What Do the WHO, NIH and Other Health Organizations Say About Circumcision?

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Or Chaim Nagar, eight-days-old, lies in his stroller after his circumcision. David Silverman/Getty
Or Chaim Nagar, eight-days-old, lies in his stroller after his circumcision. David Silverman/Getty

Debate has erupted over a November ballot initiative in San Francisco that aims to ban circumcision of minors.

In addition to ethical and religious concerns, the health implications of circumcision (and non-circumcision) are also part of the conversation.

But before we examine that debate, let's start with some basics.

So, what would the bill do?

If passed, the proposed bill, Male Genital Mutilation, would make it "unlawful to circumcise, excise, cut, or mutilate the whole or any part of the foreskin, testicles, or penis of another person who has not attained the age of 18 years."

The bill would provide an exemption if there is a "a clear, compelling, and immediate medical need with no less-destructive alternative treatment available." It would not create a religious exemption.

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If someone was caught performing a circumcision, it would be a misdemeanor charge with a maximum of a $1,000 fine, or no more than a year of imprisonment.

The San Francisco initiative was written by Matthew Hess, who has also written a federal version, 46 state versions, and another ballot initiative in Santa Monica.

Hess says that the bills are modeled on existing federal and state female genital mutilation laws, which is why much of the language is similar to those statutes.

You can read all the bills at MGMbill.org, an anti-circumcision organization run by Hess and 15 others.

Hess declined our request for an interview, but he got us in touch with Lloyd Schofield, who in addition to speaking with us, has spoken to many other media outlets on the subject.

Who, where, and how often?

The World Health Organization estimates that about 30 percent of men worldwide are circumcised. Both Jewish and Muslim groups often circumcise their boys. So while many Americans are circumcised, many countries in the Middle East have similar if not higher rates. Muslim men make up about two-thirds of all men circumcised in the world.

The number of circumcised men is growing worldwide, predominantly in Africa because of some new studies linking being uncircumcised to the spread of HIV.

Culturally, circumcision was never much of a thing in Europe, so rates are much lower there.

The Centers for Disease Control found that 79 percent of adult males in the U.S. report being circumcised, but, according to WHO circumcision is declining in America. The CDC confirms this in its most recent analysis, which shows that there was a decline in newborn circumcision, from 60 percent in 1998 to 55 percent in 2005. Also, the most recent National Hospital Discharge Survey estimates that 55.4 percent of infants were circumcised at the end of 2007 compared with 64.7 percent in 1980.

There are a multitude of reasons for this decline. It's speculated that one of the main factors is the change in the makeup of race, ethnicity, and religious orientation in America over the years.

What do medical associations say?

Most medical organizations we've surveyed take a middle-of-the-road approach, characterizing the procedure as essentially a choice "in which there are potential benefits and risks." Here's what some have to say on the subject:

American Academy of Pediatrics

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child.

Read more.

National Institutes of Health

The merits of circumcision have been debated. Opinions about the need for circumcision in healthy boys vary among health care providers. Some believe there is great value to having an intact foreskin, such as allowing for a more natural sexual response during adulthood.

Rather than routinely recommending circumcision for healthy boys, many health care providers allow the parents to make the decision after presenting them with the pros and cons.

There is no compelling medical rationale for the procedure in healthy boys, although some boys have a medical condition requiring circumcision.

Read more.
However, NIH also notes that circumcision can help stop the spread of AIDS.

CDC
The CDC have not issued a statement on circumcision, but one is in development, according to spokesman Scott Bryan.

British and Canadian Pediatric Associations
Both organizations says that circumcision is unnecessary as a routine procedure, but make allowances for cultural and religious reasons.
Read the British Medical Association's statement
Read the Canadian Paediatric Association's statement.

WHO

Male circumcision is one of the oldest and most common surgical procedures worldwide, and is undertaken for many reasons: religious, cultural, social and medical. There is conclusive evidence from observational data and three randomized controlled trials that circumcised men have a significantly lower risk of becoming infected with the human immunodeficiency virus (HIV).

WHO notes that studies have shown that circumcision can help prevent urinary tract infections, inflation of the glans and foreskin, penile cancer, some sexually transmitted diseases such as chancroid and syphilis, HIV, and from passing on HPV which causes cervical cancer to female partners.

It also points out that circumcision can cause harm:

As with any surgical procedure, [circumcision] carries a risk of post-operative infection. In inexperienced hands, penile mutilation and even death can occur.

Read more

The HIV/AIDS Connection

WHO, NIH and the CDC have concluded that circumcision can help stop the spread of HIV, the virus that causes AIDS. However, the studies these organizations sponsored or reviewed have been interpreted differently, and are often the subject of criticism by anti-circumcision groups.

Anti-circumcision say the studies were flawed because they were stopped 1-2 years prematurely. The scientists involved in the studies, however, say they ended the research because the evidence was sufficiently conclusive, and that it would be unethical to continue.

Opponents also say that variations seen between two analysis of the same data lowers the credibility of the study.

WHO and the CDC note that circumcision should not be considered the only way to stop the spread of AIDS. Both organizations promote condom use and sex education.

The CDC also cautions that the results of the studies in Africa can not necessarily be applied to United States.

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KQED will continue to cover the conversation around circumcision as we approach November.