In an opinion column titled, “Circumcision Saved My Life,” Diane Cole writes that her late husband’s circumcision saved her from becoming infected with HIV after he became infected during a blood transfusion in the mid-1980s. Perhaps, but anecdotes make very bad policy. This is especially true when the anecdote doesn’t apply to the facts at hand:
It’s a personal story, but let it also serve as a public health rebuttal to the proposed ban on male circumcision that will be on the San Francisco ballot this November.
San Francisco’s ballot initiative would prohibit circumcision on all males under the age of 18. It would allow no religious exemptions, and it apparently gives no regard to the numerous studies demonstrating that male circumcision can substantially reduce—by more than 50%—the transmission of the HIV virus during sex.
The protection from HIV has been shown in Africa using voluntary, adult male circumcision. The San Francisco proposal would not prohibit voluntary, adult male circumcision. It’s ethically different from non-therapeutic male child circumcision because children cannot consent to having their healthy foreskins removed. Ms. Cole’s story is sad and unfortunate, but it is not a rebuttal to the proposal in San Francisco.
CBS News offered the first mainstream article I remember seeing that considers the possibility that male circumcision may be genital mutilation without at least cushioning the psychological hit by putting mutilation in quotes. That’s worth applauding, even if some of the article should be better. For example:
As for circumcision’s effects on sexual function, several studies conducted among men after adult circumcision suggest that few men report their sexual functioning is worse after circumcision. Most report either improvement or no change, according to the CDC.
This is not an acceptable summary of these studies since they show more variation than the reporter suggests here. For example, if a study reports that 18% of men aren’t happy with the results of circumcision, that qualifies as more than “few men”. This approach also fails to explore the assumptions in reaching those results that may be questionable. Self-reporting and why the respondent chose circumcision likely factor into the individual’s conclusion in some manner. But even if “few” is correct, ignoring individual conclusions about sexuality misses the ethical principle involved. Generalizing in place of considering what the individual male might want does not, therefore, justify applying the preferences of a majority onto any individual. (And I can uncritically provide studies (pdf) that reveal the opposite of the article’s statement.) Does the individual male child want to be circumcised? No one can know, which is why his lack of need is what matters.
The article concludes with this, a common misguided analysis.
“People care way too much about this little piece of skin,” Dr. Mark Alanis, assistant professor obstetrics and gynecology at the Medical University of South Carolina in Charleston, who has written a history of circumcision, told the Washington Post. “At the end of the day, it’s unlikely to significantly change your child’s life for better or worse.”
Unlikely is not certainty, which demonstrates that this discussion must include ethics. All males will suffer some level of objective negatives, since no surgery is free of harm. A few will suffer worse objective negatives than the typical circumcision. These facts are indisputable, and suffice to rule out the imposition of non-therapeutic circumcision on a child. Dr. Alanis ignores that.
In his quote, he dismisses the subjective aspect of individual preference. Many males have – and will continue to – conclude that there are subjective negatives in addition to the objective harms of circumcision. He has no more standing to state that I care too much than I say he cares too little. The correct analysis is that I care about myself and he cares about himself. Each viewpoint is valid, but only as it applies to ourselves. Where he thinks circumcision is minor, I think it is major. Where he states it is a “little piece of skin,” I state that my foreskin was my little piece of skin. Rights matter. That’s where the emphasis must be.
Beyond ethics, his argument misses a larger issue. The burden of proof rests with people who want to circumcise children. But the correct test is need, not possible benefits. So, when advocates of non-therapeutic circumcision suggest that it doesn’t matter, the follow-up against this argument is why the advocate insists on permitting (or encouraging) circumcision. If it’s not important either way, then the superior option is that which doesn’t harm and maintains future choice. The response to that approach is generally a recitation of the claimed potential benefits, whether medical or cultural. Although only one justifiable conclusion exists, considering those is a better approach because it requires thought. In that willing participants can recognize that there are reasons to prefer being intact and that intact males aren’t destined to death-via-foreskin or even the rare medically necessary circumcision.
