3 10 240 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> An editorial in the January edition of the (Australian) Journal of Paediatrics and Child Health calls circumcision a “bizarre mutilation” and dismisses claims that it contributes to hygiene or improves child health. The editorial, by the editor in chief, David Isaacs, covers several aspects of both ritual and “health” circumcision, runs through the origins of circumcision as a religious/cultural rite in the region bordering the Red Sea, and comments that “there seem to be insufficient health benefits for circumcision to have evolved through natural selection”. He also devotes some attention to the rise of medically-rationalised circumcision of infants in nineteenth century Britain and the USA, and although the discussion is brief, he correctly notes that at that time the principle selling point for the operation was that it would discourage masturbation in infants and boys. Professor Isaacs concludes with a question that deserves greater debate – “Should the autonomy of an infant to choose when he is older outweigh his parents’ right to choose to have their infant son circumcised?” – but does not explore this issue. His remark that circumcision is no laughing matter seems undermined by the rather flippant style in which the editorial is written. Overall its message is that circumcision is primarily a cultural ritual and from a medical point of view too trivial a matter to be discussed in medical journals. The editorial, followed by our comments, appears below. <h2>Editorial: Circumcision</h2> What is the name of the useless bit at the end of a penis? A man of course, but circumcision is no joke. If you crave controversy, choose a topic concerned with sex or religion. The ancient ritual of circumcision meets both criteria. In the second century BC, tribes on the Red Sea, now Egypt, practised both female and male circumcision. One possible explanation relates to the belief that gods were bisexual and humans, like gods, had both a female and a male soul. The man’s female soul which resided in the prepuce and the woman’s male soul which resided in the clitoris had to be removed for healthy gender development. [1] An alternative theory is that female circumcision was a means for men to control women’s sexuality. Islam is opposed to female circumcision and Muslims attribute its continued practice in some Africa countries to traditional custom, not to religion. The modern re-naming of female circumcision as female genital mutilation is a clear ethical statement opposing this practice. Male circumcision, unlike female circumcision, is incorporated into major religions. Neonatal circumcision is practised routinely by Jews, Muslims and some African Christians while adolescent circumcision is a common tribal manhood initiation ceremony. The World Health Organization estimates that 650 million or 30% of all males aged over 14 are circumcised, 70% of whom are Muslims. [1] That the bizarre mutilation of ritual male circumcision is so customary suggests some deep significance. There seem to be insufficient health benefits for circumcision to have evolved through natural selection. Freud suggested that circumcision represented a metaphorical ritual castration of the son by his father to control the son’s Oedipal rivalry. Whatever the veracity of psychological explanations for male circumcision, its historic and geographic spread is intriguing. The ancient Greeks hated circumcision and the practice consequently declined under Greek rule. From about 1900, however, male circumcision became common in the United States, Australia and other English-speaking countries. In the UK there was a clear social gradient. It was purportedly impossible for a boy to attend Eton with either his foreskin or his tonsils intact. Neonatal circumcision, whether religious or cultural, was often performed without either analgesia or anaesthetic. This further example of our barbaric denial of neonatal pain, following neonatal surgery for pyloric stenosis and other conditions, is now unconscionable. A Cochrane meta-analysis shows that dorsal penile nerve block and, to a lesser extent local anaesthetic cream, is markedly superior to placebo. [2] Inadequate pain relief for circumcision persisted into the 1990s but is no longer tenable. What happens to the foreskin after circumcision? Many are discarded but intriguing uses include incorporation into face creams and anti-ageing cosmetics, skin grafts, and as the foreskin fibroblast cell lines to feed stem cells, grow viruses and produce beta-interferon. In Africa, the foreskin may be dipped in brandy and eaten by the patient or the circumciser. [1] There are some controversial medical benefits of male circumcision. In Africa, male circumcision halves the risk of a man acquiring HIV heterosexually. [3] Infant male circumcision reduces the risk of urinary tract infection (UTI) significantly, but because only 1% of normal boys has a UTI, 111 boys need to be circumcised to prevent one UTI. Since 2% of circumcisions are complicated by infection or haemorrhage, therapeutic circumcision should be reserved for boys with recurrent UTI or severe vesicoureteric reflux. [4] There is no evidence that circumcision improves hygiene, although this and the fond belief that it prevented masturbation were the main motivating factors in twentieth-century Western countries. Circumcision is a rich ethical topic. Should the autonomy of an infant to choose when he is older outweigh his parents’ right to choose to have their infant son circumcised? Who should pay? Non-therapeutic circumcision is rarely publicly funded. The RACP is revising its recommendations on circumcision, but previously did not recommend routine male circumcision, while acknowledging that informed parental choice should be respected. Circumcision is a topic for endless debate. But no laughing matter. Professor David Isaacs Editor-in-Chief, Journal of Paediatrics and Child Health Children’s Hospital at Westmead (Sydney) <a class="__cf_email__" data-cfemail="3c58554f5d5d5f4f7c5f544b12595849125d49" href="/cdn-cgi/l/email-protection">[email protected]</a> References 1. Wikipedia. Circumcision. Available from: http://en.wikipedia.org/wiki/Circumcision [Accessed March 2010]. 2. Brady-Fryer B, Wiebe N, Lander JA. Pain relief for neonatal circumcision. Cochrane Database Syst. Rev. 2004; 3: CD004217. DOI: 10.1002/14651858.CD004217.pub2. 3. Siegfried N, Muller M, Deeks JJ, Volmink J. Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane Database Syst. Rev. 2009; 2: CD003362. DOI: 10.1002/14651858.CD003362.pub2. 4. Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies. Arch. Dis. Child. 2005; 90: 853–8. <h3>Comments from CIA</h3> Although we welcome Professor Isaacs' description of circumcision as a “bizarre mutilation” and his dismissal of the many claims for its “health benefits” in children, there are a few aspects of his editorial that demand comment. 