JAKARTA: Why female genital cutting is so common in Indonesia

Rappler
December 5, 2016

Why the cutting of a woman's clitoris is so prevalent in Indonesia

Female genital mutilations is a widespread practice in the 4th most populous nation in the world. Here's why.
by Ayunda Nurvitasari

The perception that females must be circumcised like males, as well as religious belief, social pressure, and encouragement from health workers are behind the rampant practice of female genital mutilation (FGM) in Indonesia, a new research reveals. ["like males" takes male cutting for granted, but many of the same arguments deployed here can equally well be used against it.]
 
Conducted by Hivos Southeast Asia, an organization that focuses on global development, and the Center for Gender and Sexuality Study at the University of Indonesia, the research found that among mothers who have had FGM procedure done to their daughters, 97.1% believe circumcision is a must for both male and female. About the same percentage of the respondents also said that they believe the practice has a strong religious justification, and that they did it because it is considered a cultural tradition practiced by most of the people they know.

The study, which was unveiled last week, found that up to 61% of girls underwent female genital mutilation (FGM) before they turned one year old. It also identified a predominant perception that uncircumcised girls will be alienated because they are considered filthy and will grow up promiscuous and unwanted.

The report was based on in-depth interviews, literary reviews, focus group discussions and surveys conducted in Medan, North Sumatera; Sumenep, East Java; Ketapang, West Kalimantan; Bima, West Nusa Tenggara; Polewali Mandar, West Sulawesi; Gorontalo; and Ambon, Maluku. Held in January 2015 to April 2015, the study involves 700 respondents, half of whom are mothers who had the FGM procedure done to their daughters. The remaining half did not opt for the procedure.

Insufficient knowledge
The WHO (World Health Organization) determines female genital mutilation (known as “sunat perempuan” in Indonesia) as a very dangerous practice because it can cause severe bleeding, urinating problems, infections and many other complications, while giving no health benefits at all. The practice is considered a violation of human’s rights to girls and women.

However, the study recorded that up to 90% of Indonesian mothers believe that FGM will make their daughters healthier. A total of 84.6% also believe female genital mutilation can make their daughters’ vagina cleaner, 55.4% believe it will enhance their daughters’ fertility, and 54.6% believe it will control their daughters’ sexual drive.

In addition to false assumptions regarding the health impacts of FGM, the respondents practice FGM due to religious beliefs and social pressure. Up to 88% of the respondents believe that not circumcising their daughters would make them sinners, and as much as 36% believe that FGM will make it easier for their daughters to find a husband.

Based on their educational backgrounds, the highest number of mothers who circumcised their daughters are high school graduates at 32.3%, followed by elementary school graduates at 26.6%, and junior high school graduates at 23.7%. At least 9.4% of mothers who practice FGM have a bachelor’s degree.

Dangerous procedure
Half of the mothers who have their daughters circumcised believe the procedure involves injuring the tip of the clitoris. About 36.6% sees it as cutting a small part of clitoris, 9.1% believes it involves wiping the clitoris with antiseptic, and 1.1% sees FGM as the piercing or scraping of vagina.

The WHO categorizes FGM into 4 types, two of which are commonly practiced in Indonesia.

One of the common practice in Indonesia is clitoridectomy, which is the partial or total removal of the clitoris or the fold skin surrounding the clitoris (the prepuce). In Indonesia, this can be found in Bima, West Nusa Tenggara, where the procedure involves cutting the tip of the clitoris that they called “isi noi.” In other areas in the country, such as Ambon, the same procedure entails a partial removal in the size of “biji padi” (a grain of rice).

The most common form of FGM in Indonesia, which was found in 6 out of 7 areas surveyed, is what the WHO categorizes as type 4. It involves injuring the vagina until it bleeds a little, scraping the clitoris until it shows blood on the surface, or pinching the clit with small knife to extract the white “haram” part – a practice called “cubit kodo”.

Other than these two, female circumcision in Indonesia is merely a “symbolic” practice that does not involve cutting the vagina – practices like wiping the clitoris with cotton and dab the cotton with antiseptic to symbolize blood, a practice that is common in West Kalimantan and East Java. In Gorontalo the procedure involves touching the clitoris with a small knife; in some areas, there is even no touching of the genital involved.

More than half of the FGM procedures is conducted by dukun bayi (baby shaman) and a quarter is done by dukun sunat (circumcision shaman), while 17 percent of midwives and 0.9 percent of doctors conducted the procedure, the study shows.

The danger lies in the fact that the tools used for the procedures are not always hygienic.

Knives, razors
Dr. Johanna Debora Imelda, a member of the research team at the Center for Gender and Sexuality Study UI, listed some of the tools used in the procedures, from small knives, razor blades to eyebrow scissors.

“The small knife being used is usually considered sacred, so it is not washed for years, often ending up rusty,” she said during the launch of the report.

In the report a girl from Bima testified about her experience: “I was 6 years old and I felt so afraid that I cried. I didn’t have the courage to look at it. It bled for two days, so I was treated with traditional medicine. Then I was told to bathe in the sea. After the circumcision it felt painful when I peed.”

She recalled her friends’ experiences: “One of my friends was too afraid that she moved a lot during the process. She bled a lot like a woman in childbirth. Another one was so afraid to have it done after hearing of others’ experiences, so her parents persuaded her by buying her gifts so she would agree to the procedure,” the girl explained.

Social and cultural
Johanna says the practice of FGM is deeply embedded in Indonesian culture, although female circumcision is not mentioned in the Quran. The study found that society sees the practice as sacred and that it is the parents’ responsibility to have their daughters circumcised.

Support and pressure from family, neighbors, religious figures and health practitioners contribute to a mother’s decision to circumcise their daughters.

Often women’s values lay on whether or not she is circumcised. There will be social sanctions to anyone who goes against the practice. The report describes how different societies practice this.

In Poliwali Mandar and Sumenep, for instance, women who are not circumcised are labeled promiscuous and believed to have high sexual drive. They also believe that women who are not circumcised run the risk of turning into sex workers. In Ambon, uncircumcised women are not allowed to enter the mosque, pray or read the Quran. In Bima no man would want to marry an uncircumcised woman.

Riri Khariroh, a commissioner at the National Commission on Violence against Women (Komnas Perempuan), said during the report launch that eliminating the practice of FGM in Indonesia will require redefining the term to shed its association with religion. [They want to "eliminate the practice" even though some versions do not involve touching the genitals....]
 
