violation of accepted bioethical and human rights norms, such as the child’s right to bodily integrity and an open future. As the paper concludes:
The most one can say about the medical evidence concerning circumcision is that it is contested and inconclusive. On a global scale, there is a strong balance of opinion among experts in paediatric medicine that the foreskin is not inherently harmful to health, and that the circumcision of infants is entirely unnecessary. In 2011 alone, nearly a dozen infant boys had to be treated for “life threatening haemorrhage, shock or sepsis” as a result of their non-therapeutic circumcisions at a single children’s hospital in Birmingham. This information was made public due to a specific freedom of information request, and so would not otherwise have been reported.
It is clear, then, that we are seeing only the tip of the iceberg in terms of risks and complications. Since circumcision does carry risk, therefore — as with any surgical procedure — and since it removes a healthy, and indeed private, part of the body, the individual who must wear the lifelong consequences of the intervention should be the one to make the decision. Professor Morris has a different view, and he is entitled to express it; but he does not speak on behalf of “science.” Since the mid-nineteenth century all sorts of dubious theories about the nature of the foreskin (and the “health benefits” of infant circumcision) have been advanced and later debunked. The appropriate attitude for a skeptic is not to swallow these claims unblinkingly, but rather to approach them with suspicion and subject them to a rigorous critique.
Source: Brian Earp and Robert Darby. Does science support infant circumcision? A skeptical reply to Brian Morris. UK Skeptic, 10 June 2014.
“Circumcision must not be made an exception to the natural, negative right to self-ownership — a birthright which should prevent a parent from physically harming a child from the moment of birth going forward.” This is the argument of two libertarian thinkers, who have just published paper which presents a natural rights argument against the practice of male child circumcision and also considers some of the physical and psychological consequences of the practice. This is a powerfully argued paper, showing that the right to bodily integrity in the circumcision context is not a positive right (i.e. a demand for power or resources that implies duty or requires action on the part of others), but a purely negative right, like the concept of negative liberty proposed by Isaiah Berlin - that is, the right not to be subject to coercion or otherwise interfered with. It is a demand for non-action on the part of others. As the authors write:
“From a Lockean perspective on natural rights and self-ownership, there is no justification for male child circumcision as long as there is no excuse for child abuse. If we acknowledge that our bodies are inherently ours in a natural state, then we need not set an arbitrary date to define when parents must start respecting those rights. Despite the legality of neonatal circumcision, Locke was clear in noting that natural rights cannot be surrendered to cultural customs or a social contract; they exist at birth. Furthermore, these rights are negative, not positive, meaning a person is entitled to non-interference in accordance to them — a freedom from coercion. Positive rights refer to entitlement to a good or service. Surely no one is entitled to circumcision; most males are not circumcised, and there is a lack of evidence to demonstrate that circumcision is significantly beneficial.”
Abstract: Despite the millenniums-old tradition in Abrahamic circles of removing the foreskin of a penis at birth, the involuntary and aggressive practice of circumcision must not be made an exception to the natural, negative right to self-ownership — a birthright which should prevent a parent from physically harming a child from the moment of birth going forward. This paper will present a natural rights argument against the practice of male child circumcision, while also looking into some of the potential physical and psychological consequences of the practice. It will compare the practice with that of female circumcision, which is banned in developed nations but still practiced in the third world, as well as other forms of aggressive action, some once-prevalent, while disputing arguments made for parental ownership of the child, religious expression, cultural tradition, cleanliness, cosmetics, and conformity.
Source: Patrick Testa and Walter E. Block. Libertarianism and circumcision. International Journal of Health Policy and Management. On-line first, 26 May 2014.
Three people have been charged over the genital mutilation of two girls, aged six and seven, in 2010-12. The accused are the mother, a retired nurse, Kubra Magennis, and a “sheikh” (i.e. Islamic community leader) Shabbir Vaziri, from Auburn. Police state that the cutting was performed for “cultural reasons”. Charges against the girls father, a Sydney doctor, were dropped. When the trio appeared in court, their defence lawyer sought to argue that the girls were not victims of genital mutilation because they received no more than “a nick” to their clitoris. The magistrate dismissed the submission, stating that under the section of the NSW Crimes Act covering female genital cutting, “Any cut or nick to the clitoris will amount to mutilation.”
