New AAP policy must discourage male circumcision

Times have changed, and American Academy of Pediatrics need to get with them. Originating before children were believed to feel pain or have rights, male circumcision became a social custom in the United States. Since then medical justifications were invented with fervor and at great expense, but they always fall under scrutiny. The latest group of physicians to put this in writing are Royal Dutch Medical Association (KNMG), dating to 1849.

Speculation that AAP might take the unprecedented action of recommending newborn circumcision rests on studies conducted in Africa on HIV transmission. But KNMG--and several other physicians organizations--have issued statements since publication of those studies and found the data not compelling.

"In recent decades, evidence has been published which apparently shows that circumcision reduces the risk of HIV/AIDS, but this evidence is contradicted by other studies.

Moreover, the studies into HIV prevention were carried out in sub-Saharan Africa, where transmission mainly takes place through heterosexual contact. In the western world, HIV transmission is much more frequently the result of homosexual contact and the use of contaminated needles. That the relationship between circumcision and transmission of HIV is at the very least unclear is illustrated by the fact that the US combines a high prevalence of STDs and HIV infections with a high percentage of routine circumcisions. The Dutch situation is precisely the reverse: a low prevalence of HIV/AIDS combined with a relatively low number of circumcisions. As such, behavioural factors appear to play a far more important role than whether or not one has a foreskin."

Uncertain for adults, not relevant for newborns:

"Insofar as there are medical benefits, such as a possibly reduced risk of HIV infection, it is reasonable to put off circumcision until the age at which such a risk is relevant and the boy himself can decide about the intervention, or can opt for any available alternatives."

Babies don't have sex.

But they do have rights, which AAP learned the hard way after issuing a statement suggesting a "nick" to the genitals of young girls if it may avoid more severe cutting. People were outraged. Girls have rights--their bodies, certainly their genitals, are not to be modified, however slightly. AAP buckled under intense pressure from Intact America and others. After a very short career they "retired" the controversial policy statement. This is the 21st century: Children have rights.

KNMG had never before issued a policy on male circumcision. Why did they do so now? They explain,

"The reason for our adoption of an official viewpoint regarding this matter is the increasing emphasis on children’s rights. It is particularly relevant for doctors that children must not be subjected to medical proceedings that have no therapeutic or preventative value. In addition to this, there is growing concern regarding complications, both minor and serious, which can occur as a result of circumcising a child. A third reason for this viewpoint is the growing sentiment that there is a discrepancy between the KNMG’s firm stance with regard to female genital mutilation and the lack of a stance with regard to the non-therapeutic circumcision of male minors, as the two have a number of similarities."

American Academy of Pediatrics exhibits discrepancy of a more serious nature. They have policies pertaining to both males and females, but--if we believe all children have the same rights--they are in conflict. As KNMG state:

"Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity."

AAP now have an opportunity to narrow the discrepancy by taking a stance discouraging non-therapeutic circumcision of boys. The right trajectory for children's rights is more. When AAP issue a new policy, it must be aimed squarely in that direction. Recognizing boys' rights to freedom from non-therapeutic circumcision--even if like KNMG they don't recommend it's abolition--will align AAP, medically and ethically, with their physician colleagues worldwide.

AAP should be keen to avoid repeating their recent mistake of shifting policy in the wrong direction--the direction of less autonomy, less physical integrity for their young patients. It's time they close the policy gap with their peers. It's time American Academy of Pediatrics discourage newborn male circumcision.

KNMG Viewpoint Non-therapeutic circumcision of male minors