Attorneys for the Rights of the Child Protecting Children’s Newsletter Bodily Integrity © ARC Fall 2009. Volume 7, Issue 3 (Whole Number 21)

In This Issue 2009 CDC National HIV Prevention over time evolved to something like:

Feature Articles Conference, Atlanta, Georgia, “We are Intact America, a new chil- August 23-26 dren’s rights organization focused on CDC Conference (Bollinger).....page 1 protecting babies from harm. Normally, (Intactivist Report 1) CDC Conference (Taylor)…...... page 2 By Dan Bollinger we are at baby fairs and medical con-

ferences educating about the harms of GIAW 2009………….……..…..page 3 Aubrey Taylor and I staffed the circumcision and the care of the intact IAS 2009 Cape Town………….page 5 booth at the Centers for Disease Con- penis. When we heard that the CDC trol and Prevention’s (CDC’s) 2009 Paul Mason Speaks………...…..page 7 was preparing to issue a policy state- National HIV Prevention Conference ment recommending circumcision for Boldt Case Update……………..page 8 for the duration of the event. Geor- all American baby boys, as children’s

From the Executive Director ganne Chapin of Intact America (IA) advocates, we had to show up and and ARC, Jack Travis, M.D., Amy Cal- speak out.” I don’t know the exact Executive Director’s Message....page 9 lan of IA, and David Llewellyn (like count, but we collected about 6-7 pages Book Reviews Georganne Chapin, an ARC Board of signatures on our CDC petition. Member) also attended as their sched- Circumcision & Human Rights page 10 Pretty amazing considering almost eve- ules permitted to give interviews, ask ryone there is funded by the CDC or Fearful Symmetries……….…..page 10 questions at sessions, and attend meet- has ties with them. There were a lot of

Female Circumcision………....page 11 ings. Aubrey and I have worked dem- open minds and a lot of closed minds, onstrations together before; our combi- and very little in between. We got a lot In the News nation of male/female, young/old of perplexed looks (always a good con- ICGI Press Release..……...... page 13 worked very well here, too. The six of versation starter). us made a good team, each of us sup- MGMBill Press Release……....page 13 porting the others in our particular Tasmania Issues Paper…...…...page 14 strengths.

HIV Breakthrough………...….page 14 The booth looked great. Photos of it

Gays Not Protected……..….....page 15 accompany this article. It is a huge step forward from what pro-intact booths $400K Malpractice Award…....page 16 have looked like in the past and this is

Baby Dies; Parents Sue….……page 16 important since the quality and profes- sionalism of the display reflects on the $2.3 Million Settlement……....page 16 quality and professionalism of the or- Circumcision May Be Illegal....page 17 ganization.

South Africa Parents In Court...page 17 By far the booth item that got the

Uganda: Hard To Implement....page 18 most attention (besides Aubrey’s hair!) was the list on the main banner of ten Tribune Discusses Inactivism...page 18 reasons not to circumcise. I would let

Uganda To Outlaw FGM……..page 20 visitors read a few of the points before l to r: David Llewellyn, Georganne introducing myself and I’d often be Chapin, Aubrey Taylor at 2009 CDC Times Mentions Intactivists ….page 20 Conference on HIV chided to let them finish reading. These Circumcision Is A Crime……..page 21 points are important since they sum up We spoke with more than two dozen Helsinki Article Published...….page 22 our position (see the website www. intactamerica.org/node/6t for the list CDC employees. They stopped by to UK Mom Sues After Botch..…page 22 along with text explaining each one in check us out and to collect information. depth). The second most attention- They were surprised to see a group that getting item was the poster made espe- had the balls to show up at a CDC-led Attorneys for the Rights cially for this conference in which we conference in opposition to where the of the Child mentioned the CDC by name, calling CDC appears to be heading. [But see the Executive Director’s Message else- 2961 Ashby Ave., them to task about circumcision and where in this issue, where the CDC’s Berkeley, CA 94705 HIV. posted statement the day after the con- Fax/phone: 510-595-5550 From the booth, our primary com- ference backpedals in an apparently www.arclaw.org munication to passersby varied, and page 2 Attorneys for the Rights of the Child Newsletter Fall 2009 direct response to the intactivist pres- circumcision could possibly have any- week. If nothing else, we provided ence at the conference—Editor] CDC thing to do with helping the HIV pan- CDC officials who think like us the staff politely listened to our claims and demic. Both promised to sign our peti- opportunity to speak out against cir- position. None argued with us. In fact, tion (they were ‘on the clock’ and rep- cumcision and HIV. I am confident that they were the most boring group of resenting the CDC, but said they would we influenced the pending statement to people I spoke with because they just sign online once they were home as an our benefit, but to what degree I don’t stood there with a blank look on their individual, not a CDC employee). know. We need to keep the pressure on face, listened politely for a few min- Health department officials and until the policy statement is issued or utes, asked a few questions, and then staffers, including the Director of the tabled. thanked us for our time. One CDC fel- US Department of Health, were very low said he was glad we were there, open to learning more, and none be- since there was a lot of opposition to 2009 CDC National HIV Prevention lieved that circumcision would help Conference, Atlanta, Georgia, circumcision. A good conversation with HIV. They are on the front lines. I ensued. August 23-26

repeatedly heard that integration of All of the CDC staffers accepted drug counseling, safe-sex education, (Intactivist Report 2) from us copies of the IA policy state- and free condoms worked the best. By Aubrey Taylor ment directed at the flawed African Building allies within this group would I was honored to be asked to help studies and at the CDC’s imminent pol- be a very good next step, since it is staff Intact America’s exhibitor booth icy statement. We asked them to sign these folks that would implement any at the 2009 National HIV Prevention our petition, which always got a policy the CDC would issue. Conference, held in Atlanta from Au- chuckle. gust 23-26 by the Centers for Disease Most of the African and first- generation African-American delegates Control (CDC). Just a few impressions who stopped by didn’t think circumci- of how it went.

sion would work in Africa or the US, The traffic and they agreed that such programs seemed a lot would take precious funds away from slower to me than programs that did work. They were ea- booths I’ve done ger to sign the petition. in the past like the

I was surprised to hear the hygiene American Acad- rationale from so many upper level emy of Pediatrics health officials. Of course, we coun- (AAP) or baby tered by urging “washing, not amputa- fairs. People had tion” and by noting that “girls have come from a vari- more such places and no one is advo- ety of different cating they be cut.” Our comments arenas instead of Dan Bollinger at 2009 CDC largely fell on deaf ears. On the posi- Aubrey Taylor just one, so it made Conference on HIV tive side, I didn’t hear one instance of guessing what an- someone mentioning urinary tract in- gle to take with each person a little in- The overall position of the CDC fections (UTI’s) as a justification for timidating. Attendees included immi- staff, and other medically trained folks circumcision. grant health workers, public health peo- was that if circumcision works to stop ple, sex worker support people, educa- the HIV pandemic to any degree then it Another passerby, not a CDC tors, government employees, and many should be employed. When I would staffer, said that to him, the most com- others. I think we did great though, bring up that the boy’s human rights pelling argument against circumcision and overall the audience was very re- were being violated when forcibly cir- wasn’t any of the ten reasons listed on ceptive. cumcised they either disagreed or said the banner, but the 100 deaths from the violation was necessary, as vac- circumcision each year that I brought It was definitely a productive en- cines or emergency room procedures up during our conversation. deavor for us to be there, despite the slow crowd. We got the chance to are necessary. They just could not see One CDC staffer invited us back to far enough past their stethoscopes to speak to many CDC employees, and make a presentation at next year’s con- while some just listened politely and grasp the human rights issues. To the ference on immigrants and HIV educa- CDC, it seems, medicine trumps human then left, I can think of at least three tion. He said Kevin Fenton, recently that stopped to discuss the issue at rights. Countering this mistaken belief named as Director of the CDC’s Na- is the most important point we need to length and voiced their skepticism at tional Center for HIV/AIDS, would be the African trials or validity of the get across to them. there.

HIV/circumcision connection. It made Two CDC staffers I spoke with were I imagine there are a lot of discus- me feel good to know that not everyone unique. Both ridiculed the notion that sions going on at the CDC about us this involved there is believing this hoax.

page 3 Attorneys for the Rights of the Child Newsletter Fall 2009

Two further successes were the 49 on the photo: “Yes, a circumcision Personally, I think it’s about time signatures we received for the petition please!” Regardless of how laid back I someone got yelled at, and I’m thrilled to the CDC urging them not to recom- am, I can see that within the context of at the good luck of it being witnessed mend neonatal circumcision and the the situation this was offensive, unpro- by one of the CDC’s top officials. I 47% jump in web traffic for Intact fessional, and a harmful tactic aiming couldn’t help but wonder at the timing America’s website! to normalize the humiliation of intact when I read the recent statement from

The highlight of the entire time for men. the CDC (“Status of CDC Male Cir- me was watching David Llewellyn do cumcision Recommendations;” http:// what all of us have no doubt wanted to As I was rolling my eyes thinking “how www.cdc.gov/hiv/topics/research/male- do at least once: yell at a circumcision typical”, David stood up and loudly and circumcision.htm) confirming that they pusher for being insensitive to intact angrily told the man how offensive the are NOT going to suggest that circum- individuals and bigoted against the nor- photo was to intact men and to remove cision be compulsory, as some recent mal body. We all had an opportunity to it immediately. He had to demand this rumors have claimed. I think our pres- attend a presentation for Operation twice. He went on about the habit of ence last week was definitely felt, and I Abraham. This is an Israeli organiza- the circumcised to disrespect and hu- encourage everybody to sign the peti- tion that has trained African surgeons miliate the intact, and said that he was tion at intactamerica.org if you haven’t to do adult circumcisions. I listened to appalled that his tax dollars were pay- already done so; and maybe even write founder Inon Schenker, Ph.D., MPH ing for this behavior. The man did not your own letter to Dr. Kilmarx, or even speak for 20-30 minutes and I cannot apologize. Dr. Kevin Fenton, another big wig Di- tell you what he said, or what he wants rector at the CDC. Let’s let them know to do in the U.S. (Sorry if that’s not In the tiny audience of maybe 15 or so, that WE KNOW this circumcision helpful, but he didn’t say anything!) coincidentally, Dr. Peter Kilmarx, the business is bad science, and it isn’t Chief of the Epidemiology Branch of wise of a public health organization to At the end of his Power Point, he put the Division of HIV/AIDS Prevention focus only on potential “benefits” of up a photo of a nude intact man from of the CDC happened to be there. Near surgery, while ignoring the literal bene- knees to neck with an elephant painted the end of the discussion, after David fits of intact genitals. on his body so that the trunk was his stormed out of the room (demanding an Aubrey Taylor’s youtube channel is: you-know-what. Now, I am not shy. apology of Kilmarx as he went) Dr. www.youtube.com/user/ I’ve seen plenty of penis pictures, and Kilmarx made a statement to the room whatUneverknew am always pleased to see an intact one. that seemed to have the goal of distanc- The artist in me thought “how clever, ing the CDC from this presenter and his Genital Integrity Awareness Week an elephant”. Then I read the graffiti organization. March -April 2009

By James Loewen

Visitors to the US Capitol Building the last week of March were greeted with enormous bold banners stating, “Circumcision is Unnecessary and Harmful.” and asking, “Whose Penis? Whose Body? Whose Rights?”

