Category: “Voluntary”

Incomplete Progress (v2)

Two new examples of circumcision without consent that should be prosecuted, but not for a reason distinguishing it from any other non-therapeutic genital cutting on a child. First, from England.

A 61-year-old man, believed to be the doctor who carried out the procedure, has been arrested on suspicion of grievous bodily harm with intent.

The boy’s mother complained to police, saying her son was circumcised without her consent while staying with his paternal grandparents in July 2013.

If consent from one parent is permitted, it’s still a violation because the healthy¹ boy didn’t consent.

Next, from South Africa:

A police investigation is under way after a group of 27 boys were illegally circumcised in Scenery Park‚ East London‚ the Eastern Cape health department said, writes Naledi Shange.

Spokesperson Sizwe Kupelo said police‚ traditional leaders and health officials raided the initiation school on Sunday afternoon.

They were accompanied by some of the parents whose children had been circumcised without their consent.

The same point on consent applies.

As in my last post, we’ll be making real progress when the meaning of their aligns with ethical principles by referencing the boys, not their parents. Still, any pursuit that raises the issue of consent at all is almost certainly progress.

¹ This key point is why the change we need is more cultural than legal. Doctors who support non-therapeutic circumcision of children – American doctors, in particular – are inclined to believe nonsense about the foreskin, such as what Brian Morris promotes. There won’t be a change in the legal until the culture changes. But if there were somehow a legal change without cultural change, the law wouldn’t matter. The boy’s chart would read “therapeutic treatment for phimosis” or some other offensive lie. Also, having a law no prosecutor will enforce is no better.

False Distinction, Not False Equivalency

Note: I’m not going to write about the charges directly here. Anything involving a cursory glance of my work here will let you know I understand, abhor, and reject FGM in every form. If guilty of the charges, the doctors should serve the maximum sentence allowed.

I noticed something both fascinating and infuriating in this USA Today version of the Detroit Free Press article on the arrest of three doctors in Michigan on charges of mutilating the genitals of female minors. Specifically, this section:

As some medical experts on the topic stated in a 2015 article by The Atlantic:

“Male circumcision does no harm. Female gender mutilation does. Male circumcision cuts the foreskin, FGM cuts the clitoris — the two things cut are not even remotely the same. For male circumcision to be equivalent to FGM, the entire tip of the male’s penis would need to be cut off … Constantly trying to claim they are equivalent practices when they are not takes away from the unique seriousness of female ‘circumcision/mutilation,’ as most cases are performed during a traumatic developmental period and remove most sexual sensation, which is not true with male circumcision.”

Two things immediately jumped out. Who are the medical experts? Where is the link to the Atlantic article? Seeing that this is the USA Today version, I investigated to determine if the link was dropped from the original Detroit Free Press version, which is here. Nope. The link isn’t there. And not only is the link not there, those two paragraphs were removed and replaced. (More on the latter in a moment.) So I checked the Wayback Machine to see if the USA Today version is different or out-of-date. Predictably, it’s out-of-date, because the first version was what USA Today still presents. My hunch was that the reporter, Tresa Baldas, (or an editor) made an inexcusable mistake, which was then erased (incompletely, because the internet is mostly forever). It’s the conclusion I draw, but I’m open to more facts.

I found the referenced Atlantic article, “How Similar Is FGM to Male Circumcision? Your Thoughts”. It contains Baldas’ paragraph from two excerpted, merged comments. The quoted “medical experts” are a commenter called Tyfereth and a commenter, Jim Eubanks, who is an MD candidate, according to his Facebook profile. Half-right, I guess, except the initial comment is the one drawing the alleged distinction. Tyfereth’s comment:

Male circumcision does no harm. FGM does. Male circumcision cuts the foreskin, FGM cuts the clitoris, the two things cut are not even remotely the same. For male circumcision to be equivalent to FGM, the entire tip of the males penis would need to be cut off. Now that would be a harm, but cutting off the foreskin isn’t harmful.

This is ridiculous logic. (It is also incomplete knowledge of the various types of FGM.) Cutting inflicts harm. This is indisputable, except for foolish attempts such as this. Declaring that cutting the body and removing a normal, healthy body part is somehow harmless, like touching a raindrop, should raise skepticism in every reporter (and editor). That it didn’t immediately demonstrates a problem Ms. Baldas (and/or her editor) should question in her continuing coverage. Instead, she quoted Tyfereth as a medical expert on nothing more than a lame “nuh-unh!”.

