Dagens Nyheter, March 16, 2000.

"Male circumcision is also mutilation"

Professor Yngve Hofvander

Circumcision of boys is a cruel and very painful operation. It contravenes the UN Convention on the Rights of Children and should be called mutilation, just like female circumcision is now. So writes Professor Yngve Hofvander, former head of International Child Health at Uppsala University, regarding a proposed law tabled in parliament. The statement supporting the law is seriously conflicted. It would be logical even to ban male circumcision, he says. But first of all, the issue should be brought out into the light so that religious and cultural attitudes can undergo change. At the time of writing this, a tragic case has opened at the Stockholm City Court. A small Moslem boy was circumcised by a doctor in private practice, he screamed for several hours thereafter and was given a pain-relieving injection that was obviously of an incorrect dosage; shortly thereafter he ceased breathing and his life could not be saved.

This is a medically meaningless operation - thus no complications can be considered acceptable. And yet a child becomes a victim in a ritual that is characterised by the demands of adults.

In the current debate about this operation, one could easily get the impression that it is a particularly Jewish custom. Representatives of the Jewish faith have been most articulate - but Jewish circumcision is clearly in a minority.

The situation is as follows. There are four different groups that practice circumcision. The Jewish: going back to Abraham 3 000 year ago (but already in existence 2000 years before that). Done on the eighth day, involves around 100 boys in Sweden. The Moslem: going back around 1300 years to the time of the Prophet Mohammed. There is no mention in the Koran and therefore no commandment. Done in the period 2-14 years of age and involves around 3000 boys in Sweden. The traditional African: done at the onset of puberty as an initiation rite for entry to the adult world. This involves several million boys annually. See Mandela's memoirs and his anxiety due to the operation.

The Anglo-Saxon, mostly occurring in the USA: Developed in the middle of the 19th Century as a prophylaxis and treatment for masturbation, but thereafter a hundred other bizarre indications were added. Done to neonates and involves more than a million boys.

It is thus important to see the phenomenon of circumcision in this entire, global context, and not as specifically Jewish, and neither in a provincial Swedish perspective.

CIRCUMCISION IS a cruel and very painful operation. Hemostatic forceps are tightly closely in the narrow end of the immature foreskin, a brunt probe is forced between the foreskin and the glans and pushed around to break the connecting tissues that nature has put in place in babies and young children. One or two haemostats are driven as far as possible in the fold between the glans and foreskin, closed fast and the foreskin pulled out. Forceps are fastened across it and at that point it is cut off - and thus one removes the foreskin, which in the developed state amounts to 10cm2 and contains hundreds of nerve endings for erogenous purposes, and similar quantities of sebaceous glands (sic) that secrete lubricant for similar purposes.

There is really no doubt about whether this process should be denoted as mutilation - for indeed removes healthy tissue is removed from a healthy body part. There has been a mindless fear about calling things by their correct name, due to the risk of offending religious groups. It took some years before one was able to call female circumcision, mutilation - but now this term is officially sanctioned.

Nor is there really any doubt about whether this involves an abuse against a child who has not asked for the operation and who cannot defend himself, beyond trying break free and screaming loudly. One can think of the equivalent situation of an adult man being held down by forceful hands and mutilated without anaesthesia. For babies have a fully developed sense of pain - and memory. The hormonal and biochemical changes that arise in the body correspond to those found during torture.

SINCE THERE ARE currently considerable millions of boys circumcised annually - can all their parents really be at fault for having it done?

I want to answer 'unquestioningly yes' to this question. Many millions of girls are sexually mutilated annually - are their parents right or wrong? Many millions of Chinese girls had their feet bound so that they did not develop - were their parents right or wrong? It was the custom to beat children (with support from authorities, including pronouncements in the Bible!) - were their parents right or wrong? Up until 200 years ago it was the religious custom at Jewish circumcisions to suck blood from the circumcised penis (thereafter forbidden when it was shown to spread syphilis and tuberculosis) - was it right or wrong of the parents to accept this practice?

