NORWAY: Doctors defy law, refuse to cut

News in English (Norway)
January 22, 2015

Doctors defy new circumcision law

by Nina Berglund

Since January 1st, all of Norway’s state-run hospitals have become legally obliged to offer circumcision of newborn baby boys. A majority of doctors all over the country, however, have been refusing to perform the operation that’s often part of religious rituals, claiming it’s an unnecessary surgical procedure on otherwise healthy infants.

Only one hospital in all of southeastern Norway is officially offering to circumcise newborns, according to an internal document obtained by newspaper Dagsavisen. In a response to the state health ministry’s request for a status report on circumcision, state agency Helse Sør-Øst (Health Southeast) wrote on January 16 that only the hospital in Kristiansand (Sørlandet Sykehus) offered to circumcise newborn baby boys. A few others offered circumcision only to boys more than a year old.

Strong opposition
At Akershus University Hospital (Ahus) northeast of Oslo, fully 13 of its 15 urologists have submitted written statements reserving themselves against performing circumcision. “The opposition to this emerged before the law on circumcision was approved,” Dr Anja Løvvik, leader of the urology department at Ahus, told Dagsavisen this week. “The fact that many (doctors) want to reserve themselves against this should not be unexpected.” Her colleague Dr Frode Steinar Nilsen at Ahus called circumcision “a surgical operation with no health advantages and one that, as with all surgery, carries with it a risk and a burden for the child. That’s why we don’t want to perform it.”

Doctors, however, have no right to reserve themselves against the procedure in the new law, making their resistance potentially illegal, according to state secretary Cecilie Brein-Karlsen at the health ministry. She told newspapers VG and Dagsavisen that Norway’s public health system must now offer the procedure to parents who want their baby boys circumcised. The Parliament approved the new law last year after reports that babies in Norway risked being seriously injured during circumcision rituals performed outside the health care sector. One baby boy died in Oslo in 2012.

The law was approved by a large majority in Parliament but not without controversy. Doctors’ and nurses’ professional organizations opposed it as did many individual Members of Parliament, but they followed their parties’ lines. In addition to fearing that circumcision would continue to be performed by non-health professionals in Norway, party leaders didn’t want to be seen as being either anti-Jewish or anti-Muslim, since circumcision is traditional in the Jewish and Muslim communities. Others pointed to how millions of men around the world are circumcised including a majority of American men regardless of religious persuasion.

Fending off any ‘fear of foreigners’
“I think many (MPs) were afraid to be accused of anti-Semitism or fear of foreigners,” Jenny Klinge, an MP for the Center Party, told Dagsavisen. She unsucessfully proposed offering hospital circumcision only to males over the age of 18, when they could decide themselves if they wanted to be circumcised. Klinge added that she could understand the health care professionals’ opposition to performing circumcision: “It is in principle wrong for the state to carry out such surgery on babies. One shouldn’t cut into small children in the name of God.”

US health authorities view male circumcision positively, but their Norwegian counterparts don’t. Some doctors’ attempts to reserve themselves against performing abortions also have sparked controversy, not least last winter, but Nilsen of Ahus is adamant: “If (politicians) think they can force an entire profession to perform surgery they feel is wrong both medically and morally, I think that’s remarkable.”

Brein-Karlsen told Dagsavisen that she also understands “that this is a difficult issue.” She said hospitals should take the doctors’ objections into consideration, “but the regional health agencies are still responsible for making sure that an offer (of circumcision) is there.”

Ahus, located in Lørenskog, has estimated that parents of as many as 400 babies a year may request circumcision, and worry they won’t have the capacity to perform it. “Children who need other operations are already having to wait,” Løvvik said. “If we have to offer circumcision, they may need to wait even longer.” Ahus has told expectant parents that it will only offer the procedure after the child is a year old, at the earliest. Hospitals in Bærum, Drammen and Ringerike have set an age limit at two years, while Oslo University Sykehus was expected to start offering ritual circumcision next month, for boys over one year of age.


Earlier story

SWAZILAND: Ingatja Men Reject Circumcision on Cultural Grounds

The Times of Swaziland
January 22, 2015

Ingatja: Circumcision against Swazi culture

by Siusiso Shange

 NGABEZWENI – While the Church Forum and other organisations have embraced circumcision, some members of Ingatja have not.

In an interview, some members of Ingatja, who were found debating about the subject while they waited to be dispersed by the King, said circumcision was against culture. They said the removal of the foreskin was not good for them because it was necessary to ensure that the traditional attire attire known as imvunulo stayed on. “Ideally, when a man dons traditional attire, there is no need for him to wear underwear,” they said.