At least Mr. Eubanks appears to be closer to an expert. But he isn’t making the same argument, so he shouldn’t be lumped in with Tyfereth’s nonsense. In his complete comment, he’s a bit more nuanced.:

False equivalency. You can stand against both practices, but constantly trying to claim they are equivalent practices when they are not takes away from the unique seriousness of female “circumcision/mutulation” as most cases are performed during a traumatic developmental period and remove most sexual sensation, which is not true with male circumcision. We can oppose both but take them on their own terms please.

He’s still wrong, of course. There is no false equivalency in the principle. Non-therapeutic genital cutting on a non-consenting individual is unethical. The right involved is a human right based in consent, not a female right based in degree of harm¹. The cutting done on an individual is a matter for penalty, not whether both violations or just those of females should be treated as crimes. The boy who is cut has as much right to his normal, healthy body² as the girl who is cut has to hers.

This is apparent with analysis of a more recent article Ms. Baldas wrote, “Report: Girl’s genital mutilation injury worse than doctor claims”.

A doctor’s findings, however, contradict that claim. A juvenile protection petition filed on behalf of the victims in Minnesota, along with federal court documents, cite scarring, a small tear, healing lacerations and what appears to be surgical removal of a portion of her genitalia.

I have or had all four of those injuries. I can’t state they are to the same degree, of course, so I’m not declaring that here. I’m stating the comparison is valid because non-therapeutic genital cutting without consent violates the individual. There is no false equivalency in stating that everyone has the same right to be free from unneeded, unwanted harm.

————-
Here are the paragraphs that replaced the reference to the medical experts in the Atlantic.

Medical associations also have cited health benefits to male circumcision, but have found no such benefits to female genital mutilation, which has been condemned by medical organizations worldwide.

For example, The American Academy of Pediatrics and the U.S. Centers for Disease Control have both found that the health benefits of newborn male circumcision outweigh the risks, though both groups say the final decision should be left to the parents as it may involve religious or cultural beliefs. The benefits cited by both groups include the prevention of sexually transmitted diseases, including HIV, and a lower risk for urinary tract infections in infants.

Neither group, however, endorses female genital mutilation in any form and has cautioned physicians against practicing it. The same goes for the World Health Organization, which has condemned female genital mutilation, but has recognized health benefits to male circumcision, stating: “There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%.”

First, the “FGM has no medical benefits” argument is a false distinction. It’s true, but irrelevant in the comparison. Most, if not all, opponents do not oppose FGM because it has no medical benefits. They oppose it because it violates the girl and inflicts harm on her. It’s a “spaghetti against the wall” argument. If researchers were to find (potential) benefits, the harm would still be real. Few opponents would change their mind. Rightly, of course, but it demonstrates the argument’s irrelevance.

Next, the American Academy of Pediatrics did not “find” that the health benefits outweigh the risks. They declared it to be true in the same way Michael Scott declared bankruptcy. The ethics section (Pg. 759) of its 2012 technical report states:

… Reasonable people may disagree, however, as to what is in the best interest of any individual patient or how the potential medical benefits and potential medical harms of circumcision should be weighed against each other. …

This is obviously true. The value of a potential risk reduction at the expense of risk and an objective physical cost with the lost foreskin is a subjective conclusion based on the individual’s personal preferences. Yet the Abstract misrepresents what’s in the Technical Report when it declares, “preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure”. The AAP knows this is not a factual statement. Lazy, uncritical journalism perpetuates this subjective conclusion as fact.

Even the alleged bioethicist involved in the Task Force knows the truth, despite what he signed off on with the Abstract. Dr. Douglas Diekema said, “Not everyone would trade that foreskin for that medical benefit.” All individual tastes and preferences are unique. I think the potential benefits probably have merit. I don’t care. I don’t want them in exchange for my foreskin. I’d rather have my foreskin and a (tiny) higher absolute risk of a foreskin-related problem than my circumcision. This is true in spite of my parents preferring me circumcised. The proper analysis is cost-benefit, not risk-benefit. The risks are a relevant cost, but the loss of the foreskin is the primary cost of circumcision. For indefensible reasons, most – including the AAP and CDC – ignore it completely.

