Preamble The Rationalist Society of Australia Inc. (RSA) seeks to promote a pluralistic, multicultural and secular Australia. Government policies and laws should be based on evidence, reason and compassion, not religious beliefs. Everyone should be free to follow their own religious or non-religious worldview, provided that doing so does not harm or unnecessarily restrict others.
The RSA’s 10 Point Plan for a Secular Australia1 includes a number of policy principles that have informed the positions adopted in this statement:
The RSA recognises the inherent right of all human beings to security of person, in particular their right to physical and mental integrity and bodily autonomy. The RSA rejects all non-consensual, medically unnecessary genital cutting or modifications, and calls upon the medical community and state and federal governments to educate the public of the harms of these procedures, and to change the law to ensure all children are protected from genital mutilation.
Rationalist Society of Australia. Genital Autonomy, February 2017.
Writing in the Conversation, bioethics scholar Brian Earp identifies the inconsistencies in the way the law in most countries treats male and female genital cutting (circumcision and FGM and argues that "Given this asymmetry, and the need for consistency in the law, there are two main ways this can go. Either “minor” forms of sterilised FGM will have to be legally tolerated in the US, especially when performed for religious reasons (as in the case of the Dawoodi Bohra), or medically unnecessary forms of genital cutting on children that do not have vulvas will have to be restricted in some way, at least before an age of consent."
Brian Earp, ‘Unconstitutional’ US anti-FGM law exposes hypocrisy in child protection. The Conversation (UK), 11 January 2019
A paper published in the Journal of Tissue Engineering reports progress in the development of a tissue engineering technique that may lead to a method to restore or regrow the foreskin of circumcised males. The abstract follows:
The circumcision of males is emphatically linked to numerous sexual dysfunctions. Many of the purported benefits do not hold up to the scrutiny of extensive literature surveys. Involuntary circumcision, particularly when not medically warranted, is also associated with many psychological and emotional traumas. Current methods to reconstruct the ablated tissue have significant drawbacks and produce a simple substitute that merely imitates the natural foreskin. Extracellular matrix–based scaffolds have been shown to be highly effective in the repair and regeneration of soft tissues; however, due to the unique nature of the foreskin tissue, commercially available biomaterial scaffolds would yield poor results. Therefore, this study discusses the development and evaluation of a tissue engineering scaffold derived from decellularized human foreskin extracellular matrix for foreskin reconstruction.
A chemicophysical decellularization method was applied to human foreskin samples, sourced from consenting adult donors. The resulting foreskin dermal matrices were analyzed for their suitability for tissue engineering purposes, by biological, histological, and mechanical assessment; fresh frozen foreskin was used as a negative control. Sterility of samples at all stages was ensured by microbiological analysis. MTT assay was used to evaluate the absence of viable cells, and histological analysis was used to confirm the maintenance of the extracellular matrix structure and presence/integrity of collagen fibers. Bioactivity was determined by submitting tissue extracts to enzyme-linked immunosorbent assay and quantifying basic fibroblast growth factor content. Mechanical properties of the samples were determined using tensile stress tests. Results found foreskin dermal matrices were devoid of viable cells (p < 0.0001) and the matrix of foreskin dermal matrices was maintained. Basic fibroblast growth factor content doubled within after decellularization (p < 0.0001). Tensile stress tests found no statistically significant differences in the mechanical properties (p < 0.05). These results indicate that the derived foreskin dermal matrix may be suitable in a regenerative approach in the reconstruction of the human foreskin.
Valeria Purpura, Elena Bondioli, Eric J Cunningham et al. The development of a decellularized extracellular matrix–based biomaterial scaffold derived from human foreskin for the purpose of foreskin reconstruction in circumcised males. Journal of Tissue Engineering, 22 December 2018.
A fully-referenced article in the Journal of Pediatric Surgery replies to claims (largely speculation) that the origins of culturally or religiously motivated circumcision are to be found in hygienic or other practical considerations, and concludes that since circumcision is on balance harmful to to health, there is no connection. Full text on this site.
A Federal judge in Detroit, Michigan, has ruled that the Federal United States law criminalising any form of female genital mutilation (FGM) is unconstitutional. The case arose when Federal law enforcement officials prosecuted members of an Islamic sect, the Dawoodi Bohra, for performing ritual cutting on the genitals of young girls. The defendants did not deny that the cutting took place, but contended that it was allowable under the principle of religious freedom, and further that the law prohibiting it was not valid. It is significant that the judge did not make any ruling on the principal claims of the defendants, that the cutting was not mutilation but a harmless nick or scraping, and that it was required by their religion and permitted as an instance of religious freedom. The judgement was strictly on the constitutional and jurisdictional grounds that the US Constitution did not give Congress the power to legislate on this matter (essentially an instance of criminal assault) and thus that the law was ultra vires. As the judge remarked, "There is nothing economic or commercial about FGM, As despicable as this practice may be, it is essentially a criminal assault" - and thus a matter for State law.