William Stowell

This year marked the 16th annual demonstration and march against infant circumcision in Washington DC to celebrate Genital Integrity Awareness Week (GIAW). Led by David Wilson, founder of the Stop Infant Circumci- sion Society, intactivists gathered daily on the West Lawn of the U.S. Capitol Building to speak with many thousands of visitors. “We get a full range of re- sponses from the public,” said intactiv- Intact America’s mobile billboard at 2009 CDC Conference on HIV page 4 Attorneys for the Rights of the Child Newsletter Fall 2009 ist Van Lewis. “People come here from Hanny Lightfoot-Klein spoke of her sonal courage that were needed, to do all over the world responding with eve- childhood in Germany. “I was a Holo- what Marilyn did.” rything from complete incredulity that caust survivor only in terms of Milos said she felt awkward receiv- Americans do this to their children. [psychology]... I was never in a camp, ing an award for doing something she Others know that we do this and are my blood was never shed, but I came “couldn’t not do.” She gratefully ac- completely appalled. With Americans out of Germany... pretty crazy at the knowledged those who began speaking again it's a full range, from complete age of eleven. It took me a long time to out against circumcision before she did, and total support for our actions to ter- get over it.” Lightfoot-Klein recounted several of whom were present that ror, in which case they just pass by on how she traveled to Africa and learned night. Milos recalled witnessing the the other side of the road. In between about FGM on her first night in Khar- circumcision that started her activism are people who are curious, people who toum. “It was instantly clear to me that and wondered why seeing a circumci- have an opinion but are open to re- this is why I was saved, and this is go- sion wasn’t enough to motivate every- thinking, people who mildly agree with ing to be my life’s task from now on, one to stop it. “What happens to us,” us and want to know more. It’s a won- and it has been.” she asked, “that we lose the empathy to derful place to come and educate peo- Intact America presented Soraya ple.” Mire with an award for personal cour- age. Mire spoke about the difficulties encountered speaking out against her Karen & own culture in which women are be- Carter lieved not to know right from wrong. Glennan She also spoke of being disowned by her family and Somali culture for speaking out against genital mutilation. Every year since 1994, this protest “This journey was hard and painful,” has brought new intactivists to the fore. Mire said. “I dared to question the (l to r): Award winner Hanny Lightfoot- This year, two young men, Zachary powerfully held tradition of female Klein, presenter Georganne Chapin, Levi Balakoff and Jason Seigel joined genital mutilation, and I dedicated my presenter John Geisheker the protest and expressed their outrage life to being my culture's first advocate over circumcision with a hunger strike. respond to a baby as we all should be Jason Seigel explained his reason for responding?” protesting, “The issue of circumcision In order to study circumcision prior is so repressed, and the people of this to 1989, one had to go to various disci- country are in such a state of denial plines, Milos recalled, so she organized about a blatant atrocity occurring to a conference and invited scholars from babies every single day. There is a long history, religion, anthropology, psy- and complex history about why such an chology, sociology, medicine, ethics insane thing would be allowed to be and law to discuss the issue. The pres- practiced in any country where freedom entations from that first symposium and common sense exist.” Three award winners (l to r): Hanny were published [in the Truth Seeker Lightfoot-Klein, Soraya Mire, Marilyn magazine--Ed.], the first text to look at Milos the subject from many perspectives. Since then the papers from the NO- for its abolition.” CIRC International Symposia have Laurie Evans Mire explained why she also speaks gained greater and wider circulation, out against male circumcision and what now being published by Springer, the continues to drive and inspire her dedi- world's leading medical text publisher. cation to eradicating FGM, “My goal Milos also spoke with enthusiasm always is to heal, inspire and show how about recent YouTube videos being On Sunday, March 29, Intact Amer- one heart could hold the light and never made by young people on the subject of ica celebrated the long-time achieve- let go.” circumcision, “using terminology that ments of three remarkable women. Georganne Chapin, director of In- we instigated in the eighties...and that Marilyn Milos, Hanny Lightfoot-Klein makes me really proud!” tact America, became emotional as she and Soraya Mire, who have each de- introduced and presented the Intact The next day, Monday, March 30, voted the better part of thirty years to- America Award for Humanitarian Ser- Greg Hartley, a father of two, joined ward eradicating genital mutilation of vice to Marilyn Milos, the mother of the demonstration at the White House. children. the genital integrity movement, ac- “I think the biggest problem is Ameri- Accepting the Social Justice Award, knowledging “the huge amounts of per- can males don’t want to admit that page 5 Attorneys for the Rights of the Child Newsletter Fall 2009 they’re damaged,” said Hartley. “It’s CTICC, which is a large, very modern thusiastic about our presence and asked sad that it’s such an entrenched feeling facility. It was obvious immediately questions about why we are challeng- that I’m ok, my son will be ok. It’s hard that IAS 2009 was a big deal, as there ing the "conventional wisdom" that to get past that. It’s hard to admit that were many dozens, perhaps hundreds, male circumcision (MC) reduces infec- you’re damaged. It was hard for me, of volunteers directing traffic and using tion risk. Interestingly, most visitors but fortunately I had enough informa- electronic scanners to allow delegates were mentioning that they're being told tion from wonderful people like and exhibitors into the exhibition hall. that MC not only reduces the risk of

Marilyn (Milos) and Dr. Paul Fleiss. Dean took charge of setting up our contracting HIV, but also the risk of all This wealth of information helped me booth, which was well-situated for foot Sexually Transmissible Infections realize that there’s no reason for my traffic and visibility. We were assigned (STI's), which in turn affects the risk of son to be like me, no reason at all. In one small, round table, maybe 2 feet in contracting and passing HIV. We have fact he should be better than I am, he diameter, while other booths had 5-foot had to do a lot of verbal education, and should have all his parts.” it would have helped if we had some long rectangular tables. We opted to Genital Integrity Awareness Week switch to the larger table at a cost of 38 materials on hand that refuted the euros, an expense that will have to be widely-held idea that intact men harbor settled after the conference. We then more of all types of STIs, or if the ICGI Report by Martin Novoa from taped up our various signs and banners page for this conference had links de- bunking this idea. IAS 2009 Cape Town and opened for business. Days 1 & 2 Day 1 brought only two or three

Regards from Cape Town, South "difficult" visitors who refused to ac- Africa, where it was the middle of win- knowledge that MC may not reduce the ter in July but the days are extraordi- risk of contracting HIV by 50-60%. After a while we agreed to disagree. narily beautiful (75 degrees and sunny).

IAS 2009 was the big AIDS confer- We finished up around 6 PM when ence of the year for pharmaceutical we saw that most of the other exhibi- companies, testing equipment manufac- tors had closed down shop. We left turers, and researchers. This was an about a dozen of each handout on the "off" year, as the even larger AIDS table and left the posters and banner conferences are sponsored by a differ- taped up, but took all other materials home for safety. We felt that without a ent international organization and are Dean Ferris, Jack Travis, Martin Novoa held only in even years (since about Photo by Andy Fabre budget for reprinting, we could not risk 2002). In the odd years, a group out of having an opponent steal our materials Vancouver, BC organizes these confer- The first day's crew consisted of from under the tablecloth and dispose Jack, Michael, Martin and Shelton. of them. ences to fill in the gap. However, im- portant announcements may still be Dean stayed for the first hour, but then Day 2 made at these slightly less prestigious had to leave for the airport for his trip I arrived at the CTICC about 9:30 confabs. to Mozambique. Conference attendance was quite light for the first day, as we and started setting up and fielding early Day 1 visitors. No one had disturbed our dis- learned vividly on Day 2. My take on On Sunday, 19 July our group con- this is that most delegates see these play. Michael, Jack and Andy arrived vened for the first time for a collective events as worktime, and do not will- together about 10 am. Today was Jack's breakfast at Arnold's Restaurant just ingly give up any of their personal big day for presentations and inter- south of downtown. Cape Town is a weekend time to "do business". Also, views, so he was gone for most of the major port city that faces more or less the bulk of presentations did not begin day. Andy was there for part of the day, north, with the Cape Town Interna- until Monday. As such, numerous ex- but left early to tend to family matters. tional Convention Centre (CTICC) hibitor booths were not staffed on Sun- So, we had a skeleton crew but a lot right at the harborfront. day, but merely had literature available more delegates coming by. Michael to passers-by. was able to attend the poster sessions Dean Ferris organized the breakfast, and videotape some of them. which included Jack Travis, Michael On Sunday, we had occasional visi- As with the previous day, most visi- Smith, Martin Novoa, Shelton Kartun tors to our booth. Most were politely tors to the NOCIRC-SA booth were of NOCIRC-SA, Andy Fabre of NO- inquisitive and took some or all of our politely inquisitive and a few were CIRC-SA and David de Kiewit of five materials, which consist of three really enthusiastic about our presence. NORM-SA. We used this first meeting letter-size handouts, a quarter-page Michael kept an informal tally of atti- to get acquainted and to go over some handout on cardstock that mimics our tudes. The most common comment was of the basic materials of the conference, poster, and a glossy business card with that it was great someone was challeng- including key schedules. a photo of two men and the ICGI web ing the conventional wisdom and vali- address. A few booth visitors were en- Just before noon, we got to the dating common sense. page 6 Attorneys for the Rights of the Child Newsletter Fall 2009

Several visitors demanded to know and that it is important that the compre- sic message across, but mostly we had "who" was behind our presence and hensive MC programs in Africa move to just turn those visitors away. Andy where our funding was coming from. ahead quickly and without encum- did convince the exhibitors from AC- They refused to accept that we were a brances. We had a few visitors come by TUP Paris to offer to help translate for loose-knit group of volunteers and who were disturbed and confused by us on Days 3 and 4, but I'm not sure the conflicting messages. what favor they may want in return. walked away complaining about our "agenda" and ulterior motives. The confusion only increased on Numerous visitors asked whether

A few people came by and simply Day 3, when we talked to delegates we oppose all circumcision. I explained noted that we were, "wrong," and that who were coming directly out of pres- that in the context of this booth, our very prestigious researchers had really entations where they are told that the message was simply that circumcision settled the debate on whether MC was a question of MC is settled. Many people is a dangerous diversion from programs valid health intervention. Two visitors have already commented on how trou- and treatments proven to work. Most stood out as particularly difficult -- a bled they are by the utter confidence of were relieved to hear that we were not young US woman whom Michael presenters, that all discussion over the actively campaigning at the CTICC fielded very adroitly and a US man in benefits of MC is closed and accep- against tribal and religious circumci- tance is universal. sion. his mid-30's who was incredulous (and not in a nice way) that we were there Day 2 saw probably three or four Communication was a serious prob- with our message and kept walking times the visitors that Day 1 did. lem. Most of our cell phones didn't away and coming back saying "this is General Thoughts work or cost $2.00 a minute to make or just unbelievable". He took our group receive calls in South Africa. There photograph as, "evidence." Interest- Nearly everyone who came by the was a tiny wifi zone set up about thirty ingly he eventually dragged a woman booth was interested in the Rakai study feet behind us, but the signal was unbe- colleague over to our table who was in the Lancet showing that HIV- lievably weak and unstable. Coordina- also skeptical but listened politely and positive circumcised men are 50% tion among us was therefore bad. We took our materials. more likely to pass the virus to female badly needed a better system, like inex- partners than intact men are. Unfortu- pensive walkie-talkies. nately, the study was several pages long and we had only two display cop- Few other exhibitors stopped by, ies. We were assuring visitors that a and we did not go to other exhibits. By link is on the ICGI conference page, and large, our visitors were IAS 2009 but many were still quite disappointed. delegates. Curiously, at the very end of each day, we tended to get swamped by Visitors were asking for more de- conference volunteers (local young tailed information about which pro- people) asking for information. grams we believe work better than MC against AIDS and what the precise data Overall, I found contributing to our are. They were requesting exact refer- presence at IAS 2009 to be a very posi- ences and exact countries. I personally tive experience. We were the only felt very ill-equipped to help them "official" voice speaking out against Martin Novoa, South Africa, July 2009 when challenged directly. the wild rush towards mass male cir- Photo by Andy Fabre cumcision in Africa. Our presence was I saw no delegates so far from the We maintained a sign-in sheet and widely praised. We projected a very UK, Germany, Austria (the site of next asked visitors to put down their infor- professional presence that went over summer's big AIDS conference), Spain, mation, but most declined to do so. We well. or anywhere in Asia. Very odd. There obtained about a dozen names and were a handful of South Americans, As I complete this report, Day 3 is emails in the first day and a half. We lots of South Africans and other Afri- just beginning and looks slightly lighter also asked for business cards and about cans, some French, Dutch, and Scandi- than yesterday. Most curious visitors four people gave them in the first day navians. have already come by on the first two and a half. days of the conference. The delegates from the USA were There was a booth just catty-corner far and away the most skeptical and to ours run by the Treatment Action difficult to deal with. Some were down- Coalition of South Africa. They had a right unpleasant and seemed to take our two-page handout for visitors that was challenge to MC rather personally. a little problematic for us. It declared Visit our Website at: that the issue of MC and HIV preven- We had six or seven native French tion is well-settled, that MC improves speakers who really couldn't communi- www.arclaw.org women's health as well, that circum- cate with us. I used my high school cised men have lower rates of all STIs French a couple of times to get our ba- page 7 Attorneys for the Rights of the Child Newsletter Fall 2009 Transcript of Tasmanian Children’s government." yourself and who you are. That has