The reference to the CDC is curious for another reason. Its proposed guidelines have not proceeded beyond the flawed draft recommendations from 2014. Again, uncritical journalism is probably to blame. Most treated the draft as final, despite it clearly stating “draft” and open to review. I assume this happens due to laziness and confirmation bias. Insert your own theory why. It doesn’t matter. The result is misinformation spreads further.

With respect to FGM, the AAP briefly proposed a ritual nick as an alternative, which has implications for the “false equivalency”. But it is correct they don’t endorse it today. The WHO, however, is clueless and/or hypocritical. From its FGM factsheet, it states:

Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.
…

FGM has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls’ and women’s bodies. Generally speaking, risks increase with increasing severity of the procedure.

Everything there that isn’t the “spaghetti against the wall” argument (and “total removal” for the pedants, although it occurs) is true of male circumcision. WHO recognizes FGM as “a violation of the human rights of girls and women”. It is a violation of human rights, not female rights. Injury to the genitals without need or consent is the problem, not the form of the body part.

¹ Even though, yes, what is done to females is usually more harmful than what is done to males.

² This applies to intersex children, too. Obviously.

“Being Targeted”, Predictably

The latest strategy to circumcise children is underway:

Over 900 boys and men in Mombasa County are being targeted for circumcision in a new drive by the government to reduce new HIV infections caused through the exercise.

The National Aids and STI Control Programme (NASCOP) said on Friday that it is targeting men aged between 10 and 50 years to undergo the cut under Voluntary Medical Male Circumcision (VMMC).

The first paragraph mentions boys. The second paragraph discusses 10-year-old men, because fewer would participate in the lie of “voluntary”. It’s always this way in advocating for circumcision, with the meaning of words being malleable to the goal. (e.g. “Medical” rather than “medicalized”) When public health officials advocate for voluntary, adult male circumcision, they never mean “voluntary” or “adult”.

The Lie Feeds Itself – PrePex Is Predictably More Unethical on Circumcision

Over the course of five years, it’s been clear where PrePex would go. Circ MedTech made it clear earlier this year that it would not be satisfied with a device aimed at voluntary, adult male circumcision. It only cares about two of those four words. Its adherence to the use of PrePex in voluntary, adult circumcision was always a delay in technology, not a wall of ethics. Now, it shares predictable evidence of its lack of ethics in developing and promoting PrePex. From its FAQ, Is PrePex available for adolescent boys?

The manufacturers of PrePex are committed to assisting males of all ages with appropriate male circumcision technology. Non-surgical circumcision using PrePex is now available for males ages 13 years and above. Devices for Infants & Children (0 days to 13 years) based on the existing PrePex technology are underway.

The only appropriate male circumcision technology appropriate for a normal, healthy male under 18 who does not – or cannot – consent is the technology that remains in the package, unused. Instead, Circ MedTech wants to assist¹ males of all ages, whether or not they want – or will ever want – to be assisted. It does not care about voluntary or adult.

Note that, despite being dated December 3, 2014, that link did not include the italicized language on April 22, 2016. It stated:

The manufacturers of PrePex are committed to assisting males of all ages with appropriate male circumcision technology. Non-surgical circumcision using PrePex is not yet available for youths under the age of 18, although it is being developed and tested.

An ethical organization would not mislead in this manner. I will not pretend to be surprised, however small the offense.

Circ MedTech’s absurdity with language continues in Who is eligible for circumcision with PrePex?:

PrePex has been proven safe and effective for adult and adolescent men over the age of 13. In studies to date, approximately 90% of men who volunteered were eligible to undergo the procedure. Men interested in medical male circumcision should consult with a trained healthcare provider to determine whether PrePex is right for them.

Every time I think circumcision advocacy can no longer shock me, something ridiculous like “adolescent men” appears. Dare I predict the eventual use of “infant men”? Surely that’s too absurd?

I have another ethics question. Did all of the “adolescent men” volunteer, or were they volunteered by their parents. And it’s disgusting² that the prospective patients in “Is PrePex available for adolescent boys” became “adolescent men” when discussing the actual circumcision of those healthy-and-unable-to-consent individuals.

