To Cut or Not to Cut

Circumcision is being touted as an hiv prevention method, but much of the research is driven by ideology.

Left Field by Patricia Nell Warren

Recently the old circumcision controversy exploded to a new level. The spark: introduction of ballot measures banning the practice in two California cities. In San Francisco, non-therapeutic circumcision of a minor male could get you a year in jail and a stiff fine. U.S. religious groups that practice ritual removal of the foreskin—not only orthodox Jews and Muslims but also evangelical Protestants who identify with Old Testament law—are protesting the proposed bans fiercely. They insist that their religious freedom is at stake. According to one evangelical blog, the ballot measures are an “effort to enforce a secular society.”

Interestingly enough, some protestors buttress their age-old arguments that God demands male circumcision with the recent theory that circumcision can prevent HIV and STD infection. They lament the ongoing drop in U.S. circumcision statistics, and predict that this trend—if it isn’t reversed—will mean disaster for the nation’s health.

Starting in the 1960s, male circumcision came under fire as growing numbers of progressive Christian and non-religious parents decided against cutting a healthy foreskin off an infant. They’re moved by the fact that babies can’t legally consent to the operation—that it’s often done without anesthetic. An estimated sixty-plus percent of U.S. male babies are circumcised every year—the number is sharply down from an eighty-five-percent high in the 1960s, but it’s still way higher than circ stats in Europe or Latin America. According to the International Coalition for Genital Integrity, an estimated 117 U.S. babies die every year as a result of botched circumcisions. Progressive Jews and Muslims who do not circumcise their sons join in these human-rights concerns.

Up until three years ago, the CDC was officially neutral on circumcision, leaving it up to the parents’ choice. But by 2009, it looked like the CDC was moving towards recommending “universal circumcision” for all male minors in the U.S. A CDC recommendation is usually not interpreted as having the force of law. Impetus for the possible change had come from three African studies said to prove that circumcision helps prevent HIV infection. Two years later, however, the recommendation still hasn’t happened…which makes me wonder if the CDC is a little nervous about criticisms launched at those African studies.

In the West, religious circumcision seems to have started in ancient Egypt. As early as 2400 B.C., it was mainly the upper-class men who had themselves cut, inspired by a belief that the sun god Ra had circumcised himself. From there, the practice spread to some tribes in the African interior. It also popped up in ancient Judaism, where it was viewed as a collective covenant with the Hebrew god. Every Jew was required to have his children, even his slaves, circumcised. However, the ancient Greeks and Romans rejected the practice.

When Christianity first appeared, a controversy flared as to how “Judaic” the religion was going to be. The reluctance of many non-Jewish men to have this painful procedure done became a barrier to their conversion. So church leaders made a deft decision: as children of the New Testament, followers of Christ would not be obliged to follow Old Testament ritual practice. Result: circumcision was nixed. This shift in doctrine, coming on top of Greek and Roman influence across Europe, ensured that Europeans would stay largely uncut through the centuries to come. In the 8th century A.D. when Islam burst on the scene as the next new religion, it did as Judaism had done, and established circumcision.

Since many Protestants base their moral teaching on the Old Testament, and reject most anything that is patently Catholic, it was inevitable that they would rediscover circumcision. In his 1999 book Male and Female Circumcision: Medical, Legal and Ethical Considerations in Pediatric Practice, Jim D. Bigelow, PhD, tells the story of how American Protestants launched the massive trend to majority circumcision in America. It started in the 1870s, when Victorian medical experts began touting circumcision as a purveyor of health benefits for men. These experts were influenced by “muscular Christianity,” a powerful men’s movement of the time. Among the claims for circumcision: It lessened male sexual pleasure and therefore helped men to stay “morally clean” (meaning no fornicating, adultering, or masturbating). On into the 1900s, the movement alleged that circumcision could even prevent sexually transmitted infections like syphilis and gonorrhea.

Today, according to Bigelow, “Most infant males circumcised in the United States for religious reasons are born to Christian parents—particularly evangelicals.” Some born-againers even preach circumcision as a Christian obligation for today. Example: influential minister Bill Gothard, founder of the Institute in Basic Life Principles. Gothard fumed: “The attack against circumcision in the United States coincided with the revolt against morality and authority in the 1960s.”

If the CDC does decide to advocate circumcision for all American males, might it be as a result of influence by these ultraconservative Protestant religious lobbies? I’ve wondered. After all, the ultra-Protestant lobbies are aiming to dictate every other aspect of U.S. policy.

First of all, the National Institutes of Health (NIH) funded the three circumcision studies in Africa—Uganda, Kenya, and South Africa. NIH did this after previous studies, including one done in 1997, found no evidence that circumcision is effective against HIV. To head the studies, the NIH tapped four men who were known circumcision advocates—thus creating an obvious conflict of interest. Two of those studies were done in Uganda and Kenya—countries where U.S. ultraconservative missionaries have gained enormous leverage. Uganda is the most notorious example—it is now an evangelical theocracy where harsh Bible-based laws like the famous anti-gay bill are being passed. Even South Africa, which went secular after the fall of apartheid, is now an arena of intense missionizing by U.S. evangelicals—to the point where the SA government has committed to getting two million men circumcised.

Is there real science in these studies’ claim that circumcision can prevent HIV? Supporters of the idea say yes. All three studies stopped early, with the insistence that early results provided sufficient evidence that the circumcised cohort had a way lower rate of HIV infection than the uncircumcised cohort—by fifty percent or more. These were heterosexual men having sex with HIV-positive women.

But other experts say no. Doctors Opposing Circumcision (DOC), an international advocacy group, points out a number of damning flaws in the studies. According to DOC, the early termination happened “before the incidence of infection in circumcised males caught up with the incidence of infection in the non-circumcised males. If the studies had continued for their scheduled time, it is probable that there would have been little difference between the circumcised group and the non-circumcised group.” DOC also points out the glaring cultural bias: The four circumcision advocates could hardly be expected to conduct three impartial NIH studies. Indeed, says DOC, “United States medical literature, as compared with the medical literature of other nations, is highly biased in favor of male circumcision.”

Yet—as I said—the religious groups who now demand “freedom” to go on circumcising their children have added the dubious HIV-prevention theory to their arsenal of arguments.

As a descendant of immigrants who were Catholic, Protestant, Jewish, Quaker and Freemason, I’m all for religious freedom. But I draw the line where any one religious belief begins to swing national public-health policy. So let’s hope that this “religious freedom” debate doesn’t help CDC to recommend an ancient ritual practice for all Americans—one that (so far, anyway) appears to be based on research that may be faulty and biased.

Further reading:

Why the African Studies Are Unreliable:

DOC: Facts About Alleged Medical Benefits of Circumcision:

Author of fiction bestsellers and provocative commentary, Patricia Nell Warren has her writings archived at Reach her by e-mail at [email protected]

August 2011

Copyright © 2011 by Patricia Nell Warren. All rights reserved