According to media reports, 27 of the US states have passed laws criminalising FGM. This does not necessarily mean that the practice is legal in the other 23, as instances could still be prosecuted under normal laws of assault, wounding, bodily harm etc, as occurred in Australia with the Graeme Reeves ("butcher of Bega") case. As the judge pointed out in his ruling, "counsel for the government argued ... that FGM is criminal sexual conduct because it involves unlawful touching and penetration. If that is correct, then FGM could already be prosecuted in every state under existing criminal sexual conduct statutes, to say nothing of battery or child abuse statutes." Because the charges have been dismissed on jurisdictional (technical legal) grounds, the substantive issues remain in contention: we may expect to see a great deal more debate as to whether the principle of freedom of religion extends to practices that inflict harm on the bodies of children, and whether general principles of human rights and bioethics apply to boys as much as to girls.
When the FGM law was presented to Congress in 1996, the proposer (Senator Reid) was emphatic that the fundamental objection to FGM was that it was a violation of a girls' human rights: “I want everyone within the sound of my voice to understand that what I am going to talk about here today does not deal with religion and it does not deal with sex. It deals with violation of a person’s human rights. It deals with degradation of women and young girls. It deals with the most inhumane thing a person can imagine.” Critics have since pointed out that these observations are equally applicable to circumcision of boys and that there were also grounds for finding the FGM law unconstitutional in the basis that it denied equal treatment to males.
Further information on this site
Full details: Tresa Baldas. Judge dismisses female genital mutilation charges in historic case. Detroit Free Press 20 November 2018.
Brian Earp. Does Female Genital Mutilation have health benefits? The problem with medicalizing morality. Quilllette, 15 August 2017.
Robert Darby. Female genital cutting: harm, human rights and the possibility of a sex-neutral approach. Quillette, 3 March 2016.
A study of the response of infants to pain has found that the brains of babies "light up" in a very similar way to adults when exposed to the same painful stimulus, a pioneering Oxford University brain scanning study has discovered. It suggests that babies experience pain much like adults. The study looked at 10 healthy infants aged between one and six days old and 10 healthy adults aged 23-36 years. Infants were recruited from the John Radcliffe Hospital, Oxford, and adult volunteers were Oxford University staff or students. During the research babies, accompanied by parents and clinical staff, were placed in a Magnetic Resonance Imaging (MRI) scanner where they usually fell asleep. MRI scans were then taken of the babies' brains as they were "poked" on the bottom of their feet with a special retracting rod creating a sensation "like being poked with a pencil" – mild enough that it did not wake them up. These scans were then compared with brain scans of adults exposed to the same pain stimulus.
The researchers found that 18 of the 20 brain regions active in adults experiencing pain were active in babies. Scans also showed that babies’ brains had the same response to a weak "poke" (of force 128mN) as adults did to a stimulus four times as strong (512mN). The findings suggest that not only do babies experience pain much like adults but that they also have a much lower pain threshold. As the lead researcher of the study commented, "Thousands of babies across the UK undergo painful procedures every day but there are often no local pain management guidelines to help clinicians. Our study suggests that not only do babies experience pain but they may be more sensitive to pain than adults. We have to think that if we would provide pain relief for an older child undergoing a procedure then we should look at giving pain relief to an infant undergoing a similar procedure."
Source: University of Oxford News, 21 April 2015
At a conference in July this year, Brian Earp drew attention to the double standard in the attitude of the law to FGM, on the one hand, and circumcision on the other. He then pointed out that there was an anatomical continuum between totally male and totally female genitals and that the legal status of intermediate (intersex) forms was unclear. Were they female, in which case any form of surgery was illegal? Or were they male, in which case any form of surgery was legally permissible? He went on to argue that such anomalies were legally and ethically unsustainable, and further that no child - male, female or intersex - should be subject to medically unnecessary genital cutting. The abstract of his talk follows.
Recent court cases in England and the United States have highlighted a paradox in the current legal treatment of female, male, and intersex children with respect to the protections they are afforded against medically unnecessary genital cutting. In particular, there are legally prohibited forms of female genital cutting (such as the so-called ritual 'nick') that are less invasive or risky than permitted forms of male and intersex genital cutting, creating a "collision course" for law and policy in the immediate future.
Attempts to "quarantine" male versus female forms of genital cutting (MGC, FGC) based on appeals to supposedly different parental intentions (regarding, e.g., sexual control) or the religious versus cultural status of the cutting have been undermined by recent scholarship. This scholarship shows that there is far more "overlap," both physically and symbolically, between male, female, and intersex genital cutting than has traditionally been assumed, when the full spectrum of each type of cutting across cultures is considered and like cases compared with like. Recognizing that a "zero tolerance" policy toward FGC may lead to restrictions on ritual male circumcision, defenders of the latter practice have begun to argue that purportedly "minor" forms of female genital cutting should be considered morally acceptable and should be legally tolerated. This trend in the literature has emboldened proponents of female "circumcision," who are now basing their defence of the practice on Western tolerance and even promotion of MGC and intersex cutting, citing problematic (e.g., racialized) double standards. Some have even raised the prospect of "health benefits" for so-called minor forms of FGC, since this approach has apparently proved successful in countering ethical objections toward even more invasive forms of MGC.