The “it doesn’t matter either way” approach is nothing more than declaring that one’s own personal, subjective preferences are universal and “right”. It’s a form of arrogance masked as an indifferent, considered statement of scientific fact. It is not. It is an opinion based on a subjective evaluation of competing thoughts. The only appropriate person to make that decision is the person who would be circumcised.
In this essay on the rights of females in Egypt to be free from genital mutilation, Maureen Gill makes several common mistakes in analyzing the subject, which allows her to extend that mistake to missing the comparison male genital cutting. She states:
This issue is at the very core of what it means to have personal control over one’s own bodily integrity and human sexuality.
The issue is female genital mutilation.
That is exactly the core of the issue. I don’t know why the obvious gender-blind leap is difficult.
After a brief introduction about FGM, she continues:
FGM comes in three basic forms, from the most extreme to the still extreme. …
WHO recognizes four types, ranging from pricking to the most extreme forms Gill describes. I agree that they’re all harmful and should be illegal and punished where there isn’t consent by the individual affected. But facts don’t change just because we have a particular angle we want to sell. While uncommon, medical organizations recognize pricking as a distinct, practiced type of female genital cutting. It is less severe than male circumcision. It is still illegal in Western nations. (And chaos predictably and correctly erupts when it’s seemingly endorsed by Western medical authorities.)
… It has been referred to as female circumcision but that is a gross misnomer …
I agree on this point, and not just based on the semantics of the word circumcision. But, then, I refer to male circumcision by its accurate description, male genital mutilation. Names should include ethics, where appropriate.
… and imparts on this practice a suggestion that it is the equal of male circumcision.
It is not.
The two are the same, ethically. Non-therapeutic genital cutting on a non-consenting individual, female or male, is unethical and immoral.
Of course, I acknowledge quite readily that the harm from female genital cutting as it’s typically practiced is more severe than the harm from male genital cutting as it’s typically practiced. But that doesn’t mean that male genital cutting gets an ethical pass because there’s something worse in the world. Every argument Gill makes in favor of protecting a female’s rights applies to males. To repeat her words:
This issue is at the very core of what it means to have personal control over one’s own bodily integrity and human sexuality.
Why do boys not deserve personal control over their bodily integrity and sexuality? Gill makes no serious attempt. (More on this in a moment.)
If male circumcision were its equal then male circumcision would be (in its most benign form) the reduction or modification of the male penis in order to reduce or eliminate full sexual pleasure. …
If intent matters instead of the actual harm caused by the surgical intervention, then parents merely need to claim good intent for cutting their daughter’s genitals to satisfy the low standard Gill established. Within the WHO link above on FGM, there is a clear statement that some excuses offered by parents for female genital mutilation mirror some of the excuses offered – and accepted – for male genital mutilation. She wouldn’t accept such a parental justification for females, so why does it matter that parents don’t intend to harm their sons? They harm them. That’s the unavoidable outcome.
Nor is FGM always performed to inhibit sexual pleasure, although that’s the likely result. Some women indicate that they still feel sexual pleasure after being cut. Does that matter? I contend no, and I’m sure Gill does, as well. Thus, it’s unpersuasive to base her argument on the generalizations she uses, or to miss the similarities she rejects.
A few individuals challenged her in the comments to her essay. She replied:
… No baby male child was ever circumcised without a parental consent form and I never met a man who refused the procedure for his child although I know there are some who would. …
To repeat, where is personal control over one’s own bodily integrity and human sexuality when parental consent is all that’s necessary to force an unnecessary, harmful, permanent action on a male child’s genitals? For me, I do not want to be circumcised. I want personal control over my own bodily integrity and sexuality, which I can never have. It’s not a violation of my personal control over my own bodily integrity and sexuality because I have a penis rather than a vagina? That’s flawed, sexist thinking.
Via David Wilton at Male Circumcision and HIV, here’s an excellent report by Russia Today that looks at unnecessary surgery and experimentation on intersexed children in the U.S.
The connection with the unquestionable human rights of male children is obvious, but this issue stands on its own. Medical need is the only valid justification for surgical intervention in children. Being different is not enough. As long as the child is healthy, parents and physicians must refrain from forcing conformity. Let the child decide.
