MALAYSIA: Health Ministry wants "medical" female cutting

ABC (Australia)
December 7, 2012

Malaysia storm over female circumcision

Audio: Activist Azrul Mohamad Khalib speaks to Connect Asia about female circumcision in Malaysia (ABC News)

Debate is raging in Malaysia over Muslim female genital mutilation as the country's health ministry reportedly develops guidelines to reclassify it as a medical practice.

In 2009, the Fatwa Committee of Malaysia's National Council of Islamic Religious Affairs ruled that "female circumcision", as it has become known, was obligatory for Muslims but if harmful must be avoided.

Human rights activist Azrul Mohamad Khalib has written a scathing commentary calling for abolition of the practice.

He says it has no religious or medical benefits.

But according to the results of a university survey the practice is widespread, with more than 90 per cent of Malay Muslim female respondents reporting they have been circumcised.

Azrul Mohamad Khalib told Radio Australia's Connect Asia: "It certainly is a surprising figure, really. The study involves more than 1,000 female respondents and when we look at it, around 90 per cent or so are Malay Muslims."

Disappointing
Azrul Mohamad Khalib is also communications and resource mobilisation adviser of the SPRINT project with the International Planned Parenthood Federation.

He said that to have anecdotal evidence "captured" in the study is really "both surprising and a little bit disappointing".

What about the suggestion that the health ministry may be about to register the practice?

He said: "One of the things I find quite alarming with regards to this development is that the Ministry of Health is actually depending on a fatwa, a religious opinion that was actually issued by the national fatwa council, in which they made it obligatory, or 'wajib', for all Muslim women to be circumcised.

"It seems that the Ministry of Health is now (instituting) that fatwa.

"So, in contrary to quite a number of best practices as well as a WHO (World Health Organisation) advisory, the Ministry of Health is taking steps now to sort of make it standardised, or medicalised, in such a way that it might be applied to all public health-care facilities."

At the moment the practice is carried out generally by traditional practitioners, as well as private health practitioners, the activist said.

"One of the things that those working on gender issues in Malaysia have come to realise is that a barrier when we deal with these sort of issues is the lack of awareness - the 'why' of such practices and how harmful it can be.

"Certainly when it comes to female circumcision, the position that has been taken is that if it does do no harm why not do it? Well . . . if there are no benefits to doing it, why do it?

"One of the first steps that we are trying to push out forward is that we are very much trying to spread awareness that such practices are unnecessary.

"They're not required by religion, they're not having any medical benefits whatsoever and certainly when we look at it it's strictly cultural in its entirety.

"But as you mentioned, it is going to be extremely hard if more than 90 per cent of the Malay Muslim population already practising it."

MANCHESTER: "Discredited" method used to circumcise baby who died

Mancunian Matters
December 7, 2012

Nurse accused of killing Oldham baby in botched circumcision used 'discredited' procedure, court hears

by Lucy Kenderdine

A nurse accused of killing a four-week-old Oldham baby in a botched circumcision used a ‘relatively dangerous’ and ‘discredited’ procedure, a court heard today.

Grace Adeleye, 67, of Sarnia Court, Salford, denies manslaughter by gross negligence where 27-day-old Goodluck Caubergs died following the operation at his home.

The jury in Manchester Crown Court heard evidence from expert circumcision consultant Nigel Zoltie on the Nigerian religious ‘clamp and cut’ procedure used by Adeleye in the circumcision.

He said: “Bleeding is such a significant risk that it must be explained to the parents, particularly for the method used on Goodluck.”

Mr Zoltie added that the traditional method carries risks greater than others currently used and the procedure has largely been discredited by medical circles.

But he did argue that it whilst the instruments used by the defendant, artery forceps and surgical scissors, were not the ideal tools, if ‘used with skill’ they could do the job effectively and safely.

The prosecution also argued that the high risks and complications that can arise as a result of the procedure were not properly explained to the parents.

This could mean that full consent for the circumcision was not given as the parents did not fully understand what it entailed and how it would be done, the court were told.

Adeleye also did not get written consent from the parents to carry out the procedure as it is not customary to do so for community and religious circumcisions, the jury heard.

However she defended herself by saying that she discussed the risks with the parents before the procedure through a series of phone calls with the father on the day of the circumcision.

She said: “I explained everything to him and he told me he understood.”

Adeleye added that the fact that they had asked her to perform the circumcision was enough consent for community circumcisions and written consent was never given.

The court also heard evidence surrounding the aftercare of baby Goodluck and what information the parents were given regarding his safety.

Neither parent received written information on what to look out for in terms of complications after the procedure.

Adeleye said: “I told them they should watch out for bleeding and infection.”

The trial continues next week.

Earlier story

MANCHESTER: Nurse circumcised baby who died "culturally"

Manchester Evening News
December 5, 2012

Salford nurse accused of Oldham baby's manslaughter after 'botched' circumcision defends method

A nurse accused of the manslaughter of a four-week-old baby after a home circumcision said today she had carried out "more than a thousand" such procedures without a single problem.