CIA comment: The firm reaction of the authorities to this instance of violence and cruelty to children is a vivid contrasts to their indifference when two boys were circumcised (i.e. had their entire foreskins cut off - a far more damaging surgery than a mere nick) for similar cultural reasons in Bundaberg in 2002. The SMH report states wrongly that these three are the first people to be charged with FGM in NSW; in fact, south coast doctor Graeme Reeves was prosecuted and convicted for this offence in 2013: details on this site.
Sources: Emma Partridge. Female genital mutilation: Three charged with circumcising girls committed to stand trial, Sydney Morning Herald, 23 May 2014; Sydney sheikh, mum and nurse face mutilation judgement. News.com.au, 24 May 2014.
Recent reports from African countries that have pursued ambitious American-funded circumcision campaigns in the belief that it would solve their HIV-AIDS problem show that circumcision is not reducing the incidence of infection, but (as in parts of Kenya) actually increasing it. At the same time, opposition to the programs is growing, especially in Zimbabwe, where critics have accused the (highly authoritarian) government of misleading propaganda and unethical efforts to circumcise boys and infants rather than consenting adults. (This is contrary to the original recommendations of the World Health Organisation, which stressed that circumcision should be performed only as a free, informed choice, and that programs should be conducted in accordance with human rights principles.)
In an interview with the Jewish Quarterly, film maker Francelle Wax talks about why she is making a documentary on United States circumcision practices. In this film she will try to explain why routine (non-therapeutic) circumcision of normal male infants remains so common in the USA, in striking contrast with the the other anglophone societies (Britain, Australia, Canada) that originally took it up as a “health” measure. In the course of the interview she mentions delusions about hygiene; ignorance about normal male anatomy on the part of the medical profession; the importance of the foreskin for normal sexual function; and the sexist double standard that regards female genital cutting as abhorrent, but male genital cutting as benign or harmless. As she explains in the interview, she was drawn to the subject after studying in Britain, where she found that almost no males are circumcised (and they all love their foreskins) and where everybody she spoke to was horrified at the idea of doing such a thing to baby boys.
The American-funded circumcision campaigns in Africa should be regarded not as a benign example of medical aid, but as an instance of medical imperialism, based on the racist idea that Africans are incorrigibly sex-crazed, undisciplined and have to be told what to do by superior white witchdoctors. These startling ideas are put forward in a lengthy and well referenced blog post by Joseph4gi, who has subjected the arguments for mass circumcision of Africans to critical scrutiny and find that they hold neither scientific nor ethical water. It seems that what is going on in Africa is very close to the idea put forward by racist American writers in the nineteenth century, that African Americans should be forcibly circumcised to reduce their sex drive and thus make white women safe from rape. It is one thing to regard voluntary circumcision of adult males as a possible option within a range of HIV prevention tactics; it is quite another to exploit fear of AIDS as a means to promote circumcision.
Source: Mass circumcision campaigns: The emasculation and harassment of Africa, Joseph 4GI Blog, 18 May 2014.
Meanwhile, in the developed world, the United States Centers for Disease Control recommends a pill that provides 90 per cent protection against HIV infection, and does not mention circumcision at all.
Adding to the critiques of the American Academy of Pediatrics 2012 circumcision policy already published, an article in the Medical Students Journal of Australia finds the AAP’s conclusion – that the “benefits” of circumcision outweigh the “risks” – to be both premature and inappropriate. It also argues that the new statement has no relevance to Australia and should not lead the Royal Australasian College of Physicians to modify its own policy that routine circumcision is not warranted in Australia or New Zealand.
The article, by ANU medical student Samuel Norman, points out that the claimed justification for the AAP’s slight change of stance was what it called “new evidence” from some African countries that circumcision could reduce the risk of female to male transmission of HIV during unprotected intercourse. But he points out the obvious fact (obvious to anybody except the AAP task force) that this evidence is confined to heterosexual transmission in underdeveloped regions with high HIV prevalence and is not relevant to places – such as the United States or Australia – where HIV prevalence is very low and largely confined to homosexual sub-cultures. There is no evidence that circumcision provides any protection in male/male sex. Norman further observes that the epidemiological evidence from both African and Western countries shows no consistent relationship between circumcision incidence and HIV prevalence.
