Friday, August 28, 2009

reiterating the risks of male circumcision in infants

Sometimes it helps to remember that parenting is not black and white. What works for one family may not work for another. Aside from abuse, I firmly believe every family has the right to make their own choices, in birth choice, vaccination, discipline, and even circumcision.

As a postpartum doula, one of the code of ethics that I follow is to NOT bring my personal opinion and choices into my relationship and care with clients. I am to give them information on both sides of a parenting issue and let THEM make their own educated decisions. It goes like this with circumcision, vaccinations, infant feeding, diapering, etc. I already know what I believe as I have the right to informed consent, as do my clients. And my clients need to be given the same respect in their parenting decisions. If they are given unbiased information, facts, and resources on BOTH sides of an issue, they will be able to make their own decision. A lot of times, it will be what I consider to be the RIGHT decision, sometimes, though, their decision is vastly different than mine.

With circumcision, I personally believe the procedure it to be abuse and genital mutilation, taking the rights of personal choice away from the boy who the procedure is performed on. But it is still a common procedure, with over half of all male infants receiving the procedure in the US. Ethically, as a birth/postpartum professional, I cannot and would not look down on a family who makes that choice for their sons, whether it be for religious, congruous, or mainstream reasons. It is their path to walk.

This week, I have seen a slew of statements from various sources about the CDC possibly pushing through routine circumcision of all infant boys born in the United States. The CDC lists their official stand here: Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States

In regards to these recent news headlines about recommending male circumcision for HIV prevention, I have some concerns about the plausibility of using circumcision as a prophylactic measure.

Neonatal circumcision is surgery and carries many risks, which include bleeding, disfigurement, and death. An Atlanta boy and his mother were recently awarded 2.3 million dollars as payment for a botched circumcision, in which part of the boy's glans was accidentally amputated. A Canadian boy, Ryleigh McWillis, died from hemorrhaging to death following his August of 2002 circumcision, leading the Canadian government to further discourage parents from having the procedure performed. It seems a bit far fetched, to say the least, to expose a boy to these real risks on the theoretical idea that he may possibly be part of a population with who takes part in risky behavior 20 years down the road.

Not only does neonatal circumcision carry serious risks, it also violates a man's right to choose. If a grown man, after being presented with all the facts, decides on a circumcision, that is his right. However, subjecting infants to a non-medically necessary procedure to which they cannot give consent violates those infant's right to choose how their genitalia look and function or if they want to use a more conservative approach, such as abstinence or condoms, to decrease their risk of contracting the HIV virus.

It is also important to remember that, in the United States, it is currently illegal to make a token cut on the genitalia of a female minor, even if no tissue is removed. According to the constitution of the United States, all persons should be entitled to equal legal protection, regardless of sex.

Typically, proponents of circumcision cite only the short term risks of circumcision, while they unfairly cite both the short and long term risks associated with having an intact foreskin. Evaluations of circumcision as a preventative measure need to take into consideration the long term complications that can arise from circumcision, such as erectile dysfunction, keratinization, painful erections due to excessive skin removal, meatal stenosis, skin bridges, sensitivity loss, etc. I urge the CDC to consider those factors before putting a recommendation into place which would result in even more boys being exposed to those long term risks.

Additionally, the Randomized Control Trials sited in the CDC research and circumcision recommendations (which can be viewed at the link above) show only a reduction in risk for female to male transmission, not male to female transmission, or male to male transmission. In addition, this reduction was only over a two year period, meaning that the protection was only for that time frame; it is unclear if the protection will continue beyond two years or not.

It is crucial to keep in mind that the studies sited by the CDC is limited only to one culture, that of Africa. African culture is very different than the culture of the United States. Rape, dry sex, and other practices common in African culture are not practiced in American culture. To make a recommendation to circumcise millions of newborn males for a hypothetical benefit 15-20+ years down the road, based on studies conducted in another drastically different culture is questionably unsound and should be subject to further evaluation.

Finally, no national or international medical association recommends routine circumcision. Also, major worldwide HIV/AIDS organizations, including the World Health Organization, French Nation Council on AIDS, Australian AFAO, and many more, do not support the use of circumcision as a prophylaxis in countries where HIV is low prevalence and relates to specific high risks groups. The United States falls in to this category.

I am happy to report a new statement from the CDC was released on Thursday: Status of CDC Male Circumcision Recommendations. I am interpreting this statement as the CDC taking all the advocates condemning the practice of infant male circumcision seriously.

We are making progress by informing people that they do have a choice, informing them of the statistics and risks of both sides of circumcision. Letter writing to your government representatives and to the CDC is already making a difference. We cannot change every policy overnight, but we can keep fighting of our rights and the rights of our children.

Keep up the letter writing to help prevent painful, permanent and involuntary body alteration of children!

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