The above-mentioned often-bizarre traditions and practices have had social, cultural and sometimes legal acceptance, within their respective cultural worlds. Afterwards, in accord with human justice principles, they were no longer tolerated and were forbidden by law or forced out of practice.

So certainly millions of people can be wrong. There are many other examples of wrongful practices that have been inflicted particularly on children, or others without power or whose voices were not heard.

So I say that the time has now come to seriously question male circumcision and mutilation. To this end we have a remarkable tool in the UN Convention on the Rights of the Child, which can indeed be applied in many contexts, including the planning of housing and road crossings. Article 19 of the convention states that all legal measures should be taken to protect children against all forms of physical and mental violence, injury or abuse. And (as stated in Article 24) countries that sign the convention are required to take all effective and appropriate measures to eliminate traditional customs that are harmful to the health of children. Could this be stated more clearly? Moreover, children have priority when interpreting the convention - whenever there is any difference between the rights of adults and children.

But to change immigrant traditions, especially those with religious overtones, is extremely difficult. Not least in the case where a much longed-for party is an integral part of the ceremony. What makes it even harder to work against circumcision is that it is a very lucrative business for those doctors who devote themselves to this industry as "village barbers". This conclusion was very evident at an international symposium on the subject in Sydney recently. One cannot count on any supportive lead from within these circles.

There are however some bright aspects. In many places around the world people have begun to practice circumcision without surgery, buy while carrying out the whole ceremony in all other respects. This is to oblige the many parents who cannot accept that their child should be mutilated, but who still want to be connected with their religious traditions. It is remarkable however that this has not been introduced in Sweden; no religious representative says it would be acceptable: "it would like vaccinating with water". Is there no innovator who can contemplate breaking the ice?

There is now a proposed bill tabled before parliament. This has been circulated as a proposal to 50 interested parties. I have read all the responses and been depressed; they go off in all directions. The Jewish Central Council continues to assert that infants do not feel pain during the first two months of life and therefore they can be circumcised without anaesthetic, and that circumcision has clear medical benefits. (These assertions are officially refuted by a large number of weighty medical organisations in many countries).

A NUMBER OF RESPONDENTS considered that the operation is compatible with the UN Convention on the Rights of the Child - with the exception, however, of the Children's Ombudsman, who in all likelihood knows what she is talking about. The National Board of Health and Welfare failed in many aspects with its preceding investigation and does not want to undertake a resource-demanding policing function. The board pointed out that the requirement for pain relief would mean that health care personnel must perform the operation, and that the child must have a veto right, a point that is difficult to fulfil when in numerous cases one is dealing with babies and small children. Save The Children also emphasised the veto right, but did not draw the logical conclusion that one must therefore postpone the operation until the child is in its teenage years and can make manifest its wishes.

The proposed bill is now before the parliament and will be reviewed by The Standing Committee on Social and Health Matters and in the parliamentary chamber. Of course from a medical point of view it would be only logical to ban the phenomenon, as was done with female circumcision. It would however be unrealistic to demand this, not primarily due to fear that the operation would then be transferred overseas, but rather to allow time for a necessary change in attitude. Bringing the phenomenon out into the light where it has never been before, and freely debating it, would assist this process.

At the above-mentioned international circumcision congress in Sydney in December of 2000, there were appeals from many parties that Sweden must continue to stand out as a good model of child health care, and not further sanction the circumcision of boys with an law officially accepting circumcision as such (even with safe surgical measures). The law would go against all the good forces around the world working for enlightenment and to end circumcision.

As a minimum, the legislation must firmly state that circumcision is contrary to the Convention on the Rights of the Child, and that the law - if it is to be - should have a time limit while awaiting a very welcome change in attitudes.

Let it happen!
Yngve Hofvander

Cite as:
(File revised 7 April 2001)

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