HERALD NEWS
Thursday, August 16, 2007

'Intactivists' push for end to circumcision
By SACHI FUJIMORI

Never one to picket on street corners, Adrienne Soti found her cause this March when her sister-in-law, who was expecting twin boys, said she planned to have them circumcised.

Giving birth to a son more than 2-1/2 years ago, Soti never even considered the procedure. In her native Hungary, it's uncommon. Now the Garfield stay-at-home-mom has become a full-fledged "intactivist," as concerned parents and others who advocate for leaving the foreskin of boys intact call themselves."My maternal instincts for protecting my nephews were awakened," she explains.

After some Internet research, Soti attempted to sway the views of her brother and sister-in-law, citing facts about the lack of medical evidence supporting circumcision.

Her sister-in-law hung up on her.

"It's (circumcision) the American thing to do," Soti recalls her brother saying.

Frustrated, she became a local representative of a national anti-circumcision group, the National Organization of Circumcision Information Resource Centers, traveling to Washington in April to participate in Genital Integrity Awareness Week, waving banners with slogans like, "The foreskin is not a birth defect." In July, at the Passaic County Fair, she set up a table distributing pamphlets.

* * *

Nationwide, circumcision rates are declining from a peak of 90 percent in the early 1960s. In 2003, the percentage of male infants circumcised in the hospital was 56 percent, according to Child Trends DataBank, a nonpartisan, nonprofit research group. Rates vary regionally from 50 to 90 percent. Hospital circumcisions in New Jersey decreased from 66 percent of newborn males in 1997 to 58 percent in 2004, according to state Department of Health statistics.

The surgery, previously viewed as a standard medical procedure to improve hygiene and reduce rates of infection and cancer, is currently the subject of medical and ethical debates.

Once fully in favor of circumcision, the American Academy of Pediatrics revised its position in 1997 to a neutral stance. It said medical data "is not sufficient to recommend routine neonatal circumcision ... parents should determine what is in the best interest of the child."

The American Medical Association (AMA) and the American Academy of Family Physicians have issued similar reports, stating they do not recommend routine neonatal circumcision.

"A majority of boys born in the United States still undergo non-ritual circumcisions," according to a 1999 AMA report. "This occurs in large measure because parental decision making is based on social or cultural expectations, rather than medical concerns."

But public health experts disagree. Recent studies in Africa found that male circumcision reduces the transmission of HIV from females to males by 60 percent. In March, the World Health Organization and UNAIDS Secretariat recommended that countries with high HIV transmission rates and low circumcision rates consider increasing access to the procedure.

Robert Bailey, an epidemiologist at the School of Public Health at the University of Illinois in Chicago, supports male circumcision in the United States, which he says "is very cost-effective from a public health perspective."

Beyond reduction of HIV transmission, Bailey cites other benefits: fewer urinary tract infections in boys, lower incidence of penile and cervical cancer, and reduced phimosis, a condition where the foreskin cannot retract.

Penile cancer is rare in the United State, with 0.9 cases per 100,000 people. And studies have shown low incidences of urinary tract infections in uncircumcised infants, according to the AMA.

Another area of dispute is whether circumcised males experience less sexual pleasure than their uncircumcised counterparts. A McGill University study published in July in the Journal of Sexual Medicine found no difference in sexual sensation between the groups.

Outside of the United States, in Europe and Asia, circumcisions are rarely performed for non-religious reasons.

In the 1940s, Britain had rates of circumcision comparable to the United States, about 40 percent. But when that country established a national health care system and subsequently stopped covering the procedure, the rate dropped to just 10 percent, says Edward Laumann, a sociologist at the University of Chicago.

Among American parents with no compelling religious or cultural reason to choose circumcision, why does the practice continue?

"An awful lot of inertia," says Laumann, who published a 1997 Journal of the American Medical Association study on male circumcision and its effects on sexuality. Starting in the Victorian era, doctors performed circumcisions to curb masturbation, which was believed to be the root of all illnesses, according to Laumann. A culture of "prudery" in the 1940s made new mothers squeamish about cleaning the genitals of uncircumcised infant boys, he said.

Today, societal views toward sexual health have evolved and "no smoking gun" of medical benefit exists, says Laumann, but circumcision likely continues because "a number of parents do it for aesthetic reasons because they say they want their kids to look like their dads."

Dr. Gurmit Chilana, chairman of the Obstetrics and Gynecology Department at Paterson's Barnert Hospital, witnesses this copycat effect outside families, as well. Some immigrant parents from countries that don't circumcise boys (Latin and South Asian) say they choose it so their American-born sons can fit in. "They talk to their neighbors," says Chilana. "If everybody has it, they get it."

Chilana, a Sikh, says circumcision is not practiced in his religious community. His two teenage sons are uncircumcised, with no health complications. He opposes the practice, and says that before performing the procedure on newborn boys, he tells them, "My friend, I don't enjoy this, but my duty is to do this."

In his department, nearly 80 percent of infant boys are circumcised. "We tell parents medically it's not required, and explain the potential complications of surgery," he says. Often he asks parents if they would like to witness the surgery. They almost always say no. "I think if the mothers saw it, they would never choose it."

Picking up her 3-year-old son on a recent afternoon at Paterson's CASA Daycare Center, Rufilia Sanchez said her son, born in Mexico, was uncircumcised.

"Unless you request it, they just leave it be," she said through a translator. But if she gave birth to a son in the United States, she would choose it.

"I didn't know about it, but, yes, because it's healthy and there's no infections," she said.

Amara Wagner, a Carlstadt mom, chose to not circumcise her 14-month-old son -- part of her philosophy of natural parenting.

She is a member of the Holistic Moms Network, a New Jersey-founded national parenting community that encourages practices such as at-home births, breastfeeding, co-sleeping, eating organic food and treating illnesses with natural remedies.

Wagner read circumcision articles on the Internet and concluded it's a misconception that uncircumcised boys are more prone to infection. She also worried that her grown son might resent her if she chose the surgery. "Who am I to have this baby, who is perfect, and ask him to cut it off (the foreskin)? If he's a teenager, and wants to have it," then that's OK, she said.

Initially, she had to convince her husband, who is circumcised. One of his concerns was, "My kid's going to be weird in the locker room," she recalls him saying.

Her response to her husband: "I hope that he's strong enough to have the confidence and wherewithal to say, 'Why are you staring?'"

Reach Sachi Fujimori at 973-569-7154 or fujimori@northjersey.com.

RESOURCES

NOCIRC, the National Organization of Circumcision Information Resource Centers, a nonprofit "intactivist" group

The American Academy of Family Physicians

Stop Infant Circumcision Society

What major religions say about circumcision

Judaism

Circumcision symbolizes God's covenant with the Jewish people.

On the baby's eighth day of life, the ceremony called a brit milah welcomes a boy into the Jewish community.

A mohel, a specially trained circumciser, performs the ritual.

Islam

Circumcision is not specifically mandated in the Quran, though most Muslims circumcise their sons. Allah ordered Mohammed to follow the way of Abraham, who circumcised himself. Muslims also believe it's a form of cleanliness.

The ritual can be done at any time before a boy's seventh year.

Christianity

Christianity does not require circumcision, because it does not believe it's a religious obligation to follow the laws of the Old Testament.

Most babies in the United States are circumcised in the hospital for health reasons.

Source: beliefnet