Today is International FGM Zero Tolerance Day. As its name suggests, Choose Intact aims to help end non-therapeutic genital cutting on any non-consenting individual, which is when genital cutting becomes genital mutilation. Our primary focus is from an American view against male circumcision, but gender is irrelevant in this struggle. Even though I disagree with typical refusal to accept the moral equivalence, I support this day as a way to make the daily effort better known.
Before going further, I’ll reiterate one standard point. Non-therapeutic genital cutting (i.e. mutilation) is ethically wrong, whether it’s forced on girls or boys. There is no distinction in the analysis of whether or not it is a violation of the child’s bodily integrity and autonomy, since mutilation is mutilation. However, it’s also clear that the common forms of FGM are more severe than the common form of male circumcision. Often, the cutting is significantly more severe. This distinction is valid. Fighting against both is not an attempt to ignore this or pretend that facts are different. The core issue, regardless of the damage inflicted, involves human rights. These rights aren’t conditional based on the extent of damage or the intent behind its imposition.
To promote International FGM Zero Tolerance Day, I want to focus on this brief interview with Sister Fa (Fatou Diatta), a musician from Senegal who is a victim of genital mutilation. Her unfortunate story is instructive because it highlights the complexity in how mutilation is practiced and the common misconceptions that lead to erroneous distinctions in genital mutilation based on gender. From the interview:
Rebellion is in the words. You are dealing with issues such as forced marriage, female genital mutilation. How important is this for you? “It’s more than important. But my struggle is not against Female Genital Mutilation (FGM, ed.). Me, I do not even use the word “mutilation,” because mutilate means cutting with the intention to hurt. I say ‘cutting’. I’m campaigning so that people would know that it is important that we can educate a child without going through certain practices that may harm his/her health. I’ve been a victim of this practice and I know its effect. It hurts.”
The word mutilation has problems because it carries a perception that the outcome was the intent. I prefer accuracy in words, and mutilation is accurate, but there’s a level of deference to marketing necessary surrounding this issue. The common misunderstanding when the topic is male circumcision and mutilation is used is that the boy’s parents intended to mutilate him, or that they forced circumcision on him maliciously. That is not the case, obviously. Parents don’t have that intent, but intent isn’t tied to outcome for genital cutting. We need to find a way to communicate that. Ms. Diatta’s approach may not satisfy our (unproductive) need to feel righteous. That’s okay because moral victories don’t stop unnecessary genital cutting.
But how big is the issue of female circumcision and forced marriage in Senegal? “In my village, 89 percent of girls are circumcised. If you are not, you’re marginalized. You cannot get married, you cannot cook for anyone. It is a criterion for a good marriage. You have to be circumcised. Even if your mother does not like it, she has to do it. To protect yourself against what? Against your own society.”
“There are people who confuse things, especially Westerners. They think it’s a barbaric act. That it is a mutilation. That it is terrible for a mother to mutilate her own child. It is not the case! It is one of the reasons for the failure of this communication to really try to erase this practice in my country.”
I think it’s useful to recognize here that some of the societal perceptions she cites are similar in logic to the cultural rationales given for male circumcision. It’s about inclusion more than anything. We recognize the fallacy of cutting girls for this type of reason. There’s no reason to exempt cutting of boys for the same type of reason(s).
The second paragraph is the key here. It took me a few reads to grasp her meaning. She’s saying the culture doesn’t need to change, that ideals and values can still be instilled. The only change would be to drop the cutting. It’s the same concept as transitioning from a brit milah to a brit shalom. Respect for tradition is good and can be altered just enough to maintain a cultural connection while respecting the child’s rights. Again, even though it feels good to denounce as strongly as possible, Ms. Diatta is on the right path.
This movie starring Sister Fa is powerful in showing her resolve and methods. It also instructs on the complexity of FGM and how and why it’s carried out.
The movie is worth your time. A few quotes from Sister Fa from the movie:
It was my mother who did it to me. Even today I don’t understand why.
Mothers don’t do it because they are malicious. It’s a contradiction.
They want to protect their children against a society which could marginalise them.
From Ibrahima Diatta, Sister Fa’s father:
“You know in our African societies and especially in the Diola Ethnie, the woman has her affairs where she doesn’t have to consult her husband. So when it was the matter to cut Fatou I didn’t know about it. I was just informed that she got cut.”