Commissioner Paul Mason Presenta- What needs to be changed? Marilyn been my perspective and my approach tion at joint FORWARD-NORM-UK [Milos] told me she’d been working to this whole issue and I think that's the press conference, London, within this organization and Steven easiest way to respond to the HIV trials September 3, 2008 in Africa. The most recent information [Svoboda], John [Geisheker], David Transcribed by Travis Konzelman [Llewellyn] and other people have been from the World Health Organization slugging away at this issue for decades (WHO) is that genital modification sur- Thank you everybody. The commis- geries are being botched and need to be sioner of children, like your commis- before I stumbled upon it last year. I think there can be an element of navel- done properly in order to achieve a sioners of children in the United King- good outcome. That is all very well and dom, is a body independent of elected gazing in the movement, with every- body sitting around congratulating each I might enter the debate of what adults government and created under statute want to do with adults and what adult that deals with child protection. It does other for their views. And the reason I have come halfway around the world health promotion programs want to do not import the rights of children from with adults. But WHO should take the Convention on the Rights of the from a tiny rocky island town in Aus- tralia is because I really do want some- great care regarding non-emergency Child (CRC) into domestic Tasmanian surgery on children. I am concerned law. It says these are the guiding prin- thing to happen. I want our message to be heard in the larger world. about children and I am concerned ciples. So when I came into the job a about the voice of the voiceless. Hu- year and a half ago, I was looking at a man rights for children are a new thing. wide range of issues. I stumbled across Children in history have been treated as FGM (Female Genital Mutilation) and- chattel for disposal. They have been -I will be glad to talk to Naana [Otoo- treated as slaves. In later times, they Oyortey MBE, Executive Director of have been treated as cheap labor. Only FORWARD] about this later—in Tas- in the very end of last century did they mania and Australia we do have gov- start to be seen as people. ernment programs to educate, assist and support families who feel the pres- In 1948, the United Nations Decla- sure to conduct genital mutilation on ration of Human Rights, which in- Paul Mason, cludes a reference to personal integrity, the girls. We are devising various ways Tasmanian Children’s Commissioner of assisting those families around the does not refer directly to children. It very problems Naana is talking about. does talk about people. It took until We also have legislation like your leg- My British grandfather always 1989, when the CRC was created, for islation in the UK that criminalizes the talked about the “golden thread” of the U.N. to clear up this particular di- procedure and criminalizes parents British law, the presumption of inno- lemma and say maybe we ought to traveling out of the jurisdiction in order cence. The golden thread in the circum- have rules for children as well because to have the procedure conducted on cision issue is the rights of the child. people seem to be overlooking that fact their daughters. All of the arguments of the proponents that children are people. The rights that were protected under the United Na- I will start my speech by referring to for FGM and for male circumcision revolve around the needs of adults. tions Decloration of Human Rights in the person in Tasmania who leads the 1948 were being ignored when it came bicultural teams in Tasmania. When I They all revolve around religious needs of adults, cultural needs of adults, tradi- to the little people. We got a new set of first talked to her about FGM a year rules in 1989. ago she said, “You know what? 100% tional needs of adults and the epidemi- of the time, when we hear through the ological studies by adults about adult The march of children toward full grapevine that a family is contemplat- sexually transmitted diseases. Adults humanity continues. I see all the people ing a procedure on a girl or is contem- are saying these are appropriate things involved in intactivism as being in- to do to children. volved with the march of history to- plating leaving for Indonesia to have the procedure done there, 100% of the My perspective as Tasmania's Com- wards protecting the humanity of chil- time they say to us, “You do it to boys! missioner for Children is that I am re- dren. This is what it is about. This is You DO NOT tell us not to do it to sponsible for 117,000 children out of why I am optimistic. It may not be in girls!” And she said meeting this re- Tasmania's total population of 480,000. my lifetime, but I know there are cul- sponse is like walking into a brick wall. My approach to my job has always tures that perform mutilation on the We have not yet come up with an an- been to lower the camera angle and boys and girls in their own cultures that swer for that. So I said to this bicultural look at the world from about table used to do other things in their own leader, "I think I can help you. I think I height. What do you see? The world histories that they no longer do. All can help you, if we can work together, looks enormously different from down cultures change. That is good news for yourself as a professional and myself as there. Cars are a lot bigger and faster. us. It is good news for all the people an independent advisor to the govern- Parks are a lot more beautiful and your living in those cultures. I am interested ment to try and turn around the eyes of body is much more connected with to hear Naana report that women do not think that circumcision is a good idea page 8 Attorneys for the Rights of the Child Newsletter Fall 2009 for their sisters, aunties, mothers, and Boldt Case Update nine, the court could more easily have girls. That voice is a voice that By John Geisheker, ignored him and humored the father. emerged from this century and at the Doctors Opposing Circumcision So the delay, while unconscionable, end of last century. That voice was not may have saved him. During the present 150 years ago. So history ARC Newsletter readers will re- intervening half decade, he had the marches forward. Germaine Greer said member the case of Misha Boldt, the time to develop some of the aplomb of she was not concerned about the set- now fourteen-year-old Oregon boy fac- an adult, as well as an evident sense of backs for feminism. She said history ing a non-therapeutic and unwanted himself as in charge of his own destiny. circumcision sought by his custodial marches two steps forward and one So far so good. step back. That is a wonderfully direct father after the father's claimed conver- view of history. I acknowledge Ger- sion to Judaism. The Jackson County court released maine for that. I have to acknowledge its written decision this past June 3 on Australia for that; she is possibly the the question of whether Misha's differ- most famous Australian. ences with his father over religion and other issues constitutes a ‘substantial It is often said that parents have a change in circumstances’ sufficient to right to decide what surgery their chil- change custody. We argued in the dren undergo. But the other change that briefs long and loud that the issues of emerged from the twentieth century is custody and circumcision ought to be the understanding that the rights of per- analyzed and adjudicated separately. son A cannot trump the rights of person We thought it was unethical of the OSC B. The rights of children are discrete. to link the issues, basically forcing the They exist on their own. If you ask child to choose unnecessary surgery children, they will agree with you. If John Geisheker with one parent or freedom from the you ask parents, they tend to get a little surgery with the other parent. This funny about questions of whether or Early last year, the Oregon Supreme Hobson’s choice would not permit a not they have the right to hit "their" proper consideration of either the medi- child, to whip "their" child, to wound Court (OSC) ordered that the boy’s testimony be taken at a remand hearing. cal or the custody issues. It was abso- "their" child or to ask a doctor to lutely cruel and stupid to link the is- wound "their" child on their behalf. The father and a consortium of Jewish organizations attempted to appeal the sues, tying Misha's hands. Though I think one of the ways this move- OSC's decision to the United States again, ironically, this worked out in the ment is going to broaden its message is end to suit his (and our) purposes. Supreme Court on the grounds that the to tackle the medical profession, not circumcision was the father’s decision In a sad coda to the proceeding, primarily on medical grounds but on to make and not the son’s. Jackson County Judge Greif said on the the human rights issues and the finan- record that Misha had begged her not to cial issues. I am here to bat for the chil- Permission for the appeal, also known as certiorari, was unceremoni- send him back home with his father dren of Tasmania who are still at risk that day and that he was afraid of the of genital mutilation and of injury by ously denied. father. When I heard her say that I corporal punishment in the home. I On April 22, in the remand hearing thought, “Judge, here’s your opening! have come all this way because I be- in Jackson County, Oregon, the boy What are you waiting for? Send the boy lieve that no one who champions the privately testified in the judge's cham- home with the mother as temporary rights of children can support the prac- bers with neither of his parents guardian; it’s a no-brainer!!” The attor- tice of routine neonatal circumcision. If allowed to be present. Misha told the neys explained later that under Oregon a child grows up and wants to have a judge that he did NOT want to be cir- law, such temporary guardianship can circumcision for any reason, I respect cumcised and did NOT want to be Jew- only be ordered where an imminent that. But the child who is a neonate can ish. The Judge went on the record in threat of bodily harm exists. Psycho- not make that decision. CRC Article the courtroom accepting that testimony. logical pressure is not enough. Two says the child has the right to have In early June she issued an order find- a voice in decisions that are made about ing that significant cause existed to We are hoping that Misha can hold the child. There is no urgency to cir- warrant testimony on whether custody his own until the custody hearing, and cumcision. So my message about cir- should be given back to the mother. that the father has enough residual san- cumcision is that it can wait. I call on ity to leave the lad alone, what with so all congresspeople and all commission- Yes, we won. But the real hero of many adults, including the Court, on ers of children in every jurisdiction the Boldt case is Misha himself. alert. Misha has the private cell number around the world to work together to At age fourteen, few of us would have of his own attorney, and has carte eradicate this practice and to eradicate the courage to defy our father’s blanche to call him any time, day or wishes in so public a way. night, if he feels threatened. all non-medically indicated surgical practices on children of all kinds. Ironically, had Misha’s preferences At the moment, the family is under Thank you! been asked five years ago when he was page 9 Attorneys for the Rights of the Child Newsletter Fall 2009 evaluation by a neuropsychologist, paid John Geisheker provides yet another ing male as well as female genital in- for by donors to DOC. of his learned yet accessible updates on tegrity, the precise topic of the article

We are left to wonder: Would the the ongoing drama of the Boldt v. by Rob Darby and myself in the Fear- Court have protected the boy if he had Boldt legal case in Oregon. (The latest ful Symmetries book. ARC has submit- acquiesced to the father's wishes? At news is very good.) Also included are ted a formal response to this Issues Pa- what age may a boy express a prefer- a review of an important new book on per along with a number of articles we female genital cutting that also ad- urged the TLRI to review. ence regarding circumcision? At what age may a child express a preference dresses issues relating to male genital Perhaps the best recent news is a regarding religion? May parents im- backpedaling statement that the CDC pose a surgery on a child for reasons posted on August 27 (http://www.cdc. relating to a parent's religion? gov/hiv/topics/research/male-

I want to thank all who helped with circumcision.htm. The CDC was ap- this case—with earmarked donations, parently directly responding to the in- brief editing, ideas and encouragement. tactivist presence at their HIV confer- I especially want to thank the members ence, which ended the preceding day. of NORM-UK, who, though far from The statement said that the CDC’s up- the scene, were extraordinarily gener- coming circumcision recommendation ous following the conference at Keele would be “completely voluntary” and in 2008. It is a real joy to have a win at may simply be a recommendation that long last. Steven Svoboda and Marilyn Milos parents be educated about risks and presenting at the APPPPAH Conference, benefits so they can make an informed John V. Geisheker, J.D., LL.M. Pacific Grove, CA April 26, 2009 decision. Also welcome was the Royal Executive Director, Australian College of Physi- General Counsel, integrity, and a list of contents of two cians’ (RACP’s) recent reaffirmation of Doctors Opposing Circumcision recently published books: the Springer their previous findings that neonatal volume Circumcision and Human circumcision lacks medical justification Rights collecting essays from the 2006 Executive Director’s Message and raises ethical and human rights Seattle NOCIRC Symposium and Ro- concerns. (Go to http://www.racp.edu. Greetings. Newsletter editor Al dopi’s Fearful Symmetries book. (We au/page/health-policy-and-advocacy/ Fields and I hope you enjoy the current have one article in the Springer book paediatrics-and-child-health and select newsletter issue, which is jam-packed and two in the Rodopi book.) News the August 27, 2009 position state- with news and features, reflecting the items include stories from the US, ment.) recent wealth of developments relating South Africa, Uganda, and Australia, to genital integrity. And here’s the best and regarding lawsuits in the US and part: a lot of the recent news has been UK. Press releases are reprinted from positive. This issue includes several the International Coalition for Genital wonderful feature articles including not Integrity (ICGI), MGMBill.Org, and one but TWO first-hand reports by Dan from the Tasmania Law Reform Insti- Bollinger and Aubrey Taylor on the tute regarding their Issues Paper Num- recent HIV conference held in Atlanta ber 14 on Non-Therapeutic Male Cir- and organized by the Centers for Dis- cumcision. One major new develop- ease Control and Prevention (CDC); ment: News stories on circumcision are and a delegate’s report by longtime ac- starting to routinely mention intactiv- Marilyn Milos, Steven Svoboda, Eli tivist Martin Novoa on the movement’s ism. Since our last issue, articles have Svoboda (7.5 yrs. old), and Sarita Svoboda, successes at the recently concluded In- appeared in the New York Times (as (4.5 yrs. old). ternational AIDS Society meeting in reprinted here), the Chicago Tribune Cape Town, South Africa. Tasmania (also reprinted here), the San Francisco Much has been happening at ARC. Children’s Commissioner Paul Mason Chronicle, Cleveland Plain Dealer, and In late April, Marilyn Milos of NO- has authorized us to transcribe and other publications too numerous to CIRC and I teamed up for a well- print his historic speech at the ground- mention. received presentation, "Circumcision: breaking FORWARD-NORM-UK Past, Present, Future," given at the an- The Tasmanian Issues Paper is an press conference held in London on nual convention of the Association for important development as it may be the September 3, 2008. James Loewen Pre- and Perinatal Psychology and first position paper to be issued by law contributes an eyewitness photojournal- Health (APPPAH), held this year in reform institute that centrally addresses istic report on Genital Integrity Aware- Pacific Grove, California. male circumcision. Its creation by the ness Week and the first Intact America Tasmanian Law Reform Institute As noted elsewhere in this issue, our Awards in March-April of this year in (TLRI) may reflect the growing under- publication success has continued in Washington, DC. standing of the importance of protect- 2009, with the appearance of the Fear- page 10 Attorneys for the Rights of the Child Newsletter Fall 2009