“We should change the term ‘sunat perempuan’ (female circumcision) because ‘sunat’ has a strong association and attachment to religiosity and is therefore difficult to eliminate. We should start using the term ‘pelukaan genitalia perempuan’ (female genital mutilation) instead,” she said. – Rappler.com

GEORGIA: Government may make [female?] genital cutting criminal

This is Georgia the country next to Turkey, and it's not a done deal yet


Agenda.ge
November 24, 2016

Gov’t takes step to declare circumcision a criminal offence

Georgia's Ministry of Justice has begun proceedings to make circumcision, same as female genital mutilation (FGM) illegal in Georgia. [A careful reading suggests that "same as" means "such as" not "like" and that this whole article refers only to female genital cutting.]
 
Acting Minister of Justice Thea Tsulukiani said the Justice Ministry had initiated a law amendment that would make circumcision a criminal offence.

Her comment yesterday followed local media reports that two-three of villages in eastern Kakheti region, inhabited by Muslim Kist people, still addressed FGM.

Several locals told media that circumcision remained part of their tradition that played a role in the 'coming of age' of a girl and was necessary before marriage.

Throughout the world FGM is widely frowned upon, with the World Health Organisation (WHO) saying FGM is the deliberate mutilation of female genitalia, with FGM being described as any procedure that injured the female genital organs for non-medical reasons.

The Muslim Kist population still believed FGM was appropriate and meant girls would be a virgin for their wedding night and remain faithful to her husband, as the mutilation prevents women from achieving sexual pleasure.

The process was generally carried out by people who do not have relevant medical knowledge and experience, with no anesthesia and sometimes could be fatal.
"Over the last four years the Government of Georgia has taken a range of steps ... to ensure high level protection of children’s rights,” Tsulukiani said. "The process must continue and conclude with the ratification of the Istanbul Convention I had the honour of signing two years ago. I have big hopes that the new Parliament of Georgia will ratify the Convention,” she added.
A couple of days ago the Ministry of Justice introduced an Article in the Istanbul Convention that envisaged circumcision would become illegal and punishable, said Tsulukiani, adding "unfortunately” there was no earlier information about the existence of the archaic tradition in the "two or three” villages in east Georgia where the practice still occurred.

Representatives of the Muslim religion said their holy scriptures "said nothing" about circumcision and said it was a custom of some ethnic groups that mainly resided in Africa, consequently Islam generally doesn't support FGM.

Georgia’s civil sector has already addressed the issue and said circumcision was one of the "highest level violation of human rights.”

Circumcision is generally carried out on young children aged 2-4 years of age but it can also be carrier out on young adults through the initiative of family members.

UGANDA: Cutting men does increase the HIV risk to women

Medindia
April 29, 2015

Male Circumcision Curbs HIV Spread but Risk of Transmission High While Wound Heals
Real news: Male Genital Cutting INCREASES Risk To Women

by Bidita Debnath
While circumcision reduces the risk of human immunodeficiency virus (HIV) transmission by infected men [that has NOT been established], there is actually a possible increased risk of infecting female sexual partners while the circumcision wounds heal, warns a new research.

The World Health Organization (WHO) recommends male circumcision (the surgical removal of foreskin from the penis) [for consenting adults] which reduces HIV acquisition by 50-60%. [They have to include their mantra.]
 
"There is a window of a few weeks after circumcision when the risk that an HIV-infected man could transmit the virus to a female partner actually increases," said the study's first author Aaron Tobian, associate professor of pathology at the Johns Hopkins University School of Medicine. "During that time, more HIV-infected men are shedding the virus, and on average they are shedding greater amounts of it, than before circumcision," he noted.

However, scientists report that a new study of HIV-infected men in Uganda has identified a temporary, but potentially troublesome unintended consequence of the procedure: a possible increased risk of infecting female sexual partners while the circumcision wounds heal.

[See the weasel-words and euphemisms: infecting more women with HIV is exactly contrary to what this whole campaign is supposed to be about.] 

The study examined 223 HIV-positive Ugandan men who were medically circumcised. Circumcision reduced the number of HIV-positive men who were shedding the virus more than five-fold over the long term, but it had the opposite effect in the weeks right after the surgery. Case by case, the likelihood of HIV transmission from a newly-circumcised man to his female partner is less than one-tenth of one percent, the researchers estimated.

But with the WHO seeking to circumcise nearly 29 million men, the study projects that this small increase could add up to 17,000 new infections among female partners of newly circumcised HIV-infected men.

"Although we're counseling men not to have sexual intercourse while their wounds are healing, we know that they are," Tobian said.

The solution, he says, may lie in another one of the study's findings. "If the men are on anti-retroviral drugs, this reduces the risk of their shedding the virus by about 90%," he pointed out. The study was published in the journal PLOS Medicine.

[But if the men are known to be HIV-positive, WHY CUT THEM? It is TOO LATE. This just underlines how this whole campaign is not about preventing the spread of HIV/AIDS, but promoting the spread of male cutting.]
 
Source: IANS
[Wawer et al. started to find this six years ago, but they cut that study short "for futility" - it didn't find benefit - before it could be confirmed.]

THAILAND: Minimal female cutting persists in Muslim south

The Guardian
April 1, 2015

In Thailand’s Muslim south, authorities turn a blind eye to FGM

Female genital mutilation, banned by the WHO, seems to be common in the
three Muslim-majority southern provinces, but officials are taking no action
by Gabrielle Paluch
Eight-week-old baby Amiyah grimaces when sunlight falls on her face as though she isn’t used to the idea of having been born yet. On a Saturday afternoon, in Thailand’s southern Pattani province, her Muslim mother has brought her to a small clinic so midwife Dah can slice her clitoris for sunat. The practice, a form of female genital mutilation (FGM), has been banned by the World Health Organisation.

In majority Buddhist Thailand, the public health department says FGM does not happen. But in the three southernmost provinces of Yala, Narathiwat and Pattani, ethnic Malay Muslims are a majority. Some are locked in an intractable conflict with the Thai government, which labels them insurgents. Here, midwife Dah says she has cut almost all female births she has attended.

“Her clitoris is so small,” says Dah, 64, who seems a little flustered as she swabs the crying baby’s vulva with alcohol with her gloved hands. Despite her experience, she is having difficulty finding the clitoris as the baby squirms on the operating table. She holds a sterile surgical blade, for which she has fashioned a handle out of tin foil.

After five long minutes, during which the baby cries relentlessly and the mother tries to comfort her, the incision is finally made. The midwife mops up a drop of blood with a cotton swab, recites the name of God, and declares the baby “circumcised”.

“I feel relieved that I have done my duty,” the mother says.

The conflict in the southern Thailand can make it hard for women to access healthcare, according to Dr Sudarat Teeraworn, a public health supervisor for maternal health in neighbouring Yala province. Sudarat says FGM isn’t on the health ministry’s agenda – though according to her, almost every Muslim baby girl in the south is cut.

“There are no laws about it because there are not many health consequences, and it’s a cultural practice,” she says.

Thai health authorities have taken a pragmatic approach, apparently turning a blind eye.