1. It is very unlikely that the persistence and spread of circumcision have anything to do with any supposed “deep significance” of the rite. The persistence arises simply from the fact that it is usually performed by powerful adults on infants or children who have no capacity to say No; it is more like a bad habit, handed down thoughtlessly from father to son, not so different from smoking. As to the spread of circumcision, this is explained by the comment that 70 per cent of the world’s circumcised men are Muslims; in other words, the large number of circumcised men simply reflects the wide distribution of Islam, the armies of which conquered vast swathes of central and southern Asia, northern Africa, south-east Asia and eastern Europe from the 8th to the 17th centuries. In India, Hinduism, and in south-east Europe, including Greece, Christianity resisted mass conversion, but in Africa, central Asia and south-east Asia the new religion wiped out the indigenous cultures and imposed circumcision on the conquered populations. 2. Muslims do not traditionally practise neonatal circumcision. The canonical age for circumcision in Islam is eight years, though in places such as Turkey it is usually done at any time between the ages of 6 and 9, in an elaborate ceremony with much dancing and drinking, and a certain amount of kicking and screaming from the central figure. As circumcision is medicalised, however, more parents are doing it in the manner of the Jews and modern Americans, soon or very soon after birth, in a coldly clinical rather than a warmly celebratory setting. Once medicalised in this way, circumcision loses whatever cultural significance it might have had. 3. It is not true, as Isaacs states, that “Islam is opposed to female circumcision and Muslims attribute its continued practice in some Africa countries to traditional custom, not to religion.” For one thing, unlike the major Christian denominations, Islam has no central authority determining doctrine. This means that every local preacher is free to interpret the sacred writings in pretty much any way he chooses, issue rulings and fatwas, call for the murder of blasphemers such as Salman Rushdie, and generally make up his own rules. Many Muslim authorities are strongly in favour of female circumcision, which is widely practised in north Africa, parts of the Middle East and among Muslims in Malaysia and Indonesia. Criminalisation of female genital mutilation in countries such as Egypt has had very little impact on local practice. Much the same comment as that quoted could as truthfully be made about male circumcision. There is no mention of circumcision in the Koran, and but the prophet Mohammed is reported to have stated that “Circumcision is a sunnah for the men and a makrumah for the women”. (Note the reference to men and women: nothing about boys and girls.) The term sunnah means customary or traditional; the term makrumah means meritorious. The most you could conclude is that circumcision was customary for men and meritorious for women, and thus desirable for both but obligatory for neither. In these respects Islam is quite different from Judaism, which requires the head of the household not only to circumcise his baby sons at eight days, but also his male servants and employees, which makes no mention of women in this context, and in which the rule of circumcision is stated prominently in the first book of the Jewish bible. Mohammed further laid down five rules for Muslim men: shaving the pubic hair; circumcision; trimming the moustache; plucking the hairs from the armpits; and clipping the nails. These constitute the fitrah, or laws of personal deportment, to which a pious man in pursuit of perfection must conform. According to Dr Sami Aldeeb, “They are not compulsory, but simply advisable”. The vital point about this list is that circumcision is a recommendation for adult men, perhaps no more important than trimming their moustache or shaving their pubic hair. It is thus less obligatory than the rule of prayer five times a day, the pilgrimage to Mecca, fasting at Ramadan or abstention from alcohol and pork. There is certainly nothing in the fitrah which requires parents to circumcise their children. Sami A. Aldeeb Abu-Sahlieh, <a href="http://www.nocirc.org/symposia/fourth/aldeeb.html">Jehovah, his cousin Allah and sexual mutilations</a>, in George C. Denniston and Marilyn Milos (eds), Sexual mutilations: A human tragedy (New York: Plenum Press, 1997) Sami Aldeeb, <a href="http://www.cirp.org/library/cultural/aldeeb1/">To mutilate in the name of Allah or Jehovah: The legitimation of male and female circumcision</a>, Medicine and Law, Vol 13, No 7-8, 1994, pp. 575-622 Sami A. Aldeeb Abu-Sahlieh, Male and female circumcision among Jews, Christians and Muslims: Religious, medical, social and legal debate (Warren PA: Shangri-La Publications, 2001) 4. It is true that non-therapeutic (medically unnecessary) circumcision is rarely publicly funded, but one of the few places where it is funded by the taxpayer out of the health budget is Australia. Medicare provides a no-questions-asked rebate for medically unnecessary circumcision, even though <a href="http://www.medicareaustralia.gov.au/public/claims/what-cover.jsp">its own guidelines state</a> that rebates are not available for “medical services which are not clinically necessary” or “surgery solely for cosmetic reasons”. 5. It is odd that Professor Isaacs writes that the Royal Australasian College of Physicians “is revising its recommendations on circumcision” when in fact the new policy was issued in October 2010, several months before the editorial was published. In the new statement the RACP maintained the opposition to routine circumcision of male infants and boys that Australian paediatric authorities had first formulated in 1971. The most recent statement is quite clear: “After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.” Other medical bodies, such as the British Medical Association and the Royal Dutch Medical Association, have issued policies even more strongly opposed to the practice. Only in backward and impoverished places such as the United States and some regions of darkest Africa does faith in the health-giving powers of this mutilation linger. (For details, see <a href="https://www.circinfo.org/doctors.html">statements from medical authorities</a> on this site.) 6. Finally, we are surprised that a professor should cite the Wikipedia as an authority for anything, let alone a topic as controversial as circumcision. This would not have been acceptable in an assignment written by one of his students, and it should not be regarded as acceptable for somebody in a senior academic position. Why go to the Wikipedia, when scholarly texts by David Gollaher, Leonard Glick and Robert Darby are readily available? David Gollaher, Circumcision: A History of the World’s Most Controversial Surgery (New York: Basic Books, 2000) Leonard Glick, Circumcision from Ancient Judaea to Modern America (New York: Oxford University Press, 2005) Robert Darby, A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain (Chicago University Press, 2005) Robert Darby, “‘A source of serious mischief’: The demonisation of the foreskin and the rise of preventive circumcision in Australia”, in George C. Denniston, Frederick Hodges and Marylin Milos (eds), Understanding circumcision: A multi-disciplinary approach to a multi-dimensional problem (London and New York: Kluwer Academic and Plenum Press, 2001) <a href="http://www.historyofcircumcision.net/index.php?option=com_content&task=category&sectionid=6&id=71&Itemid=50">Available at History of Circumcision</a>. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Child health journal calls circumcision "bizarre mutilation" darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h2>Female genital mutilation happening in Australia</h2> by Emily Bourke for AM Health authorities in Australia say they are concerned about the growing number of women who have undergone some form of genital mutilation. Female circumcision is illegal in Australia, but experts say there is evidence that it is being practised here. More and more migrant women are also seeking help after having the procedure in their home countries. Across Africa, the Middle East and parts of Asia, female genital mutilation is practised on about three million girls and women each year. The centuries-old custom has been outlawed in Australia since the 1990s. But that has not stopped it happening here, according to Dr Ted Weaver from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. "There is some evidence to suggest that it does happen in certain parts of Australia," he said. "It's hard to gauge the actual numbers because it's prohibited by legislation and it's something that is performed in an underground way. "But certainly there have been reports of children being taken to hospital after having the procedure done with complications from that procedure." Melbourne's Royal Women's Hospital says it is seeing between 600 and 700 women each year who have experienced it in some form. Somali-born Zeinab Mohamud, from the hospital's Family and Reproductive Rights Education Program, says much of her work involves untangling some outdated cultural traditions and religious misconceptions. "Some questions that we ask the women is 'why were you doing it?' and they will tell you, 'because of my religion'," she said. "We bring imams or priests to convince them that there is nothing from both books that says you have to do circumcision to girls. So why are you doing it?" Ms Mohamud is optimistic the practice will end, but she fears migrant communities or individual women will be demonised. "Some people when they hear they say, 'how can that happen?' It's when something is cultural and the people have been doing it for so long, it's not easy to either eliminate it or to say, 'you have got a bad culture'," she said. "You have to work with them, listen to them. You have to know where they are coming from in order to help them." Dr Ted Weaver agrees and he says ordering people against the practice would be inappropriate. "If we try and dictate and pontificate about this and not provide culturally appropriate care, we'll further disenfranchise those women," he said. "Any progress will be incremental. I don't think that it's something that will stop overnight. "But I think all we can do is advocate against it, speak out, try to educate women, try to empower women, certainly in this country, and we should do our best for international organisations that are also espousing the same message." <a href="http://www.abc.net.au/news/stories/2010/02/06/2812147.htm?section=justin" rel="noopener" target="_blank">Posted Sat Feb 6, 2010 11:15am AEDT</a> <h3>Comment</h3> The ABC's report was in recognition of the United Nations' declaration of 6 February as International Day Against Female Genital Mutilation, but the UN's position has been condemned as sexist, misandrist (men-hating) and hypocritical by the <a href="http://www.icgi.org/">International Coalition for Genital Integrity</a>, which asks why the UN is concerned only with women and ignores the much larger number of boys and young men who are forced to submit to various forms of genital cutting. ICGI writes: The United Nations says that female circumcision is now widely recognized as a violation of human rights. And so, the UN has declared February 6th as the “<a href="http://www.unifemuk.org/news-international-day-against-female-genital-mutilation.php">International Day Against FEMALE Genital Mutilation.</a>” Instead, it should be declaring an “International Day Against HUMAN Genital Mutilation.” We say the UN is sexist and misandrist. The UN is also hypocritical. In 1989 the UN issued its <a href="http://www2.ohchr.org/english/law/crc.htm">Convention on the Rights of the Child</a>, which “proclaimed and agreed that everyone is entitled to all the rights and freedoms set forth therein, without distinction of any kind, such as … sex.” Ironically, by declaring an International Day Against Female Genital Mutilation, the UN has also circumcised their Convention on the Rights of the Child. The World Health Organization says female circumcision can cause severe bleeding, urinary and reproductive tract infections, and even death. All of these are also true for male circumcision. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Female genital mutilation in Australia darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Not a surgical vaccine: There is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia.</h3> In October 2010 the Medical Journal of Australia published an opinion piece by David Cooper, Alex Wodak and Brian Morris, calling for a significant “boost” in the incidence of infant circumcision in Australia in order to combat heterosexually acquired HIV infection. The editorial attracted much media attention, and so much criticism that the journal (eventually)<a href="https://www.circinfo.org/MJA_Cooper_letters.html"> published eight letters in reply</a>. A much longer and detailed rebuttal of the editorial by medical historian Robert Darby and pediatrician Robert Van Howe has now been published in Australia’s leading journal of public health issues, the Australian and New Zealand Journal of Public Health. A summary of the article follows. ABSTRACT Objective: To conduct a critical review of recent proposals that widespread circumcision of male infants be introduced in Australia as a means of combating heterosexually transmitted HIV infection. Approach: These arguments are evaluated in terms of their logic, coherence and fidelity to the principles of evidence-based medicine; the extent to which they take account of the evidence for circumcision having a protective effect against HIV and the practicality of circumcision as an HIV control strategy; the extent of its applicability to the specifics of Australia’s HIV epidemic; the benefits, harms and risks of circumcision; and the associated human rights, bioethical and legal issues. Conclusion: Our conclusion is that such proposals ignore doubts about the robustness of the evidence from the African random-controlled trials as to the protective effect of circumcision and the practical value of circumcision as a means of HIV control; misrepresent the nature of Australia’s HIV epidemic and exaggerate the relevance of the African random controlled trials findings to it; underestimate the risks and harm of circumcision; and ignore questions of medical ethics and human rights. The notion of circumcision as a “surgical vaccine” is criticised as polemical and unscientific. Implications: Circumcision of infants or other minors has no place among HIV control measures in the Australian and New Zealand context; proposals such as these should be rejected. <h3>SUMMARY</h3> 1. A conservative position To reject infant circumcision is to follow the policy of Australian medical authorities, which have discouraged routine circumcision since 1971. It was the suggestion in the Med J Aust that was radical, and far out of step with the policies of relevant medical authorities: Royal Australasian College of Physicians, British Medical Association, Canada Pediatric Society, Royal Dutch Medical Association, American Academy of Pediatrics. The timing of the editorial suggests that it was intended to influence or criticise the circumcision policy statement about to be released by the task force set up in 2007 by the Paediatric and Child Health Division of the Royal Australasian College of Physicians. This policy stated clearly that the evidence of the African circumcision trials were not relevant in developed countries and that routine circumcision was not warranted in Australia or New Zealand. 