Grace Adeleye, 67, performed the procedure on Goodluck Caubergs without anaesthetic and using only a pair of scissors, forceps and olive oil, Manchester Crown Court heard.

Goodluck was born on March 22, 2010, in Rochdale Infirmary and died on April 17, after bleeding to death the day after the circumcision, aged 27 days old.

The defendant is originally from Nigeria, where she qualified as a nurse and midwife, as [are] the youngster's parents, where the circumcision of newborns is the tradition for Christian families, the jury heard.

Mrs Adeleye said after praying before the operation, as is her custom, she used the traditional, Nigerian "clamp and cut" method, which she had used hundreds of times, without any pain-killers for the child.

And she told the jury when she left the boy with his parents, Sylvia Attiko and Olajunti Fatunla, there [were] no problems but [she] warned them to monitor closely any bleeding from the wound.

...

But today Mrs Adeleye, a mother-of-six told the jury she herself performed circumcisions on her two grandsons and carried out more than a thousand such ops while practising in Nigeria.

She said it was custom to have a naming ceremony for the child on the eighth day after birth then she would travel from church to church performing the operation.

And since coming to the UK in 2004, working as a state registered nurse in Litchfield, she had performed a further 20 home circumcisions.

None had required hospital treatment or suffered excessive bleeding.

Mrs Adeleye said she performed the same circumcision technique on Goodluck like the others.

"It's the cultural one in Nigeria. It's clamp and cut," she said.

Peter Wright QC, defending asked her: "Is there anaesthetic administered to the child before the procedure?"

"We don't usually, no," she replied.

"The culture, why we don't need anaesthetic, that's why we do it early in life. We believe if it's done early the pain is not as well as in an older child."

The prosecution claim Adeleye also failed in her duty of care to the child because the boy's parents knew nothing about the procedure or medical matters.

But the witness said she had discussed the procedure and what needed to be done with firstly the father then the mother separately,

"Mr Fatunla asked me , he told me about the procedure he wanted to do," the defendant told the jury.

"He said he has inquired amongst the Nigerians. That he wanted to do the cultural one."

She added: "He said he's scared of blood. He said he doesn't want to see blood."

Mrs Adeleye said she did not want to use "big medical words" so spoke to the father in their own Yoruba dialect from Nigeria - and stressed the boy must be monitored for bleeding from the wound.

The defendant said she questioned the parents about the health of mother and baby, sterilised the instruments she used and cleaned the boy's groin with TCP before the op began.

She used artery forceps to clamp the excess skin for one minute then used surgical scissors to "trim" the foreskin which only took a "few seconds," before gauze, vaseline and bandages were applied.

The skin was given to the boy's father, because Nigerian custom has it, that if it is discarded carelessly the boy will grow into a "promiscuous" man, the jury were told.

Mrs Adeleye said she remained at the house for one hour to monitor any bleeding before leaving.

She told the jury there was "no problem" with the parents thanking her and about to cook a meal before she left.

She told the jury they would hardly have been "dining and wining" if there had been complications with their son's op.

Proceeding

Earlier Story

AUSTRIA: Charges filed against circumcisors by victims

December 5, 2012

Charges brought against two religious circumcisers for the first time in Austria

Criminal charge: grievous bodily harm inflicted on at least 2000 babies and small children

(Vienna, 29 November 2012) – Charges are being brought against the community rabbi and mohel of the Jewish Religious Community in Vienna. The rabbi has stated himself that for religious reasons he has performed operations, where there was no medical indication, on the genitals of over 1000 male babies. The second accused is a general practitioner who runs a circumcision centre in Vienna and is specialized in ritual Islamic circumcision. He is also the president of the Islamic Religious Community in Vienna. On his website he proudly presents photos of circumcised children online. The doctor also faces charges by the disciplinary commission of the Chamber of Doctors. The rabbi will also be charged for violation of medical law.

Circumcision is a severe trauma for children

“The removal of the penis foreskin is a surgical operation on the physical integrity of the patient. In cases where there are no medical reasons, it is a matter of deliberate grievous bodily harm,” explains Anja Oberkofler, lawyer. Even nowadays the operation is often carried out without an anaesthetic and is extremely painful: babies have no protective mechanism and because of the shock often fall into a momentary coma. The circumcision ritual is often performed without any explanation and frequently also without any anaesthetic; for little boys aged between 6 and 8 this causes severe trauma. The foreskin is the most sensitive part of the penis and thus highly erogenous tissue. When it is removed the glans is covered by a layer of hard skin. This can result in the loss of sexual sensitivity and a limited ability to achieve an orgasm, as testified by many of those affected. Possible complications can occur after the operation such as bleeding or mutilation: according to current medical information the ratio is between 2 and 10 per cent.