Brian Earp is Associate Director of the Yale-Hastings Program in Ethics and Health Policy at Yale University and The Hastings Center Bioethics Research Institute, and a Research Fellow in the Uehiro Centre for Practical Ethics at the University of Oxford. Publications available at his Academia page.
Available at Youtube: https://www.youtube.com/watch?v=sQQTIpBWqvY
"Steep and sustained increases in STDS" are reported by the United States Centers for Disease Control for the years 2013 to 2017. According to its August media release, the most serious increases were in gonorrhoea, syphilis and chlamydia:
Of particular concern is the problem that gonorrhoea is becoming more difficult to treat as it develops resistance to available antibiotics. "The threat of untreatable gonorrhea persists in the United States, and reports of antibiotic resistant gonorrhea abroad have only reinforced those concerns. Over the years, gonorrhea has become resistant to nearly every class of antibiotics used to treat it, except to ceftriaxone, the only remaining highly effective antibiotic to treat gonorrhea in the United States. "The CDC recommends that health care providers make screening for STDs (i.e. regular testing and checks) as a standard part of medical care.
CIA comment: We have pointed out on many occasions in the past that the United States, despite a high incidence of circumcision among sexually active males, has always shown a far higher incidence of sexually transmitted infections than countries in Europe, where circumcision is rare. It is thus perfectly obvious that circumcision does not significantly reduce a male's risk of contracting an STD, and that organisations (such as the American Academy of Pediatrics and Centers for Disease Control itself) who identify prevention of STDs as the most important "benefit" of circumcision, do not know what they are talking about. There is in fact evidence going back to the 1850s that circumcised men are at greater risk of gonorrhoea and other urethral infections than men with normal genitalia. It may be that the foreskin acts as a barrier to the entry of certain pathogens.
Media release: New CDC analysis shows steep and sustained increases in STDs in recent years
California on Tuesday became the first state in the nation to condemn unnecessary surgeries on intersex children. The Legislature passed a resolution demanding the medical community halt nonconsensual medical procedures that try to cosmetically "normalize" variations in intersex children's sex characteristics. The resolution, which calls the practice a human rights violation, is a landmark moment for the intersex community, advocates say. "It means for the very first time a U.S. legislative body has affirmatively recognized that intersex children deserve dignity and the right to make decisions about their own bodies – just like everyone else," Kimberly Zieselman, executive director of interACT Advocates for Intersex Youth, told USA TODAY. Intersex individuals are born with sex characteristics such as genitals or chromosomes that do not fit the typical definitions of male or female. Up to 1.7 percent of the population is born with intersex traits, according to the United Nations, a figure roughly equivalent to the number of redheads.
Being intersex relates to biological sex characteristics. It is not the same as transgender: Someone whose gender identity – how they feel inside – does not correspond with their birth sex. An intersex individual can be straight, gay, lesbian, bisexual. Surgeries on intersex youths, such as clitoral reductions or vaginal reconstruction, are often framed as "social emergencies" interACT says, but are irreversible, physically damaging, emotionally wrenching – and medically unnecessary. ... Performing these types of surgeries, which have been taking place since the 1960s, without a child's consent violates their rights, says Alesdair Ittelson, director of law and policy for interACT. The procedures have been rebuked by numerous human rights and medical groups worldwide from Amnesty International to the World Health Organization. "We don't condone female genital mutilation, nor should we condone the medically unnecessary, deeply harmful interventions like clitoral reductions and sterilizations that constitute intersex genital mutilation," Ittelson said. "This is an issue that transcends party lines because it is easy to understand the basic humanity of these vulnerable children."
CIA comment: What about the basic humanity of baby boys and their human rights? Every one of the comments here about human dignity, human rights, consent, a person's right to make the decision about his/her own body are equally applicable to circumcision, which is also an irreversible operation that makes medically unnecessary alterations to a child's body. There is no need to labour point: if the California legislature upholds these principles, it must in conscience, for consistency and to avoid charges of hypocrisy, also condemn non-therapeutic circumcision of children.