“Nawulijaha uyancwadza futsi nebetemphilo bayakukhutsata kushaywa ngumoya. Ngaphandle kwemvunulo kufana nekutsi uhamba ngcunu, pho ungahlalaphi nasesisokile,” wondered Bheki Mnisi, who was found buying a product to make umncadvo, which is worn as underwear by males in traditional regalia..

TURKEY: $250,000 payout for botched cut

The Guardian
January 20, 2015

Record award for family of Turkish boy whose circumcision was botched

Boy who was taken to mass circumcision ceremony for disadvantaged children lost large portion of his penis and health ministry ordered $255,000 payment

A Turkish court has approved a record compensation payment for the family of a boy who had a large portion of his penis removed and burnt off in a botched circumcision operation, media reported.

The boy, who is now six, underwent the operation when he was one year old in a mass circumcision ceremony for boys from disadvantaged families in the south-eastern city of Batman.

The upper portion of the penis was mistakenly cut and burnt off during the operation, and the boy was still receiving care for his wounds, private Dogan news agency reported.

On Tuesday, a Batman court ordered the health ministry to pay the boy’s family a record 600,000 Turkish liras ($255,000) in damages, Dogan said.

The family of seven claimed that the operation was carried out only by a health technician because no qualified doctor was present during the circumcision.

The boy was sent home with burn creams and was told to “have some rest to heal properly”.
The parents, however, are not satisfied with the amount, saying that their child might require further treatment, including care abroad.

They are still seeking more than 2 million more Turkish liras ($850,000) in damages, Dogan said.
Circumcision is widely practised in all Islamic countries, including predominantly Muslim but staunchly secular Turkey.

It is an expense that many families find difficult to afford, with the operation costing hundreds of dollars and the ensuing celebrations even more.

As a result, many parents choose to pay unskilled circumcisers or barbers, who perform the operation with unsterilised instruments.

MIAMI: Proposed cutting of 4-year-old spurs protests

Yahoo! News
January 20, 2015

Fla. boy's circumcision spurs lengthy legal battle, protests

By Matt Sedensky

BOYNTON BEACH, Fla. (AP) — An estranged Florida couple's fight over whether to circumcise their son has become a rallying cry for those who denounce the procedure as barbaric.

The dispute between Heather Hironimus, the mother opposing circumcision, and Dennis Nebus, the father favoring it, has sparked a prolonged court battle, protests and the rapt attention of a movement of self-proclaimed "intactivists."

Judges have ruled in favor of the father, meaning the surgery is likely to happen, but the possible closure of the legal chapter has done little to mute the case's most passionate followers. Though many [other people] still choose to remove their sons' foreskins at the suggestion of a doctor, for religious or cultural reasons, or out of habit, opponents have been bolstered by the overall waning popularity of circumcision, and the fact this fight has gone on so long the boy at its center is now 4 years old.

"I couldn't speak when I was cut, but I can speak now," said Thomas Frederiksen, a 39-year-old machinist who traveled from Orlando to protest, wearing a red beret and "I (Heart) My Foreskin" T-shirt and speaking breathlessly about the issue.

Volumes of court filings tell the story: Hironimus and Nebus had a six-month relationship that resulted in a pregnancy, the birth of a boy named Chase, and a fight over nearly everything since. Nebus sued to prove his paternity and to get partial custody of the boy and the couple whittled out a parenting plan outlining everything from his surname to his legal address, to whom he calls mommy or daddy and, notably, what becomes of his penis.

In that document, the circumcision of the child was agreed to by both parents. When it came time to schedule the procedure, though, the mother resisted, having researched the subject further. The matter wound its way through circuit court, which ruled in Nebus' favor, then to the Fourth District Court of Appeal, which refused to overturn the lower court's ruling. Hironimus could ask for a rehearing in the appellate court, but has made no further legal filings.

"Just the normal thing to do," the father said of circumcision, according to the court files. "To me, it's not worth it to put my son's life at risk for a cosmetic procedure," the mother said.

The parents entered an agreement on Dec. 24 to not talk to the press and to avoid any other campaigns or actions that might exploit the child. There is no indication in the court documents the circumcision is being done for religious reasons. The attorney that had represented the mother, who lives in Boynton Beach, is no longer being retained and has not been replaced, the lawyer's office said. The attorney for the father, who lives in Boca Raton, did not respond to requests for comment.

Though circumcision rates have fallen in the U.S., a majority of boys still undergo the removal of their foreskin. ... Meantime, a bubbling anti-circumcision movement has grown.