FGM as practised in Thailand falls under type IV in the WHO’s classification, which involves pricking, piercing, incising, scraping and cauterisation. Types I and II involve excision of either clitoris or labia or both, and type III includes a procedure where the vulva is sutured together after removal of the clitoris and labia. The WHO says the procedure has no known health benefits, arises from a deep-seated gender-bias, and amounts to a violation of both children’s and women’s rights.

Just across the border in Malaysia, a study conducted in 2011 showed 93% of Muslim women have been cut, including in Kelantan state on Thailand’s border, which is culturally and religiously similar to Pattani. Though the practice dates back centuries for Muslims living across the Malay peninsula, Malaysia’s highest religious authority did not issue a fatwa until 2009 requiring the cutting of all Muslim women.


Malaysia’s fatwa has put health workers in an awkward position. As women increasingly give birth in hospitals, mothers looking for a safe way to cut their female babies are essentially asking doctors to break WHO guidelines.

To reduce the prevalence of FGM in Malaysia , Saira Shameem, who works for the UN Population Fund (UNFPA) in Kuala Lumpur, is working with health authorities to make the practice symbolic, with a routine alcohol swab performed by obstetricians at birth. “What the fatwa does not do, is it does not specify what the procedure should be,” she says, “that allows us an avenue to define the procedure in a non-invasive, non-harmful manner and shift the practice accordingly.”

In southern Thailand women are also increasingly giving birth in hospitals. Traditional midwives who pass their trade on from generation to generation are disappearing, and mothers are increasingly having their babies cut by doctors.

Many women in southern Thailand don’t even know they’ve been cut until adulthood, when they read about it. The practice is not talked about.

Dr Patimoh Umasa is one of the only female doctors in Yala, where she runs a small clinic on the edge of the city’s Muslim quarter. She knows the WHO guidelines, and doesn’t believe what she does directly contravenes them. “If it is done by a doctor and they are using the right technique, then never mind,” she says. “It’s just a little. Just an incision, no excision.”


But doctors such as Nawal Nour, director of the Global Women’s Health Centre at Harvard Medical School, believes a “right technique” does not exist. “There are girls who suffer short and long-term consequences, even from type IV,” she says. “The clitoris on a baby girl is tiny, and in error, cutters can remove it completely. Also botched jobs can lead to haemorrhage, infection, sepsis and death.”
Back in Pattani, Peung, 33, has gathered her family together to watch her eight-month-old daughter, Mia, being cut by her mother-in-law, who is sterilising a pair of nail scissors with alcohol. Some of Mia’s cousins are playing on the floor in the living room.

Peung’s two older daughters are curious. “What are they doing? Will it hurt?” they ask. “Sunat, we all must do it,” Peung responds. “The children are so eager, but it is not good for them to watch this. It will become a phobia for ever.” She caresses her youngest infant, about to be cut. “At least she doesn’t know what’s going on here.”

The baby’s grandmother draws blood from the clitoris with the curved tip of the nail scissors, a technique she says she developed herself to be safer. Mia cries loudly.


Peung is pleased her daughter is now “complete”, but she isn’t sure why. “I don’t know what the benefit is behind it, but I believe there must be one. I know the prophet said it is desirable for the husband when women are cut. Actually in Islam we believe that women have more desire than men, so there must be something to control the women, give them humility and modesty – and this could be one way to do it. Maybe in the future the scientists will find out and then we will know the benefit. All the girls here in the south do it.”

Some names have been changed

MALAYSIA: Female cutting on the rise

The Express Tribune (Pakistan)
February 20, 2015

Female circumcision on the rise in Malaysia

Syahiera Atika, a 19-year-old Malaysian girl  has happily embraced western-style capitalism but in contrast strictly follows the local interpretation of Islam as she informed the Vice of her circumcision.
 
Female circumcision involves the surgical removal of all or part of a woman’s clitoris. The World Health Organisation (WHO) has classed this procedure as Female Genital Mutilation (FGM).

WHO also defines it as an operation that “involves partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.”

Syahiera however, rejects the notion that it is inhumane and says that ”I’m circumcised because it is required by Islam.” She refers to it as ‘wajib’, which means any religious duty commanded by Allah.

“I don’t think the way we do it here is harmful,” she said, adding that “it protects young girls from pre-marital sex as it is supposed to lower their sex drive. But I am not sure it always works.” [Of course it does not affect their drive, only their sensations.]

According to a 2012 study conducted by Dr Maznah Dahlui, over 93 per cent of Muslim women surveyed had been circumcised. This made Syahiera among the majority of Muslim women in Malaysia.

Dr Dahlui also noted that the procedure was increasingly performed by trained medical professionals in private clinics, instead of by traditional circumcision practitioners.

Shocking to Western sensibilities, Dr Maznah insisted that Malaysia’s version of the procedure in less invasive than in other parts of the world.

Obstetrician and gynaecologist, Dr Mighilia of the Global Ikhwan private clinic located in Rawang, north of Kuala Lumpur, admitted that she performs a more drastic version with a needle or scissors. “I just take a needle and slit off the top of the clitoris, but it is very little,” she said. “Just one millimetre.”

WHO has declared FGM to provide no medical benefits whatsoever. It simply reflects the deep-rooted inequality between the sexes. For this reason, the United Nations General Assembly in 2012 unanimously passed a resolution calling it a “human rights violation” and urged states to ban the practice.

Some Malaysian medical practitioners also defend the practice by passing judgment onto other countries. “We are very much against what is going on in other countries like Sudan,”says Dr Ariza Mohamed, a Consultant Obstetrician and Gynecologist at KPJ Ampang Puteri Specialist Hospital in Kuala Lumpur.

“That is very different from what we practice in Malaysia,” she said adding “and there is a big difference between circumcision and female genital mutilation.”

All Malaysians however, do not support the practice. Syarifatul Adibah, who is the Senior Programme Officer at Sisters in Islam, a local women’s rights group, insists that female circumcision isn’t once mentioned in the Quran.

Instead she points to its popularity as a stemming from an increasingly conservative interpretation of Islam. “Previously it was a cultural practice but now because of Islamisation, people just relate everything to Islam. And when you link something to religion, people here follow it blindly, they don’t enquire,” she explained.

The practice is not banned in Malaysia, although public hospitals are prevented from performing the surgery. More concerning however is that in 2009 the Fatwa Committee of Malaysia’s National Council of Islamic Religious Affairs ruled that female circumcision was obligatory for all Muslim women, unless it was harmful.

LEEDS, UK: "Male cutting worse than some female cutting" - Judge

InsideMAN
January 15, 2015

Male circumcision can be worse than FGM rules senior judge

by Glen Poole

One of the country’s most senior judges has courted controversy by declaring that male circumcision can be more harmful than female genital mutilation (FGM).

