Zimbabwe Commits to Unethical Infant Circumcision

In July I wrote about Zimbabwe’s plan to focus its “voluntary, adult” circumcision efforts on infants. This wasn’t a surprise because the truth always remains. When public health officials say voluntary or adult, they never mean voluntary or adult. And, as I wrote at the time in response to the claim that their “sole aim is to try and reduce new HIV infections”:

No, the sole aim is to implement circumcision. They believe their intentions are noble, a fact I do not doubt. But if their sole aim is to try to reduce new infections, they’d focus limited medical resources on those currently at risk of sexual transmission. They’re not, unless we stupidly assume all males aged 15 to 49 in Zimbabwe have been circumcised. Instead, they’re shifting to males who can’t consent. They still have 500,000 males to circumcise before 2015 to reach their target. The target is what matters, not the individuals being targeted.

There’s further evidence on both the low number of volunteers and the predictable efforts to “volunteer” infants. On the former (emphasis added):

Government intends to circumcise one million men between 2013 and 2015. The turnout has been very low in the previous years with only 85 000 circumcised since the inception of the programme. Chances of a man acquiring HIV from an infected partner if circumcised are less than 60 percent.

Instead of the 500,000 men who need to be circumcised, as reported in July, Zimbabwe is 915,000 men short of its goal. Or they intend to circumcise one million newborn “men”. Either way, it would be more prudent to ask why men (i.e. adult males) aren’t volunteering as expected than to violate healthy infants by forcing circumcision on them.

Also, notice the last sentence. In the best interpretation, it’s poor English. In the worst, it’s dangerously wrong. Regardless of the interpretation, men aren’t volunteering. Why? Instead of finding out, or publicly explaining why, public health officials push to impose non-therapeutic circumcision on children.

CHILDREN will soon be circumcised at birth under a national programme to achieve maximum results of the medical procedure, senior health officials have said. Aids and TB Unit director in the Ministry of Health and Child Welfare Dr Owen Mugurungi said Government was planning to start neonatal circumcision as soon as possible.

“We hope between 2013 and 2014 we would start neonatal circumcisions at a national scale,” he said. “It is actually more sustainable than adult circumcisions.”

Of course it’s more sustainable. Infants can’t refuse or fight back when they’re being violated. When public health officials say voluntary or adult, they never mean voluntary or adult. It’s easier.

[Dr Mugurungi] said for every 200 000 babies circumcised, about 1 500 new infections are averted.

Have they discussed the declining return, if their projections prove correct? (There is evidence to the contrary, as circumcised men in Zimbabwe may have a higher rate of HIV infection than intact men.) For every 1,500 fewer infections in their projections, the population-wide transmission rate decreases. Thus, the number of circumcisions needed to prevent each new infection increases. At what point in their flawed lack of ethics does the ethical question finally appear? When does the cost to individuals become too much to impose on them without their consent, allowing Zimbabwe to return to voluntary circumcision?

The answer, of course, is they haven’t and aren’t interested. The willingness to force circumcision on healthy infants is self-fulfilling. Ingrain it in the culture, and suddenly the rational respect for the current health and rights of infant males somehow appears absurd. The United States is evidence of this.

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