They have made the boy at the center of this case their cause celebre, as evidenced by one of several small sidewalk protests here featuring signs including "Let Chase Keep His Foreskin," ''Don't Cut Chase's Penis," ''Don't You Dare Circumcise Chase!" and "Ethics 101: No Disease, No Consent, No Circumcision." Some passing motorists honked or gave gestures of support; some looked puzzled or shouted "Who's Chase?"

Jonathan Friedman, 27, who organized the demonstration as part of his "Saving Chase" campaign, traveled from Chicago for the event and makes anti-circumcision advocacy the focus of his life. He wore a "Children Never Forget Trauma" T-shirt and said he became vocal on the issue when he realized the harm of his own circumcision, which he blames for bleeding, chafing and painful erections.

What has driven supporters to his side, Friedman says, is the age of the boy in this case.

"People are not OK with a 4-year-old boy being circumcised — a conscious, articulate boy. That's just not OK," Friedman said. "Not everyone is against circumcisions, but I think everyone is against a 4-year-old's circumcision."

...

Gathered quietly near the office of a pediatric urologist who examined the boy and who may be chosen for the surgery, [the protesters] said the circumcision should be put off until adulthood, when the patient could decide for himself. To those who view the procedure as minor, they gave a list of reasons they believe shows it is not — from loss of sensation to unseen psychological damage.

"They think it's just a little snip and it's not," said Jennifer Blanchard, 34, of Miami. "It's a big deal."

Earlierstory

LONDON: Doctor charged with cutting woman after childbirth

BBC
January  19, 205

Doctor 'performed FGM on new mother in hospital'

A British doctor performed female genital mutilation on a young mother after she gave birth in hospital, a court has heard.

Dhanuson Dharmasena, 32, is accused of carrying out the illegal procedure at the Whittington Hospital in north London.

The doctor, of Ilford, London, denies the charge in what is the first prosecution of its kind in the UK.
A second man, Hasan Mohamed, 41, denies encouraging and abetting the offence.
...
Carrying out female genital mutilation carries a maximum sentence of 14 years in prison.

'Encouragement' The mother-of-two, who cannot be identified, first underwent FGM aged six in Somalia, London's Southwark Crown Court heard.

She was 24 and living in Britain when she give birth to her first child in November 2012.

The court heard that during labour, her FGM stitches were torn and Dr Dharmasena, a junior registrar in obstetrics and gynaecology, sewed her back up in a procedure that amounted to FGM.

The prosecution alleges the doctor did so at Mr Mohamed's "insistence or encouragement".

Kate Bex, prosecuting, told jurors that FGM was "very dangerous for a woman's health and psychological well-being"....

"It increases the risk of death in childbirth to both mother and baby."

Jurors heard the woman would have been most exposed to these side-effects when the surgery was first performed when she was six.

Dr Dharmasena's stitches would not have carried the same risks, but should not have been sewn at all "unless medically necessary", Ms Bex said.

'Changed tack' The hospital trust launched an investigation into the incident within a few weeks.

In a statement, Dr Dharmasena said he had carried out the procedure because he thought the woman wanted him to. He also said Mr Mohamed had urged him to do so.

He said: "At no point in time did I intentionally or deliberately want to cause any harm to the patient. I had obeyed all of the patient's wishes."

But jurors were told he had changed his justification when he was interviewed by police in August 2013.

Ms Bex said: "It would seem that Dr Dharmasena had familiarised himself with the law and you may feel that he changed tack as a result."

Ten months after the operation, he raised the possibility that it had been "medically justified", she told the court.

Dr Dharmasena denies one count of female genital mutilation.

Mr Mohamed denies one count of aiding or abetting the procedure, and one count of intentionally encouraging or assisting the commission of an offence.

The trial continues.

TANZANIA: Girls cut after leaving refuge - one father arrested

Tanzania Daily News
January  19,2015

Tanzania: Police Confirm Single Arrest Over Forced FGM in Tarime

By Mugini Jacob Tarime — POLICE have arrested a man here for allegedly forcing her daughter to undergo female genital mutilation (FGM) at a village in Tarime, Mara Region .

The single arrest came in the wake of shocing reports that dozens of girls who escaped the cut and camped at Termination of Female Genital Mutilation(TFGM) Masanga Centre in the critical months of November and December when FGM was widely conducted in area, are now being subjected to forced circumcision.

More than 600 most school girls refused the cut and sought shelter at the rescue centre, which operates under the Roman Catholic Church of Musoma Diocese with the support of several partners, including United Nations Population Fund(UNFPA) and Children's Dignity Forum(CDF), a nongovernmental organisation, which has of late enhanced the battle against FGM in the area.