ful Symmetries and Circumcision and Book Announcement Reconsidering "Best Interests": Male Human Rights books and the Journal of Circumcision and the Rights of the Law, Medicine & Ethics paper written Circumcision and Human Rights Child; Marie Fox and Michael Thom- by Bob Van Howe and myself address- son . ing—for the first time, we believe--the Denniston, George; Hodges, Freder- incompatibility of circumcision re- ick; Milos, Marilyn F. (Eds.) 2009, Cultural Relativism at Home and search with ethical and human rights 276 p. 53 illus., 26 in color., Hardcover Abroad: An American Anthropologist obligations imposed by the Helsinki ISBN: 978-1-4020-9166-7 $219.00 Confronts the Genital Mutilation of Declaration. Social & Legal Studies is www.springer.com Children; Zachary Androus. publishing two of my book reviews that "There is hardly a reason to circum- Variations in Penile Anatomy and originally appeared in the ARC News- cise a little boy for medical reasons be- Their Contribution to Medical Mis- letter. Our writing efforts continue to cause those medical reasons don’t ex- chief; Ken McGrath. strive to broaden perspectives on geni- ist," said Dr. Michael Wilks, Head of The Perils of Circumcision; James L. tal integrity and related issues. Ethics at the British Medical Associa- Snyder. Webmaster Rick King and I were tion, who admitted that doctors have able to find the time to accelerate ex- circumcised boys for "no good reason." Conservative Management of Foreskin Conditions; John Dalton. tensive enhancement of the ARC web- In the United States, parts of Africa, site. I am excited that, with the help of the Middle East, and in the Muslim Methicillin-Resistant Staphylococcus ARC Secretary Georganne Chapin, In- world, 13.3 million infant boys and 2 Aureus: An Emerging Risk for Circum- tact America General Counsel Irene million girls have part or all of their cised Boys; George Hill.

Dillon and I are nearing completion of external sex organs cut off for reasons Fitting in and Getting Off: Adult Male two different “Know Your Rights” bro- that defy logic and violate basic human Circumcision in the United States; chures for potential plaintiffs. rights. Doctors, parents, and politicians Zachary Androus. have been misled into thinking that cir- I am very pleased that in addition to NORM-UK; David Smith. the ARC Newsletter’s longstanding and cumcision is beneficial, necessary, and harmless. Circumcision: If It Isn’t Ethical, Can it mutually beneficial relationship with ProQuest, the two other leading content Be Spiritual? Miriam Pollack. In Circumcision and human rights, providers, EBSCO and Gale, have now internationally respected experts in the also selected this Newsletter to be in- fields of medicine, science, politics, Book Announcement cluded in the journals it provides to law, ethics, sociology, anthropology, thousands of libraries across North history, and religion present the latest "Fearful Symmetries" Book About America and the world. research on this tragedy, as a part of the Genital Cutting Now Available

Thanks as always to every one of worldwide campaign to end sexual mu- you for your emotional and financial tilation. They outline steps for eradicat- support. When I say we could not do it ing this abusive practice to enable without you, I am quite serious, and it males and females the dignity of living is something we never take for granted. out their lives with all the body parts As always, no one at ARC receives any with which they were born. sort of stipend, so that 100% of your tax-deductible donation is put to work defraying the costs of protecting chil- dren. Donations can be sent to J. Ste- ven Svoboda, ARC, 2961 Ashby Ave- nue, Berkeley, CA 94705, or made through Paypal at our website (www. I am pleased to announce the recent arclaw.org/arc_donate) or using the Paypal address [email protected]. publication of a potentially ground- breaking new book on genital cutting. Our next issue will be out for the Written for: Rodopi Press, an academic press Winter Holidays. Until then, we wish Every male and female person in the known for its medical works with of- you all the best this world has to offer! world, college, university, and hospital fices in Amsterdam and New Jersey , libraries, female and male genital muti- has issued Fearful Symmetries: Essays J. Steven Svoboda lation researchers, physicians, medical and Testimonies Around Excision and Executive Director historians, lawyers, bioethicists. Circumcision. The editor is Chantal Attorneys for the Rights of the Child Selected Contents: Zabus, one of the speakers at the 2008

Delusional Psychologies of Circumci- NOCIRC Symposium in Keele , United sion and Civilization; David Chamber- Kingdom , where I had the great pleas- lain. page 11 Attorneys for the Rights of the Child Newsletter Fall 2009 ure to meet her in person. The book, as about making a case for symmetry be- weaknesses of edited volumes. Some its title suggests, addresses differential tween these two practices. Fearful contributions (those at the beginning perspectives on female and male geni- Symmetries investigates the sociologi- and end of the book) are highly engag- tal cutting. It may be the first volume to cal, medical, legal, and religious justifi- ing and enlightening, while several of explicitly treat FGC and MGC with cations for male circumcision and fe- the middle chapters add little to the ex- virtually complete parity. male excision while it points to various isting literature or to our understanding.

Fearful Symmetries contains two symmetries and asymmetries in their Things start off very promisingly pieces to which I contributed. One arti- discursive representation in cultural indeed. Following a well-written if cle has my esteemed collaborator anthropology, law, medicine, and lit- somewhat pro forma overview of the erature. Robert Darby of Australia as its lead chapters to come written by editor author and is an extensively updated Experts have been convened in the Abusharaf, Egyptian-American anthro- version of our article from the Medical above fields – SAMI ALDEEB ABU- pologist Fadwa El Guindi provides us Anthropology Quarterly, retitled, "A SAHLIEH, DOMINIQUE ARNAUD, with a fascinating, laudably free- Rose by Any Other Name?: Symmetry LAURENCE COX, ROBERT thinking overview of FGC among Nu- and Asymmetry in Male and Female DARBY, ANNE–MARIE DAUPHIN– bians in Egypt. El Guindi’s title, “Had Genital Cutting." The other article is an TINTURIER, TOBE LEVIN, MI- This Been Your Face, Would You account as told to me by an acquaint- CHAEL SINGLETON, J. STEVEN Leave It As Is?” suggests her mission ance of mine, Jerry K. Brayton, of his SVOBODA – along with first-person to re-examine practices in a manner as personal experiences relating to cir- testimonies from J.K. BRAYTON, SA- free of cultural biases as possible. Her cumcision. Rob Darby also has a sec- FAA FATHY, KOFFI KWAHULÉ, extensive experience as an activist is ond article in the volume co-authored and ALEX WANJALA. The volume evident. “Over forty years ago… with Laurence Cox analyzing numer- covers various genres such as sacred [Charles] Callender and I argued for ous personal accounts of the psycho- writings, literary and philosophical the significance of the notion of the logical and physical impacts of male texts, websites, songs, experiential vi- cultural equivalence of male and fe- circumcision, titled, "Objections of a gnettes, cartoons, and film as well as a male circumcision. [citation omitted] I Sentimental Fearful Symmetries Char- vast geographical spectrum – from Al- argue now that this cultural equivalence acter: The Subjective Dimensions of geria, Ivory Coast, Egypt, Kenya, and extends analytically as a structural Foreskin Loss." Complimentary PDF's Somalia to the then Congo and contem- equivalence: that is, the two gendered or (for those without a computer) hard porary Northern Zambia; from Syria to rituals play equivalent roles in the tran- copies of the articles are available on Australia and the United States. sition of male and female children to request from ARC. In addressing many variants of excision adulthood… mark[ing] a transitional and circumcision as well as other prac- phase between birth and marriage.” This page also contains an overview of the book's contents. The book lists tices such as the elongation of the labia, El Guindi trenchantly notes that for $92 in cloth (to my knowledge, no and various forms of circumcision in “Americans who express concern about paperback edition is planned) and is Jewish, Islamic, and African contexts, female circumcision in other places do available directly from Rodopi Press Fearful Symmetries provides an un- not campaign against [nose jobs, face- (www.rodopi.nl) or from Amazon.com. precedented, panoptical view of both lifts, and breast enlargement] with practices. equal fervor despite the known health Steven Svoboda Executive Director risks involved.” Subsequently she ex- Attorneys for the Rights of the Child pands on the analogy. “The phenome- Book Review non deceptively called ‘breast enhance-

ment’ could well be called ‘breast mu------Female Circumcision: Multicultural Perspectives. tilation.’ Culturally, it amounts to sub- Fearful Symmetries: stituting men’s sex pleasure in Edited by Rogaia Mustafa Abusharaf. Essays and Testimonies Around women’s breasts for their maternal Philadelphia: University of Pennsyl- Excision and Circumcision function.” Accordingly: “Cross-cultural vania Press, 2006. 287 pp. discussions about these matters should ZABUS, Chantal (Ed.) Amsterdam/New www.upenn.edu/pennpress. employ a single standard, not apply York, NY, 2008, XXXII, 306 pp. No price stated on cover but website different standards to boys and girls or ISBN 978-90-420-2572-1 € 68 / US$ 99 gives price as $19.95. to Americans and Arabs or Africans.” www.rodopi.nl Review by J. Steven Svoboda El Guindi finds a lack of choice and Often labeled ‘rituals’ or ‘customs,’ Longtime Sudanese-American activ- a lack of ritual to be the two most pun- male circumcision and female excision ist against female genital cutting (FGC) gent problems with MGC: Choice is are also irreversible amputations of hu- Rogaia Mustafa Abusharaf has edited not brought up in relation to men who man genitalia, with disastrous and at Female Circumcision: Multicultural undergo very severe circumcision in times life-long consequences for both Perspectives. For better and for worse, various parts of the world, or the male males and females. However, scholars this book exemplifies the strengths and babies in America who are operated and activists alike have been diffident page 12 Attorneys for the Rights of the Child Newsletter Fall 2009 oninvoluntarily. I find the cruelty of ber of times blithely asserting the in- FGC programs by providing us with American male infant circumcision to comparability of MGC and FGC. Me- several moving, heart-rending first- lie in two dimensions: the absence of thinks they protest too much! More- person accounts by women who sur- choice, and the absence of ritual. . . . over, reading between the lines, they vived infibulations.