On April 21st, that link stated:

PrePex has been proven safe and effective for adult men over the age of 18. In studies to date, approximately 90% of men who volunteered were eligible to undergo the procedure. Men interested in medical male circumcision should consult with a trained healthcare provider to determine whether PrePex is right for them.
Non-surgical circumcision is not yet recommended for youth under the age of 18 outside the clinical evaluation framework. Several African countries are currently investigating the safety and efficacy of the PrePex procedure for adolescent men, and study results should be available in early 2014.

“Adolescent men” was already there, but within one two-sentence paragraph, Under-18s transitioned from youths to adolescent men. That’s at least impressive in its shamelessness, I suppose.

As always, when public health officials speak of voluntary, adult male circumcision, they never mean voluntary or adult.

¹ The violation of rights seems to require euphemisms.

² I rewrote the euphemism I initially used. I prefer to speak truthfully.

The Lie Feeds Itself -PrePex and Unethical Circumcision

Note: I updated the title after posting this entry.

I wrote this in December 2011:

… And to be fair to Circ MedTech, it promotes PrePex for adult male circumcision. We’ll see if their focus remains on voluntary, adult male circumcision.

And this, in February 2012, in a footnote:

This is where I’ll invoke the articles on the PrePex as an example. My objection to the recent pieces about it centers on the poor journalism rather than the device. I expect the device will eventually be tweaked to allow for infant circumcision at some point. That would be wrong. For now it’s a device for voluntary, adult circumcision. I have no objection to that. The claimed risks involved with the device are low. The claim that adult circumcision is more dangerous than infant circumcision doesn’t appear to hold up, generally, regardless of the method. This claim is a framing device of dubious quality rather than a fact to be [sic] negate ethics.

I expect the device will eventually be tweaked to allow for infant circumcision at some point. And four years later, this press release, from last month (emphasis in original, footnote added):

The World Health Organization (WHO) expanded the Intended Use of the currently-prequalified PrePex device to include adolescents aged 13 years, and above. Effective immediately, the PrePex device, manufactured by Circ MedTech, can be offered for adult and adolescent males in the 14 priority countries in Southern and Eastern Africa. PrePex was the first male circumcision device to receive WHO Prequalification on 31 May 2013.

Circ MedTech’s CEO, Eddy Horowitz said: “The expanded use of PrePex for younger ages will sustain Voluntary [sic] Medical Male Circumcision (VMMC) programs in the 14 Sub-Saharan Africa priority countries and will serve the new UNAIDS Sustainable Development Goal (SDG) of an additional 27 Million male circumcisions by the year 2020.”

Circ MedTech Ltd. is in the advanced stages of adapting its PrePex technology for use with infants¹ and children, thus offering safe male circumcision services to all ages, worldwide.

At least they dropped their lie about “voluntary” in the last paragraph. But they still include it in their FAQs.

Why is it called “Voluntary Medical Male Circumcision?”

“Voluntary Medical Male Circumcision” is a term used by the global health community to emphasize that circumcision is a personal choice.

“Voluntary Medical Male Circumcision” is a term used by the global health community for propaganda. The global health community (i.e. public health officials) does not care, has not cared, and apparently will not care, about “voluntary” (or even “medical”, since this surgery is “medicalized”, not medical, circumcision). The expansion of PrePex to children who can’t consent demonstrates this. Volunteer and volunteered are not synonyms here. The global health community legitimizes whoever’s choice results in a statistic, the removal of another normal, intact male’s foreskin. Remember, the measure of success in these campaigns is “male circumcisions”, not something relating² to HIV infection rates, the alleged, stated aim of “Voluntary” “Medical” Male Circumcision.

If those involved with PrePex cared about ethics, this expansion of the product line wouldn’t occur. But here we are with the above evidence and the questions raised by more from their FAQs, such as:

What is Voluntary Medical Male Circumcision? (click to read answer)

In 2007, the World Health Organization (WHO) and UNAIDS announced recommendations,based on extensive studies, to scale up Voluntary Medical Male Circumcision (VMMC) to men in areas of high risk for heterosexual HIV transmission. The studies showed that men with a circumcised penis are approximately 70 percent less likely to contract HIV from heterosexual intercourse than men with an uncircumcised penis–in addition to other health and hygiene benefits.

This finding, replicated in rigorous, repeated studies across several countries, has led doctors and public health professionals to recommend that men in high-risk areas have access to VMMC.