... The girls left the centre early this month in a colourful function officiated by Minister for Labour and Employment, Ms Gaudensia Kabaka.

Tanzania Media Women's Association (TAMWA) Executive Director Ms Valerie Msoka described the report about the girl who was forcibly cut in Tarime as "shocking and humiliation of the highest order".

She called for immediate new effective measures that will help to save girls from the outdated harmful culture. FGM is illegal according to the law. "
...

KENYA: Wife sends whole village to publicly cut husband

Diaspora Messenger (Kenya)
January 17, 2015

Wife sends a whole village to circumcise her husband in broad daylight

A man was forcefully circumcised in Chwele Market Bungoma county after his wife reported him to the elders.

A 39-year-old man woke up to the shock of his life when he found thousands of people gathered outside his house waiting to circumcise him.

The father of 11 is said to have had an argument with his wife when she decided to go and expose him to the elders on his state of manhood.

He was drugged out of his house and circumcised in front of a large multitude in Chwele market.

He was later awarded gifts and is expected to stay in isolation for four months before elders teach him on how to be a man, according to the Bukusu culture.

Social media was awash with critics some condemning the act while other praised the act under #GoCutMyHusband

ATLANTA, GA: Most of 2000 responses to CDC proposal are anti

The Washington Times
January 15, 2015

Circumcision proposal by CDC drawing detractors

Nearly 2,000 postings against the practice

by Cheryl Wetzstein

A federal proposal to encourage discussions about circumcision for baby boys and at-risk men of all ages has drawn nearly 2,000 mostly negative comments and a planned protest in front of a federal agency this month.

The proposal from the Centers for Disease Control and Prevention (CDC) doesn’t explicitly recommend circumcision, but it urges health care providers to proactively discuss the benefits and risks of circumcision with parents of baby boys and “uncircumcised at-risk heterosexual males” to allow people to make well-informed decisions about the procedure.

A public comment period on the proposal in the Federal Register ends Friday.

Circumcision, which cuts away a section of the tissue covering the head of the penis, is associated with a lower risk for acquiring HIV, genital herpes and human papillomavirus, as well as penile cancer and infant urinary tract infections in male infants, the CDC said in its draft recommendations.

The overall risk of adverse events is “low,” with minor bleeding and inflammation cited as the most common complications, the agency said.

“The scientific evidence is clear that the benefits outweigh the risks,” Dr. Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, told The Associated Press when the proposal was unveiled in November.

But the vast majority of the 1,978 public comments on the CDC proposal opposed it — often furiously.

“Stop mutilating helpless babies,” wrote one commenter named Lucy Brenton. “There is no reason to cut healthy tissue of a normally functioning organ, especially without the permission of the owner,” she wrote.

Others decried the physical harm and deaths that have occurred with circumcision, as well as lifelong trauma associated with the loss. An online organization called foreskin-restoration.net said it had more than 5,000 members, some of whom “are so bothered by the imposed loss of their foreskin that they endure a tedious process of nonsurgical foreskin restoration to undo some of the sexual damage.”

Other critics noted that circumcision is unlikely to dent HIV transmission in the U.S. since most HIV cases are among men who have sex with men. The CDC proposal recognized this, saying that the studies showing circumcision as an effective HIV-prevention strategy only involved men who had sex with women.

U.S. health care providers “should inform men who exclusively have sex with men that male circumcision has not been proven to reduce the risk of HIV or [sexually transmitted infections] during anal sex,” the CDC said, adding that circumcision is still advised for bisexual men as well as men who have sex with HIV-infected women, commercial sex workers, injection-drug users and women who live in areas with a high HIV prevalence in the population.

The CDC proposal got a few supportive comments.

“Please don’t listen to the hysterical nay-sayers. Look at the evidence,” wrote one medical doctor, while a man writing as “Anonymous” said his bouts with balanitis, a swelling condition of the penis in uncircumcised men, “could have been prevented if I had been circumcised as an infant.”

Another circumcision supporter, Dr. Jeffrey Klausner, urged the CDC to recommend that the U.S. Preventive Services Task Force review the issue of newborn circumcision. If that task force would endorse newborn circumcision with “an A or B recommendation,” he wrote, it would require Medicaid and Medicare to pay for the procedures as a preventive intervention.

A peer review panel will also be assembled to examine the evidence for the proposal and offer expert opinion on whether the CDC recommendations are justified and appropriate for the intended audience. Final recommendations are likely to be published later this year in the Morbidity and Mortality Weekend Report, the CDC said.