Sir James Munby acknowledged he was entering “deep waters” by highlighting inconsistencies in the law, but said it would be “irrational” to dispute the fact that male circumcision can be more harmful than some forms of FGM. The High Court judge made the comments as he passed judgment in care proceedings brought by a local authority seeking to take a brother and sister, from a Muslim family, into care on the grounds that the girl was a victim of Type IV FGM.

While the case failed on the grounds that damage to the girl’s genitals was probably caused by a condition called vulvovaginitis, Munby, who is president of the family division, felt compelled to highlight the sexist double standard that the case brought to light.

In summing up the judge noted that while subjecting a girl to Type IV FGM could result in that child being taken into care, male circumcision would not lead to a boy being removed from his family, even though the procedure is more harmful than at least some forms of Type IV FGM.

An inconvenient truth 
Campaigners against male circumcision have long been hampered by the myth that subjecting girls to FGM is different and always worse than circumcising boys.

The uncomfortable truth, to which Munby has now given judicial credibility, is that male circumcision is different and sometimes worse than FGM.

This is particularly true of Type IV FGM which incorporates practices such as pricking, piercing and nicking the genitals, which are less harmful and invasive than removing the foreskin in it’s entirety.
Male circumcision in the UK is often performed without anaesthetic, in non-medical conditions and can cause complications such as life threatening haemorrhage, shock, sepsis an in extreme cases death.

In 2012 a Freedom of Information request revealed that two boys a week are admitted to the emergency department of Birmingham children’s hospital as a result of male circumcision.

Society more tolerant of male circumcision 
However, despite Munby’s assessment that ”on any objective view” male circumcisions is sometimes worse than FGM, he also made clear that current judicial thinking is that there is no equivalence between the two practices.

“In 2015 ,” he said in his judgment, “the law generally, and family law in particular, is still prepared to tolerate non-therapeutic male circumcision performed for religious or even for purely cultural or conventional reasons, while no longer being willing to tolerate FGM in any of its forms.

“Given the comparison between what is involved in male circumcision and FGM WHO Type IV, to dispute that the more invasive procedure involves the significant harm involved in the less invasive procedure would seem almost irrational. In my judgment, if FGM Type IV amounts to significant harm, as in my judgment it does, then the same must be so of male circumcision.”

The phrase “significant harm” is important as this is the first threshold that must be crossed before a child can be taken into care under section 31 of the Children’s Act 1989. There is another criteria which must also be considered in care proceedings and this is whether the care given to a child is “what would be reasonable to expect a parent to give”.

Why the law is different 
According to Munby, while it can never be reasonable parenting to inflict any form of FGM on a child, the position is quite different with male circumcision.

Munby argued that there are at least two important distinctions between the two practices. Firstly, that FGM has no basis in any religion, while male circumcision is often performed for religious reasons. Secondly, that while FGM is said to have no medical justification and confers no health benefits; male circumcision is seen by some people as providing hygienic or prophylactic benefits, although opinions are divided.

Even taking the conflicting medical evidence on any perceived benefits into account, Munby concluded that “reasonable” parenting should be seen to permit male circumcision.

And that is where UK law stands on the matter today. The Head of the Family Division of the Family Court has judged that while male circumcision is sometimes worse than FGM, it is deemed to be reasonable for parents of all backgrounds to circumcise their sons, while carrying out a less invasive and less harmful from of Type IV FGM on their daughters is not considered reasonable parental behaviour.
...

MICHIGAN: Circumcision Prevention Seminar coming

Metro Times (Michigan)
November 11, 2014

Circumcision prevention seminar comes to U of M campus

by Alysa Offman
No doubt MT readers already know we have a fascination with circumcision round these parts. Michigan has a startling high rate of non-religious circumcision and we sought to find some reasons why when we wrote a cover story about it a couple months ago.

Of course, the story of why some people are obsessed with the idea that our sons must be circumcised while others are obsessed with the idea what they should absolutely not be is one that never ends. [It never began in most of the developed world, and it has virtually ended in the rest of the English-speaking world.]

NoCirc of Michigan, an anti-circumcision organization, is holding a seminar entitled New Perspectives next month to discuss and extrapolate on what it means to circumcise, including the surgery's history and what it means culturally, socially, medically, and ethically.

“Our goal is to educate the public about this ancient practice that is generating modern controversy worldwide. The practice of circumcision around the world raises many compelling issues for healthcare providers, parents, and the general public," said NoCirc of Michigan head Norm Cohen in a release.

Cohen and NoCirc contend that 83 percent of newborn boys in Michigan are circumcised, which ultimately costs taxpayers $3 million every year when 19,000 surgeries are covered through Medicaid.

New Perspectives is free and takes place on University of Michigan's Ann Arbor campus on Sunday, Dec. 7. from 1-4:30 p.m.

The presentation will include speakers like Robert Van Howe, MD, MS, FAAP. He's an anti-circumcision professor and Interim Chairman of Pediatrics at Central Michigan University College of Medicine. He has lectured and been published internationally on the topic of circumcision and has been a consultant to the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the World Health Organization, according to the release as well as John V. Geisheker, JD, LL.M, Director and General Counsel, Doctors Opposing Circumcision. He has practiced medico-legal law as an arbitrator, mediator, litigator, and law lecturer for over 30 years.

MALAWI: World Bank funds genital cutting

Star Africa
August 8, 2014

World Bank funds Malawi circumcision programme

The World Bank has agreed to fund Malawi's voluntary medical male circumcision (VMMC) programme to the tune of MK6 billion (about US$15million) for the next four years, the Ministry of Health announced Friday.Ministry spokesperson Henry Chimbali said the funding would enable the Malawian government to roll-out the programme in remaining districts.

"We have been unable to expand the service to other districts due to inadequate resources to train service providers, formulation of communication messages and purchase of supplies therefore the funding will help fill this gap," he said.

He said the ministry would take the VMMC programme to the districts of Nkhotakota and Lilongwe in Central Region and Blantyre, Phalombe and Zomba in Southern Region, targeting 45,000 adult males aged 15 to 49 years.

He said VMMC was one of the HIV and AIDS interventions in the country. It reduces chances of contracting the virus by up to 60 percent.

Malawi
HIV Rates:	Circumcised men	10.3%
	Intact men	7.9%
Source: dhsprogram.com/pubs/pdf/FR247/FR247.pdf p207

VMMC also has other benefits such as hygiene and helps a man from developing cancer, he said.

[Ah yes, always the bait and switch.]

The World Health Organisation recommended the inclusion of male circumcision for countries with generalised HIV epidemics like Malawi in their national HIV prevention strategy.

MALAWI: Boys being circumcised again

Polysurgery addiction by proxy...

Malawi News Agency
April 23, 2014

Double knifed to fulfill the needful

by Josephine Chinele
Blantyre, April 23: Even though his son had gone through the traditional male circumcision, Geoffrey Linje, a Manase resident was not satisfied.