Why do not activist feminists care are evidently twisting their respon- The final section, on debates in about men’s circumcision? Their dents’ words to make them conform immigrant-receiving societies, is more agenda is narrowly focused on women sufficiently with their feminist shibbo- even-handed and engaging. Audrey in Africa and the Middle East, who can leths. Macklin addresses attempts to use the be presented as inferior, less advanced, The degree to which the three au- criminal law to combat FGC in Canada, or more oppressed than Western thors are weighted down with dogma is showing the potentially counterproduc- women. . . Most interventionist de- ironic, given that the two principal pro- tive outcomes of such overly paternal- bate. . . assumes that women in non- grams they are reviewing, Maendeleo istic approaches. Intriguingly, she ob- Western societies are childlike and Ya Wanawake Organization (MYWO) serves that the basis for outlawing helpless, passive victims of their men, and Program for Appropriate Technol- MGC was actually stronger than for the who must be saved by Western mission- ogy in Health (PATH), have helped action the Canadian government took aries and feminists. This stance is ar- reduce FGC while remaining culturally in explicitly criminalizing FGC when rogant and ethnocentric. sensitive and retaining a balanced per- the practice had already been pro- El Guindi’s conclusion is highly sym- spective that permits ceremonial, non- nounced illegal under existing laws pathetic to intactivism: “In considering mutilating rituals to continue. I also against assault: From a purely doc- circumcision, we must include male wonder why the three musketeers men- trinal perspective, it would have made and female forms in the same discus- tion but fail to respond to “critics [who] more sense to create an exemption sion. . . “ questioned the priority given to eradi- from the law of assault for male cir- In the chapter following this ex- cating FGM in light of other prevalent cumcision, a common cultural and reli- tremely promising start, intactivist health problems, such as malaria.” gious practice in North America. . . Swiss-Palestinian academic Sami A. Most alarmingly, the authors assume The fact that no one seriously fears Aldeeb Abu-Sahlieh notes “a tendency that men (apparently by themselves) criminal prosecution for circumcising a to exaggerate the harmful sexual effects are forcing FGC upon girls to control male child speaks to the power of domi- of female circumcision and to underes- their sexuality, whereas typically it nant cultural norms to supersede the timate those of male circumcision.” In tends to be mothers and grandmothers letter of the law and determine what the the end, Aldeeb finds that it comes who are the primary continuers of the law is “really” about. down to human rights. “The right to practice. After lengthy investigation, Macklin physical integrity is a principle. We Amal Abdel Hadi tells a happier discovers, to her astonishment, that the must accept or reject genital cutting in tale of Deir El Barsha, a Christian vil- primary impetus to criminalize FGC in totality. If we accept this principle, we lage in Egypt, which discontinued FGC Canada “emanated from women in im- must refrain from cutting of children’s in 1992 as a natural outgrowth of de- migrant communities who inserted genitals regardless of their sex, their velopment efforts promoting women’s themselves directly into the legislative religion, or their culture.” I found Al- participation and equality. The next process.” Macklin contradicts herself deeb’s contribution to include a rather two chapters, respectively by Nafissa- on at least one point, stating on p. 216 more detailed review of religious doc- tou J. Diop and Ian Askew, and by that no one has ever been charged in trine than necessary, and yet one cannot Hamid El Bashir, are more conven- Canada with an FGC-related offense, help but welcome the perspective of the tional pieces that do little to advance and then asserting four pages later that author of the excellent book Male and the ongoing dialog about reconciling a Sudanese couple was charged in 2002 Female Circumcision Among Jews, opposition to FGC with concerns about for performing genital cutting on their Christians, and Muslims: Religious, daughter. cultural imperialism. Shahira Ahmed’s Medical, Social and Legal Debate review of the work of Sudan’s Babiker Charles Piot checks in with a brief (Shangri-La Publications, 2001, previ- Badri Scientific Association for yet perceptive, provocative, and brave ously reviewed in these pages). Women’s Studies and the Eradication analysis of the Kasinga case in which Following this stellar beginning, of Female Circumcision is even worse, US political asylum was granted to a we quickly and sharply decline in most uncritically parroting Muslim clerics’ Togolese woman based on her alleged of the chapters from the succeeding attempts to justify their opposition to fear of FGC. I could not help but no- section on African programs to eradi- FGC and their simultaneous support of tice that this appears to simply be an cate FGC. Asha Mohamud, Samson MGC. earlier version of his similar article in

Radeny, and Karen Ringheim address The next chapters improve greatly. Bettina Shell-Duncan and Ylva “Community-Based Efforts to End Raqiya D. Abdalla, who nearly thirty Hernlund’s superlative 2007 edited vol- FGC in Kenya.” This triumvirate of years ago published the groundbreak- ume Transcultural Bodies: Female authors clearly never met a male fore- ing book on FGC, Sisters in Affliction, Genital Cutting in Global Context (also skin they liked, and are probably the concludes the section on African anti- reviewed in these pages). Neverthe- record holders (no mean feat) for num- less, Piot is so good at what he does page 13 Attorneys for the Rights of the Child Newsletter Fall 2009 that I enjoyed reading again his even- The media hasn't been communicat- everyone's mind, a bill proposal that handed review of this woman’s fraud- ing this in their articles on HIV. This would require patients to be eighteen filled story and of the systemic biases misleads parents into thinking that cir- years old to consent to circumcision and crude anti-African prejudice cumcision might be beneficial for their is making its way through Congress (among the court and the public alike) children. Insider information says the and more than a dozen state that contributed to her eventual victory. CDC and AAP are falling into this trap, legislatures. The proposed legislation

The unfailingly brilliant Nigerian- too. While parents are understandably was drafted by MGMbill.org, a Califor- American scholar L. Amede Obiora confused by the science, the CDC and nia based health and human rights AAP have no excuse. group. concludes the book with an afterword ostensibly reviewing and integrating What follows is an excerpt from an Matthew Hess, the group's presi- the volume’s contributions. Much as I op/ed by John Murray, National Centre dent, argues that boys are being treated enjoy Obiora’s writing and her commit- in HIV Epidemiology and Clinical Re- unfairly when it comes to circumcision. ment to FGC scholarship that is free of search, Australia: "We need to stop discriminating groupthink and committed to balancing “Benefits of circumcision in the de- against male infants," said Hess. culture and rights, I was disappointed veloped world have been observed to "When girls are born, they are wel- by her failure to even mention Sami occur only in approximately one-third comed into the world peacefully. But Aldeeb’s contribution to Female Cir- of homosexual men who were predomi- for more than half of our nation's boys, cumcision. Despite the engaging and nantly the insertive partner. This life begins with painful and irreversible varying grappling with MGC in which equates to about 0.05% of the male cosmetic surgery. While I support several contributors participated, population who might be at lower risk every man's right to undergo circumci- Obiora focuses exclusively on FGC. of HIV infection due to being circum- sion if he chooses to do so, no child Female Circumcision: Multicul- cised. should be forced to have this unneces- tural Perspectives ends up as bit of a “Obviously new parents don´t know sary surgery. Ten out of ten babies op- mixed bag, but a reasonably-priced at the outset whether their sons will pose circumcision - and for good rea- book whose opening and concluding son." grow up to be one of the 0.05% of the chapters amply repay the reader’s at- population at risk of HIV who will be That's why the Pandians in Clay, tention and financial outlay. Recom- gay and predominantly the insertive New York, refused to circumcise their mended. partner. The decision about circumci- son, even after being pressured by their sion as protection against HIV in this former pediatrician.

