The controversy surrounding Male Circumcision: Child rights versus Health benefits

Male circumcision is the surgical removal of part or the entire foreskin (prepuce) of the penis. This procedure is usually performed to fulfil religious obligations, cultural rites of initiation into adulthood, for personal hygiene, and is used as medical treatment for conditions such as recurring balanitis and phimosis. It is a common practice among Muslim and Jewish people worldwide, and in Africa (North Africa and West Africa). It is estimated that 30% of men globally have been circumcised.

A judge in Germany (Cologne) sparked controversy last month with the pronouncement of a verdict, which suggests male circumcision to be a criminal act against children (boys). This verdict was made in a case involving a German physician, who had performed a circumcision procedure on a four year boy resulting in minor complications. The court did not find the doctor guilty of committing grievous bodily harm, but it found that “the right of parents to raise their children in a religion does not override the right of a child to bodily integrity.”  The inference of this ruling is that the male child should be allowed the right of self-autonomy to decide for or against circumcision at the age of consent (18 years and above). Muslims and Jews in Germany and other countries of the world oppose the court ruling, stating that it could be used as a reference to judge future cases. Some doctors in Germany have counseled parents to decide for or against male circumcision based on its health benefits.

The World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS), encouraged the scale-up of Voluntary Medical Male Circumcision (VMMC) as a preventive intervention against HIV infection in 2007. The evidence from clinical trials shows that VMMC confers 60% protection against heterosexual (female-to-male) acquisition of HIV infection. Hence, the WHO and UNAIDS made recommendations to focus VMMC in 13 countries in Eastern and Southern Africa with high prevalence of HIV and low levels of male circumcision (Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe). This procedure also prevents the development of genital ulcers and penile cancer in men, and reduces the risk of women developing cervical cancer by 28% from Human Papilloma Virus (HPV) infection acquired through sexual intercourse.

Health experts are concerned that the rising controversy could impact negatively on the timely delivery of this intervention. It is documented that risky sexual behavior is high during the adolescent and teenage periods. Hence, the protective effect of male circumcision may be lost, if boys are allowed to attain the age of consent before having the procedure. They also argue that the risk of complications resulting from the procedure is reduced in the infant and early childhood age-groups.

My opinion is based on existing scientific evidence. Voluntary Medical Male Circumcision performed by well-trained and well-equipped health providers in safe and hygienic conditions helps to reduce heterosexual transmission of HIV. It can help turn the tide against HIV/AIDS in sub-Saharan Africa.  Public health educators must emphasize to all that it confers partial protection, and will be most effective when used in combination with other existing prevention tools (early access to HIV testing services, adoption of safe sexual practices,  correct and consistent use of male & female condoms, abstinence from sex before marriage, and been faithful to one sexual partner).