Norman also considers the AAP’s claim for circumcision having a protective effect against certain other STIs, such as syphilis and human papilloma virus (HPV), but finds the evidence inconsistent and the case unproven. Such problems, moreover, are experienced only by sexually active adults, and thus not something that infants and children need to worry about. The only condition in children to which circumcision may provide some protection are urinary tract infections (UTIs); but these are too rare and too readily curable with antibiotics to serve as a justification for mass precautionary circumcision of normal infants or boys.
Contrary to a slogan popular among some extreme circumcision advocates, circumcision is not a surgical vaccine, but rather should be categorized like any other surgery: “an intrusive procedure that has specific indications, presupposes inherent risks, and is performed on the balance of medical ethical principles. Delaying decisions regarding neonatal MC until the patient is able to offer their own informed input affords the greatest respect for autonomy and informed consent, and allows the patient to consider cultural, social and religious factors for himself.” Norman concludes that the AAP fails to demonstrate its claim that the benefits of circumcision outweigh the risks; and that there is no reason for Australian paediatric authorities to alter their own position.
Source: Samuel Norman. The AAP’s revised policy on routine neonatal circumcision: Critical evaluation and relevance to the circumcision debate in Australia. Medical Students Journal of Australia Vol. 5 (1), May 2014.
Among the mounting criticisms of Brian Morris’s latest sermon on the evils of the foreskin (Mayo Clinic Proceedings, 4 April), the sceptical comments of Kevin Pringle (Professor of Paediatrics at University of Otago), Wellington, NZ) have stood out. In several interviews for the medical and popular press he has been forthright in describing Morris’s claims as misleading, alarmist, worrying and “absurd”. In an interview with IntactNews he has gone so far as to describe his attempt to paint circumcision as no different from vaccination as “crazy”. As he comments: “My big concern initially was that the fact that in my view the authors have absolutely minimized the risks of circumcision and to say that circumcision should be packed up there alongside vaccination is just, sorry, that’s crazy.” Professor Pringle also comments critically on the American Academy of Pediatrics 2012 policy as suspiciously selective in its literature search, with a strong bias in favour of papers with a pro-circumcision slant, and many of them concerned with adults in Africa, not children in the United States.
Further critiques of Prof Morris's claims have come from medical ethicists and historians
Elizabeth Reis. Circumcision Debate: Cut the Hyperbole. Nursing Clio, 8 April 2014.
Robert Darby. Call to circumcise ignores the evidence. One-Line Opinion, 5 May 2014.
Although widely reported in the American media, Professor Brian Morris’s latest claims about the dangers of the foreskin have been ridiculed by scientists and child health experts as exaggerated and implausible. Dr Kevin Pringle, Professor of Paediatrics at the University of Otago, Wellington (New Zealand), rejected Morris’s assertions as an instance of confusing cleanliness with godliness. Contrary to his assertions, circumcised men did not enjoy a vastly reduced risk of cancer or sexually transmitted infections. Professor Pringle dismissed Morris’s analogy of circumcision with vaccination as irresponsible and unscientific, and pointed out that “Circumcision is an intervention with significant risks (ignored or minimised by the authors of this paper) to prevent problems that will not develop in the vast majority of males.”
Meanwhile, American biologist P.Z. Myers has described Morris as “the Man Who Hates Foreskins”, and points out that he has been peddling the same sloppy data for over a decade. To take one example, his claim that circumcised boys had one tenth the risk of contracting a urinary tract infection turns out to be based on a single study of 36 children, half of whose circumcision status was unknown, and in which the difference in UTI risk between circumcised and normal was found to be not statistically significant. Myers notes that most of Morris’s claims about the risks of not circumcising are are equally speculative, and refers to claims about Morris’s links with the notorious Gilgal Society, whose leader, Vernon Quaintance, is currently facing serious child sex charges.