“During our time, the traditional circumcision was okay but nowadays, it’s fashionable to have both,” he said, whilst waiting for his 11 year old son who was having the second time circumcision procedure inside the make shift theatre at Namasimba primary school in Blantyre.

Linje recalls that during his youthful days, anyone who was not circumcised was regarded as a toddler even if they grew up and raised a family.

World Health Orgsanisation describes Voluntary Medical Male Circumcision (VMMC) as the surgical removal of the foreskin- the retractable fold of tissue that covers the head of the manhood.

It is believed that traditional male circumcision rite is not fully done hence other people like Linje are taking their children to have VMMC.

The father of six children, two of whom are boys proudly says the first boy also had two circumcisions and this makes him feel better.

“The first circumcision is like a mere transition from a ‘toddler’ to a fully grown adult. Now with the advent of many diseases, it’s very necessary that such children should also have medical male circumcision,” he elaborates.

Linje is however quick to say he did not know of any VMMC campaign until his 11 year old boy told him that he heard from ‘chimkuza mawu’ (Mobile Public Address system) which was going around their area announcing the same.

He points out that VMMC reduces a man’s chance of contracting HIV and helps in hygiene of the individual.

Linje’s child is one of the many youths that expressed interest in VMMC at Namasimba mobile clinic.

Site supervisor, Jofirisi Jofirisi says the centre circumcised an average of 25 youths per day from April 9 to April 15, 2014.

“I believe adults are not forthcoming because of perception. May be they think they are already married and no longer need VMMC. The youth may be coming because they want to fit among their peers,” he says.

Nevertheless, Jofirisi reveals that all youths who present themselves for VMMC are tested for HIV, counseled and clearly told that VMMC is not an HIV vaccine.

“We also advise them to take a lot of fluids so that they should have frequent urination to avoid erection since this could disrupt the healing process and increase bleeding on the stitched area,” he says.

World Health Organisation says there is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60 percent.

[Except in the real world:]

Malawi
HIV Rates:	Circumcised men	13.2%
	Intact men	9.5%
Source: www.measuredhs.com

“Male circumcision provides only partial protection, and therefore should be only one element of a comprehensive HIV prevention package which includes: the provision of HIV testing and counseling services; treatment for sexually transmitted infections; the promotion of safer sex practices; the provision of male and female condoms and promotion of their correct and consistent use,” reads the information in part.

[ A traveller came to a farmhouse and offered to make the occupants Nail Soup in return for a night's shelter. He threw a large iron nail in a pot of boiling water, but said: -
"A Magic Nail provides only partial soup-making power, and therefore should be only one element of a comprehensive soup-making package which includes: vegetables; meat; herbs; stock; the provision of pepper and salt and spices and promotion of their correct and consisten use," he said in part.
The farmer's wife accepted this, and in the morning the traveller went on his way, refreshed after a night in a comfortable bed, minus the Nail, with some gold coins in his pocket and the thanks of the family ringing in his ears for the wonderful Magic Nail that made such delicious Nail Soup.
Thus if a circumcised man doesn't get HIV, circumcision will get the credit, but if he does, he can be blamed for failing to take the other precautions. And if a non-circumcised man gets HIV, his foreskin will be blamed, but if he doesn't, nobody will take any notice.
Circumcision is as good at preventing HIV as a Magic Nail is at making soup.]

PSI Community Counselor responsible for Blantyre Manyowe, Chikondi Magalasi, says many people still do not know the difference between VMMC and traditional circumcision.

“I have at least encountered situations where people decided to take their children for VMMC even after they had the traditional one like the case of Mr. Linje,” he says.

Magalasi says to some extent, ‘Angaliba’ (Traditional circumcision surgeons) are feeling threatened by the coming in of VMMC since they think it may take away their source of income and public respect.

“VMMC is not only cultural but a must-have for today’s man. Women should also take a role by encouraging their spouses to go for it since one benefit of VMMC is that when a man is circumcised, they don’t carry the Human Papaloma Virus (HPV) which causes cervical cancer to their spouses,” he elaborates. [That is completely false]

Another Community Counselor responsible for Nancholi, Jonathan Dinesi says it is pleasing to note that some parents have been taking their children to have VMMC even if they already had the traditional one.

“I have personally met three of such children aged between 10 and 15. It takes an understanding parent to do that,” he says. [Misunderstanding, rather.]

Ministry of Health’s deputy spokesperson, Adrian Chikumbe says the fact that other parents are taking their children for VMMC even after the traditional rite is an indication that people understand the VMMC concept. [Except "Voluntary"]

“The message, however, still stands that VMMC is a supplement to all other HIV prevention measures not a vaccine therefore people should still observe abstinence and condom use,” he emphasizes.

Chikumbe says the ministry is trying to work together with ‘Angaliba’ so that they should be arranging for the initiated boys to have VMMC at a medical facility then take them back to their initiation camps so that their job is not compromised. [Oh dear, heaven forbid that their jobs should be compromised?]

BOTSWANA: "Safe" infant circumcision - with Accu-circ and Mogen clamps

Daily News (Botswana)
February 4, 2014

Ministry introduces SMC device for infants

The Ministry of Health has introduced two new devices for infants’ Safe Male Circumcision (SMC).
The SMC national coordinator, Mr Conrad Ntsuape said the two devices were the best that Botswana opted for. He noted that the entire procedure was bloodless, requiring no anesthesia, suturing or a sterile setting.

Mr Ntsuape said the median time for complete healing was seven days after device removal. The devices Mogan Clamp and AccuCirc would be administered on children from zero to two months, eight hours after birth. Circumcision would be done on physically fit babies with no signs on abnormality weighing more than 2.5 kg and a penis of at least one centimetre.

He said the two devices were safe and effective for nonsurgical male circumcision without anesthesia or sterile settings. The distinction between the two devices is that the Accucirc is disposable while the Mogan Clamp is useful in mass circumcision programmes particularly in resource-limited setting. The disposable component of it is the razor blades.
[The Mogen has caused several serious botches, resulting in the Mogen company losing lawsuits and going bankrupt and out of business. The Accu-circ has had no impartial field trials. It chops the foreskin off out of sight, with no knowledge of how the cut will turn out - or whether it will be complete. The word "Safe" is deeply ironical here.]

He said the decision to adopt the two devices followed a lengthy consultation process that focused on acceptability of infant male circumcision as part of HIV prevention and male reproductive health efforts that was conducted by the governments of Botswana and United States through Harvard Institute in 2008. The survey was also done on the acceptability of infant male circumcision among mothers of newborn male infants in Botswana.