The agency did not directly respond to a question about whether its expert-review panel would include anyone who is critical of circumcision. [Will even one of them have a foreskin?]  But it said its peer reviewers would be selected because of their expertise in such matters as urology, pediatrics, public health, infant circumcision and prevention of sexually transmitted diseases such as HIV/AIDS. [Foreskin anatomy and function, sexology, ethics?]

Anti-circumcision advocates in Atlanta said on their Facebook page that they are planning a rally Jan. 22 outside the CDC offices to protest the proposal.

“We all know that there are no benefits to the amputation of healthy body parts,” said organizers, including members of Bloodstained Men & Their Friends, who protest while wearing white pants with bright red circles at the crotch.

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.
...

NEW YORK: Metzitzah: Rockland adopts own protocol

Capital (New York)
Janauary 9, 2015

Rockland takes a new tack on risky circumcisions

by Dan Goldberg 

While New York City remains stalled in its efforts to come up with a better way of regulating a controversial circumcision ritual practiced by some Orthodox Jewish sects, Rockland County health officials made a deal with a local community to create a protocol to assess and mitigate risks associated with the practice.

The ritual, called metzitzah b'peh, involves a mohel—the practitioner of the circumcision ritual—suctioning blood from a baby's wounded penis with his mouth. The practice of placing mouth to open wound has been linked by city health officials to the spread of Herpes Simplex Virus-1 to babies.

The protocol worked out in a nonbinding agreement between health officials and community leaders in Rockland County—home to one of the state's largest concentrations of ultraorthodox Jews—is as notable for what it doesn't attempt do to as what it does.

It doesn't alter the ritual, or require parents of boys undergoing it to sign a waiver acknowledging the dangers of the practice, as New York City currently requires. It also doesn't immediately eliminate the risk of babies contracting herpes from infected mohels.

But it does, by securing the cooperation of a deeply religious community that is sometimes hostile to regulation by secular authorities, allow for testing and data-gathering to identify and ban mohels who infect circumcised babies with herpes.

Per the agreement between the county health department and community leaders, if a mohel is found to be the direct source of a baby contracting HSV-1, then that mohel would be permanently banned from performing the ritual, according to Dr. Oscar Alleyne, the county's director of epidimiology.

The Rockland health department has so far tested eight babies who presented with herpes symptoms after circumcision, Alleyne said. Of those, three had the virus. In two cases, the Rockland health department concluded the mohel was not responsible. One case was inconclusive.

“From Rockland County's perspective, the individuals who did the metzitzah b'peh were not the ones who matched, and that tells us we have to look at the bigger picture,” Alleyne said.

It's a very small sample, but the effort attempts to address, however imperfectly, the health-based concerns about the practice.

Of the cooperation with the Orthodox community, Alleyne said, “That in and of itself was a major breakthrough."

Under the system set up in Rockland, if a state lab determines a circumcised baby has HSV-1, county officials work to identify all the potential point sources that come into contact with the infant. Those individuals are then swabbed and tested to see if they have HSV-1 and if their strain matches the infant's. Because the virus is not always detectable, the county conducts 60 swabs over a period of 30 to 60 days to try and ensure that nothing is missed.

The agreement also requires mohels not to perform the ritual on other babies while testing is taking place, and Rockland health officials are discussing additional measures that can make the practice more hygienic.

The community has agreed, according to Alleyne, that if a mohel is found to be the cause of infection then he will voluntarily stop performing anywhere in the world for the rest of his life.

The agreement between Rockland and the Orthodox communities there—the largest communities are in Monsey and New Square—is similar to one that was discussed with the New York City health department in 2006. That plan was rejected by the city, according to court documents.

By only testing mohels after the fact of an infection, the system can reduce but never actually eliminate the health risk. And it leaves in place a ritual that is unhygienic and, according to New York City health officials, among others, inherently dangerous.

But Alleyne says it is clearly the best option available to the county.

“We are a health department," he said. "We can't legislate the procedure. We don't have the ability to do so and there is the question of how efficacious it would be anyway. But there are ways for us to encourage practices to be safer.”

New York City's efforts to reckon with metzitzah b'peh would seem to bear him out, in terms of the difficulty of imposing a more aggressive system of regulation.

The issue has been a live controversy in New York City since the Bloomberg health department first sought to regulate the practice by requiring that parents sign a consent form acknowledging that the city health department does not believe the ritual is safe.

The regulation was challenged in court. Attorneys representing the Orthodox sects said the city's health department was overestimating the dangers, and that there was insufficient evidence to prove metzitzah b'peh is dangerous enough to warrant a public health intervention.

Mayor Bill de Blasio promised to address the consent-form arrangement—which the neither the city nor the Orthodox sects affected by it were happy with—on his first day in office. But he has yet to address the topic in any meaningful way.

