Thursday, August 16, 2007
push for end to circumcision
By SACHI FUJIMORI
Never one to picket on street corners, Adrienne Soti found her
cause this March when her sister-in-law, who was expecting twin
boys, said she planned to have them circumcised.
Giving birth to a son more than 2-1/2 years ago, Soti never even
considered the procedure. In her native Hungary, it's uncommon.
Now the Garfield stay-at-home-mom has become a full-fledged "intactivist,"
as concerned parents and others who advocate for leaving the foreskin
of boys intact call themselves."My maternal instincts for
protecting my nephews were awakened," she explains.
After some Internet research, Soti attempted to sway the views
of her brother and sister-in-law, citing facts about the lack
of medical evidence supporting circumcision.
Her sister-in-law hung up on her.
"It's (circumcision) the American thing to do," Soti
recalls her brother saying.
Frustrated, she became a local representative of a national anti-circumcision
group, the National Organization of Circumcision Information Resource
Centers, traveling to Washington in April to participate in Genital
Integrity Awareness Week, waving banners with slogans like, "The
foreskin is not a birth defect." In July, at the Passaic
County Fair, she set up a table distributing pamphlets.
* * *
Nationwide, circumcision rates are declining from a peak of 90
percent in the early 1960s. In 2003, the percentage of male infants
circumcised in the hospital was 56 percent, according to Child
Trends DataBank, a nonpartisan, nonprofit research group. Rates
vary regionally from 50 to 90 percent. Hospital circumcisions
in New Jersey decreased from 66 percent of newborn males in 1997
to 58 percent in 2004, according to state Department of Health
The surgery, previously viewed as a standard medical procedure
to improve hygiene and reduce rates of infection and cancer, is
currently the subject of medical and ethical debates.
Once fully in favor of circumcision, the American Academy of
Pediatrics revised its position in 1997 to a neutral stance. It
said medical data "is not sufficient to recommend routine
neonatal circumcision ... parents should determine what is in
the best interest of the child."
The American Medical Association (AMA) and the American Academy
of Family Physicians have issued similar reports, stating they
do not recommend routine neonatal circumcision.
"A majority of boys born in the United States still undergo
non-ritual circumcisions," according to a 1999 AMA report.
"This occurs in large measure because parental decision making
is based on social or cultural expectations, rather than medical
But public health experts disagree. Recent studies in Africa
found that male circumcision reduces the transmission of HIV from
females to males by 60 percent. In March, the World Health Organization
and UNAIDS Secretariat recommended that countries with high HIV
transmission rates and low circumcision rates consider increasing
access to the procedure.
Robert Bailey, an epidemiologist at the School of Public Health
at the University of Illinois in Chicago, supports male circumcision
in the United States, which he says "is very cost-effective
from a public health perspective."
Beyond reduction of HIV transmission, Bailey cites other benefits:
fewer urinary tract infections in boys, lower incidence of penile
and cervical cancer, and reduced phimosis, a condition where the
foreskin cannot retract.
Penile cancer is rare in the United State, with 0.9 cases per
100,000 people. And studies have shown low incidences of urinary
tract infections in uncircumcised infants, according to the AMA.
Another area of dispute is whether circumcised males experience
less sexual pleasure than their uncircumcised counterparts. A
McGill University study published in July in the Journal of Sexual
Medicine found no difference in sexual sensation between the groups.
Outside of the United States, in Europe and Asia, circumcisions
are rarely performed for non-religious reasons.
In the 1940s, Britain had rates of circumcision comparable to
the United States, about 40 percent. But when that country established
a national health care system and subsequently stopped covering
the procedure, the rate dropped to just 10 percent, says Edward
Laumann, a sociologist at the University of Chicago.
Among American parents with no compelling religious or cultural
reason to choose circumcision, why does the practice continue?
"An awful lot of inertia," says Laumann, who published
a 1997 Journal of the American Medical Association study on male
circumcision and its effects on sexuality. Starting in the Victorian
era, doctors performed circumcisions to curb masturbation, which
was believed to be the root of all illnesses, according to Laumann.
A culture of "prudery" in the 1940s made new mothers
squeamish about cleaning the genitals of uncircumcised infant
boys, he said.
Today, societal views toward sexual health have evolved and "no
smoking gun" of medical benefit exists, says Laumann, but
circumcision likely continues because "a number of parents
do it for aesthetic reasons because they say they want their kids
to look like their dads."
Dr. Gurmit Chilana, chairman of the Obstetrics and Gynecology
Department at Paterson's Barnert Hospital, witnesses this copycat
effect outside families, as well. Some immigrant parents from
countries that don't circumcise boys (Latin and South Asian) say
they choose it so their American-born sons can fit in. "They
talk to their neighbors," says Chilana. "If everybody
has it, they get it."
Chilana, a Sikh, says circumcision is not practiced in his religious
community. His two teenage sons are uncircumcised, with no health
complications. He opposes the practice, and says that before performing
the procedure on newborn boys, he tells them, "My friend,
I don't enjoy this, but my duty is to do this."
In his department, nearly 80 percent of infant boys are circumcised.
"We tell parents medically it's not required, and explain
the potential complications of surgery," he says. Often he
asks parents if they would like to witness the surgery. They almost
always say no. "I think if the mothers saw it, they would
never choose it."
Picking up her 3-year-old son on a recent afternoon at Paterson's
CASA Daycare Center, Rufilia Sanchez said her son, born in Mexico,
"Unless you request it, they just leave it be," she
said through a translator. But if she gave birth to a son in the
United States, she would choose it.
"I didn't know about it, but, yes, because it's healthy
and there's no infections," she said.
Amara Wagner, a Carlstadt mom, chose to not circumcise her 14-month-old
son -- part of her philosophy of natural parenting.
She is a member of the Holistic Moms Network, a New Jersey-founded
national parenting community that encourages practices such as
at-home births, breastfeeding, co-sleeping, eating organic food
and treating illnesses with natural remedies.
Wagner read circumcision articles on the Internet and concluded
it's a misconception that uncircumcised boys are more prone to
infection. She also worried that her grown son might resent her
if she chose the surgery. "Who am I to have this baby, who
is perfect, and ask him to cut it off (the foreskin)? If he's
a teenager, and wants to have it," then that's OK, she said.
Initially, she had to convince her husband, who is circumcised.
One of his concerns was, "My kid's going to be weird in the
locker room," she recalls him saying.
Her response to her husband: "I hope that he's strong enough
to have the confidence and wherewithal to say, 'Why are you staring?'"
Reach Sachi Fujimori at 973-569-7154 or email@example.com.
NOCIRC, the National Organization of Circumcision Information
Resource Centers, a nonprofit "intactivist" group
The American Academy of Family Physicians
Stop Infant Circumcision Society
What major religions say about circumcision
Circumcision symbolizes God's covenant with
the Jewish people.
On the baby's eighth day of life, the ceremony
called a brit milah welcomes a boy into the Jewish community.
A mohel, a specially trained circumciser,
performs the ritual.
Circumcision is not specifically mandated
in the Quran, though most Muslims circumcise their sons. Allah
ordered Mohammed to follow the way of Abraham, who circumcised
himself. Muslims also believe it's a form of cleanliness.
The ritual can be done at any time before
a boy's seventh year.
Christianity does not require circumcision,
because it does not believe it's a religious obligation to follow
the laws of the Old Testament.
Most babies in the United States are circumcised
in the hospital for health reasons.