Susan Miller. California becomes first state to condemn intersex surgeries on children
A study of a rural community in South Africa has found that circumcised men generally are more likely to be infected with HIV, and that males circumcised in hospitals are 20 per cent more likely to be HIV positive than those left intact. Where 24 per cent of uncut men were found to be HIV positive, the incidence of HIV among males circumcised in hospitals was 31 per cent. These findings have come as a shock to the South African Medical authorities who have been following the orders of US and WHO health officials and “rolling out” the provision of mass circumcision as a response to the nation’s AIDS crisis. As the authors of the report comment ruefully, it seems that when it comes to the spread of HIV, anatomy is less important than behaviour - exactly what critics of the circumcision programs have been arguing for years. In fact, many other studies have found that in the real world there are many regions in Africa where there is little or no difference in the incidence of HIV infection between cut and uncut men, and that in quite a few places cut men are more likely to be HIV positive.
The conclusion of the report reads as follows: “Medically circumcised older men in a rural South African community had higher HIV prevalence than uncircumcised men, suggesting that the effect of selection into circumcision may be stronger than the biological efficacy of circumcision in preventing HIV acquisition. The impression given from circumcision policy and dissemination of prior trial findings that those who are circumcised are safer sex partners may be incorrect in this age group and needs to be countered by interventions, such as educational campaigns.”
Molly S. Rosenberg et al. Are circumcised men safer sex partners? Findings from the HAALSI cohort in rural South Africa. Plos One, 1 August 2018.
Report in Business Day with critical commentary
Robert Darby. Syphilis 1855, HIV-AIDS 2007: Historical reflections on the tendency to blame human anatomy for the action of micro-organisms. Global Public Health 10 (5-6), 2015.
A mother, a former registered nurse and Sydney Islamic sect leader convicted in Australia's first female genital mutilation court case — seen as a breakthrough in prosecuting the crime — have been acquitted by an appeal court. In November 2015, a jury found the mother, who cannot be named for legal reasons, and former nurse Kubra Magennis guilty of cutting the genitals of two sisters aged around six and seven during ceremonies at homes in Wollongong and Sydney's north-west.
Shabbir Vaziri, a head cleric and spiritual leader in the Dawoodi Bohra community, was found guilty of being an accessory for directing members to lie about the practice of ‘khatna’, a procedure involving the nicking or cutting a girl’s clitoris in the presence of female elders. The mother and Ms Magennis were sentenced to 11 months’ home detention, while Mr Vaziri received a maximum 15-month full-time custodial sentence and was later granted bail pending an appeal. But the New South Wales Court of Criminal Appeal has quashed the convictions of all three after reviewing new expert evidence, namely that the tip of the clitoris was still visible in each girl. “While having regard to the whole of the evidence, and the summing up, it cannot be concluded that the jury would have come to the same decision had the new evidence been available at the trial,” the judgement read.
The appeal court’s decision came despite evidence from a Westmead Children’s Hospital Child Protection Unit specialist, Dr Susan Marks, that there might be no long-term evidence of cutting or nicking in the form of visible scarring due to excellent blood supply to that area of the body. Dr Marks’ evidence at trial was that she could not see the tip of the clitoris in each girl, leaving it to the jury to decide whether the pair had had them removed.
This is the second time a prosecution under the female genital mutilation provisions of the NSW Crimes Act has failed. On the previous occasion a jury could not reach a verdict in the case of Graeme Reeves, a south coast doctor prosecuted for removing the external genitals of women who sought treatment for potentially cancerous lesions. Reeves was then retried under the normal assault provisions of the Crimes Act and convicted, as we have explained in an earlier report. In the present case, involving cultural/religious motivations rather than claimed medical need, the appeal court did not allow the prosecution to retry the case on the alternative charge of assault causing actual bodily harm. That being so, we must ask whether the FGM clauses of the NSW Crimes Act are now a dead letter.
Previous reports on this site
Sydney FGM case: Mother and midwife guilty, receive gaol sentence
A Scandinavian study of complications arising from circumcision concludes that the risk of serious harm is great enough to require that circumcision always be performed in hospitals with 24-hour emergency departments. The key points of the paper: (1) This study reviewed factors associated with complications of circumcision in infant boys in Scandinavia over the last two decades. (2) We found that 32 cases had been reported to the health authorities, with a total of 74 complications, including severe bleeding, circulatory shock and one death. (3) Based on our analyses of the severe cases, we argue that circumcision should only be performed at hospitals with a 24-hour emergency department.
This conclusion is confirmed by a study of boys brought to the emergency department of the Royal Children’s Hospital, Melbourne, which found that circumcision complications were more common when performed by GPs or in “specialist” circumcision clinics. Details on this site.
Gertrud Edler et al. Serious complications in male infant circumcisions in Scandinavia indicate that this always be performed as a hospital-based procedure. Acta Paediatrica 105 (2016): 842-850.