Religiously motivated bodily harm is not per se exempt from punishment

A further reason for the charge: for an operation with such grave consequences it is necessary to gain the consent of the person concerned. This does not occur in the case of babies and children. As lawyer Oberkofler stated, “It is incomprehensible why religious approval to inflict grievous bodily harm should be exempt from punishment.” Austria has signed the UNO convention on the rights of children which contains a regulation concerning punishment for the circumcision of children due to religious reasons. The right of protection of bodily integrity is also anchored in the Charter of fundamental rights of the European Union. “The fundamental right of the child to have physical integrity ensured cannot be annulled by arguing for the religious freedom of the parents. The religious freedom of the parents in bringing up their children ends where grievous bodily harm inflicted on their child begins”, she says.

Charge brought by victim of abuse and circumcision

The charge is being brought by Sepp Rothwangl, who was subject to sexual abuse in his childhood by a member of the church. “Nowadays I see it as my duty to ensure that children should not suffer physical and emotional harm because of religious privileges which go unpunished.” Rothwangl has also been instrumental in organizing the campaign against church privileges; signatures are at present being collected for this campaign. “I am totally against special rights for religious communities, because it should not be allowed to mutilate children’s sexual organs in the name of religion without being punished,” stated Rothwangl. “This is where civil society and the rule of law have to intervene.” The campaign against church privileges is therefore also in favour of bringing the current criminal charges.

Afflicted persons break their silence

The second person bringing charges is Cahit Kaya, who was circumcised as a child according to Islamic ritual. “I would have liked to have had the freedom myself to decide whether I would be circumcised or not”, says Kaya today. “But without my consent, without any information and without any preparation on the part of the doctor nor on the part of my parents, I was circumcised in a state hospital in Vorarlberg. Many Moslems suffer a great deal from the sexual consequences of their circumcision and are ashamed to have been a victim of this operation. If they do indeed talk about it, then only in their very closest circle of friends. This silence finally has to be broken.”

www.kirchen-privilegien.at

www.beschneidungsdebatte.info

WASHINGTON: PEPFAR targets babies

PEPFAR
November 30, 2012

PEPFAR now explicitly targetting infants

In its "PEPFAR Blueprint: Creating an AIDS-free Generation" the meaning of the word "Voluntary" seems to have been forgotten.

Action Step: Increase the number of males who are circumcised for the prevention of HIV....
10. Build the capacity of partner governments to begin planning for and financing an integrated, long-term early infant male circumcision (EIMC) program as the adult V[oluntary ]M[edical ]M[ale ]C[ircumcision] program is being scaled-up. PEPFAR’s financial support is prioritized to the adult VMMC program. However, once the adult program has progressed sufficiently, PEPFAR funds may be used to support EIMC activities. (p 23)
[There is no evidence that infant circumcision has any effect on HIV transmission]

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.

MANCHESTER: Midwife tried for circumcision death

BBC
November 27, 2012

Manchester baby boy 'bled to death after circumcision'

A four-week-old boy "bled to death" after a home circumcision carried out by a nurse, a court has heard.

Goodluck Caubergs died the day after nurse Grace Adeleye carried out the procedure without anaesthetic, Manchester Crown Court was told.

The jury heard the 66-year-old only used scissors, forceps and olive oil at an address in Chadderton, Greater Manchester in April 2010.

Mrs Adeleye denies manslaughter by gross negligence.

The court heard the medic and Goodluck's parents are originally from Nigeria, where the circumcision of newborns is the tradition for Christian families.

'Dangers ignored'

Mrs Adeleye, of Sarnia Court, Salford, was paid £100 to do the operation, the court was told.

It is alleged the defendant, who is also a midwife, left a "ragged" wound that bled and her post-operative care was inadequate.

The family home, where the procedure took place, is a mile and a half from Royal Oldham Hospital.

Adrian Darbishire QC, opening the case for the prosecution, told the jury: "The allegation essentially here is that the care she provided in the course of tha t procedure was so bad that not only did it cause the death of that young baby wholly unnecessarily, but it amounted to gross negligence and a crime."

The court heard up to three children a month are admitted to the Royal Manchester Children's Hospital because of bleeding after home-based circumcisions - a danger the nurse should have been aware of.

Mrs Adeleye went to Goodluck's home on 16 April 2010, telling his mother to fetch some olive oil and a bowl of warm water and stripping the baby to his vest, the jury was told.

'No pain relief'

The defendant brought her "instruments" out of her handbag and dipped a pair of scissors into the water in a kidney dish.

She carried out the procedure with no anaesthetic or local pain relief before cleaning the wound with cotton wool and applied a bandage, the court heard.

Between 30 and 40 minutes after surgery, Mrs Adeleye left without making any proper checks on the patient, Mr Darbishire said.

Later, the parents found the bandage had come off the wound and there was blood in Goodluck's nappy. [US: diaper]

Mr Darbishire said even a small amount of blood loss is dangerous and the loss of just one sixth of a pint of blood can be fatal for a newborn.

A post-mortem examination revealed Goodluck's death was caused by a loss of blood.

The trial continues.