regard can therefore be left to the son at “When our son was born my wife a later time, especially since the bene- Anne and I chose to keep him intact,” ICGI Press Release: The truth about fits of circumcision have to be weighed said Murugan Pandian, director of circumcision and HIV against complications arising from the MGMbill.org’s New York state office. procedure, which is over 8%. www.icgi.org “We did the research and knew that March 14, 2009 “Moreover, circumcision does not there would be those who would op- protect a man from HIV infection even pose our decision. But in the end, we There has been a lot of reporting in if they are heterosexual or homosexual came to the conclusion that circumci- the media about using circumcision to but insertive: it only reduces the risk sion is an unnecessary and irreversible prevent the spread of HIV in the world. (by approximately 60 per cent). In that surgery that should not be legal to per- Experts are divided on whether or not case, you have to ask yourself whether form on any child, regardless of circumcision will be successful in the prospective benefits against HIV, whether that child is a boy or a girl.” populations that have no access to HIV virtually only for babies who will grow Circumcision is the surgical removal testing, where 90% of cases are the re- up to be gay and always insertive, out- sult of men having sex with women, of the foreskin, a protective zone of weigh the risks of the circumcision pro- skin and tissue covering the glans of and have very high infection rates, such cedure for all newborn male babies.” as in Africa. the penis. Thousands of erogenous nerve endings including the ridged What is clear is that circumcision MGM Bill Press Release: band and some or all of the frenulum has little or no protective benefit in the Health Group Calls for a Change in are destroyed after circumcision, leav- developed world in populations where Circumcision Policy ing behind a diminished penis capable HIV testing is readily available, where www.MBMBill.org of sending fewer nerve impulses to the only 9% of cases are from men having Lawmakers are urged to pass legisla- pleasure centers of the brain. After a sex with women, and the HIV infection circumcision is performed, the body rate is very low. The fact that the HIV tion protecting boys from forced circumcision tries to replace the protective function rate is as low in the US, despite 75% of of the foreskin by forming keratin the sexually active men being circum- San Diego, CA (PRWEB) January 13, around the exposed glans and remain- cised, as it is in Europe is a good indi- 2009 -- ing inner foreskin, causing further in- cator that circumcision is ineffective. In a country where change is on page 14 Attorneys for the Rights of the Child Newsletter Fall 2009 terference with sexual sensation. Press Release: Issues Paper by 28 August 2009. Fol- Tasmania Law Reform Institute lowing consideration of responses a Trisha Darner, director of MGMbill. org’s Oregon state office, is optimistic June 2, 2009 final report will be published, contain- that U.S. laws will eventually treat ing recommendations to the Attorney- Today, the Tasmania Law Reform General. boys and girls equally when it comes to Institute released issues paper no 14, circumcision. The paper can be downloaded from Non-therapeutic male circumcision. In “I’m encouraged by what’s happen- the paper, the Institute identifies uncer- www.law.utas.edu.au/reform/ ing in the courts, and some of the re- tainty about when and under what cir- sponses that I’ve received from law- cumstances a non-therapeutic circumci- makers over the past year have been sion can be performed legally on an While we know our readers have a very supportive of our effort,” said infant male. Given that circumcision wide range of views on the meaning Darner. “The judiciary is slowly inch- has not previously been the subject of and importance of the recent HIV ing toward making forced circumcision thorough legal analysis in Australia, the vaccine news, we wanted to include a crime, but unfortunately it’s not hap- lack of clarity in the application of the it due to its timeliness and potential pening quickly enough. That is why I existing law to circumcision is the pri- relevance to inactivism-Editor feel it’s so important that legislators mary problem that the paper seeks to enact the MGM Bill now, so that boys overcome. The crux of the uncertainty HIV Vaccine News don’t have to keep waiting for the pro- is whether the consent of the parent of By Sarah Boseley and Haroon Siddique tection they are entitled to under the a male infant being circumcised can www.guardian.co.uk Equal Protection Clause of the Four- provide protection from criminal and September 24, 2009 teenth Amendment to the U.S. Consti- civil actions brought against a person tution.” for performing a circumcision. Doctors HIV breakthrough as scientists The legality of forced circumcision and those who perform circumcision in discover new vaccine to prevent is being challenged now more than ever a traditional way need to know the cir- infection: First evidence of possi- cumstances in which they will be pro- before. In 2008, the Oregon Supreme ble vaccine as US military-backed tected from the law. Court and the U.S. Supreme Court both medical trial in Thailand cuts let stand a lower court decision that The Institute received the reference HIV infection rate by a third blocked a Jewish convert from having from the Commissioner for Children his 12-year old son circumcised until who is a member of the Council of Ob- A medical trial in Thailand has the boy's own wishes are determined, stetric and Paediatric Mortality and raised hopes of a major breakthrough in helping to establish a legal precedent. Morbidity. The Commissioner asked the fight against AIDS after scientists In North Carolina, a Gaston County the Institute to investigate the legal is- said an experimental vaccine had re- father was charged with child abuse for sues relating to the circumcision of duced the risk of HIV infection by a circumcising two of his sons with a males under the age of majority. The third: The world's largest HIV/AIDS utility knife. And across the Atlantic in Commissioner was concerned that vaccine trial of more than 16,000 vol- Denmark, lawmakers are now consider- some procedures, when performed unteers was the first in which infection ing a ban on circumcision of male chil- without medical indication and without has been prevented, according to the dren. The ban is supported by the Eth- the competent consent of the child, may US army, which sponsored the trial ics Council, the National Council for traverse the rights of children. with the National Institute of Allergy Children, Social Democrats, the Red- The Institute has released the paper and Infectious Diseases. Green Alliance, and the Liberal Alli- to provide information to encourage ance. A combination of two vaccines was public deliberation and feedback on an tested on HIV-negative Thai men and State legislatures that received appropriate legal framework for non- women aged 18 to 30 at average risk of MGM Bill proposals yesterday in- therapeutic male circumcision in Tas- becoming infected. All the volunteers cluded California, Florida, Illinois, mania . Further, any reforms to clarify were given counseling and condoms to Iowa, Louisiana, Maryland, Michigan, the uncertainty in the existing legal help them avoid HIV. Then half were Minnesota, New York, Oklahoma, Ore- framework might also present an op- randomly picked to receive the vaccine, gon, Texas, and West Virginia. A fed- portunity to set or clarify the standards while the other half got dummy shots. eral version was also submitted to that those who perform circumcision Until the trial ended, nobody knew who President-elect Barack Obama and to have to meet. had been given the genuine vaccine and each member of the 111th U.S. Con- Any group or person is invited to who had not. gress. respond to this issues paper. Following A relatively small number of people consideration of all responses it is in- became infected with HIV – 51 of the tended that a final report will be pub- 8,197 people given the vaccine, and 74 lished, containing recommendations. of the 8,198 who received dummy The Institute invites responses to this shots – but the difference was statisti- page 15 Attorneys for the Rights of the Child Newsletter Fall 2009 cally significant, which means scien- enormous difference in the world. I efforts of the international community, tists believe it could not have happened think this is something we can work including the UK government, to de- by chance. It worked out at a 31% with." velop a vaccine." lower risk of infection for the vaccine Thailand's ministry of public health The Terrence Higgins Trust said it group. conducted the study, which used strains was treating the results with "cautious Colonel Jerome Kim, who helped to of HIV common in Thailand. optimism". lead the $105m (£64m) study for the Scientists stressed it was not known "This is the first step on a very long US army, said it was "the first evidence whether such a vaccine would work road," said the policy manager, Vicky that we could have a safe and effective against other strains elsewhere in the Sheard. preventive vaccine". world. The study was done in Thailand "There's a lot of research needed Recent failures had led many scien- because US army scientists carried out into how a vaccine can be rolled out, tists to believe that such a vaccine pivotal research in that country when how costly it's going to be, whether it's might not be achievable. In 2007, the the AIDS epidemic emerged there, iso- going to be effective against different drug company Merck abandoned what lating virus strains and providing ge- strains." had looked at the time like the most netic information on them to vaccine promising avenue of research after dis- makers. appointing trial results. Today the Na- The study tested a two-vaccine com- Circumcision doesn't protect gays tional Institute's director, Dr Anthony bination in a "prime-boost" approach, from AIDS virus Fauci, warned it was "not the end of the where the first one primes the immune By Mike Stobbe road", but said he was surprised and system to attack the HIV virus, and the Associated Press very pleased by the outcome. second one strengthens the response. August 25, 2009 "It gives me cautious optimism Alvac uses canarypox, a bird virus, al- www.ap.org about the possibility of improving this tered so it can't cause human disease, to ATLANTA - Circumcision, which result," he said. "This is something that ferry synthetic versions of three HIV has helped prevent AIDS among het- we can do." genes into the body. AIDSVAX con- erosexual men in Africa, doesn't help tains a genetically engineered version Every day, 7,000 people worldwide protect gay men from the virus, accord- of a protein on HIV's surface. are newly infected with HIV; 2 million ing to the largest U.S. study to look at died of AIDS in 2007, the UN agency It is unclear whether vaccine makers the question. UNAIDS estimates. will seek to license the two-vaccine The research, presented at a confer- combination in Thailand. Before the The AIDS Vaccine Advocacy Coali- ence Tuesday [August 25, 2009], is trial began, the US Food and Drug Ad- tion, an international group that has expected to influence the government's ministration said other studies would be worked towards developing a vaccine, first guidance on circumcision. welcomed the results of the trial – the needed before the vaccine could be Circumcision "is not considered third major study since 1983, when considered for US licensing. The full beneficial" in stopping the spread of HIV was identified as the cause of results of the trial will be presented at HIV through gay sex, said Dr. Peter AIDS – as "a historic milestone". The an international AIDS vaccine confer- ence in Paris in October. Kilmarx, of the U.S. Centers for Dis- executive director, Mitchell Warren, ease Control and Prevention. said: "There is little doubt that this The executive director of the Global finding will energize and redirect the HIV Vaccine Enterprise, an alliance of However, the CDC is still consider- AIDS vaccine field." research bodies and funders like the ing recommending it for other groups, including baby boys and high-risk het- Frances Gotch, professor of immu- Gates Foundation, said the results showed a vaccine was an achievable erosexual men. nology at Imperial College London, said the results appeared to be statisti- goal. "This is a historic day in the 26- UNAIDS and other international cally significant and may have been the year quest to develop an AIDS vac- health organizations promote circumci- effect of the two different vaccines cine," said Dr Alan Bernstein. "This sion, the cutting away of the foreskin, working in tandem to more powerful trial is the first demonstration in hu- as an important strategy for reducing effect. mans that, with more research, it will the spread of the AIDS virus. There be possible to develop a vaccine that is hasn't been the same kind of push for "The fact that they have seen a re- fully protective against HIV." circumcision in the United States. sponse with people with such a low incidence of infection is impressive," Deborah Jack, chief executive of the For one thing, nearly 80 percent of Gotch, who is also the principal investi- National AIDS Trust in the UK, said a American men are already circum- gator for the International AIDS Vac- vaccine, by far the most effective way cised — a much higher proportion than cine Initiative, told the Guardian. of tackling serious infectious diseases, most other countries. Worldwide, the was desperately needed. More work male circumcision rate is estimated at "Of course it's not 100% of people was needed, but the promising findings about 30 percent. [protected] but 31% could make an "justify the continuing investments and Also, while HIV spreads primarily page 16 Attorneys for the Rights of the Child Newsletter Fall 2009 through heterosexual sex in Africa and Verdicts & Settlements His parents, Forrest and Mary some other parts of the world, in the SPOTLIGHT: MEDICAL Keefe of Wood, say Dr. Douglas Leh- United States it has mainly infected gay MALPRACTICE mann failed to inform them of the type men. Only about 4 percent of U.S. men The Recorder of pain medication they should have are gay, according to preliminary CDC used. August 12, 2009 estimates released at the conference A Jury awarded $429,484 to an in- The Keefes are seeking $2 million this week. But they account for more for personal injury and wrongful death. than half of the new HIV infections fant whose penis was allegedly disfig- each year. ured for life by surgery. (Aren't ALL Sturgis lawyer Mick Strain, who penises disfigured for life by sur- represents the plaintiffs, said he and the Previous research has suggested cir- gery?- -Editor) On Nov. 12, 2006, Evan parents wouldn't talk about the case cumcision doesn't make a difference Tank was circumcised by pediatrician until it is tried or settled. The file lists when anal sex is involved. The latest [and mohel] Ralph Berberich, who ac- no attorney for the government. study, by CDC researchers, looked at cidentally cut the tip of Evan's penis. nearly 4,900 men who had anal sex Plaintiff's counsel claimed that Ber- with an HIV-infected partner and found $2.3M awarded in suit over botched berich failed to remove adhesions teth- circumcision the infection rate, about 3.5 percent, ering the foreskin to the glans, causing was approximately the same whether the glans to be pulled into the clamp By Ty Tagami the men were circumcised or not. along with the foreskin. Hence the The Atlanta Journal-Constitution Government recommendations on glans was cut off along with the fore- www.ajc.com circumcision are still being written and skin. Monday, March 30, 2009 may not be final until next year, fol- Berberich countered that penis A Fulton County jury has awarded lowing public comment. CDC doctors trauma is a recognized complication of $1.8 million in damages to a boy whose and many experts believe there is a the procedure and that Evan's parents penis was severed in a botched circum- good argument for recommending that had accepted the risk The doctor ar- cision. baby boys and heterosexual men at a gued that, rather than an error on his higher risk for HIV be circumcised. The state court jury gave another part, Evan probably had an unusual $500,000 to the boy’s mother in the The definition of "high risk" is still be- penile anatomy that caused his penis to ing discussed, said Kilmarx, chief of decision rendered Friday. be pulled into the clamp. the epidemiology branch in the CDC's Case: Tank v. Berberich RG07314573 The case involves a child, identified HIV division. only as D.P. Jr., who was born at South Court: Alameda Count Superior Court, Fulton Medical Center in 2004. In a Circumcision is a sensitive issue Hayward laden with cultural and religious mean- suit filed two years later, his mother ing, particularly when babies are in- Counsel for the plaintiff: Martin Blake, contended that the doctor who circum- volved, Kilmarx acknowledged. Baum & Blake, San Francisco cised him removed too much tissue and

Counsel for the defendant: D. Stuart that his pediatrician failed to respond "It's seen by many as more than just when a nurse complained of excessive a medical procedure," he said. It's pos- Candland, Craddick, Candland & bleeding. sible the government would just recom- Conti, Danville mend better education for doctors and The tip of the penis was placed in a parents about the procedure's benefits Parents sue over baby's death biohazard bag and might have been re- and risks, he added. after circumcision attached if a urologist had attended to the boy within eight hours, one of the By Josh Verges The prospect of the government pro- mother’s lawyers, David J. Llewellyn Argus [South Dakota] Leader moting circumcision of infants has al- of Atlanta [and ARC] said. ready drawn fire from an advocacy September 18, 2009 group called Intact America. The or- www.argusleader.com The jury found that both the pedia- trician, Dr. Cheryl Kendall, and the ganization, based in Tarrytown, N.Y., The parents of a 6-week-old boy physician who performed the circumci- parked a motorized billboard this week who bled to death after a circumcision sion, Dr. Haiba Sonyika, were negli- outside the hotel hosting the HIV con- at Rosebud's Indian Health Service gent. South Fulton Medical Center was ference, displaying the message: "Tell Hospital last year are suing the govern- the CDC that circumcising babies does- absolved of liability. ment for wrongful death. n't prevent HIV." The pediatrician’s lawyer, Roger According to documents filed Harris, said he disagreed that the jury’s "It's removing healthy, functioning, Wednesday in federal court, Eric Keefe decision indicated that Dr. Kendall was sexual and protective tissue from a per- underwent a circumcision on June 13, negligent because she didn’t go to the son who cannot consent. You're muti- 2008. His mother gave him Motrin and hospital. He hinted at an appeal. “We lating a child," said Georganne Chapin, Tylenol for pain and he suffered mas- believe there was error committed dur- the group's executive director. sive blood loss at home that night, dy- ing the course of the trial,” he said. ing at the hospital the next morning. page 17 Attorneys for the Rights of the Child Newsletter Fall 2009

Dr. Sonyika’s lawyer could not be legal position were first raised by the The 21-year-old has become em- reached for comment. Tasmanian Children's Commissioner, broiled in a clash between constitu-

Llewellyn said the money awarded Paul Mason, who referred the issue to tional rights and Xhosa tradition — and by the jury is to cover the cost of medi- the institute, based at the University of is set to take on his parents’ beliefs on Tasmania's Law School. circumcision in court on Tuesday. cal treatments and psychiatric counsel- ing for the boy and his family. The jury "The whole subject of non therapeu- The second-year microbiology stu- did not award punitive damages. The tic circumcision on boys is so fraught dent at the University of the Free State Atlanta Journal-Constitution is not with emotion and unreasonable as- will face his father, Lindile, and East- naming the mother to avoid identifying sumption that it is hard to find answers ern Cape traditional leaders in the the child. to the most basic legal questions," Mr Bhisho Equality Court in a legal fight Mason concluded. that could give Xhosa boys a say in the “This case does point out one of the way they are circumcised. dangers of circumcision that every par- He found that the risks of circumci- ent must seriously consider when hav- sion included pain, surgical mishap or Yamani claims that, shortly after he ing the procedure done,” Llewellyn complications and decreased sexual turned 18, his father and 10 other men said. He contended that parents are not pleasure. Among the claimed benefits abducted him from his home in Masele told of the risks of the procedure. were reduced chance of infections, and township near King William’s Town cultural or religious conformity. and subjected him to circumcision The 'cruellest cut' may also be illegal against his will — then forced him to The paper said the consequences of By Andrew Darby eat the skin cut from his penis. an ill-advised procedure could be hor- June 3, 2009 rendous: "Even if a court considers the This, he said in a court affidavit, The [Sydney, Australia] Age physical loss following circumcision happened three months after he tried to www.theage.com.au negligible, the social and psychological compromise with local chiefs by hav- Once routine, now often thought effects of a wrong decision can be dev- ing the procedure done at the Frere hos- unkind, the cut may also be illegal. astating." pital in East London.