2. Doubts about the African clinical trials themselves <ul> <li>only a small protective effect – somewhere between 38 and 66 per cent, and not the mythical 60 per cent reported everywhere;</li> <li>uncertainty about why: anatomy or behaviour? No convincing biological mechanism yet found that would explain greater vulnerability of uncircumcised men;</li> <li>high drop-out rate: in some of the trials more men dropped out than were infected with HIV;</li> <li>inconsistent with epidemiological evidence from population surveys, which show no consistent pattern in HIV infection between cut and uncut;</li> <li>we don’t know how much transmission is non-sexual, probably through non-sterile medical procedures;</li> <li>even advocates of circumcision solution insist that condoms must still be used: so what’s the point of getting circumcised, with all the cost, risks, and loss of both appearance and function necessarily entailed?</li> <li>evidence from African trials might justify a modest circumcision program in high prevalence countries with high female to male transmission, as one element of a broad range of preventive measures, but not the multi-billion dollar promotion of circumcision pretty much to the exclusion of other interventions. <a href="https://www.circinfo.org/Circumcision_HIV_doubts.html#lomb">Criticism of excessive focus on circumcision</a> by report published by German Development Bank; plus Bjorn Lomborg and other leading economists at Georgetown conference, that circumcision on this massive scale is not cost-effective and bad way to tackle the problem.</li> </ul> 3. Not relevant to nature of Australia’s HIV problem <ul> <li>The WHO recommendations apply to adult men in underdeveloped countries with high HIV prevalence and a high incidence of female to male transmission via unprotected intercourse. They do not apply to the developed world, and they do not apply to children anywhere.</li> <li>Africa: high prevalence; mostly heterosexual; female to male transmission;</li> <li>Australia: low prevalence; mostly homosexual, plus a few injecting drug users – these categories get no protection from circumcision;</li> <li>no evidence that hetero transmission is increasing: only 23 new cases in 2009;</li> <li>infection from prostitutes common in Africa, but in Australia there has never been a single example of a prostitute infecting a male client;</li> <li>Australia’s HIV prevention program (condoms and safe sex education) has worked very well, and we have one of the lowest rates of HIV infection in the developed world – much less than in USA.</li> </ul> 4. Suggestion departs from principles of evidence-based medicine. <ul> <li>Trials involved consenting, sexually active adult men and did not provide any evidence that circumcision in infancy would provide protection. The trials cannot therefore be cited to justify circumcision of infants.</li> <li>In any case, infants are not sexually active, not at risk, and cannot give consent.</li> </ul> 5. Suggestion ignores harm of circumcision and underestimates level of complications. <ul> <li>Circumcision is always harmful. The foreskin is a sensitive, functional body part that many men value highly; it cannot be dismissed as nothing more than a piece of surgical waste.</li> <li>Complications are under-reported, and we have no benchmarks for acceptable risk. The bar must be set higher in cases where the surgery is not immediately necessary, and even higher when it is not elected by the individual, but imposed on him by somebody else.</li> </ul> 6. Suggestion totally ignores medical ethics and human rights. <ul> <li>But all humans have an inherent right to bodily integrity that may be violated only with very good reason. Ethics should not be dismissed as an obstacle to the roll-out of circumcision programs: if we don’t have ethical principles we cannot regard ourselves as civilized, and we shall end up in a dog-eat-dog world, without values and without respect for individual rights.</li> </ul> 7. Circumcision is not a surgical vaccine. <ul> <li>The suggestion misrepresents both the nature of vaccines and the nature and level of protection given by circumcision. It is both exaggerated and mischievous in that it is likely to give a false sense of security and encourage high risk behaviour. Already there are reports from African countries of men saying that now they are circumcised they don’t need to use condoms.</li> </ul> 8. Conclusion It is generally accepted that the rapid spread of HIV in Africa was associated with a high level of sexual activity, involving numerous concurrent but often transient sexual partnerships, widespread prostitution, both formal and informal, various forms of polygamy, and reluctance to practise safe sex or use condoms. It is also probable that a significant proportion of HIV infections are the result of non-sexual transmission, such as non-sterile medical procedures. These conditions were aggravated by poorly developed health services, the co-presence of numerous other epidemic diseases, such as malaria, tuberculosis and other STIs, and the refusal of local authorities to take action until the disease had spread through the population, provoked by the misconception that AIDS was a “gay disease”, confined to decadent developed world. This crisis situation stands in dramatic contrast to that of a wealthy, developed nation such as Australia, where effective action was taken early on, based on respect for the autonomy and agency of those at greatest risk, and an emphasis on safe sex education, needle and syringe programs, and provision of condoms. This strategy has been strikingly successful: AIDS in Australia remains a relatively minor public health problem, largely confined to the sub-cultures where it has traditionally been found. There is no heterosexual epidemic that would justify a costly, authoritarian program of the type and scale that Cooper et al propose. There is every reason to think that the strategy that Australia has pursued so successfully since the 1980s will continue to protect the vast majority of the population from this disease. Source (full text available through link): Robert Darby and Robert Van Howe, Not a surgical vaccine: There is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.2011.00761.x/full">Australian and New Zealand Journal of Public Health, Vol. 35, October 2011</a>. Full text may be downloaded as PDF here: <a href="https://www.circinfo.org/documents/VaccineANZJPH.pdf">VaccineANZJPH</a><a href="https://www.circinfo.org/documents/VaccineANZJPH.pdf"></a> Figures on the incidence of HIV and other sexually transmitted infections in Australia are available from the Kirby Institute for Infection and Immunity in Society (formerly National Centre in HIV Epidemiology and Clinical Research), <a href="http://www.med.unsw.edu.au/NCHECRweb.nsf/page/Annual+Surveillance+Reports" rel="noopener" target="_blank">HIV/AIDS, Viral Hepatitis & Sexually Transmissible Infections in Australia, Annual Surveillance Reports</a> <h3>Argument confirmed by studies since paper written</h3> Results of African trials not replicated in other countries. 