Marti Adams, a spokeswoman for the mayor, told Capital the administration plans to unveil a policy "soon," but did not detail what that policy would be.

"The administration is working to develop a new, more effective policy that protects children and protects religious rights in a way that the community is comfortable with, and accepting of, and will participate in," Adams said. "We expect to announce this new policy soon.”

The city's efforts to regulate the ritual are complicated politically by the resolute opposition of the Orthodox sects who support unfettered metzitzah b'peh, but legally, by courts rulings that have made it clear that the practice can't simply be banned for being distasteful.

A federal appeals court ruled any city effort to infringe upon the practice must pass the “strict scrutiny” test, meaning the government must prove the law serves a compelling state interest and that it was written in the least burdensome way possible. The case was sent back to the lower court and has not yet been heard.

The city's health department has for years warned the practice can spread HSV-1, which is common in adults but can be dangerous for newborns.

City health officials have linked 17 cases of neonatal herpes to direct oral suction in the last 15 years. Of those, two have died and two more suffered brain damage.

The city maintains the timing and placement of the lesions is indicative of a virus that was caused by oral suction, and produced several expert witnesses who supported the claim.

Dr. Anna Wald, who assisted in drafting guidelines on the management of H.S.V. infection for the Centers for Disease Control and Prevention, said the evidence linking direct oral suction with neonatal infection is “strong, consistent, and more than biologically plausible.”

The health department argues that there are multiple lines of evidence supporting their assertion. Specifically, health officials say that no other explanation makes sense.

"Any hypothesis to explain these infections needs to explain why these infections are HSV-1, not HSV-2, occur on the genitalia, occur in newborn baby males but not females from Jewish families practicing direct orogenital suction, are clustered in a single Brooklyn zip code where there are no female infant herpes infections, have occurred in babies born to women who do not have HSV-1 infection, and occur within a time frame consistent with transmission during circumcision," said Jean Weinberg, a spokeswoman with the health department.

But without reaching an agreement with the mohels the way Rockland did, the city can't do the tests necessary to prove beyond a reasonable doubt that infected mohels cause the spread of the disease.
That's why city officials use phrases such as “the location … timing of signs and symptoms are consistent with” metzitzah b'peh.

Between 2006 and 2011, the city reported 84 cases of neonatal herpes. Among those, 30 boys had HSV-1 or untyped HSV infection, and five of these boys had confirmed or probable direct orogenital suction.‎ (The disease can also be passed on to babies by family members or other caregivers.)
...

Earlier story

COPENHAGEN: Infant male genital cutting may increase autism risk

Daily Mail
January 9, 2015

Circumcised boys may be more likely to develop autism and ADHD by the age of 10, study claims  

• The findings hold regardless of cultural background, say researchers
• They suggest the pain caused by circumcision may be partly to blame
• This may in turn affect how the brain develops and reacts to stress
• Study looked at 340,000 boys born in Denmark between 1994 and 2003 
• But experts have urged caution over the 'extremely speculative findings'

by Anna Hodgekiss 
Circumcision before the age of five can double a boy's risk of developing autism, controversial research suggests.
 
Scientists believe the finding may be linked to stress caused by the pain of the procedure.
 
The study of more than 340,000 boys in Denmark found that circumcision raised the overall chances of an autism spectrum disorder before the age of 10 by 46 per cent.
 
But if circumcision took place before the age of five it doubled the risk.
Circumcision also appeared to increase the likelihood of boys from non-Muslim families developing hyperactivity disorder. 
 

Regardless of cultural background, circumcised boys may run a greater risk of developing autism and ADHD, a study has claimed

 

The research, published in the Journal of the Royal Society of Medicine, examined more than 340,000 boys born in Denmark between 1994 and 2003.
 
At the age of nine, their health was tracked - and almost 5,000 cases of ASD were diagnosed.
 
Professor Morten Frisch of the Statens Serum Institut, Copenhagen, who led the research, said: 'Our investigation was prompted by the combination of recent animal findings linking a single painful injury to lifelong deficits in stress response...and a study showing a strong, positive correlation between a country's neonatal male circumcision rate and its prevalence of ASD in boys.
 
He added: 'Today it is considered unacceptable practice to circumcise boys without proper pain relief.
 
'But none of the most common interventions used to reduce circumcision pain completely eliminates it and some boys will endure strongly painful circumcisions.'
 
The study goes on to discuss how painful experiences in babies have been shown - both in animal and human studies - to have a long-term effect on pain perception.
 
This is a characteristic often encountered among children with autism, they add.  
 