A study based on videotapes of baby boys being circumcised identified 40 types of distress behaviour and reaches the obvious conclusion that circumcision is acutely painful and causes the infant extreme distress. One paragraph deserves quotation in full:
There were 24 common distress behaviors during circumcision. These 24 behaviors also occurred during diaper change and restraint application; however, they occurred either more frequently or for longer duration during circumcision. Neonates spent 76% of the 3-min circumcision crying, but we noted an increased variation in the pitch, tempo and urgency of the cry compared to the restraint event. Within a space of a few seconds—and especially when the surgeon inserted the probe to separate the glans—cry shifted from hoarse and strained to exhausted and weak-sounding, and from abrupt and explosive to loud or rapidly repeating. For about 63% of circumcision, neonates positioned their heads midline and their upper limbs appeared very tense, whether crying or not. They also extended their hands (fisted or palm exposed) and positioned them side or front facing, and they frequently exhibited very strained neck hyperextensions, which co-occurred with cry and handling.
How on earth was ethics approval granted for this ghoulish experiment? Did we really need videotape evidence to prove that circumcision is baby torture?
Fay Warnock & Dilma Sandrin. Comprehensive description of newborn distress behavior in response to acute pain (newborn male circumcision). Pain 107 (2004): 242-255.
The terms of the debate about non-therapeutic circumcision of minors have changed. The issue is no longer whether the so-called “benefits” outweigh the risks, or even whether the benefits outweigh the risks and harms. (As for the troglodytes who still mutter about pros and cons …) Coming on top of the judgement of a German court that circumcision is bodily harm and that it violates the child’s right to religious freedom, a leading legal philosopher now argues that boys have an inherent right not to be circumcised without medical need. In a paper forthcoming in Health Matrix, Stephen Munzer argues that current norms of autonomy and bodily integrity give male minors “a moral, anticipatory right-in-trust not to be circumcised without a medical indication.” Even more remarkably, it is now conceded by a prominent defender of religious/cultural circumcision that the practise is harmful and does violate the rights of the child. Writing in the Journal of Applied Philosophy, Joseph Mazor acknowledges the physical and moral harms of circumcision and admits that the child has “a right of moderate strength” not to be subjected to “presumably harmful circumcision”.
Both Munzer and Mazor go on to argue that, given the importance of circumcision within the cultural/religious communities that follow this tradition, the practice should not be criminalised. This is a fair point, far less important than the vital concession that circumcision is harmful and does violate the rights of the child to bodily integrity, personal autonomy and an open future. The argument about these points is over; the debate now is whether non-therapeutic circumcision is or should be illegal.
Stephen Munzer. Examining nontherapeutic circumcision. Health Matrix 28 (1) 2018: 1-77 (in press). Full text at SSRN.
Joseph Mazor. On the Strength of Children's Right to Bodily Integrity: The Case of Circumcision. Journal of Applied Philosophy, on-line first, 24 May 2018.
Further details on the human rights page
Death is recognised as a “rare complication” of circumcision in clinical settings in developed countries, but deaths nonetheless occur regularly. A new study finds that in the United States approximately 20 neonatal deaths per year can be attributed to circumcision. Neonatal here means within the first 30 days of life, so the study does not count deaths that occur after the first month. This might seem a small figure in relation to the overall number of births, but what death rate would be acceptable for a medically unnecessary operation performed without the consent of the subject? The abstract of the paper follows.
We sought to quantify early deaths following neonatal circumcision (same hospital admission) and to identify factors associated with such mortality. We performed a retrospective analysis of all patients who underwent circumcision while hospitalized during the first 30 days of life from 2001-2010 using the National Inpatient Sample (NIS). Over 10 years, 200 early deaths were recorded among 9,899,110 subjects (1 death per 49,166 circumcisions). Note: this figure should not be interpreted as causal but correlational: it may include both under-counting and over-counting of deaths attributable to circumcision. Compared to survivors, subjects who died following newborn circumcision were more likely to have associated co-morbid conditions, such as cardiac disease (OR: 697.8 [378.5-1286.6] p<0.001), coagulopathy (OR: 159.6 [95.6-266.2] p<0.001), fluid and electrolyte disorders (OR: 68.2 [49.1-94.6] p<0.001), or pulmonary circulatory disorders (OR: 169.5 [69.7-412.5] p<0.001). Recognizing these factors could inform clinical and parental decisions, potentially reducing associated risks.
Earp, B. D., Allareddy, V., Allareddy, V., & Rotta, A. T. (in press). Factors associated with early deaths following neonatal circumcision in the United States, 2001-2010. Clinical Pediatrics, July 2018, in press.
While it is clear that increasing numbers Jewish people in both Israel and the United States are abandoning circumcision and opting for peaceful naming ceremonies instead, there has been only slight evidence of questioning attitudes among Muslims. This situation now appears to be changing, with scholars and thinkers now beginning to come forward with critiques of what they argue is an outdated and harmful custom. Writing in the Indonesian journal Tarbiya, Hossein Dabbagh argues that circumcision is not a necessary part of being a Muslim and further that ethical reasoning is separate from or even superior to religious law. Meanwhile, writing in Medium, Dr Arif Akhtar argues that the objections to female genital mutilation raised by World Health Organisation and anti-FGM activists are just as applicable to circumcision of boys: “It may not be as surgically extreme as the female version but it is still an unnecessary medical procedure, carried out without consent on children, who are usually too young to complain about.” In a personal comment, the author makes clear that although he was circumcised as a child, he would prefer not to have been and regards it as a harm.