1. In the USA, study by Sansom showed that that the lifetime risk of HIV to Black men was 6.23% while 73% of Black men are circumcised, yet the lifetime risk to Hispanics was only 2.88% with a circumcision rate of only 42%. This suggests that there is no connection at all between circumcision and reduced susceptibility to HIV; or that circumcision increases the risk of HIV; or that being Black in the USA is a far greater risk factor for HIV than possessing a foreskin. (This last point may be related to the disproportionate number of Black men in American prisons, where unsafe sex is rampant.) Stephanie L. Sansom et al, <a href="http://www.plosone.org/article/comments/info%3Adoi/10.1371/journal.pone.0008723">Cost-Effectiveness of Newborn Circumcision in Reducing Lifetime HIV Risk among U.S. Males</a>, PLoS ONE 5(1): e8723. doi:10.1371/journal.pone.0008723. (<a href="https://www.circinfo.org/Foreskin_owner_decide.html">And see comment by Circinfo.org</a>) 2. <a href="https://www.circinfo.org/AIDSnews.html#heff">Study of HPV and HIV in Zambia</a> (Heffron et al) found that uncircumcised men had slightly lower incidence of HIV infection – but did not discuss this finding in their paper: Heffron R. et al, High prevalent and incident HIV-1 and herpes simplex virus 2 infection among male migrant and non-migrant sugar farm workers in Zambia. Sex Transm Infect 2011; 87: 283-8. 3. <a href="https://www.circinfo.org/Circumcision_HIV_doubts.html#kids">Study by Brewer in Mozambique</a> found that men circumcised as children had a higher incidence of HIV. Suggests that this is more evidence of non-sexual transmission: Brewer D.D. Scarification and Male Circumcision Associated with HIV Infection in Mozambican Children and Youth. WebmedCentral EPIDEMIOLOGY 2011;2(9):WMC002206 Excessive focus on circumcision criticised by economists Criticism of excessive focus on circumcision by report published by German Development Bank; plus Bjorn Lomborg and other leading economists at Georgetown conference, that circumcision on this massive scale is not cost-effective and bad way to tackle the problem. <a href="https://www.circinfo.org/Circumcision_HIV_doubts.html#lomb">See news report at Circinfo.org</a>. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource ANZ public health journal: No case for circumcision to combat HIV transmission in Australia darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> Contrary to recent, ignorant, media reports, the incidence of infant circumcision in Australia is not increasing, but, on the contrary, is static nationally and actually declining in most states and territories. This is the conclusion of an analysis of circumcision figures for the period 2000-2010, published in the August issue of the Australian and New Zealand Journal of Public Health. The article compared the Medicare rebate for circumcision of boys under 6 months with male birth statistics, concluding that the incidence of circumcision had stayed pretty steady at 12 per cent across the nation, but with big falls in some states, offset by small rises in others. The most striking feature of the figures is wide variation among the states – from a low of 1.5 per cent in Tasmania to a high of 17.3 per cent in New South Wales for 2010. In between are the Australian Capital Territory and Western Australia on 6 per cent and 6.8 per cent respectively, and South Australia and Queensland on 15.1 and 14 per cent. Another feature of the figures are the sharp falls in Tasmania, from 9.3 per cent in 2000 to 1.5 per cent in 2010; in the Northern Territory from 7.6 to 2.7 per cent; and in Queensland from 20.3 per cent to 14 per cent. There have been small rises over the same period in Victoria (5.3% to 8%) and New South Wales (14.3% to 17%), though these may well be a product of changes in hospital policy rather than evidence of increased demand for the operation. The article suggests that the rises in NSW and Victoria may be related to the decision by state governments (NSW in 2006, Vic and SA in 2007) to cease providing non-therapeutic (medically unnecessary) circumcision as a service in their public hospitals. This may have resulted in a shift in the provider of the service from hospitals (where no Medicare rebate is payable or recorded) to GPs and specialist clinics, where the procedure shows up in the Medicare statistics. The rise may thus be more apparent than real. The article wonders why Medicare is providing a rebate for circumcision, considering that the latest statement by the <a href="https://www.circinfo.org/doctors.html">Royal Australasian College of Physicians</a> does not recommend it or regard it as necessary, and the Medicare guidelines state that rebates are not available for “medical services which are not clinically necessary”. The article concludes that there is no evidence for recent assertions that “circumcision is back in favour”, and points out that, on the contrary, it is continuing its slow decline from the high-point of the mid-1950s, and is close to its lowest level for nearly a century. Source: Robert Darby, Infant circumcision in Australia: A preliminary estimate, 2000-10, Australian and New Zealand Journal of Public Health 35 (4), August 2011. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Circumcision rate continues its slow decline darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h1>Male health report fails to mention circumcision:</h1> <h2>Circumcision irrelevant to male health outcomes in Australia</h2> “Is there any other point to which you would wish to draw my attention?” “To the curious incident of the dog in the night-time.” “The dog did nothing in the night-time.” “That was the curious incident,” remarked Sherlock Holmes. — “Silver Blaze” In its report, The Health of Australian Males, issued in July 2011, the Australian Institute of Health and Welfare outlined the important health issues facing men and boys in this country. A significant feature of the report is the absence of any references to circumcision. The fact that the word does not appear at all is good evidence – proof, in fact – that Australia’s leading health research and advisory body considers that circumcision is irrelevant to male health outcomes. Indeed, none of the health problems and issued discussed in the report have the slightest connection with circumcision (or even “lack of circumcision”). This conclusion is something of a slap in the face for those few circumcision promoters and advocates (who shall remain nameless) who have, for the past decade or so, been uttering dire warnings about the public health catastrophe that is sure to lie “just around the corner” as a consequence of Australia’s low and declining incidence of circumcision. Really? Well, as it happens, we have turned many corners over the past decade, and the catastrophe somehow keeps failing to arrive. <h3>According to the AIHW, the most important health problems affecting Australian males are as follows:</h3> 1. Nutrition: They don’t eat enough fruit and vegetables. The report found that 54% of men 18 years and over don’t eat enough fruit, that 92% don’t eat enough vegetables, and only 5% get enough of both. The figures for boys 5 to 17 are better (22% eat enough – obviously they have conscientious mothers who make them eat their greens), but are still far from satisfactory. Not much scope for circumcision here: even Brian Morris would be hard-pressed to argue that circumcised men eat more broccoli. 