In a further comment Professor Pringle stated that Morris's claims were misleading and alarmist: “To compare the risks of circumcision with the risks associated with vaccination is just not true. Most of the diseases for which infants are vaccinated are potentially lethal or produce significant handicap. Go back to the last Polio epidemic and compare the risks of getting Polio with the risks of having the vaccination. Compare that with a 5-10% risk of infection or ulceration of the tip of the penis after circumcision and the small, but significant risk of death after neonatal circumcision. Vaccination is a low-risk intervention to prevent a problem with significant adverse outcomes. Circumcision is an intervention with significant risks (ignored or minimised by the authors of this paper) to prevent problems that will not develop in the vast majority of males; most of which can be simply addressed if and when the need arises."
"Frankly preposterous" claims
In another riposte in the Daily Beast, child health expert American Russell Saunders comments. “Having reviewed Dr. Morris’s study, I find his statements about the benefits of circumcision as a routine procedure overblown, and the comparison with vaccination baseless.” Morris’s claim that “declining to circumcise one’s son is as irresponsible a threat to public health as failing to vaccinate him is frankly preposterous.” Meanwhile at the Good Men Project, Toronto physician Ali Rizvi has called Morris's call for compulsory circumcision "the dumbest proposal ever".
Sources: NZ academic questions circumcision study. MSN Health News, 7 April 2014. Should you circumcise your child? Pharyngula Science Blog, 11 April 2014. Circumcision health risks and benefits – experts respond. Science Media Centre, New Zealand, 4 April 2014
The “Gardasil” HPV vaccine has halved the risk of cervical cancer in women. A study, by QIMR Berghofer and the University of Queensland, published in the British Medical Journal on 4 March, shows the value of the national immunisation program for teenagers. Developed by former Australian of the Year Professor Ian Frazer, Dr Jian Zhou and their colleagues, Gardasil was introduced to Australia’s immunisation schedule in 2007. Initially targeting teenage girls, with a catch-up program for women aged up to 26, Professor Whiteman said the study was proof of the “real world” value of the HPV vaccine. “It’s an Australian invention, it’s been rolled out across Australia and it’s having an effect on Australian women, so it’s a very positive story,” he said. Gardasil protects against the two most common strains of human papilloma virus, which cause more than half of all cervical cancers. Professor Whiteman said that range would hopefully expand in coming years. “There’s a new vaccine that now covers nine different strains of HPV, and the results from those trials look very promising,” he said. The study’s co-author and medical director of the National HPV Vaccination Program Register, Julia Brotherton, said the research was great news for Australian women. “And with the program now vaccinating boys as well, Australia is leading the way in preventing HPV infection and the cancers it can cause.”
Natalie Bochenski, Gardasil halves risk of cervical cancer. The Age (Melb), 5 March 2014.
Elizabeth Crowe, Nirmala Pandeya, Julia M L Brotherton et al. Effectiveness of quadrivalent human papillomavirus vaccine for the prevention of cervical abnormalities: Case-control study nested within a population based screening programme in Australia. British Medical Journal 348, 4 March 2014.
Vernon Quaintance, British circumcision advocate and founder of the Gilgal Society (a circumcision promotion and fetish group) has been charged with a series of sexual offences against under-age boys going back to the 1960s. He has denied the allegations and pleaded not guilty to the charges.
Why is female genital mutilation regarded as an abhorrent mutilation that must be stopped while circumcision of male infants and boys tolerated as a harmless snip or even promoted as a benefit to the child? In a discussion inspired by the Guardian-Change-org campaign against FGM in Britain, Brian Earp confronts the double standard and dispels the usual myths surrounding genital cutting, whether performed on girls, boys or intersex children. He points out that the fundamental problem is that the harms of FGM are exaggerated and the possibility of benefits ignored, and conversely that the harms of circumcision are trivialised while the benefits are exaggerated:
“When people speak of “FGM” they are almost always thinking of the most severe form of female genital cutting, done in the least sterile environment, with the most drastic consequences likeliest to follow. When people speak of “male circumcision” (by contrast) they are usually thinking of the least severe form of male genital cutting, done in the most sterile environment, with the least drastic consequences likeliest to follow. This leads to the impression that “FGM” and “male circumcision” are “totally different” with the first being barbaric and crippling, and the latter being benign or even health-conferring.”