In South Korea the US-sponsored custom of circumcision, introduced after the Korean War in the early 1950s, is now fading as people gain access to alternative information sources, such as the internet. A similar process of learning and consciousness-raising will eventually lead to the decline of circumcision among the world’s Jewish and Muslim communities.
Hossein Dabbagh. The Ethics of Non-Therapeutic Male Circumcision Under Islamic Law: A Lesson for Educational Prosperity in Muslim Communities. TARBIYA: Journal of Education in Muslim Society 4 (2), December 2017. (Abstract only; contact Circinfo.org if you would like a copy of the full paper.)
Arif Akhtar. Female Genital Mutilation is bad, so why is Male Circumcision for non-medical reasons OK? Medium, 9 May 2018.
Other sources
Riad Sattouf’s account of forced circumcision in Syria
Iranian human rights activist criticises circumcision
The forgotten critics: Jewish arguments for and against circumcision have a long history
The Australasian Institute for Genital Autonomy (AIGA) seminar was held on 20 November 2017 in Sydney, Australia. As an inaugural event, the AIGA seminar was held on International Children’s Day, commemorating the anniversary of the UN General Assembly’s adoption of the Convention on the Rights of the Child in 1989. AIGA is a not-for-profit organisation loosely affiliated with the genital autonomy movement in various countries. AIGA advocates for global recognition of children’s right to genital autonomy to safeguard all children from medically unnecessary genital modification procedures regardless of a child’s sex characteristics. AIGA condemns all forms of medically unnecessary modification of children’s sex characteristics as genital mutilation.
The seminar’s theme, “Genital Autonomy and the Rights of the Child” explored modification of children’s sex characteristics and international human rights law in the context of male and female genital cutting and intersex genital modification. The seminar featured five speakers to explore these practices in social, medical, and legal contexts. Dr Olayide Ogunsiji, Lecturer in Nursing and Midwifery at Western Sydney University, explored the complexities of caring and living with female genital mutilation through the voices of Australian midwives and circumcised women. Dr Juliet Richters, social epidemiologist and Honorary Professor at the Kirby Institute for Infection and Immunity in Society, University of New South Wales, presented her paper, “Circumcision: What We Can and Can’t Measure,” which explored the incommensurability of pro- and anti-circumcision arguments. Michael Glass, retired teacher and private researcher, explored Medicare funding for female genital cutting in Australia. Paul Mason, Family Law Barrister and Former Children’s Commissioner in Tasmania, explored international human rights law and children’s right to genital autonomy. Travis Wisdom, PhD Candidate in the Adelaide Law School at the University of Adelaide, presented the paper, “The Impact of a Physical and Mental Integrity Approach in the Family Court’s “Special Medical Procedures” Cases Concerning Intersex Minors.” The Family Court does not adopt a human rights framework in its intersex cases, but instead assumes an assimilationist approach to justify medically unnecessary genital modification on the understanding that adherence to socio-cultural norms is in children’s best interests. In this paper, Travis explored the impact of a physical and mental integrity approach in these cases in light of global human rights developments to safeguard intersex children. He argued that the Family Court should adopt a nuanced human rights framework for intersex cases, which incorporates the mosaic of human rights standards which are breached by intersex genital modification.
Full report by Travis Wisdom in Attorney’s for the Rights of the Child Newsletter, Winter 2017/18.
Advocates and defenders of non-therapeutic circumcision of children commonly assert that a decision to circumcise a child is a reasonable exercise of parental discretion, and that to regulate or restrict it in any way is to interfere with parental rights. There have been many replies to this contention (such as this paper at Sage Open and these comments on consent), and in a recent discussion Kai Moller, Associate Professor of Law at the London School of Economics & Political Science, argues that non-therapeutic circumcision of children lies outside the scope of parental authority because it involves permanent physical changes to the child’s body and thus violates his right to an open future. The abstract of the paper follows:
A recent judgment by a lower court in Germany brought the problem of ritual male circumcision to the consciousness of the wider public and legal academia. This essay weighs in on this emerging discussion and argues that ritual male circumcision is not covered by parental authority because it violates the human rights of the boy on whom it is imposed. It first considers and dismisses the best interest test of parental authority which, by focusing on the well-being of the child as opposed to his (future) autonomy, fails to take the boy’s human rights sufficiently into account. Instead, the essay proposes what it terms the autonomy conception of parental authority, according to which parental authority must be exercised such as to ensure that the child will become an autonomous adult. While parents may raise their child in line with their ethical, including religious, convictions, respect for his autonomy requires that this be done in a way that allows the child to later distance himself from these values; this implies, among other things, that irreversible physical changes are impermissible. This conclusion holds even if it could be assumed that the child would later come to endorse his circumcision: a proper understanding of autonomy implies that the religious sacrifice of a body part can only be authorised by the person whose body it is. Thus, ritual male circumcision is outside the scope of parental authority because it usurps the child’s right and responsibility to become the author of his own life.