Parental consent might not be enough It said there were cases of suicide This week he told the Sunday to protect the circumcisers of baby and attempted suicide by men forced to Times: “After that experience I decided boys from later legal action. live with lasting complications of a cir- to do something about it so no other In a rare legal analysis of the medi- cumcision performed on them as a child is put through that.” cal procedure, the Tasmanian Law child. But while he wants justice, he does Reform Institute found that criminal But for other men, the operation be- not want his parents to suffer. and civil law lacked certainty, and came an important part of their identity. that circumcision might abuse the “I don’t want my parents to be ar- rights of a child. The institute said in law, circumci- rested and I don’t want them to pay No specific laws currently regulate the sion might be considered an assault or money,” said Yamani, who is being removal of the penile foreskin in a wounding. "There is uncertainty as to helped by the Justice Alliance of South Australia, and there are few clear an- whether the consent of a parent for the Africa, a non-profit legal organisation. swers in general law, according to an circumcision of their child is sufficient “This is not revenge; I don’t want to institute researcher, Warwick Marshall. to allow a circumciser to legally per- get back at them. I just want my dad to form the procedure," it said. admit that what he did was unconstitu- "What is clear is that the current tional. laws were not framed with male “They do everything for me; I mean circumcision in mind," he said in an Parents in court over they’re paying for me to go to univer- issues paper released yesterday. circumcision sity.” About 12 per cent of newborn boys By Biénne Huisman [South Africa] Times But tension is inevitable. are believed to be circumcised in Australia, down from 90 per cent in the August 8, 2009 The court case was not mentioned 1950s. www.thetimes.co.za during the June university holidays —

Routine circumcision is no longer Bhisho case could set important which Yamani spent at home with his performed in most Australian public precedent for young men facing parents and three younger brothers. hospitals. But, according to the insti- Xhosa initiation rite Circumcision is an important part of Xhosa initiation, and marks a young tute, most practising Jews still consider Bonani Yamani is caught in a di- man’s passage from ubukhwenkwe circumcision to be a requirement of lemma. He is crossing swords with his (boyhood) to ubudoda (manhood). their faith, while Muslims are the larg- parents, who he respects and loves Henderson Dweba, an official of the est identifiable group who practice cir- dearly, over a ritual intrinsic to their Eastern Cape Health Department, said: cumcision today. beliefs — but which clashes with his “Initiation is about the passing of Concerns about the circumciser's Christian convictions. knowledge that is essential to becoming page 18 Attorneys for the Rights of the Child Newsletter Fall 2009 a responsible man. This education does Uganda Health News: Research Says Complications included excessive not happen in hospitals.” Implementing Male Circumcision bleeding, infection, excessive pain, Challenging The tradition has claimed many pain upon urination, incomplete cir- lives over the years. By Ultimate Media cumcision requiring additional surgery,

John Smyth, the director of Jasa, is Uganda Pulse and lacerations of the glans, scrotum pushing for forced circumcision to be www.ugpulse.com and thighs. March 4, 2009 declared illegal. Wounds had not healed by postop-

“Under the Children’s Act of 2005 it A new research conducted in Kenya erative day 60 in 24% of the traditional is illegal for any circumcision to be has indicated that high complication and 19% of the clinical cases. The con- done on a boy over 16 without his writ- rates challenge the implementation of sequences of adverse effects were exac- ten consent. Jasa wants a declaration male circumcision for HIV prevention erbated by limited access to health fa- in Africa. cilities for postoperative care. making this clear, even when the cir- cumcision is done as a traditional rite,” Between 2005 and 2007, three Afri- he said. can randomized controlled trials were Medical groups may recommend published that showed that adult male “We also want an order forbidding procedure on boys, but opponents circumcision could reduce the risk of the chiefs from encouraging ostracism say benefits exaggerated HIV incidence by 60%. of a youth who refuses circumcision.” The chairman of the Human Rights In these three well-publicized trials, Commission, Jody Kollapen, said Ya- including one conducted in Uganda, the Circumcision: Change in Medical mani’s case should not be seen as an complication rates of the procedure Opinion Possible attack on Xhosa tradition and culture. ranged from 1.7% to 8%; however, By Deborah Shelton “It should be an examination of aspects other studies comparing clinical and thereof that may be harmful. From the traditional circumcisions in the devel- Chicago Tribune commission’s point of view this is a oping world have reported higher com- August 27, 2009 very significant matter; in terms of en- plication rates than these trials. www.chicagotribune.com suring that children’s voices are heard In light of the recent interest in the For years the medical establishment in matters affecting them,” said Kol- role of adult male circumcision for HIV in the U.S. has avoided advising par- lapen. prevention, Bailey et al have conducted ents on whether to circumcise their Yamani — a member of the Burning a prospective study in Bungoma, newborn sons, saying the benefits do Bush Ministries in Braelynn, East Lon- Kenya to assess the safety of male cir- not outweigh the risks. Now, however, don — also has the support of the sen- cumcision practices in both clinical and new research suggests the procedure ior pastor of his congregation, Ndipiwe traditional settings. could be used to combat a major health Mcoteli. problem. In this study, 1,007 males under- “We are pro-circumcision for health went circumcision and were inter- Evidence that the surgery can help reasons, but we encourage members of viewed after surgery to determine com- prevent the transmission of HIV has led the congregation to have their children plication rates and satisfaction levels. both the Centers for Disease Control and Prevention and the American circumcised at hospitals,” Mcoteli said In total, 562 circumcisions were per- this week. Academy of Pediatrics to consider issu- formed in a clinical setting (i.e., in hos- ing first-ever recommendations on rou- “Our argument is that there is so pitals, health centers, dispensaries or tine circumcision of boys. much murder and blood flowing in private clinics), and 445 circumcisions South Africa. Then why are some were performed by traditional practitio- The groups are expected to make young men forced to eat their own flesh ners in villages or household com- their decisions late this year or early in in the bush? This teaches them canni- pounds. 2010, but already their actions are balism and violence.” sparking debate over the medical ethics A sample of 21 traditional and 20 associated with a long-standing cultural Mcoteli described Yamani — an clinical circumcisers were interviewed practice. The U.S. has one of the high- usher in the church — as responsible, to assess their circumcision training est circumcision rates in the world, committed and respectful. “I believe and experience. The first 24 procedures though rates have fallen over the last this is what we need from young men,” (12 clinical and 12 traditional proce- several decades. he said. dures) were directly observed by the investigators. Vocal anti-circumcision groups, But Yamani is not finding his bur- who refer to themselves as den easy. “It’s just something I have to Overall complication rates were "intactivists," applaud that trend and do.” high in both groups: 35.2% among the oppose any changes in medical policy. traditional circumcisions and 17.7% They say male circumcision -- the sur- among the clinical circumcisions (P gical removal of some or all of the <0.001). foreskin from the penis -- is an unnec- page 19 Attorneys for the Rights of the Child Newsletter Fall 2009 essary mutilation performed without Intactivists say claims that circumci- 58th Street, passing out fliers and toting consent. sion prevents various diseases are exag- a sign with an eye-catching message

Until now, mainstream medical gerated, at best. The majority of Ameri- that plays on the center's slogan: "The groups have said circumcision should can men are circumcised, but STD rates forefront of medicine should know the are as high or higher than those in foreskin is not a birth defect." be decided by cultural, religious and personal preferences. Potential countries where circumcision is rare, Intact America recently launched a benefits include lower rates of urinary said Georganne Chapin, executive di- national campaign aimed at persuading rector of Intact. tract infection and cancer of the penis, parents not to circumcise, but Strand- which already is rare; the surgery car- Her organization views male cir- jord said his protest is aimed at doctors. ries risks of bleeding, infections and cumcision as akin to female genital "Why are they doing something that no removal of too much skin. mutilation, a practice widely con- medical organization in the world rec- demned by physicians and human ommends?" he asked. "Since medical evidence doesn't push us one way or another, we should rights advocates. It is illegal to perform Dr. Joel Schwab, a University of leave it up to the parents," said Dr. female circumcision, which involves Chicago general pediatrician who has Douglas Diekema, a University of partial or total removal of the genitalia witnessed Strandjord's demonstrations, Washington pediatrician and member or other genital injury, in the U.S. on said he tries to be neutral when discuss- girls younger than 18. of the pediatric academy's committee ing the issue with parents. on bioethics. "There's no ethical justification for "If they ask, 'Is it necessary?' most Potentially changing that equation differentiating male genital alteration of us would say no," he said. "If they are clinical trials in Africa that have from female genital alteration," Chapin say, 'We are thinking about it,' I say, said. concluded male circumcision could re- 'That's fine.' If they say, 'We're think- duce female-to-male transmission of An estimated 79 percent of adult ing about not having it,' I say, 'Fine.' " HIV by at least 50 percent. males in the U.S. are circumcised, His advice to parents who don't have Still, the studies do not settle the according to government polling con- strong feelings one way or another: "If question. It's not clear, for example, ducted from 1999 to 2004 as part of you have no opinion about it, I would- how well research in Africa that fo- the National Health and Nutrition Ex- n't circumcise my kid." amination Survey. Rates are lower for cused on heterosexual sex translates to Texas businessman Dean Pisani re- the U.S., where gays account for the minority populations who also are more affected by HIV/AIDS. cently pledged $1 million to Intact majority of cases. The largest U.S. America because, he said, he and his study to look at the issue concluded Infant circumcision rates have fallen wife were pressured in 1999 by a phy- that circumcision doesn't protect gay over the last several decades, and sician at Northwestern Memorial Hos- men who have anal sex from the virus, in 2006, the most recent year for which pital to circumcise their first child, a it was announced this week at a na- the government had data, just more boy. They refused. tional HIV prevention conference. than half of baby boys were circum- "She made us feel very guilty about CDC spokeswoman Nikki Kay said cised. Since 1999, 16 states have eliminated Medicaid payments for cir- our decision," said Pisani, who at the the agency's recommendations on male time was living in Chicago's Lakeview circumcision for HIV prevention are cumcisions not deemed medically necessary. Illinois is not among them. neighborhood. "She said some things expected to address male infants, men that were inappropriate at the time, at high risk for HIV infection from het- Regional circumcision rates vary really putting on pressure." erosexual sex and men who have sex widely, from 34 percent in the West to with men. 78 percent in the Midwest. Rates also During his wife's 48-hour hospital stay, three other doctors asked why the The federal agency also is planning differ at Chicago-area hospitals, rang- ing from zero at Roseland Community baby was still intact, he said. a study in the U.S. to study the use of adult circumcision to prevent the Hospital in 2007 to 88 percent at Palos Hospital officials declined to com- Community Hospital. ment on the particulars of the case but spread of sexually transmitted diseases. Scientists think circumcision can pro- Dan Strandjord, who said he under- said that, in general, they regard cir- tect against HIV because the tissue of went a botched circumcision as an in- cumcision as a decision ultimately the foreskin has a high number of target fant in Maryland, has protested at the made by parents. cells for HIV infection and is suscepti- University of Chicago Medical Center "It is the physician's responsibility ble to tearing during intercourse, pro- over the last five years. At 81 percent, to provide parents with the information viding an entry point for the virus. The the medical center's circumcision rate to help them make a decision based the higher rates of certain sexually trans- ranks among the area's highest. on the risks and benefits and what they mitted diseases, such as syphilis, ob- Strandjord, whose late father was believe to be best for their own child," served in uncircumcised men also may once a physician at the hospital, lives hospital spokeswoman Amy Dobrozsi increase susceptibility to HIV infection, nearby. To protest, he stations himself said in a statement. studies suggest. at the corner of South Ellis Avenue and page 20 Attorneys for the Rights of the Child Newsletter Fall 2009

Neither the pediatrics academy nor "Now you people interfere with officials in this country appears to be the American College of Obstetricians God's work. Some say it is culture. on making recommendations for new- and Gynecologists currently recom- Yes, I support culture but you must borns, a prevention strategy that would mend routine neonatal circumcision. support culture that is useful and based only pay off many years from now.