Mr Ntsuape said the results of the survey indicated that 96 per cent of mothers in Botswana accepted early infant circumcision while the remaining four per cent were undecided or not interested. He also said infant circumcision was long overdue because Botswana was among 14 periotic [sic] countries in Africa that should scale up safe male circumcision for both children and adults.

The uptake of SMC follows a study by the World Health Organisation that had shown that such countries have high HIV prevalence and low SMC uptake. [There is every reason to suppose that in Botswana, as in Lesotho and Swaziland, circumcised men are as likely as intact men - or more likely - to have HIV.] Twenty five infants have so far been circumcised in the past two weeks at Princess Marina, Nyangabwe and Bamalete Lutheran hospitals.

He said training was conducted on midwife nurses and doctors. ... ENDS

ZIMBABWE: ...so they're doing it to babies

...so they do it to people who can't resist.

Newsday (Zimbabwe)
April 15, 2014

500 infants circumcised in government programme

THE Health and Child Care ministry has circumcised at least 500 infants in a pilot programme which started last year designed for young children before they become sexually active.
by Feluan Nleya
The ministry was working together with the Population Services International (PSI) on the programme.

PSI director for voluntary medical male circumcision Ngonidzashe Madidi said for the purposes of sustainability, they were studying the early infant male circumcision (EIMC) to ensure protective effect of male circumcision is sustained.

Madidi said they wanted EIMC to run parallel with the adult Voluntary Medical Male Circumcision (VMMC) programme.

"Currently, EIMC is in a study phase and we are happy to say we managed to circumcise at least 560 babies successfully," Madidi said.

"The first training to do implementation was done in December 2012 and that saw at least 50 babies being successfully circumcised by doctors."

Madidi said there was also a programme to train midwives to be able to circumcise infants as they were the first to make contact with babies.

The programme has so far been introduced at Edith Operman and Mabvuku clinics in Harare.
"The programme by the midwives saw them successfully circumcising 331 infants using the AccuCirc device," Madidi said.

Madidi said they planned to scale up the programme after the pilot phrase and would be guided by the ministry in implementing it.

He said EIMC protected the infant from future infections such as HIV and bladder infections by 98% and 82% respectively.
[There is no evidence that infant circumcision has any effect on HIV transmission. These figures have been pulled out of the air.]

The World Health Organisation recommends neo-natal circumcision should be a component of prevention campaigns since it is less complicated than circumcision performed in young boys, adolescents or adults. [But it isn't. Any tiny mistake on a baby is magnified on the man he becomes. Genitally cutting a baby is ethically a very different matter from doing it to an adult volunteer.]

KENYA: Female cutting spreads HIV

Daily Astorian (Oregon)
March 14, 2014

Woman combats female mutilation

by Kathy Aney
Sometimes, tradition trumps reason.
That's how Rachael Tengbom sees the practice of female circumcision performed on young girls in her native Kenya. Tengbom, now a Kennewick, Wash., counselor, spoke to an audience at Blue Mountain Community College on Wednesday.

Tengbom, part of the Maasai culture, said only about two percent of girls escape circumcision in her tribe. Though the practice is illegal, the law is widely ignored.

"You can't be a woman without female genital mutilation," she said. "You go through this between 8 and 14. They don't use pain pills -- you have to face the knife like a woman."

Tengbom cited the World Health Organization, which reported that the ritual offers zero health benefits and causes disfigurement and other lasting problems.

"When you ask the Maasai why they put their daughters through this ritual, they say it's part of us," she said.
... The surgery is done en masse, she said, and usually with the same knife. Not surprisingly, the spread of AIDS is a common byproduct.

Girls don't receive much education and are expected to marry young. Circumcision is part of preparing for marriage, which is typically arranged and accompanied by a dowry of cattle. ...

Tengbom said the tradition is slowly changing through the efforts of multiple organizations, including her own, Voices of Hope. The group offers a safe house and funds education for Kenyan girls.

...

CAIRO: Doctor and father to stand trial for girl's death after genital cutting

Middle East Online
March 11, 2014

Egypt doctor faces trial for fatal female circumcision

Although banned in 2008, female genital mutilation is still rampant in Egypt.

CAIRO - A doctor in Egypt will face trial for performing a female circumcision operation that killed a teenage girl, a judicial official said on Tuesday.

The 14-year-old girl's father who took her to the doctor for the procedure will also face trial, the official said.
Although banned in 2008, female genital mutilation is still rampant in Egypt, especially in rural areas where many believe it is part of their faith.

The doctor in the Nile Delta city of Mansoura performed the dangerous procedure at a private clinic.
The operation involves the removal of the clitoris and sometimes even more extreme mutilation, which proponents argue 'purifies' women from sexual temptation.

The practice has been common among both Muslims and minority Christians, said Nehad Abolkomsan, who heads the Egyptian Centre for Women's Rights.

A survey in 2000 said the procedure had been carried out on 97 percent of the country's married women.
The fight against the practice was dealt a setback by Islamists after president Hosni Mubarak's overthrow in 2011, who argued women's rights laws were vestiges of the dictator's regime, Abolkomsan said.

She said efforts to reach out to rural areas to end the practice had been partially successful, but more government supervision was needed.

"This will continue to need a lot of work and effort by the state to apply the law," she said.

"Most cases don't get to the attention of the prosecutor, unless the girl suffers health consequences."

The practice is also common in other African and Middle Eastern states.

The World Health Organisation estimates that between 100 million and 140 million women have been victims of genital mutilation worldwide.

Normal foreskin to be coded as an abnormal - and billable - condition

ICD10data.com

How to make a disesease - and a "cure"

by Hugh Young

A forthcoming diagnostic code proposes to make a normal baby's foreskin a "disorder" and its treatment - circumcision - billable.

When a boy is born, his foreskin has usually not separated from his glans (head), and it commonly takes several years to separate, sometimes not until puberty.

ICD10Data.com Home > 2013 ICD-10-CM Diagnosis Codes > Diseases of the genitourinary system N00-N99 > Diseases of male genital organs N40-N53 > Disorders of prepuce N47- > 2013 ICD-10-CM Diagnosis Code N47.0 Adherent prepuce, newborn N47.0 is a billable ICD-10-CM diagnosis code that can be used to specify a diagnosis.     ICD-9-CM will be replaced by ICD-10-CM beginning October 1, 2014, therefore, N47.0 and all other ICD-10-CM diagnosis codes should only be used for training or planning purposes until then. ICD-10-CM N47.0 is part of Diagnostic Related Group(s) (MS-DRG v28.0): 727 Inflammation of the male reproductive system with mcc     728 Inflammation of the male reproductive system without mcc     795 Normal newborn     Convert ICD-10-CM N47.0 to ICD-9-CM The following ICD-10-CM Index entries contain back-references to ICD-10-CM N47.0: Adherent - see also Adhesions     prepuce, newborn N47.0

This seems to be an attempt to implement (by stealth?) the AAP Task Force on Circumcision's recommendation that non-therapeutic infant circumcision should regain Medicaid coverage, to stem the decline in unnecessary circumcisions.