Thus we have the absurd situation in which the World Health Organisation runs one program to eradicate FGM (one reason for which is concern that it is a means of spreading HIV) and a separate program to promote male circumcision on the basis that it is an effective means of stopping the spread of HIV! As Earp points out, circumcision performed with filthy knives or spearheads is more likely to spread infection and death; as one comment on his post points out, since 1995 more than 800 Xhosa boys in South Africa alone have died as a result of the traditional circumcision ordeal. Earp concludes by arguing for equal treatment of the sexes: no child should be subjected to medically unnecessary genital cutting.
Source: Brian Earp, Female genital mutilation (FGM) and male circumcision: Time to confront the double standard. Practical Ethics (Oxford University), 18 February 2014.
A Dutch doctor who worked at the Holy Cross Hospital, Eastern Cape province, South Africa, has set up a website to expose malpractices in the traditional circumcision rite performed among the Xhosa people. The doctor, Dr Dingeman Rijken, took action after 43 boys died during December 2013 as a result of their circumcisions. A total of 39 boys died in June last year, bringing the number of boys who died in 2013 to 82. He has been supported by a prominent retired medico, Dr Robert Frater, who had noticed the harm caused by the traditional circumcision rite among the Xhosa as early as the 1940s. Commenting on the website, he said: “There are complications severe enough to cause death and when Dr Dingeman Rijken documented these on the web.” He believed that these practice ought to be stopped. Dr Rijken’s initiative was not welcomed by tribal leaders, who defended the traditional circumcision “schools” as an essential part of Xhosa culture and complained that critics were undermining their traditional way of life. Meanwhile, the Times Live reports that a further nine teenage boys from Eastern Cape province have lost their entire penis as a result of circumcision.
Source: Sithandiwe Velaphi, Ban traditional circumcision. The New Age (South Africa), 29 January 2014.
Dr Rijken’s website showing harm of traditional circumcision
Warning: Do not proceed if you do not wish to view ugly images of severely injured genitals
A new study from Brazil, Mexico and the United States involving more than 4000 participants has found no difference in the incidence of new Human Papilloma Virus infections between circumcised and intact men. Danish epidemiologist Dr Morten Frisch comments that the study “pulls one of the American Academy of Pediatrics’ (AAP) most promoted health claims apart.” HPV is the group of sexually transmitted agents (human papillomaviruses) that cause both anogenital warts (aka condyloma) and neoplastic lesions and cancers of both male and female genitalia, the anus and the tonsils.
Two types of HPV, known as HPV6 and HPV16, are responsible for the majority of all HPV-associated lesions, including genital warts (HPV6) and cancers (HPV16). While the overall findings of this study were negative, meaning that it found no overall differences between circumcised and intact men, among the few type-specific differences that were actually found, was a significantly reduced ability among circumcised men to clear their newly acquired HPV6 and HPV16 infections. This is particularly worrisome, because it is well-established that persistent HPV16 infection is the initial step on the path from HPV acquisition to cancer.
According to Dr Frisch, this study explodes one of Brian Morris’s and the AAP’s most cherished arguments in favour of circumcision. Notably in industrialized parts of the world where the burden of heterosexually acquired HIV/AIDS - the main health problem that circumcision is postulated to reduce - is very low. The paper must be even more disturbing to the pro-circumcision lobby because two of its authors, Xavier Castellsague and Francois Xavier Bosch, are prominent co-authors of several earlier papers claiming a protective effect of circumcision against HPV infection, including a widely publicised study in the New England Journal of Medicine (2002) [criticised here and on this site], whose findings are now seriously undermined by their new and methodologically stronger study. As Dr Frisch comments, “It seems there may soon be one pro-circumcision myth less to fight.”
Source: Ginesa Albero et al. Male circumcision and the incidence and clearance of genital human papillomavirus (HPV) infection in men: the HPV Infection in men (HIM) cohort study. BMC Infectious Diseases 14 (75), February 2014.
