Mention the phrase āāfemale circumcisionā and someone will, surely sooner than later, counter with āItās genital mutilationā.
Itās a topic on which few have no opinion. It polarises people into either a small but vocal group, who see it as a cultural imperative that young girls be circumcised, or a larger, disbelieving group who think itās dangerous and lacking justification.
And yet amongst this group would be people who would heartily support circumcising their young sons. Their justification: itās a cultural imperative.
Twice a year in my home country of South Africa, the media will carry dozens of stories of boys who have been killed or maimed through circumcision. The boys will most probably from the Xhosa community in the Eastern Cape province, where circumcision is considered a rite of passage into manhood, and is part of an elaborate initiation ceremonyĀ that is conducted either during winter between June and July, or during the summer months of November and December.
As the initiation proceedings get underway, people can follow the numbers of dead and injured as they rise. During June last year the headlines read: āEastern Cape circumcision death toll rises to 13ā, then it becameĀ 20, before leaping toĀ 33, and finally āBotched circumcisions kill 40 in South Africaā. The previous year 91 boys died in the Eastern Cape from complications following circumcision. This showed a worrying trend of an increase in the numbers of deaths and severe injuries. According to the Eastern Cape provincial Department of Health, ritual circumcisions in the five years between 2001 and 2006 resulted in 2 262 hospital admissions, 115 deaths and 208 genital amputations.
Why do they die?
āBotchedā is the key phrase here. Initiates are enrolled into traditional āinitiation schoolsā, most of them unregistered and therefore illegal, where circumcision is performed by people who are unqualified, using unsterlised instruments in conditions that are unsanitary. Invariably authorities only know the condition of those injured when they are dropped off at clinics from the back of pickup trucks. By then itās often too late to save some of those who are injured.
The nature of the injuries are all too familiar to medical staff at clinics and hospitals in the Eastern Cape. Boys arrive suffering from dehydration, septicaemia, gangrene or pneumonia. For those who donāt die, the only course of action left is often the complete removal of their genitals.
According to Sizwe Kupelo, health spokesperson for the Eastern Cape provincial government, a major cause of the injuries is not only the unprofessional nature of the incision but the equipment and method used. Itās not uncommon for so-called traditional surgeons to circumcise up to 50 boys with the same knife without sterilising it in between, only wiping it with a selection of traditional herbs.
Questions beg to be asked
Two questions spring to mind: why isnāt anything being done to stop the carnage, and why in the face of so much death and mutilation do so many boys still queue up to be circumcised?
The answer to the first question is that something is being done, but not much. Case in point: a 55-year-old unregistered traditional surgeon, Mtshiyelwa Mtshayina Ndoda, was arrested several times over a five year period for performing illegal circumcisions, during which itās estimated as many as 20 initiates died and 15 had to have their penises removed. Last year what could be called the full weight of South African law finally caught up with him and he received a three-year suspended sentence. He is no doubt still cutting boys.
And the boys will continue to stand before him to be cut for the same reason that other boys are ritually circumcised: itās part of their culture. Embedded in their cultural psyche is the belief that the removal of their foreskin is an imperative, and to not be circumcised is to invite ridicule and rejection.
When cutting is necessary
This is difficult to understand for those in cultures where circumcision is merely a cosmetic option or a necessity to address one of a number of not uncommon medical conditions such asĀ phimosis, where the foreskin of a baby boy is too tight to be retracted. In the UK, it is only under such conditions that the NHS will cover circumcision.
Over the years medical opinion in the UK has shifted towards not supporting circumcision. In fact, according to theĀ NHS, āmost healthcare professionals now agree that the risks associated with routine circumcision, such as infection and excessive bleeding, outweigh any potential benefitsā.
However, in South Africa the opinion of some medical researchers fuelled a widespread government drive to encourage circumcision, which started in 2010. Itās a controversial opinion that has seen programmes to circumcise male prisoners and boosted the queues of men at the doors of clinics and traditional surgeons alike.
In March 2007, the World Health Organisation and UNAIDS announced that they believed medical male circumcision (circumcision performed by a trained health professional) was an effective intervention for the prevention of HIV in regions with a high incidence of heterosexually-acquired HIV, such as sub-Saharan Africa.
This followed three large-scale randomised clinical trials that were conducted in Uganda, Kenya and South Africa, where the rate of HIV infection was compared between uncircumcised men who had been given a standard HIV prevention package (which included condoms, treatment for sexually transmitted infections and information leaflets), together with counselling; and men who had received the same package and counselling, but who were also circumcised.
According to the trials, men who were circumcised were estimated to have ā60 percent fewer infections than those in the control groupā.
There are ideas as to why, if it is the case, male medical circumcision may reduce the chances of HIV infection in men; but thereās no clear medical evidence to explain it. What is clear, though, is that the research examined the rate of infection of HIV in heterosexual men, not in women. Male circumcision does not reduce the transmission of HIV from an infected man to woman who is HIV negative.
Lost in translation
The results of the research were enough to encourage the South African government, currently presiding over a country with the highest rate of HIV infection in the world, to embark on a programme to encourage men to be circumcised.
Although it has been successful, in that clinics are admitting more men for circumcision, the reasons men are joining the queue have strayed from the original purpose. Word of mouth carries mixed messages about circumcision improving sexual performance,Ā increasing the size of the penis, completely preventing the possibility of HIV infection, and, more worryingly, even curing AIDS.
And the South African government has been accused of losing focus after it also decided to encourage the circumcision of young boys ā a moveĀ denounced by the South African Medical Association.
Male circumcision, like abortion and even birth control in some religions, is a sensitive and socially dividing issue, fuelled by cultural and religious beliefs.
However, what cannot be denied is that, if done properly, it is a relatively straightforward procedure with few side effects.
Then there is absolutely no reason why a child should die because of it.
Main image: Courtesy of natamagat via Flickr; Xhosa initiate image: Courtesy of Ramon Arellano