Professor Frisch said: 'Given the widespread practice of circumcision in infancy and childhood around the world, our findings should prompt other researchers to examine the possibility that circumcision trauma in infancy or early childhood might carry an increased risk of serious neurodevelopmental and psychological consequences.
[The paper goes on to spend  more space on critique and rebuttal than the detail of the study. This never happens with pro-circumcision studies, which are reported uncritically, with benefits often exaggerated and caveats ignored.}
 
However experts have urged caution over the findings.
 
Professor Jeremy Turk, Consultant Child & Adolescent Psychiatrist at Southwark Child & Adolescent Mental Health Neurodevelopmental Service, said: 'The findings of this research, while interesting, need to be considered carefully - one cannot draw very strong conclusions from the data. 
 
'This is not a causal study, but instead compares data sets and looks for correlations. 
 
'While this is a valid way of doing a study, it means that we must be careful about any implications.
 
'For example, many cases of autism are missed until children are older and as there are relatively few cases of autism this could easily skew the data.
 
'Furthermore, there are many potentially confounding variables which could explain raised ASD rates, which the authors do not explore or account for.
 
'Finally, I have some issues with the premise in that their speculations regarding early pain as a cause of autism are, to say the least, highly speculative. 
 
And Dr Rosa Hoekstra, lecturer in psychology at the Open University, said: 'I think this is an extremely speculative study. 
 
'The study is purely based on register data and takes a registered autism diagnosis at face value, without considering cultural or social factors affecting the likelihood of an (early) autism diagnosis. 
 

The researchers suggest the pain caused by circumcision may be partly to blame, in turn affecting how the brain develops and reacts to stress

 

'Even in a high income country like Denmark not all children with autism are detected and given a suitable autism diagnosis at an early age (the age under study in this paper). 
 
She added: 'An entirely different but in my view much more plausible explanation is as follows: Boys with symptoms of autism who undergo circumcision by a medical professional may have their symptoms recognised as autism more often, and at an earlier age, than boys who are not circumcised and who may therefore fly under the radar of medical professionals.
 
'In other words: the detection rate of autism (rather than the risk of autism per se) may be higher in boys seeing a medical professional for circumcision.
 
Professor David Katz, from University College London, who chairs Milah UK, a body that speaks for the Jewish community on issues related to circumcision, said: 'This report is far from convincing: correlation does not equal causation.
 
'There is a long history of attempts to link autistic spectrum disorders to unrelated practices, such as the measles/mumps/rubella association, which proved to be fraudulent.
 
He added: 'There is general agreement that in people suffering from an ASD there are abnormalities that can be identified in brain structure and/or function. 
'There is a strong genetic component, which may be a factor within the faith communities studied here, and which does not appear to have been explored amongst them.
 
'Some contemporary research does indicate that factors besides the genetic component are contributing to the increasing occurrence of ASD.
 
'For example, a variety of environmental toxins have been invoked to explain why these conditions are more prevalent today than they may have been in the past - but again proof of causation is lacking, and these factors are only likely to be relevant in those who are already vulnerable to them.'
 
Applied statistician Professor Kevin McConway, from the Open University, said: 'This study raises an interesting question, but one that cannot be fully answered with these data.'

NEW YORK: Metzitzah: Mayor De Blasio to move "soon"

Capital New York
January 7, 2015

De Blasio to act ‘soon’ on circumcision ritual

by Dan GoldbergJan The de Blasio administration says action is coming soon on the mayor's long-stalled vow to address the controversial circumcision practice known as metzitzah b'peh, promising a policy that will protect children while respecting religious rights.

The religious ritual as practiced by some Orthodox Jewish sects involves a mohel—a person who performs circumcisions of 8-day-old boys—suctioning blood directly from a wounded penis with his mouth.

Health department officials believe the practice can spread herpes simplex virus-1, which is common in adults but can be especially dangerous for infants. The communities that practice metzitzah b'peh have fiercely resisted city attempts, going back before the de Blasio administration, to regulate it.

The city's health department currently requires parents to sign a consent form acknowledging that the health department recommends against performing the practice, a Bloomberg-era policy that was challenged in court. Attorneys representing the Orthodox sects said the city's health department was overestimating the dangers, and that there is insufficient evidence to prove metzitzah b'peh is dangerous enough to warrant a public health intervention.

Mayor Bill de Blasio promised to revisit the consent-form rule on his first day in office, but has so far not addressed the topic.

 

Mayoral spokeswoman Marti Adams said the administration plans to announce a new policy, but did not detail what that policy would be or exactly when it would be revealed.