A Sydney father has been charged with arranging to have his baby daughter circumcised. The man is accused of taking his nine-month-old girl to Indonesia, where she was allegedly circumcised sometime between February and March of 2012. It was not until the mother took the girl to a doctor six months later that authorities were alerted to what had happened. Following an investigation, the father was arrested last year by officers attached to the Sex Crimes Squad. He was later charged with aiding, abetting or procuring female genital mutilation. Community Services Minister Pru Goward said earlier this month that female genital mutilation in Australia was probably “more common than the reports would suggest”. She said the crime often only came to light when the child suffered a complication from the procedure or there was a marital breakdown.
Source: Baby girl circumcised in Indonesia. Sky News, 28 January 2014.
A 14-year old boy was rushed to Royal Children’s Hospital with severe injuries after a backyard circumcision. The boy was in so much pain that doctors had to anaesthetise him so they could remove bandages from his penis. He said that his mother pinned him down while the circumcision was performed by a “witchdoctor” from the her place of origin in the South Pacific, and that as many as 13 other boys across Melbourne had been similarly done. Commenting on this case, Paul Mason, chairman of the newly-formed Australasian Institute for Genital Autonomy, called for government action to protect children: “In this instance it seems to have been a cultural practice, but many cultures have unnecessary genital surgery. In this country we've outlawed female circumcision, but for some reason it’s still OK to circumcise a boy. I can't see why it's better to cut a boy than to cut a girl. There's no logic in such discrimination.” Mr Mason said he was shocked the procedure would be carried out in backyards, saying that complications still occurred at the best hospitals in the world. He called for an outright ban on such operations. This appalling incident gives force to the recommendations of the Tasmania Law Reform Institute that medically unnecessary circumcision of male minors should be strictly regulated and legally prohibited in most instances. How can a civilized country allow children to be so brutally treated?
Source: Shannon Deery, DHS wants teen returned to mum who held him down while circumcised by witchdoctor. Sun-Herald, 26 January 2014.
Three boys undergoing tribal initiation in a remote NT Aboriginal community were so badly injured when circumcised that they had to be airlifted to Darwin Hospital for urgent medical treatment. According to the ABC report, local ambulance driver William Miller arrived at the ceremony and was horrified to find his 17-year-old grandson sitting in a pool of blood. The ABC understands instruments from the local health clinic were used in the ceremony and have regularly been supplied in the past, in line with Health Department guidelines. Nurses and doctors from the clinic have also attended previous ceremonies, but were not present at the ritual. Some of the clinic's health professionals have told the ABC they were appalled by the injuries they saw, but none is willing to speak publicly for fear of dismissal.
But it’s not child abuse. (Of course not: they’re only boys.)
The ABC report continues: “The Northern Territory Government says it is aware of the case, and so far its investigators have found the injuries do not constitute child abuse. The NT Child Abuse Taskforce received two notifications about the incident, leading to an investigation by two police officers and the Department of Children and Families. But their enquiries found that the children had not been harmed as defined by the Care and Protection of Children Act.” In other words, so long as it is what the parents want to do and there is some sort of sanction from traditional culture, no degree of physical injury to children can constitute abuse. We note that the attitude is very different when girls are being sexually abused by old men: even without injuries, that is regarded as so serious that it required Commonwealth intervention.
Norman Hermant and Alison McClymont. Anger in NT community after circumcision rite ends with three boys airlifted to hospital. ABC News 22 January 2014.
Danish doctors are becoming more vigorous in their opposition to non-therapeutic circumcision of male infants and boys. In December the Danish Health Agency issued a discussion paper, “Guidance on circumcision of boys”, which proposed that medically unnecessary circumcision was unacceptable. This was discussed by the Danish Association of General Medicine, which agreed that circumcision may be performed only when there is a medical indication for it. If circumcision is performed without a medical indication, it is mutilation. The following article on their stand was published in the Danish newspaper BT.
Doctors are now speaking out: circumcision is a violation and should be banned. General practitioners have drawn a thick line in the sand on a – in more than one sense – sensitive area: Circumcision of boys is the same as mutilation, unless there are specific medical reasons for it. The Danish Society of General Medicine, DSAM, has laid this out in a consultation response to the Health Protection Agency, which has set a deadline for Tuesday 21st January to come up with objections and comments to a new revised draft Board “Guidance on Circumcision of Boys”.