Kai Moller. Ritual male circumcision and parental authority. LSE Legal Studies Working Paper, June 2017.
Published as Kai Moller. Ritual male circumcision and parental authority. Jurisprudence: An International Journal of Legal and Political Thought 8 (3) 2017: 461-79.
In a related discussion the same author considers the controversial question of whether medically unnecessary circumcision of boys should be legally prohibited in the same way as circumcision of girls (FGM). With reference to current proposals in Iceland, Denmark and other European countries to outlaw circumcision, Professor Moller calls for respectful dialogue among the various parties, the avoidance of name-calling and abuse. He writes:
My work has led me to be strongly … opposed to male circumcision. Yet there is nothing antisemitic or Islamophobic about my argument: on the contrary, it takes Jews and Muslims who are in favour of circumcision seriously as moral agents by providing moral reasons that try to convince them that their position is wrong. This attitude is not only theoretically preferable, it also works in practice. I have recently published a scholarly article criticising circumcision as a human rights violation, and over the last couple of years I have presented my arguments at various academic conferences and events, with many Jewish and Muslim participants. The discussions were controversial but almost always respectful. They revealed that there is considerable debate among Jews and Muslims about the pros and cons of circumcision. Some are opposed to circumcision or curious and open-minded about it. … People came up to me and talked, often very movingly, about their personal struggles with the question, or the disagreements within their families. When we leave identity politics aside, refrain from lazily accusing each other of prejudice or bigotry, and begin to actually talk to each other in an honest and straightforward way, such encounters can happen. We may not be able to reach agreement, and sharp divisions may remain. But we display the courage to look each other in the eye, go through the hassle of trying to develop the best possible argument for our view, and bring up the patience to listen to the other side’s views, trying to reach some common ground. In short, we treat each other as moral agents. It’s a very democratic thing to do.
Source: Let’s talk about circumcision. LSE Politics Blog, 6 March 2018.
According to a report on SBS, Australia’s circumcision rate has fallen by over two thirds over the past decade. According to Medicare figures, there were only 6309 boys (under 6 months) circumcised in the 2016/17 financial year, compared with 19,663 in 2007/08. SBS quotes Professor Paul Colditz, head of the Paediatrics and Child Health Division of the Royal Australasian College of Physicians, as saying that only about 4 per cent of baby boys are being circumcised these days, “so I guess parents are really making up their own minds on the basis of the available evidence.” He added that there could be some procedures not captured by the Medicare data if performed by religious figures such as Mohels, but that would be a fairly small number in relation to the 6000 or so babies circumcised in the past year. Professor Colditz attributed the sharp decline to two main factors - better informed parents and more fathers not being circumcised themselves. The number of new fathers (many born in the 1980s and early 90s) who were themselves not circumcised is increasing, and they are deciding that there is no reason why they should circumcise their own sons. Parents were also making up their own minds by researching available evidence. “We've entered an era where everyone is looking at the evidence and asking, ‘Is this operation worthwhile, will it be effective, what are the risks?'" Professor Colditz said. Parents are assessing the balance between the potential for any benefits against the potential for harm and damage. “I think the whole of society is getting more sophisticated in the way they do this.”
In other words, the more people learn about circumcision, the more they are against it.
Source: Circumstitions News
All children - male, female and intersex - have an interest in “genital autonomy”. In a wide-ranging, deply-researched essay, Brian Earp and Rebecca Steinfeld argue that this means all children should be protected from medically unnecessary alterations to their genitals, but that adults should be free to undergo such surgeries if they have given informed consent. These rules are necessary not merely because surgical operations such as circumcision, female genital cutting (FGM) and intersex genital cutting (”normalisation surgery”) violate accepted principles of bioethics and human rights, particularly the child’s right to an open future; but also because such surgeries harm the child by removing erogenous tissue that makes a major contribution to sexual function. The authors point out that a person’s genitals are a particularly significant and uniquely intimate part of his/her body, and thus that in normal circumstances any unwanted touching in that area may constitute sexual assault. The various “health” and “cultural” justifications that have been offered for such procedures are the focus of intense controversy, but even if there was consensus on the “benefits” they would not outweigh the risks involved, nor the long term harms arising from the loss of significant bodily tissues.