Yes, males impose FGM on girls. Yes, it’s done to affect/destroy sexual pleasure. But these aren’t exclusive. Again, the issue is more complicated. As these (anecdotal) quotes suggest, women also impose FGM on girls. It is also done to conform rather than destroy, even if the latter is likely or inevitable. There are important, undeniable similarities between female and male genital cutting that must be recognized, even when these facts challenge what society wants to believe. Western values have (mostly) settled the moral question of female genital cutting. We err when we endorse extraneous aspects of male genital cutting and imagine that these are somehow different, despite sufficient evidence to the contrary.
The cultural, “medical”, and religious considerations granted to parents for boys are rejected for girls, as they should be. Today, I hope we can begin to cease imagining differences that don’t exist. Today is about respecting the rights of girls. That is a noble cause. It will be articulated better as we begin recognizing an equal human right to be free from unnecessary genital cutting.
Bukoba. The drive to circumcise about 9000 men living on the islands of Lake Victoria and surrounding environs in Kagera region has started in earnest, expecting to thwart the spread of HIV/Aids in the area, where prevalence of the disease is as high as 35 per cent.
As of January this year, about 1158 men of the target group aged between 10 and 50 years were circumcised, according to statistics provided by the International Centre for Aids care and Treatment Programmes (ICAP).
The target group of “men” includes 10-year-old children. This isn’t surprising, as the expressed idea of voluntary, adult male circumcision is always meant to signal a nonexistent commitment to ethics. It’s also rare that this blatant disregard for ethics is hidden. The disconnect is so strong that the presence of potential benefits is viewed as a guarantee that any non-voluntary recipient will acknowledge the gift upon proper reflection. This is a large factor in the blindness to the obvious ethical flaws of non-therapeutic child circumcision in the United States (and other Western countries).
What’s not usually quite so blatant is this level of open contradiction within a single article:
Among 1158 people circumcised towards the end of this year in the Lake Victoria islands, 317 were children aged between one and14 years, while those aged 15 to 25, the group thought to be most sexually active, were 551. Others who agreed to be circumcised included 260 men aged between 26 and 50 years.
More than 27% of the males “aged between 10 and 50 years” who were circumcised were children between one and fourteen years old. I’ve never met a 10-year-old man, but there can be signs of manhood. Perhaps the voluntary consent necessary to make non-therapeutic circumcision ethical is possible. The pretense that 1-year-old men exist and that these minors consent to surgical alteration is a disturbing, all-too-common trend in public health fanaticism.
When public health officials say voluntary, adult circumcision, they never mean voluntary or adult.
… I want her to have the freedom to come to her own conclusions about life’s major issues like religion, politics, and her own body. The reality, however, is until she can speak for herself, Nicole and I are calling the shots. Mistakes will be made. This is a parent’s burden. I can only hope she will learn to forgive us.
That’s offensive, right? Non-therapeutic genital cutting on a non-consenting female is wrong. Neither parental intent nor perceived benefits changes that fundamental concept. Mistakes can’t be justified when they’re obvious and avoidable. That’s why laws exist in the United States against any form of non-therapeutic genital cutting, whether severe or minor.
I modified the original quote. Below, here is the the actual quote:
… I want him to have the freedom to come to his own conclusions about life’s major issues like religion, politics, and his own body. The reality, however, is until he can speak for himself, Nicole and I are calling the shots. Mistakes will be made. This is a parent’s burden. I can only hope he will learn to forgive us.
This mistake will get you jail time if it involves your daughter, regardless of whether she ends up angry about it. But make this mistake on your son and you get a culturally sympathetic nod to a “parent’s burden”, perhaps especially if your son ends up angry about it? That’s unacceptable nonsense. The ethical flaw doesn’t change to make the scenario any less offensive when it involves non-therapeutic genital cutting on a non-consenting male. Both are wrong for the same reason, and should be against the law.
The above quote is from Cole Gamble’s essay on his son’s circumcision, originally printed at The Daily Beast two years ago and reprinted here today.
This article in The New York Times covers the basic summary of the recent re-analysis that voluntary adult male circumcision in Africa can reduce the transmission of HPV to females. It has one inexcusable problem and an inference a thinking person should draw from it.