The Danish Society of General Medicine has approximately 3,000 members and includes, among others, two-thirds of all the country's general practitioners, so that it is a group that speaks with authority. In response to the Health Protection Agency it gives the clear message: “The Health Agency has sent 'Guidance on Circumcision of Boys” in consultation. The DSAM’s Board of Directors has discussed the draft consultation and agree that circumcision may be performed only when there is a medical indication for it. If circumcision is performed without a medical indication, it is a case of mutilation.”
Genital mutilation of girls was made illegal in Denmark in 2003. But baby boys can still legally be circumcised, an action that is done for religious reasons by Jews and Muslims. It is estimated that between 1,000 and 2,000 baby boys are circumcised at home each year, and some of those for the sake of religion, in private. Chief Medical Officer, Professor Morten Frisch, MD PhD, is one of the most notable opponents of circumcision. He has researched the topic and has, among other things, published an article in 2011 which aroused international attention. In the article he went over the many negative consequences, circumcision has or can have, not only physically but also psychologically. Morten Frisch says to BT: “It’s an earth-shattering development that medical practitioners now, for the first time, have come out and found that circumcision is the same as mutilation. This is a very important signal, and it may very well mark the beginning of the end for circumcision of boys in Denmark.”
Master of Laws Hans Jørgen Lassen has through his specialty exposed that Denmark is balancing on the edge of both the Danish law and international conventions by allowing circumcision. Together with Morten Frisch, he has sent a consultation response to the health protection agency. The two write, inter alia: Circumcision of boys who cannot consent is a violation of their bodily and sexual integrity. There is no difference in principle between cutting the genitals of a little girl and those of a little boy. Both violate the child's right to make decisions about their own body. This was also the conclusion of the two resolutions in the autumn of 2013 from the Nordic Children’s Ombudsmen and the Parliamentary Assembly of the Council of Europe. Through an examination of Danish legislation in this area, which was the subject of Hans Jørgen Lassen's thesis at law school in 2013, it became clear that the legal basis for boys’ circumcision without medical indication being performed with impunity in Denmark is thin, and almost non-existent.”
Source: Jens Anton Havskov, Danish doctors: Circumcision of boys is mutilation. BT, 20 January 2014. Translation by Microsoft, courtesy of Circumstitions News; also: Danish available original here.
UPDATE: In a powerful essay for the Copenhagen Post, Danish epidemiologist and sexual health expert Dr Morten Frisch argues that European proposals to restrict medically unnecessary circumcision of under-age boys has nothing to do with hostility to Jewish or Muslim culture, but are motivated by concern for the rights and welfare of children. As he writes: “Such anti-religious rhetoric is unjustified. The vast majority of Europe’s opponents of circumcision are religiously tolerant, but consider cutting off an important part of a non-consenting, healthy child’s genitals to be contrary to modern ethics. This view was clearly expressed in September 2013 in a common statement of the ombudsmen and spokespersons for children in Norway, Sweden, Finland, Iceland, Greenland and Denmark. To most Europeans circumcision is an ethically problematic ritual that is intrinsically harmful to children: every child has the right to protection of his or her bodily integrity and the right to explore and enjoy his or her undiminished sexual capacity later in life.”
Morten Frisch, Circumcision divide between Denmark and Israel. Copenhagen Post, 24 January 2014.
More Americans are questioning the unthinking practice of routine circumcision of male infants. Writing in a Philadelphia newspaper, Amy Wright Glenn argues that the circumcision is wrong because there is no consent on the part of the child and it causes long-term harm to the body. She points out that the principal reasons for circumcision, both male and female, are cultural rather than medical, and draws a telling comparison between female genital mutilation and male circumcision - both examples of genital cutting performed by adults on children who are incapable of resistance. Since all humans have a right to bodily integrity, this amounts to a serious violation of human rights, as well as the accepted principles of bioethics - autonomy, non-maleficence, beneficence and justice. Encouragingly, a poll taken by the newspaper fund that over 80 per cent of respondents agreed that circumcision without consent was wrong.