Imagine a person who doesn’t know what Voluntary Medical Male Circumcision is. Now imagine that person reading the answer PrePex gave to his question, “What is Voluntary Medical Male Circumcision?”. Does he now know what Voluntary Medical Male Circumcision is? Circ MedTech already showed they don’t know what “voluntary” or “medical” mean. They should be able to pretend better than the word salad they provide.

Let me try:

What is Voluntary Medical Male Circumcision?

Male circumcision is the permanent removal of the foreskin (i.e. male prepuce), the fold of skin covering the penis. This may also involve removal of the frenulum.

The procedure is voluntary and only offered to males able and willing to consent. This consent is achieved by providing a detailed explanation of the benefits, costs, and risks associated with male circumcision. The medical provider will emphasize what is guaranteed versus what is possible for the benefits, costs, and risks. With this knowledge, the individual may decide for himself if he wishes to proceed and be circumcised or not. The procedure is carried out only with his affirmative consent.

Circumcision is best carried out in a medical setting. It is recommended that, if the individual consents, this be performed in a sterile setting with trained professionals to minimize risks and negative outcomes. The risk of complications cannot be completely eliminated.

They can’t say that because it’s true and rules out the option to circumcise healthy children. Instead, they ramble about the perceived benefits. One should assign a level of trust corresponding to how forthcoming they are on the risks, so not much.

The lesson remains the same. When public health officials (i.e. the global health community) promotes “voluntary” (“adult”) male circumcision, they never mean “voluntary” (or “adult”).

¹ WHO TECHNICAL ADVISORY GROUP ON INNOVATIONS IN MALE CIRCUMCISION: “Providers must be trained to recognize when an adolescent is not eligible for the PrePexTM device due to inability to retract the foreskin or discomfort while attempting to do so, or when there are adhesions or phimosis. …” The inability to retract the foreskin is normal at birth because it adheres to the rest of the penis.

² Even where it is something related to HIV, do we have enough to determine causation rather than correlation? Possibly. I don’t know. And to repeat, I don’t care if adults choose circumcision for themselves. What each person does with his body is up to him. Nor do I state unequivocally that all potential benefits are illegitimate. The argument for imposing circumcision on a healthy child in pursuit of those potential benefits is, though. Always. The removal of his foreskin is a price the individual may not wish to pay.

The One Concept You Need to Know about Routine Infant Circumcision

Here’s a frustrating analysis of circumcision, 5 Ways Circumcision Affects the Rest of Your Life. It’s throwaway click-bait at its core. I clicked, they won. There’s still something interesting within the list:

Most guys have no choice in whether they have a foreskin or not. Nearly 60 percent of male newborns in the U.S. get circumcised at birth, according to the Centers for Disease Control and Prevention. But your parents’ decision about that tiny bit of skin has far- and wide-ranging implications. …

The list deserves credit for not being entirely ridiculous in its approach. It provides the ethical map from its first words. The first item is circumcised men “last longer”. That isn’t presented as an unquestioned benefit. And the second item is the possibility of sexual difficulties for female partners from male circumcision. So, yay. But then the third item:

Before you get bitter[¹] about the female orgasm thing, thank Mom and Dad for this: Circumcised men are less likely to get penile and prostate cancer[²], research finds. …

It’s reasonable to get bitter about the “female orgasm thing.” It’s even more reasonable to get bitter about the “last longer” thing. The first five words of the author’s essay, “most guys have no choice,” demonstrate that mom and dad deserve no thanks or applause for taking that choice away. I accept that some men “thank mom and dad” for “last longer”. That post hoc rationalization can’t change the ethics. Bad things happen in every circumcision. Other bad things can also happen from circumcision. Until the child expresses his affirmative consent to non-therapeutic circumcision, mom and dad need to keep their preferences to their own body. His body isn’t their choice.

¹ Whether bitterness (i.e. anger) is productive as a driving motivation is a separate concern.

² Again with this.

I Guessed What Phase Two Involves

Oh, what could this transition be?

The National Voluntary Medical Male Circumcision taskforce has rolled out the second phase of circumcision on regions with a high burden of HIV this time targeting over 1 million men.

The chairman of the Inter County Taskforce on Male Circumcision Dr Ojwang Lusi said the program is transitioning to the second phase of implementation that will run to July 2019.