JAKARTA: Female cutting - "Don't touch our tradition"

Jakarta Globe
April 20, 2013

Activists Demand Repeal of Regulation on Circumcision

by Yuli Krisna

Bandung. “Once a baby girl is 40 days old, she can be circumcised. That’s the tradition,” says Lusi, a mother of one.

“My mother says the child must bleed, but the midwife said there’s no bleeding involved because she’s just cleaning it up down there.”

Lusi is one of many mothers in Indonesia who subject their daughters to a procedure involving pricking and piercing the hood of the clitoris with a needle, citing an Islamic belief that it will keep the girl’s libido in check when she grows up.

Although there is no official data to gauge the extent of the practice, women’s and children’s rights activists say it is widespread, particularly in rural areas.

Ellin Rozana, the executive director of the Women’s Institute, an advocacy group, argues that a Health Ministry regulation issued in 2010 that legitimizes the practice must be repealed.

She says the government’s rationale — that the form of female circumcision performed in the country is largely symbolic and not harmful — is irrelevant, and that no form of female circumcision can be justified on religious grounds.

“Admittedly the circumcision practiced in Indonesia isn’t as bad as in some African countries, where they mutilate parts of the girl’s genitals,” she tells the Jakarta Globe.

“Here they call it pricking and cleaning, but there’s no clear reason for why it has to be done. It’s different from male circumcision, which has clear health benefits.”

Ellin says the age-old reason given, that the circumcision prevents a girl from having a high sex drive and thus from becoming sexually promiscuous, highlights the patriarchal and discriminative nature of traditional Islamic Indonesian society toward women.

“There’s this idea that if a girl is circumcised, she will grow up to be a ‘good girl’ with a low sex drive,” she says.

“But this is a question of a woman’s reproductive rights, her right to enjoy sex.”

The government initially banned all forms of female circumcision in 2006. Four years later, however, it made an about-face and issued a regulation giving health workers the discretion to perform circumcisions as they saw fit.

The government argued that the regulation was needed because the all-out ban had led to large numbers of parents getting their daughters circumcised by unqualified shamans and traditional healers, thereby putting their children at high risk of medical complications.

The Health Ministry regulation defines permissible female circumcision as “an incision of the skin covering the front of the clitoris, without cutting the clitoris.”

But a 2003 study by the Population Council found that 22 percent of 1,307 female circumcision cases in the country were excisions, meaning that part of the clitoris or labia was removed. Of the rest, 49 percent involved incisions while only 28 percent were of the “symbolic” prick-and-clean type.

Ellin argues that as minimalist as it seems, the kind of circumcision allowed by the government is still unacceptable under internationally recognized standards on women’s rights.

In December, the United Nations passed a resolution banning female genital mutilation, which extends to the circumcision practiced in Indonesia.

Procedures such as pricking, piercing, incising, scraping, cauterization or burning that are carried out for non-medical purposes are categorized by the World Health Organization as mutilation along with practices that alter or remove any part of the genitals.

Back in Bandung, Lusi has come to realize that she did not need to have her daughter circumcised.

“I found out too late that what I did was a violation of my child’s rights,” she says.

SOUTH AFRICA: Millions spent on risky circumcision clamps

Politics Web
Marvh 13, 2013

KwZulu Natal government has spent R48.5M [$US5.3M] on risky clamps

NATIONAL ASSEMBLY

FOR ORAL REPLY QUESTION NO. 51

...

Mrs C Dudley (ACDP) to ask the Minister of Health:

(1) Why is the Tara Klamp still being used at hospitals despite reports that a clinical trial has shown it to be unsafe;

(2) what (a) is the Government paying per Tara Klamp and (b) amount has the Government spent on Tara Klamps to date;

(3) has the Tara Klamp been put out to tender?

...

REPLY:

(1) ... The World Health Organisation (WHO)'s Department of Reproductive Health & Research (RHR) hosted a consultation ... The group concluded that while rates of adverse events and device related incidents were of primary focus "it was agreed that they did not necessarily exclude the Tara Klamp device from further assessment in an adult African population, nor imply that similarly high complication rates would be see in younger men or adolescents".

(2) (a) The cost per unit item for the TK is R222.30 [$US 24.81] VAT inclusive depending on the rand/dollar exchange rate.

(b) -->The KwaZulu/Natal Department of Health has spent R48,544,916.75 [$US 5,368,736.66] from April 2010 to date on the purchase of the TK device.
(3) ... The Department procured the device from the sole distributor for Africa,...
Issued by Parliament, April 8 2013

BERLIN: Female cutting growing in Germany

Jewish Press (!)
February 6, 2013

Female Circumcision Now a Growing Problem in Germany

For many of these women, urinating can take up to 30 minutes, and is very painful.

Between 130 and 150 million women are victims of genital mutilation – most of them are Africans, Deutsche Welle reports. Now, doctors, teachers and social workers in Germany report being confronted by this practice in ever growing numbers.

Jawahir Cumar, who moved to Germany with her parents from Somalia when she was a girl, witnessed, at age 20, on a visit to her grandparents’ village, the funeral of young girl who had bled to death after being “circumcised.”

Female genital mutilation (FGM) is practiced in 29 African countries, even though it is illegal in some of them. It is usually done when girls are between the ages of four and eight – using razor blades, kitchen knives and even broken glass and tin lids. Because these tools are used more than once, it also increases the spreading of bllod-based diseases like HIV/AIDS and hepatitis.

FGM alters or injures female genitalia for non-medical reasons, according to the World Health Organization (WHO). ...

An estimated 30,000 women living in Germany have been subjected to FGM and 6,000 girls are at risk, according to human rights organization Terre des Femmes.

“Mothers-in-law and grandmothers, especially, call all the time, write letters and send messages,” says Cumar. And the message is always the same, “you have to cut your daughters! Or just bring them to us and we will do it.”

...

She was able to prevent 17 girls from being subjected to FGM last year. But there’s still a lot of work to be done in Germany as well, says Cumar, pointing to how long it took for “honor killings” to be viewed by police as a criminal offence and not simply as the customs of immigrants.

...

JAKARTA: Muslim group pushes against FGC ban

The Jakarta Post
January 22, 2013

Muslim body pushes Indonesian govt to circumcise girls

The Indonesian Ulema Council (MUI) is bucking a United Nation's campaign to ban female circumcision, demanding that the government keep the practice legal.

MUI deputy secretary-general Amirsyah Tambunan told reporters at a press conference on Monday that the government should continue to allow female circumcision, calling it a constitutional right.