Abstract. Purpose of review: To survey recent arguments in favor of preserving the genital autonomy of children—female, male, and intersex—by protecting them from medically unnecessary genital cutting practices. Recent findings: Nontherapeutic female, male, and intersex genital cutting practices each fall on a wide spectrum, with far more in common than is generally understood. When looking across cultures and comparing like cases, one finds physical, psychosexual, and symbolic overlaps among the three types of cutting, suggesting that a shared ethical framework is needed. Summary: All children have an interest in genital autonomy, regardless of their sex or gender.
The authors conclude: “Western societies, if they wish to be consistent, may soon face a choice between two courses of action. Either they must consider tolerating at least some relatively mild forms of “culturally motivated” nontherapeutic female genital cutting (FGC) performed on minors—so long as they do not cross an arbitrary threshold of presumed harmfulness—or they must consider a less tolerant attitude toward “cosmetic” female and intersex surgeries as well as medically unnecessary male circumcision performed before an age of consent. Although each approach has advantages and disadvantages, a benefit of the latter approach is that it would prioritize the genital autonomy of all vulnerable children, regardless of their race, religion, sex, or gender, thus eliminating concerns about fair treatment and equal protection.”
Brian Earp and Rebecca Steinfeld. Genital autonomy and sexual well being. Current Sexual Health Reports, in press. Full text available here.
In an earlier paper prepared for the European Parliament the same authors argue that the old genital cutting paradigm - circumcision good or OK, FGM bad and unacceptable - is outmoded, and should be replaced by a new paradigm based on gender neutrality. Under the new paradigm, all children - male, female and intersex - should be protected from medically unnecessary alterations to their private parts. This would not necessarily mean heavy-handed attempts to criminalise or otherwise legally prohibit circumcision and other forms of genital cutting, as such efforts are likely to fail in the teeth of popular resistance. In countries where FGM is entrenched as a cultural practice, laws against it have had little impact. Far more effective are efforts to discourage such practices through community education programs and the elimination of financial and other incentives, such as health insurance rebates.
The abstract reads as follows: “Moral and legal opposition to the non-therapeutic cutting of children’s genitals has traditionally focused on female children. In recent years, however, a growing movement of scholars, activists, and individuals affected by childhood genital cutting have argued that all children, regardless of sex or gender, should be protected from such intimate violations. By drawing attention to the overlapping harms to which female, male, and intersex children may be exposed as a result of having their genitals cut, this movement posits a sex and gender neutral—that is, human—right to bodily integrity and genital autonomy. This article introduces and outlines some of the main arguments supporting this perspective.”
Conclusion: Policy Implications
What are the implications of the foregoing discussion for policy? At a recent WHO-sponsored conference on female NGC held at Geneva University Hospitals, we argued that a gender-inclusive approach—based on an individual’s capacity to provide informed consent to NGC—is not only better supported by the available evidence, as explained above, but also carries several practical advantages:
Adopting such an approach, however, does not necessarily entail “banning” all pre-consensual NGCs. History shows that the enactment of strict legal prohibitions prior to cultural readiness can backfire, creating intense resistance among those who are dedicated to the practice, often driving it underground. Prohibition of childhood female NGC, for example, has been largely unsuccessful in many countries, and recent attempts to criminalize childhood male NGC have either been blocked or overturned. There are many “levers” society can pull to discourage harmful practices: the law is only one among them, and not necessarily the most desirable or effective. Some authors have proposed step-wise regulation of childhood NGCs, along with community engagement and education, as alternatives and/or supplements to formal prohibition. Whatever specific policies are implemented, however, what is clear is that fundamentally different treatment of female, male, and intersex children—with respect to the preservation of their bodily integrity—will become increasingly difficult to justify in the coming years.
Brian Earp and Rebecca Steinfeld. Gender and Genital Cutting: A New Paradigm.
In a major statement based on a comprehensive survey of the medical literature, the Canadian Urological Association has concluded that routine prophylactic circumcision of male infants and boys is not justified as a preventive health measure. The statement is of particular interest because it reaches this conclusion on the basis of a very narrow calculation of medical benefits, costs and risks, pays little attention to the harms of circumcision (such as effect on male sexuality, moral harm of denying choice etc) and largely ignores bioethical and human rights issues. The statement emphasises that the results of clinical studies in underdeveloped regions with acute health and social problems cannot be mapped onto developed nations with quite different epidemiological and social environments, and point out that “The effect of MC has to be analyzed at the individual and societal level.” The statement is at pains to point out that the evidence as to the benefits and risks of circumcision is contradictory and inconclusive, and that much of it is of poor quality, especially studies claiming to show that circumcision has little impact on sexual sensation and function. The final conclusion is that while circumcision does offer some advantages, they are small, can be achieved by other, non-surgical means, and are outweighed by the risks and harms. This being the case, routine circumcision is not justified as a health measure and cannot be recommended.
Source: Sumit Dave, Kourosh Afshar, Luis H. Braga, Peter Anderson. CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants. Canadian Urological Association Journal 2017 Dec. 1; Epub ahead of print. http://dx.doi.org/10.5489/cuaj.5033
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