2. Exercise: Men don’t get enough physical exercise, especially after age 24. 3. Weight: Men tend to be overweight: 42% of men 18-plus are overweight, and 26% are regarded as obese. (These figures may be somewhat exaggerated, as the definitions of overweight and obese are rather broad; but even if the figures were halved there would still be cause for concern.) 4. Smoking: As every schoolboy knows, smoking is the most serious preventable cause of poor health and disease, including many cancers (not just lung cancer). The good news is that only 18% of men 14 years and older are daily smokers, and the number is in decline. 5. Violence: Contrary to popular opinion, men are far more likely than women to be victims of violence (other than domestic or sexual violence). Men aged 18 to 24 were especially likely to be victims of violence, usually from other males in public places.** <h3>Causes of death</h3> The leading causes of all male deaths in Australia are as follows: heart disease (17%), lung cancer, stroke, respiratory disease, prostate cancer (4%). For males 15 to 44 years, however, the leading cause of death is “intentional self-harm” (i.e. suicide). The report does not give reasons for this, but it probably arises from psychological issues, such as depression. <h3>Most serious diseases</h3> This is confirmed by the list of the most serious diseases affecting men (in descending order of importance): heart disease, diabetes, anxiety and depression, lung cancer, stroke, other respiratory diseases, hearing loss, self-inflicted injuries, prostate cancer. Speaking of cancers specifically, the report names cancer of the prostate, bowel, lung and testes in that order. Another slap in the face for circumcision advocates is the absence of cancer of the penis from this list: it is simply too rare to rate a mention. <h3>Prostate cancer and circumcision</h3> Some circumcision advocates (notably Brian Morris) have claimed that uncircumcised men are more vulnerable to prostate cancer and have urged circumcision of infants as a precaution against this risk. When the Royal Australasian College of Physicians investigated this claim, however, they found the only evidence in its favour to be the speculative ramblings of an American crank called Abraham Ravich, way back in the 1940s. In its policy statement on circumcision the RACP comments: “This association [between lack of circumcision and prostate cancer] has not been consistent, and more recent reviews have failed to confirm it.” [1] This is a polite way of saying that the claim of a connection is bullshit. There is, however, evidence that circumcision can increase the risk of other prostate problems and urinary symptoms, such as enlargement of the prostate. Research on Australian men by McCredie et al concluded that “being circumcised, or not currently living as married, were associated with increased prevalence of urinary symptoms.” [2] These findings are important because urinary symptoms are often an indication of benign prostatic hyperplasia (BPH). Enlargement of the prostate is a common male ailment, often requiring surgery such as transurethral resection of the prostate (TURP) to improve the sufferer's quality of life. In about 80% of cases, TURP results in infertility (because the semen goes into the bladder rather than being ejaculated) and in 5% to 8% of cases, TURP results in impotence. About 400,000 TURPs are performed annually in the United States. If being circumcised increases a man’s risk of BPH by 50% (as found in the study above), then if 60% of the at risk population in the USA have been circumcised, almost 100,000 of the 400,000 TURPs (25%) were the result of circumcision. Quite apart from the loss of function, think what a waste of surgical resources this represents. There was no media coverage of this paper, but you can be sure that if the study had, on the contrary, shown that being circumcised was associated with reduced prevalence of urinary symptoms, there would have been newspaper headlines, and the circumfanatics would have been crowing about yet another reason to circumcise baby boys. <a href="https://www.circinfo.org/cancer.html#circprost" rel="noopener" target="_blank">Further information on (the lack of a link between) circumcision and prostate cancer</a> <h3>Reproductive and sexual health</h3> This is looking more promising: surely the report is going to say something about circumcision in relation to male sexual and reproductive health. After all, many circumcision advocates insist that circumcision is an essential component of male sexual health. Bad luck: the report makes no mention of circumcision at all. The principal problems facing males in this area are: low testosterone, erectile dysfunction, urinary tract symptoms and prostate disease (both of which, as suggested above, may be worsened by circumcision). The report does not find sexually transmitted infections to be a serious problem among Australian males. As you would expect, nearly all (94%) of HIV cases are male, the vast majority of which are homosexual men. As we have pointed out <a href="https://www.circinfo.org/hiv.html">elsewhere on this site</a>, there is no heterosexual HIV problem in Australia, and even among gay men, HIV infections are steady or in decline. [3] The most common STI experienced by Australian men is chlamydia (234 per 100,000); but there is no evidence from Australia that uncircumcised men are at greater risk of this or any other STI, [4] and even if they were, most STIs are easily cured with antibiotics. (In the case of chlamydia, a single pill does the job.) The inescapable conclusion is that circumcision is not relevant to the health of Australian males. As Sherlock Holmes would say, we draw your attention to the significant remarks of the AIHW on circumcision and male health. “But Holmes, the AIHW says nothing about circumcision and male health.” That silence, Watson, is what is so significant. ** Though many would argue that circumcision without informed consent is in itself sexual violence. In other parts of the world, notably underdeveloped countries and regions of war and conflict, <a href="https://www.circinfo.org/Sexual_violence_against_males.html">men