"Circumcision is a part of the Islamic teachings that were recommended for Muslims, both male and female," Amrisyah said at MUI headquarters as quoted by Antara news agency. "The MUI and Islamic organisations in the country firmly stand against any efforts to ban female circumcision."

Female circumcision performed by licensed doctors, nurses or midwives was legalised by a Health Ministry regulation issued in 2010 that defined the practice as "incising the skin that covers the front part of clitoris, without harming the clitoris".

Last month, the UN approved a non-binding resolution urging its 193 member states to enforce legislation prohibiting female genital mutilation.

According to the World Health Organisation, female genital mutilation can cause urination problems, severe bleeding and complications during childbirth.

In Indonesia the practice ranges from the symbolic - a small tap with a bamboo stick - to slicing the clitoris off with scissors.

The National Commission on Violence against Women (Komnas Perempuan) has consistently urged that the 2010 ministerial regulation be revoked, claiming it violated women's reproductive rights.

Meanwhile, Huzaemah, a member of MUI's fatwa commission, said that female circumcision was a religious obligation that should be done to control women's sexual desire.

Separately, the executive director of the Wahid Institute, Ahmad Suaedy, disagreed, saying that the practice was based on fiqih (Islamic jurisprudence) that could be interpreted differently by different ulemas.

"Female circumcision is not in the sharia. Maybe, the MUI drew their conclusions from a fiqih that was applied in a particular context and region," he told The Jakarta Post.

Meanwhile, Enrico Renaldi, a physician from the Indonesian General Practitioners Association, said that local medical schools did not teach female circumcision procedures.

"I also have never heard of female circumcision training for doctors. Traditionally, this practice is only performed by midwives," he told the Post.

Earlier story

JAKARTA: Govt told to stop female circumcision

The Jakarta Post
December 23, 2012

Govt told to stop female circumcision

As the United Nations has adopted a resolution urging member states to ban female genital mutilation, the government has been told it has no choice but to revoke a Health Ministry regulation issued in 2010 that condones female circumcision.

National Commission on Violence against Women (Komnas Perempuan) deputy chairwoman Masruchah said that the 2010 ministerial regulation runs counter to the UN resolution because it legalizes a practice that is harmful to the sexual and reproductive health of women.

The UN General Assembly unanimously approved the resolution, which is not legally binding, on Thursday, urging its 193 member states to enforce legislation that prohibits female genital circumcision.

The 2010 Health Ministry regulation stipulates that female circumcision is allowed as long as it is performed by licensed doctors, nurses or midwives.

“We have consistently pushed the ministry to revoke that regulation because it abuses the reproductive rights of women. This practice stems from the erroneous interpretation of cultural and religious teachings,” Masruchah told The Jakarta Post.

Many Indonesians, she said, believed that female circumcision could control the sexual desires of girls.

Instead of providing health benefits, female genital mutilation can cause severe bleeding, urination problems and can lead to complications during childbirth, according to the World Health Organization (WHO).

The Health Ministry website claims that female circumcision, as stipulated in the regulation, cannot be categorized as female genital mutilation.

The regulation stipulates that “female circumcision is an action of incising the skin that covers the front part of clitoris, without harming the clitoris”.

The Indonesian Doctors Association chairman, Zaenal Abidin, said that the association would study the UN resolution and that they would issue a recommendation related to female circumcision.

“The association cannot make any recommendations unilaterally. We will involve religious scholars and communities in the deliberations. We will also study the suggestions from the WHO and international doctors’ associations,” he said.

...

Indonesian General Practitioners Association member Enrico Renaldi, who believes that female circumcision is unnecessary and harmful, said that medical practitioners in the country were facing challenges in preventing the practice.

“It is hard for doctors to be agents of change. There are strong pros and cons in the matter. Indonesians, particularly those in rural areas, see female circumcision as a necessity,” Enrico said.

Iffah Ainur Rochmah, the spokesperson for the Islamic group Hizbut Tahrir Indonesia (HTI), rebuffed the negative assumptions about female circumcision practices in Indonesia.

“This is a part of our culture rooted in Islamic teachings. The practice should be carried out through procedures that will not cause health implications,” she said.

Iffah called on the global community, including the UN, to not liken Islamic female circumcision with the unhygienic and inhumane practice of female genital mutilation.

She explained that Islam teachings regulated female circumcision as a minor incision of the skin that covers the front part of the clitoris.
...
Earlier story

BERLIN: Paediatric Association condemns circumcision law

Gesetzentwurf der Bundesregierung
November 27, 2012

German Pediatric Society roundly condemns infant circumcision.

Dr.Wolfram Hartmann, President of the Professional Association of Child and Youth Doctors in Germany, spoke on November 26, 2012 to the Bundestag committee considering the Government's "Draft law on the scope of child's care regulations at a circumcision of the male child" and the draft law of MPs Marlene Rupprecht, Katja Dörner, Diana Golze, Caren Marks, Rolf Schwanitz, other MPs: "Draft law on the scope of the child's care and the rights of the male child at a circumcision "

The Association opposes the first, which sets conditions for the performance of child circumcision, but no limit on who may do it, and supports the second, which sets a minimum age of 14, with informed consent.

Dr Hartmann told the committee

This statement is coordinated with the German Academy for Child and Youth Medicine (DAKJ), the umbrella organization of all pediatric associations in Germany (German Society for Child and youth medicine DGKJ, Professional Association of the Child and Youth doctors, German Society for social pediatrics and youth medicine DGSPJ), to which other organizations are co-opted (see also . I also refer to the statement of the Germany Society for Child Surgery) on that subject.

From a medical point of view, there is no reason to remove the intact foreskin of under-aged boys not capable of giving consent. In pre-school age, it is also very rare to have a true medical indication to remove (circumcise) the foreskin. At this age, the foreskin (prepuce) is physiologically more or less strongly fastened to the glans. Attempts to pull back the immature and adhered foreskin often cause inflammations and painful fissures.

"The male foreskin is part of the dermal organ and fulfills an important role in protecting the very delicate glans. ...

The repeatedly-quoted statement of the AAP contradicts earlier statements by the same organization, without being able to refer to new scientific evidence. The AAP statement has meanwhile been considered scientifically untenable by almost all pediatric societies and associations worldwide.

... The American lawyers association for children's rights, Attorneys for the Rights of the Child also criticized the AAP statement in a letter to the Pediatrics magazine [Which was not published there, but was published here]. It [says the AAP policy] contains errors and inconsistencies and violates both the AAP's own statements regarding bioethics, and several civil and criminal law regulations in the USA.

The WHO recommendations for prophylactic circumcisions only refers to mature, sexually active men in countries with low hygienic standards and is not suitable to justify the prophylactic circumcision of under-aged boys not capable to give consent. ...

.... The government's current draft law on the scope of child's care regulations at a circumcision of the male child unwillingly opens the door for demands to legalize the circumcision of girls.