Source: Amy Wright Glenn, Circumcision, cultural bias, and the question of consent. Philly.com (Philadelphia, USA), 14 January 2014. See also the lecture by Professor Ryan McAllister, Child circumcision: The elephant in the hospital.
As worldwide opposition to routine circumcision grows, increasing numbers of Jewish people in Israel are deciding not to circumcise their sons. A well-researched article in the newspaper Haaretz (June 2013) reports the results of a survey conducted in 2006 which found that while nearly 5 per cent of respondents had not circumcised, fully a third (33 per cent) of parents would have preferred not to circumcise; they were only persuaded by fear of social pressure. The greatest anxiety is about the reaction of relatives, especially grandparents - who usually get over their shock once they see their grandson and realise how beautiful he is. For example, Ido (an uncircumcised Jerusalem resident) told Haaretz that his paternal grandmother “did not stop crying from the moment she heard that her grandson was not going to be circumcised − until the first time she saw him and was enchanted by him. After that, he says, the subject never came up again.”
Further evidence of the changing tide of sentiment are the increasing numbers of opinion pieces in Israeli newspapers criticising and rejecting circumcision, such as Uri Misgiv, who challenges the connection between circumcision and Judaism, declares his opposition to the cutting of children’s genitals on ethical and human rights grounds, and wonders why “people without any religious faith anxiously keep track of every heartbeat of their infant in the womb, run with him to the monitor, sonogram and every possible pregnancy test, guard him carefully from the moment of his birth – and then hasten to cut his sexual organ.” Also of significance is an editorial in Haaretz which stated firmly that “individual rights take precedence over religious customs”. The editorial was referring to a case in which an Israeli religious (rabbinical) court ordered a woman to have her boy circumcised and fined her for refusing; criticising the court’s decision, the editorial rejected forced circumcision and asserted the primacy of personal autonomy.
Update: in another powerful opinion piece published in the Jerusalem Post, Jewish film maker Victor Schonfeld argues that the Israeli parliament should be protecting children, not trying to promote the observance of antiquated religious rites among Europeans. Full details on the Jewish circumcision page.
The Australasian Institute for Genital Autonomy supports NSW Minister for Family & Community Services Pru Goward’s concerns about female genital mutilation (FGM) in Australia. Ms Goward has stated that although tough laws are in place, social and cultural conditions need to be addressed to eradicate the “hideous” crime against children. AIGA welcomes Ms Goward’s suggestion that changing social norms and cultural education are important to protect children’s rights to bodily autonomy and self determination. However, her comments that “immigration authorities have to get much more vigilant about advising communities” about children’s rights casts the issue as exclusively a problem for immigrating communities and fails to acknowledge the broader context within current Australian culture and fails to consider how to protect girls from being removed (for example) to South East Asia for religious and cultural “sunnat” or genital cutting, including UNICEF/WHO Types I, II (some tissue removed) and Type IV (no tissue removed).
Elwyn Moir, Secretary of the AIGA said “it’s easy to imagine genital cutting crimes against children are a problem only in foreign cultures; however Ms Goward’s argument that we need social change in Australia highlights the importance of a consistent approach to children’s rights and genital autonomy”. AIGA accepts that parents submit their children to genital surgeries with the best intentions, but point out that they overlook the fact that they are irreversibly removing their children’s right to their own later freedom of choice. Mr Moir said “unnecessary genital surgery on boys and intersex children are still confusingly mistaken as parental choices in Australia, which remain a minority practice. To reduce the incidence of FGM in this country, we need to re-examine our own cultural assumptions and promote the right to mature self-determination and an open future for all children, not just girls.”
Law reform reviews in Queensland and Tasmania have suggested clarifying legislation criminalising unnecessary circumcision of boys. In 2013 a Senate Inquiry recommended court supervision of unnecessary surgery on intersex children as their rights to genital autonomy are not protected by supposed parental rights. Inconsistent legislation and out-dated Medicare rebates continue to send mixed signals that perpetuate these human rights abuses. AIGA takes the UN Charter of Human Rights and Rights of the Child as its starting point and contributes to advancing an ethical approach in our culture to issues of unnecessary surgery on children’s genitals.
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