"Male circumcision is an elective on scientific information," he added. Critics say it subjects baby boys to procedure to be performed, at the Last year, the United Nations passed medically unnecessary surgery without request of the parents, on newborn boys their consent. a resolution that called female genital who are physiologically and clinically mutilation a violation of the rights of But Dr. Peter Kilmarx, chief of epi- stable," according to a joint policy women and said it constituted demiology for the division of H.I.V./ statement issued by the two groups. "irreparable, irreversible abuse". AIDS prevention at the C.D.C., said

But Dr. Edgar Schoen, chairman of The resolution also said female cir- that any step that could thwart the the pediatrics academy's 1989 task cumcision increases the risk of HIV spread of H.I.V. must be given serious force on circumcision, thinks the doc- consideration. transmission, as well as maternal and tors group should abandon its middle- infant mortality. The UN estimates that “We have a significant H.I.V. epi- of-the-road approach. If all the benefits between 100-million and 140-million demic in this country, and we really are added up, he said, it is clear the pro- worldwide have undergone the prac- need to look carefully at any potential cedure is worthwhile. tice. intervention that could be another tool

"If there is a 10 percent benefit for in the toolbox we use to address the urinary tract infections and 60 percent epidemic,” Dr. Kilmarx said. “What for HIV and 50 percent for [human Officials Weigh Circumcision to we’ve heard from our consultants is papillomavirus], you are protecting Fight H.I.V. Risk that there would be a benefit for infants yourself against all of these diseases," By Roni Caryn Rabin from infant circumcision, and that the he said. benefits outweigh the risks.” The New York Times

Crystal Seals, who lives less than a August 24, 2009 He and other experts acknowledged www.nytimes.com that although the clinical trials of cir- mile from where Strandjord conducts his frequent protests, said she decided cumcision in Africa had dramatic re- Public health officials are consider- to have both of her sons, now 3 and 4, sults, the effects of circumcision in the ing promoting routine circumcision for circumcised at the medical center be- United States were likely to be more all baby boys born in the United States cause she considered it an insurance muted because the disease is less to reduce the spread of H.I.V., the virus policy against future medical problems. prevalent here, because it spreads that causes AIDS. through different routes and because Neither boy suffered complications, The topic is a delicate one that has the health systems are so disparate as to but one had to undergo the procedure already generated controversy, even be incomparable. a second time because not enough fore- though a formal draft of the proposed skin was removed. Clinical trials in Kenya, South Af- recommendations, due out from the rica and Uganda found that heterosex- "[Circumcision] would have been Centers for Disease Control and Pre- ual men who were circumcised were up more painful for them when they were vention by the end of the year, has yet to 60 percent less likely to become in- older, and I thought it could become a to be released. fected with H.I.V. over the course of medical issue," she said. "I think it was Experts are also considering the trials than those who were not cir- a choice they would want me to make." whether the surgery should be offered cumcised.

to adult heterosexual men whose sexual There is little to no evidence that Uganda to Outlaw Female practices put them at high risk of infec- circumcision protects men who have Circumcision tion. But they acknowledge that a cir- sex with men from infection. cumcision drive in the United States [Uganda] Mail & Guardian would be unlikely to have a drastic im- Another reason circumcision would July 3, 2009 pact: the procedure does not seem to have less of an impact in the United www.mg.co.za protect those at greatest risk here, men States is that some 79 percent of adult American men are already circumcised, Uganda will pass a law banning fe- who have sex with men. public health officials say. male genital mutilation, which is ram- Recently, studies showed that in Af- pant among pastoralist tribes in the rican countries hit hard by AIDS, men But newborn circumcision rates country's eastern region, the president who were circumcised reduced their have dropped in recent decades, to said in a statement on Friday. infection risk by half. But the clinical about 65 percent of newborns in 1999 from a high of about 80 percent after "The way God made it, there is no trials in Africa focused on heterosexual World War II, according to C.D.C. fig- part of a human body that is useless," men who are at risk of getting H.I.V. ures. And blacks and Hispanics, who President Yoweri Museveni told a gath- from infected female partners. have been affected disproportionately ering in the eastern Karamoja district. For now, the focus of public health by AIDS, are less likely than whites to page 21 Attorneys for the Rights of the Child Newsletter Fall 2009 monly used term "circumcision". Yet circumcise their baby boys, according pose circumcision on broad philosophi- the former is only ever used in relation to the agency. cal and medical grounds, Ms. Chapin to the removal of parts of female repro- argued that the studies in Africa found Circumcision rates have fallen in ductive organs, and the latter, gener- only that circumcision reduces H.I.V. part because the American Academy of ally, for the removal of the foreskin infection risk, not that it prevents infec- Pediatrics, which sets the guidelines for from a male's penis. Make no mistake, tion. “Men still need to use condoms,” infant care, does not endorse routine a circumcision is the mutilation of Ms. Chapin said. circumcision. Its policy says that cir- genitals regardless of the terminology. cumcision is “not essential to the In fact, while the clinical trials in Male children from the Jewish and child’s current well-being,” and as a Africa found that circumcision reduced Muslim faiths have their foreskins re- result, many state Medicaid programs the risk of a man’s acquiring H.I.V., it moved at a young age under as part of do not cover the operation. was not clear whether it would reduce religious practice. This is an irreversi- the risk to women from an infected The academy is revising its guide- ble procedure that would otherwise be man, several experts said. lines, however, and is likely to do away classed as grievous bodily harm, con- with the neutral tone in favor of a more “There’s mixed data on that,” Dr. trary to section 18 of the Offences encouraging policy stating that circum- Kilmarx said. But, he said, “If we have Against the Persons Act 1861. The fact cision has health benefits even beyond a partially successful intervention for that it is performed with parental con- H.I.V. prevention, like reducing urinary men, it will ultimately lower the preva- sent has been deemed sufficient in al- tract infections for baby boys, said Dr. lence of H.I.V. in the population, and lowing this procedure to be performed Michael Brady, a consultant to the ultimately lower the risk to women.” under English law.

American Academy of Pediatrics. Circumcision is believed to protect He said the academy would proba- men from infection with H.I.V. because The argument that parental consent bly stop short of recommending routine the mucosal tissue of the foreskin is suffices to override the law falls flat surgery, however. “We do have evi- more susceptible to H.I.V. and can be when compared with the act of tattoo- dence to suggest there are health bene- an entry portal for the virus. Observa- ing. The Tattooing of Minors Act pro- fits, and families should be given an tional studies have found that uncir- hibits the tattooing of any person under opportunity to know what they are,” he cumcised men have higher rates of 18, regardless of whether a parent con- said. But, he said, the value of circum- other sexually transmitted diseases like sents on their behalf. A tattoo is argua- cision for H.I.V. protection in the herpes and syphilis, and a recent study bly less permanent than a circumcision. United States is difficult to assess, add- in Baltimore found that heterosexual If a person must reach the age of 18 ing, “Our biggest struggle is trying to men were less likely to have become before being deemed able to understand figure out how to understand the true infected with H.I.V. from infected part- and consent to the permanence of a tat- value for Americans.” too, then why should this not apply to a ners if they were circumcised. male child being circumcised? Circumcision will be discussed this week at the C.D.C.’s National H.I.V. Religious grounds have long been Prevention Conference in Atlanta, Circumcision – above the law? cited as the reason for this anomaly. which will be attended by thousands of By Rosa Freedman Britain prides itself, rightly so, on its health professionals and H.I.V. service The [Manchester, UK] Guardian freedom of religion. Why then is male providers. circumcision allowed at any age, and October 1, 2009 Among the speakers is a physician www.guardian.co.uk female circumcision proscribed even from Operation Abraham, an organiza- after a woman turns 18? Surely reli- In anything other than a religious tion based in Israel and named after the gious freedom cannot be given solely context, male circumcision would biblical figure who was circumcised at to males. be regarded as a crime. The law an advanced age, according to the book must be made clearer. Furthermore, if circumcision of of Genesis. The group trains doctors in males is allowed on religious grounds, Africa to perform circumcisions on Dan Rickman recently stated the then the ruling in the case of Adesanya adult men to reduce the spread of H.I. case for circumcision by setting out its must have been erroneous. The court V. central importance to Judaism and Jew- here decided that a Nigerian woman ish identity. These are the arguments Members of Intact America, a group could be prosecuted for cutting her that convinced me to circumcise my that opposes newborn circumcision, teenaged sons' faces according to her own son. However, in dealing with have rented mobile billboards that will cultural norms. It seems that freedom to some of the issues raised, he failed to drive around Atlanta carrying their commit GBH only extends to males, engage with the most cogent argument message that “circumcising babies and only then of particular faiths or cul- against circumcision – the fact that it is doesn’t prevent H.I.V.,” said Geor- tural backgrounds. fundamentally at odds with English ganne Chapin, who leads the organiza- law. The final spin of the dice for the tion. pro-circumcision group is the health The term "genital mutilation" Although the group’s members op- argument. Circumcised males have sounds far less civilised that the com- page 22 Attorneys for the Rights of the Child Newsletter Fall 2009

been proven to have a lower incidence Mum to sue GP over son's botched Mrs Akram, of Knight Street, Tun- of a number of diseases, and even a circumcision operation stall, said: "I couldn't believe what we lower chance of contracting HIV. Yet saw. It was like a circumcision factory. religious circumcisions are not per- The [Staffordshire, UK] Sentinel formed on the grounds of health, and June 5, 2009 "There were 12 other babies waiting are often performed by religious practi- www.thisisstaffordshire.co.uk to be seen. When it was Naveed's turn, tioners who are not medically qualified we had to leave him on a wooden table A Muslim mother is planning legal with just a changing mat." to do so. The health argument is merely action against a GP [general practitio- a coincidental, although happy, one. ner] after her baby son's circumcision Days later, Mrs Akram took Naveed Were this to be the decisive factor, then went wrong. to a doctor. He referred him to a sur- surely circumcision should be extended geon at the University Hospital, who to all male children at birth as has re- Faiqa Akram paid £80 for three- tried to correct the damage. month-old Naveed to be circumcised at cently occurred in some American The General Medical Council and states. Moreover, according to this line a private clinic because she could not have the treatment on the NHS. Kirklees Primary Care Trust, which of reasoning, circumcisions should all covers Dr Butt's surgery, have con- be performed by doctors, or medical But Naveed is one of four boys who firmed they are investigating medical practitioners, and at a time that is opti- have needed treatment at the University issues relating to Naveed's treatment. mum for the health of the child rather Hospital of North Staffordshire after than at a religiously prescribed point in suffering complications following pri- The Sentinel made a number of at- his life. vate circumcisions. tempts to contact Dr Butt, but a spokes- man for his clinic said: "He isn't here, I am not advocating the abolition of Naveed, now 18 months, required a but I'm sure we will not comment." male circumcision. However, the law full operation under general anaesthetic needs to create guidelines that are ap- and still needs more surgery to put The Healthcare Commission has plicable to all persons regardless of things right. investigated the four cases at the Uni- versity Hospital after concerns were creed, gender, or religion. The exis- Now, Mrs Akram and husband tence of different sets of rules for dif- raised by a consultant there. Nadeem are preparing a claim for po- ferent groups can only be seen as plac- tential clinical negligence against Dr It is not clear which private clinics ing some people on a pedestal, elevated Munir Butt, who runs the clinic, in the other boys were referred from. above the laws that the rest of us must Manchester. Hospital medical director Robert follow. The move comes as Mrs Akram Courteney-Harris said: "The Commis- launches a campaign to make NHS sion asked us how these had been man- Helsinki Convention Stoke-on-Trent pay for religious non- aged. Evidence was provided and the Article Published medical circumcisions. issue is now closed."

An article by Robert Van Howe, M.D. and myself was published in February address- ing--for the first time, we be- lieve--the ethical requirements imposed by the Helsinki Con- vention on medical studies ad- dressing the efficacy of anes- thetic for neonatal circumcision. It is entitled, "Neonatal Pain Re- lief and the Helsinki Declara- tion" and it appears on pp. 803- 823 of the Winter 2008 issue of the Journal of Law, Medicine and Ethics.

Steven Svoboda, Genital Awareness Week, Washington, D.C., March 29, 2009