When Cutting Isn't Cruel

[Guest guest]

When Cutting Isn't Cruel

By Saletan, Sunday, August 20, 2006; Page B02

For thousands of years, we humans have lovingly mutilated our

children. We give birth to them, swaddle them and then cut their

genitals. Some people condemn these rituals; others defend them. Now

reports from Africa are shaking assumptions on both sides. Our

mutilation of girls may be killing them. Our mutilation of boys may

be saving their lives.

According to UNICEF, at least 100 million women , largely in Africa,

have been genitally disfigured. Two months ago, the World Health

Organization reported that these women, compared with their uncut

peers, were up to 69 percent more likely to hemorrhage after

childbirth and up to 55 percent more likely to deliver a dead or

dying baby. For every 100 deliveries, the WHO estimates that female

genital mutilation kills one or two additional children.

Fortunately, the world is mobilizing against this practice. More

than 50 African nations have signed a protocol against female

mutilation. Last year, two reports found it was declining across the

continent. The governments of Djibouti and Mauritania have

campaigned against it; public support has diminished in Egypt,

Ethiopia and Senegal. Last year, dozens of practitioners in Ivory

Coast renounced the trade and gave up their instruments. Three weeks

ago, a group of colleagues in Sierra Leone followed suit. Britain

and Sweden are cracking down on immigrants who try to import the

practice.

But why stop with girls? Why not rescue boys, too? That's the

argument of the anti-circumcision movement, whose constituencies --

groups such as Mothers Against Circumcision, Jews Against

Circumcision and Catholics Against Circumcision -- are flooding the

Internet. There's a site for " intactivists " and another for foreskin

restoration. There's a gallery of naked men, literally uncut. Some

groups troll for personal injury plaintiffs; others promote marches

on Washington to honor Genital Integrity Awareness Week.

To its credit, the movement has challenged custom and inertia. It

has pleaded for " scientific research " and " an open mind, " and

doctors have listened. Seven years ago, the American Academy of

Pediatrics concluded that evidence of potential benefits was " not

sufficient to recommend routine neonatal circumcision. " The American

Medical Association agreed . Fewer boys are being circumcised today

than in 1970.

But scientific rebellions against religion have a nasty habit of

becoming religions themselves . First come the myths. Last month,

Dan Bollinger, director of the International Coalition for Genital

Integrity (ICGI), launched Project: OUCH!, a " collection of first

hand accounts " by victims of genital mutilation. The first account,

written by Bollinger, described a recurring " flashback of my

circumcision when I was three days old. " It was a moving story. But

according to brain researchers, such memories at that age are

impossible.

Then comes the ideology. Foreskin advocates say uncut men

are " intact, " " natural " and " normal. " Circumcised men, by

implication, aren't. Technically, according to Doctors Opposing

Circumcision, it's up to you whether to " go through life with

incomplete genitalia. " But what kind of man would choose that?

Half the time, anti-circumcision activists talk like antiabortion

activists. They're pushing federal legislation that would impose a

prison sentence of up to 14 years on anyone who " cuts or mutilates

the whole or any part " of the foreskin of a boy younger than 18.

(Call it the " partial bris " bill.) They're planning lawsuits to

intimidate doctors and ban infant circumcision.

The rest of the time, they talk like radical feminists. They're

outraged that we deplore female mutilation but tolerate male

circumcision. They call this sex discrimination and a violation of

the Constitution's equal protection clause. The ICGI has even

proposed an international legal code equating removal of the

foreskin with removal of the clitoris.

Have these people lost their heads?

The stakes in that question are becoming deadly serious. Of the 5

million people who contracted HIV last year, two-thirds lived in sub-

Saharan Africa. Four years ago, the U.S. Agency for International

Development analyzed 38 studies, most in Africa, and concluded that

circumcised men were less than half as likely as uncircumcised men

to get HIV, apparently because of the susceptibility of foreskin.

Last fall, a randomized controlled trial in South Africa found that

circumcision reduced female-to-male transmission of the virus by 60

percent . " Male circumcision provides a degree of protection against

acquiring HIV infection, equivalent to what a vaccine of high

efficacy would have achieved, " the authors wrote. It was, they

observed, " the first experimental study demonstrating that surgery

can be used to prevent an infectious disease. "

Think about that: surgery as a vaccine. Drug researchers would kill

for an HIV vaccine half as effective as circumcision. Condoms and

abstinence often aren't effective because they require diligence.

Circumcision works more reliably for the same reason that foreskin

enthusiasts hate it: It lasts forever. Using the new data,

scientists estimate that over the next 20 years, circumcision in sub-

Saharan Africa could prevent 6 million infections and 3 million

deaths.

What do you do when mutilation turns out to save lives? Anti-

circumcisionists can't bear it. Years ago, they denied the HIV-

prevention effect. When evidence from Africa defied them, they

changed the subject to Europe. When evidence from Europe defied

them, they changed the subject again. Some say a link between

circumcision and HIV can never be proved. Others ignore it. Others

insist it's unethical and false. It can't be true. It's heresy.

The strongest argument against circumcising babies to prevent HIV is

that they're too young to consent. But we vaccinate babies all the

time. Should we treat circumcision like a vaccine? At clinics across

southern Africa, men are lining up , pleading to be circumcised.

They want protection. Can we assume their sons would want the same

thing?

Next weekend in Seattle, critics of genital mutilation will convene

an international symposium on circumcision. The program lists 40

sessions . Not one mentions AIDS or male circumcision in Africa.

Something's sorely missing from this conversation, and it ain't

foreskin.

human@...

Saletan covers science and technology for Slate, the online

magazine at www.slate.com.

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