and boys are certainly victims of sexual violence</a> on a large scale. References [1.] RACP, Policy statement on circumcision, October 2010, p. 13. [2.] McCredie M; Staples M; Johnson W; English DR; Giles GG. Prevalence of urinary symptoms in urban Australian men aged 40-69. J Epidemiol Biostat 2001;6(2):211-8. [3.] <a href="http://www.hivthebigpicture.org.au/hivrates/remainedstable">See the analysis by ACON</a> - which again makes no mention of circumcision. [4.] <a href="https://www.circinfo.org/newsindepth.html#nsu">See study by Ferris et al 2010</a>. <h2>The Health of Australian Males</h2> <h3> Summary of the report</h3> There is increasing awareness that males and females have distinct health needs and concerns related to their biology and roles in society. This is illustrated by different rates of injury, illness and mortality; different attitudes towards health and risks; and the way each group uses, or does not use, health services. In this context, in May 2010 the Australian Government launched the National Male Health Policy, which provides a framework for improving the health of Australia’s males (DoHA 2010a). This report is the first in a series funded under the Policy. Drawing on a range of data sources, this report presents a snapshot of the health and wellbeing of Australia’s males. It is not intended to be exhaustive, but to provide a summary for policymakers, researchers and others interested in male health issues, and set the scene for future reporting and research. Australia’s males at a glance In June 2010, there were 11.1 million males living in Australia –just under half of the total population (ABS 2010a). The median age was 36 years; 20% of males were aged under 15 years and 12% were aged 65 years and over. The male population is continuing to age, associated with increasing life expectancy. Some males make healthy lifestyle choices and have positive health outcomes: <ul> <li>Around two-thirds of males participate in sport or physical activity (2009–10).</li> <li>Nearly 40% of males discuss healthy lifestyle issues with a health professional (2007–08).</li> <li>20% of males rate their health as excellent (2007–08).</li> <li>Survival rates for prostate and testicular cancer have improved overall (1998–2004).</li> </ul> But many males are still at risk of poor health: <ul> <li>5% of adult males consume sufficient fruit and vegetables (2007–08).</li> <li>Around two-thirds of adult males (18 years and over) and one-quarter of boys (5–17 years) are overweight or obese (2007–08).</li> <li>Half of all males report being a victim of violence at least once in their lifetime (2005).</li> </ul> And many males are already experiencing poor health: <ul> <li>4% of males rate their health as poor (2007–08.</li> <li>Nearly half have ever had a mental health condition (2007), nearly one-quarter have a disability (2009) and nearly one-third have a chronic health condition (2007–08).</li> </ul> With under-use of some health services and over-representation in others: <ul> <li>Males make up a smaller proportion of GP encounters (2009–10), hospitalisations (2008–09) and some mental health services (2008–09) compared with females.</li> <li>Males make up a greater proportion of emergency department presentations (2008–09) and some other mental health services (2007–08) compared with females.</li> <li>16% of males do not use any Medicare services in a year (2008–09).</li> </ul> The full report, The Health of Australian Males, <a href="http://aihw.gov.au/publication-detail/?id=10737419204">is available from the Australian Institute of Health and Welfare</a>. <h3>Government reports show …</h3> <h2> <a id="aihw" name="aihw"></a>Male and child health improves as incidence of circumcision declines</h2> Confirming previous studies <a href="https://www.circinfo.org/news_upto2010.html#News5">summarised on this site</a>, reports issued this year by the Australian Institute of Health and Welfare show that the health of Australian children continues to improve, and that while males generally are less healthy than women, their problems have nothing to do with lack of circumcision. Most strikingly, the infant mortality rate has more than halved since 1986, the very period during which the incidence of routine circumcision fell from around 40 per cent of boys under 6 months to around 12 per cent today. The most serious child health problems identified by the report are asthma, lack of breast feeding, and arising from social factors such as poverty and Aboriginality. These reports offer good empirical proof that “lack of circumcision” does not increase child health problems. Even more significantly, it is a decisive refutation of “scientific” predictions by various antiquated circumcision enthusiasts that the fall in the circumcision rate would lead to an explosion of genito-urinary problems in boys. No such problems are identified in these reports, which do not even mention any health problems affecting the genito-urinary area. If we were to be as unscrupulous in mixing up correlation with causation as many pro-circumcision zealots tend to be, we could reasonably conclude that Australian children have become healthier because the incidence of circumcision has fallen, not merely at the same time. But there is no need to go that far. At the very least, A Picture of Australia’s children is definitive proof that there is zero connection between circumcision and improved child health outcomes. The reporst tels a similar story with male health, finding that the main risk factors for poor health problems to be living in remote or country areas; being poor; getting old; and being of Aboriginal or Torres Strait Islander descent. None of these social factors has anything to do with circumcision. Further information on this site <a href="https://www.circinfo.org/health.html#child" rel="noopener" target="_blank">Health and disease</a> <a href="https://www.circinfo.org/Circumcision_and_public_health.html" rel="noopener" target="_blank">Circumcision and public health</a> <h3>Health of Australia’s males: Summary</h3> This report is the second in a series on the health of Australia’s males. It examines the distinct health profiles of five population groups, characterised by Aboriginal and Torres Strait Islander status, remoteness, socioeconomic disadvantage, region of birth, and age. Key findings Aboriginal and Torres Strait Islander males generally experience poorer health than the overall population, highlighted by a life expectancy of 67 years (11.5 years less than that for non-Indigenous males). Factors that contribute to this poorer health status include: <ul> <li>high rates of tobacco smoking, risky alcohol consumption and illicit substance usage;</li> <li>higher rates of chronic diseases (such as lung cancer, diabetes and kidney disease) and health conditions (such as scabies, trachoma and acute rheumatic fever) that are uncommon in the general population;</li> <li>higher rates of hospitalisation, with 45% of these for dialysis.