We all guessed what this means.

The second phase will lower the circumcision age of boys to between 10-14 years.

I assume there’s a Phase Three – or an undocumented aspect of Phase Two – involving infant “men”. Predictably, it’s obvious why.

Lusi further noted that some challenges emerged in the first phase that they will strive to address as the second phase.

He said most of the men above 25 years declined to go for the exercise with limited number of women getting involved in the exercise with their husbands.

Men won’t volunteer, so child men get “volunteered”. As always with those who are unethical, because outcome matters instead of consent.

Joint Government Effort to Eradicate Consent

As always:

The Ministry Of Information and Communication Technology in partnership with the Ministry of Health and the centre for Disease Control in America are collaborating on a National Strategic framework known as the Voluntary Medical Male programme which is a joint government effort to eradicate the long struggle of HIV/AIDS infections.

HIV/AIDS has always been the countries top priority with the health ministry being pressured to reach their ambitious 2030 vision to bring HIV/AIDS infections to zero in the country.”The Centre for Disease Control and the Ministry of health have had three randomised controlled trial runs of the voluntary medical male circumcision programme prior to it’s launch in 2009. With the success of the programme around 20,000 sexual active males have been circumcised to date thus raising 80% awareness to men to encourage more males in considering medical circumcision,”said programme specialist Mr Dan Rutz of CDC.

Somehow success is measure in “males circumcised” without giving any statistics on HIV rates¹. So it’s easy to predict what “encouraging more males to consider ‘medical’² circumcision” means:

“Medical male circumcision has been found to be cost effective, as well as all procedures are free at clinics it has been known that healthy employers increases work productivity within any work environment which leads to a steady healthy work environment that enables the economy to grow,” added Rutz.All males that have not been circumcised are encouraged to do so as procedures can be performed at all local regional clinics in the country as government want to achieve it’s target to circumcise 330,000 men between 15 to 49 years by the end of 2016.The Ministry would also like to implement a national policy programme known as an Early Infant Circumcision strategy in the near future that will enable newly born babies to be circumcised.

“Enable”. Newborn males won’t get to consider or volunteer. They will be considered and volunteered, their needs, preferences, and preventative options deemed irrelevant. They are only pieces by which public health officials measure their own professional success.

As always, when public health officials discuss voluntary or adult circumcision, they never mean voluntary or adult.

¹ A drop in HIV infections would be welcome. It cannot justify violating ethical obligations to protect the rights of non-consenting individuals.

² Circumcision in this context is medicalized, not medical. Merely performing non-therapeutic genital cutting in a sterile operating environment does not make it necessary. This is also not a defensible term to justify performing non-therapeutic genital cutting on a person who does not offer explicit consent.

“Voluntary” Never Means “Voluntary”, Part Who Can Keep Count?

Zimbabwe has a plan, because public health officials just know.

THE ministry of health has launched an ambitious US$100 million male circumcision programme that is expected to see at least 80 percent of the male population being voluntarily circumcised.
…

Some 400 235 males have been circumcised since 2009 with ministry managing to introduce the non-surgical method of circumcision at some sites and launch preliminary studies on infant male circumcision.

If the infants aren’t volunteered, they might not volunteer. So, as always, when public health officials propose voluntary, adult male circumcision, they never mean voluntary or adult. (e.g. EIMC) Bonus points to Zimbabwe’s health minister, I guess, because he didn’t pretend the plan was only aimed at adults. But, as I wrote in the PEPFAR-EIMC post, I suspect that means officials know they no longer need to pretend to care about ethics. That isn’t progress.

President’s Endless Plan for Avoiding Rights

PEPFAR held an event today, described as:

Join global health experts in PEPFAR’s sixth VMMC Webinar to consider the pros and cons of offering early infant male circumcision (EIMC) as part of routine Maternal, Newborn and Child Health (MNCH) care.

The title of the event was, “Scaling Up Routine Early Infant Male Circumcision within Maternal, Newborn and Child Health”. I wonder what the outcome of considering the pros and cons will be.

It’s also worth noting how circumcising infants has been separated as EIMC from “voluntary” male “medical” circumcision (VMMC). Is it progress if they’ve stopped pretending that infant circumcision is voluntary? Not really, I think, since no one involved cared anyway and dropping it means they’re comfortable with making it clear they don’t care.