First, the problem:
Male circumcision, which has been shown to decrease a man’s risk of contracting the virus that causes AIDS, also appears to help protect his sexual partners against cervical cancer. …
The study, led by researchers from Johns Hopkins University, did not last long enough to see how many women actually developed cancer; that can take years or decades.
HPV doesn’t appear in the article. Instead, voluntary adult male circumcision “appears” to help protect against cervical cancer. Yet, the reporter then states that the researchers didn’t actually study whether or not circumcision reduces the risk of cervical cancer because studying cancer can take years or decades. So why does the reporter write that circumcision protects against cervical cancer, rather than writing the actual suggestion that circumcision appears to reduce the risk of HPV transmission? HPV is not one virus, and not all strains cause cancer. This is irresponsible journalism based on the myth that circumcision is “good”.
Cervical cancer was once a major killer in wealthy countries, but because of Pap smears it is now much rarer. In poor countries, it kills almost 250,000 women a year, according to the National Cancer Institute.
Papilloma vaccines like Gardasil and Cervarix provide much greater protection than circumcision does, but they are too expensive for most poor countries.
Cervical cancer is now much rarer in the Western nations because we have methods to detect it earlier. It is also less likely to kill in the future because now there are non-surgical vaccines that provide much greater protection than circumcision. So, the findings aren’t nearly as impressive for the readers of The New York Times because there are better detection and prevention methods. And the target audience for circumcision among the readers of The New York Times are parents of infants today. Those children will grow up in the same world where better detection and prevention methods exist, and will likely improve further by the time they’re at risk for sexual transmission of HPV.
Medically and ethically, this finding is irrelevant to the question of whether or not parents should consider forcing circumcision on their children.
There are complicated issues of religion involved in this essay. As I intend to make clear in the future, they’re not so complicated that we shouldn’t discuss them for fear of offense or pretend that religion is in some way a special exception to the basic human rights issue involved in non-therapeutic child circumcision. However, I don’t want to delve too deeply into them this early in Choose Intact’s history.
Instead, I want to focus on the last sentence of the essay’s first paragraph to discuss framing. The religious aspect of the first paragraph is superfluous for this point. (emphasis mine)
Human rights start at home. We must defend them for children in the Jewish community as much as adults in others. Day eight in the life of Jewish boys should be no exception, even as we engage in the ritual excision of foreskin from their penises. Both the pain and unnecessary foreskin can be cut together.
As I wrote on Twitter this morning, [a]lways be aware of how #circumcision advocates mix subjective adjectives and objective facts for equal consideration. The author(s) frame the remainder of the essay with the stated assumption that the foreskin is ‘unnecessary’. This is true in the simplest form of argument, in that a boy does not need his foreskin to survive. Neither does a girl need her labia to survive. The latter is usually more horrific than the former in practice, but both are horrific because they remove healthy, functioning tissue from a non-consenting child.
The author(s) inevitably do not intend this meaning. ‘Unnecessary’ is short-hand for ‘unwanted’ or ‘superfluous’, for the belief that the child will be indifferent, at worst, to the removal of his foreskin. It frames the discussion away from the considering potential objections from the child. We are to accept that he wants circumcision because his parents want him circumcised. There is no way to confirm this for any individual child. The child may want his foreskin.
From the basics of circumcision, whether ritual or cultural, we can only draw the conclusion that the pain is unnecessary, not that the foreskin is unnecessary. That is the objective fact involved, as long as the child is healthy. No pain is necessary. In order to respect the child’s human rights, we must therefore refrain from inflicting any form of it if human rights are to mean anything. (Related: The author(s) talk of proper anesthesia during the procedure, but ignore the question of post-operative pain from the surgery. This matters, too, since children can’t receive the same pain management as adults.)
The human right involved is summarized in a simple principle: non-therapeutic genital-cutting on a non-consenting individual is wrong. Contrary to the essay, the only way to honor that is to not circumcise the healthy child. If he wants to be circumcised, he may choose it for himself. Imposing circumcision on a him violates his human rights. It’s more humane to use proper pain management when circumcising, but it isn’t a meaningful victory for human rights.