"The administration is working to develop a new, more effective policy that protects children and protects religious rights in a way that the community is comfortable with, and accepting of, and will participate in," Adams said. "We expect to announce this new policy soon.”

In 2014, the health department reported four cases of neonatal herpes it believed were linked to the practice.

Earlier story

OSLO, NORWAY: Ritual cutting to be publicly funded

The Nordic Page (Norway)
January 1, 2015

These are New Rules in Norway by 2015

Female conscription, cheaper online shopping from overseas, more flexible alcohol sale, legalized poker and changes in abortion laws are among the most controversial changes that have been in force by 2015. ...

New rules on circumcision: Public hospitals can implement ritual circumcision of male children with state reimbursement. [Almost all the boys will be Muslim and hence  old enough to remember it, not newborn. How do Norwegian taxpayers feel about paying for this?]

Bill Would Cut Circumcisions From Medicaid

New Hampshire Public Radio
December 26, 2014

Bill Would Cut Circumcisions From Medicaid Payments

By Jack Rodolico

A bill proposed in the state legislature would end Medicaid payments for circumcisions.

The bill’s sponsor, state representative Keith Murphy of Bedford, describes the practice as unethical.

"To me there’s something fundamentally wrong about strapping a baby boy to a board and amputating perfectly healthy, normal tissue," says Murphy.

Murphy adds trimming circumcisions from the state budget will save money, although how much will be determined by the legislature next year.

The American Academy of Pediatrics says the medical benefits of circumcisions outweigh the risks. Eighteen states deny Medicaid dollars for the procedure, including California, Maine and Florida.

Circumcisions are an important religious procedure for Muslims and Jews.

NEW YORK: Metzitzah: Another baby has herpes

Capital (New York)
Deceber 23, 2014

City reports new case of herpes after metzitzah b'peh

by Dan Goldberg
The city's health department reported that another infant has been diagnosed with neonatal herpes following the Jewish circumcision ritual known as metzitzah b’peh.

There have now been four reported cases in 2014, and though Mayor Bill de Blasio promised to address the issue on "Day 1" of his term, there have been no policy changes during his first year in office.

Metzitzah b’peh involves a mohel sucking the blood directly from the wounded penis and has been roundly criticized by public health experts and by most authorities in the Jewish community.

While some in the Orthodox community contend this is the only acceptable way to perform a circumcision, or Brit Milah, many authorities condone squeezing the blood out or using sterile pipette to suction the blood, which decreases the chance of infection.

This is the 17th case since 2000, the health department said. Of those 17, two infants have died and at least two more have suffered brain damage.

The most recent case involved a boy born in November. Twelve days after his circumcision, the baby was brought to a pediatrician’s office because of concerns about fussiness after feeding, according to the health department. The boy had a “cluster of papules” on his penis and was sent to a dermatologist who then sent the boy to the emergency room.

The location of the lesions, timing of signs and symptoms, and laboratory identification of HSV-1 are consistent with transmission of the herpes virus during direct contact between the mouth of the ritual circumciser and the newly circumcised infant penis, the health department said.

Circumcision usually occurs on the eighth day of life, a time when an infant's immune system is not fully developed. While many adults can have mild cases of herpes, the virus can be far more dangerous if contracted by a newborn.

Dr. Thomas Farley, the city health commissioner under former mayor Michael Bloomberg, "strongly advised" the practice "never be performed."

In 2013, the Bloomberg administration instituted a rule that required mohels to obtain written consent before performing metzitzah b’peh. The consent form contained the warning that “the New York City Department of Health and Mental Hygiene advises parents that direct oral suction should not be performed.”

The policy, which did nothing to prohibit the practice, enraged many in the Orthodox community who felt their religious freedoms were being violated.

The regulation, according to reports in The Jewish Daily Forward, was rarely enforced, and in August a federal appeals court ruled it must pass a stricter constitutional test than was applied by the lower court.

During a Democratic mayoral primary debate in 2013, de Blasio was asked if he approved of the consent form, and he criticized Bloomberg for not engaging in a dialogue with the “community.”

“I would start over,” de Blasio said. “Change the policy to find a way to protect all the children but also respect religious tradition in an appropriate manner and come in Day 1 to City Hall with a new policy that's fair.”

De Blasio has not changed the policy.

When introducing Dr. Mary Bassett, his choice for health commissioner, de Blasio said he intended to leave the Bloomberg consent policy in place until some better policy could be found.

“I've said we will keep it in place while searching for a solution that is more effective,” de Blasio said at the time. "The current approach can be better and that's what we are going to figure out a way to do—with the community.”

De Blasio has not changed the approach.

His office did not immediately respond to a request for comment.

Earlier story