</li> </ul> Remoteness is associated with poorer health. Males living in remote areas generally have a shorter life expectancy and poorer self-assessed health status. As remoteness increases, the following health-related factors also increase: <ul> <li>rates of obesity, tobacco smoking and risky alcohol consumption;</li> <li>new cases of lung cancer, and deaths from chronic obstructive pulmonary disease, diabetes and suicide;</li> <li>hospitalisations for Type 2 diabetes mellitus.</li> </ul> Socioeconomic disadvantage is also associated with poorer health. Males living in more socially disadvantaged areas generally have a shorter life expectancy. As socioeconomic disadvantage increases, the following health-related factors also increase: <ul> <li>rates of obesity and tobacco smoking;</li> <li>new cases of lung cancer, and deaths from coronary heart disease, lung cancer, chronic obstructive;</li> <li>pulmonary disease, diabetes and suicide;</li> <li>hospitalisations for Type 2 diabetes mellitus.</li> </ul> Males born overseas generally enjoy better health than other males, with fewer risk factors and lower overall mortality and hospitalisations. There are areas where males born overseas experience poorer health, compared with males born in Australia, with: <ul> <li>lower rates of physical activity and bowel cancer screening;</li> <li>higher rates of lung cancer, and more deaths from diabetes and lung cancer;</li> <li>higher rates of hospitalisations for Type 2 diabetes mellitus and heart attack.</li> </ul> Older males (aged 65 and over) are living longer than ever before, and generally have fewer risk factors such as overweight/obesity and tobacco smoking than younger males. As age increases, the following health-related factors also increase: <ul> <li>inadequate vegetable intakes and inadequate physical activity;</li> <li>new cases of bowel cancer and melanoma, and rates of dementia and of injury from falls;</li> <li>all hospitalisations, including cardiac rehabilitation, cataract and melanoma of the skin.</li> </ul> The AIHW is a major national agency set up by the Australian Government to provide reliable, regular and relevant information and statistics on Australia's health and welfare. <a href="http://aihw.gov.au/publication-detail/?id=10737421980" rel="noopener" target="_blank">The full report can be downloaded from the AIHW website</a> <h2>Health of Aussie kids continues to improve as incidence of circumcision declines</h2> <h3>Infant deaths halved since 1986</h3> A picture of Australia's children 2012 provides the latest information on the health and wellbeing of Australia's children aged 0-14. Many are faring well, but there is scope for further gains, particularly among Aboriginal and Torres Strait Islander children and those living in areas with the lowest socioeconomic status. The good news Death rates for infants (aged under 1) and children (aged 1-14) more than halved between 1986 and 2010, with rates slightly ahead of the Organisation for Economic Co-operation and Development (OECD) average for infants, and equal to the average for children under 5. Notably, child deaths from injuries halved between 1997 and 2010. The prevalence of asthma has decreased, while the incidences of diabetes and cancer have remained stable. Almost three-quarters of children aged 0-2 have stories read or told to them regularly, and most children achieve above the national minimum standard for reading and numeracy. Australia's average score for mathematics was in the top half of OECD countries. Smoking in households with children has decreased, while rates of risky drinking and smoking among children have declined. Most parents rate their health as excellent, or (very) good, and the majority of households with children perceive their neighbourhood as safe. Most households with children, including Indigenous, reported that they could get assistance from outside the household in times of crisis. Areas where improvement needed Around 1 in 7 women smoked during pregnancy, and about half of pregnant women drank alcohol. Exclusive breastfeeding was initiated for 90% of infants at birth; however only 2 in 5 infants were exclusively breastfed to around 4 months. An estimated 45% of children aged 6 and 39% of children aged 12 experienced dental decay. Almost a quarter of children were developmentally vulnerable on one or more domains of the Australian Early Development Index at school entry. About 15% of parents were affected by mental health problems. Aboriginal and Torres Strait Islander children experience higher death rates, including from injuries, than the national average. They were less likely to have achieved the reading and numeracy minimum standards, and had higher smoking rates than the general child population. Children living in the lowest socioeconomic status (SES) areas were less likely to have stories read or told to them regularly, more likely to be exposed to tobacco smoke in the home, and more likely to smoke themselves than children living in the highest SES areas. Teenage birth rates were higher in the lowest SES areas than in the highest SES areas, and parents living in the lowest SES areas were more likely to report fair/poor health and poorer mental health compared with those in the highest SES areas. AIHW media release <h3>Most Aussie kids doing well, room for further gains</h3> Most Australian children are doing well in terms of their health and wellbeing, but there is room for improvement for some, according to a report released by the Australian Institute of Health and Welfare (AIHW). The report, A picture of Australia's children 2012, shows that death rates for infants and children halved since 1986, the prevalence of asthma among children has dropped, and rates of risky drinking and smoking among children aged 12-14 are down. Smoking in households with children has also dropped. Almost three-quarters of children aged 0-2 have stories read or told to them regularly and most children achieve above the national minimum standard for reading and numeracy. The majority of households with children in Australia perceive their neighbourhood as safe. Most households also reported that they could get assistance from outside the household in times of crisis. “The report indeed shows that most Australian children are faring well, but despite this good news, there are several areas where improvements could be made,” said AIHW spokesperson Dr Fadwa Al-Yaman. For example, while exclusive breastfeeding was initiated for 90% of infants at birth, only 40% of infants were exclusively breastfed to around 4 months (exclusive breastfeeding is recommended to 6 months). Around 45% of children aged 6 have dental decay, as do 39% of children aged 12. The report also shows that almost one-quarter of children are developmentally vulnerable at school entry. About 7% of Australian children had a disability in 2009 and, of these, over half had profound or severe core activity limitations. The most common disability types among children were intellectual, affecting 161,600 children (3.9%), and sensory/speech (119,100 children or 2.9%). Injury and cancer are the two leading causes of death in children. In 2008-2010, injuries contributed to 662 deaths of children-a rate of 5 per 100,000 children. Infants (aged less than one year) had the highest rate of injury death (11 per 100,000 infants). Over the period 2004-2008, an average of 583 new cases of cancer were diagnosed annually among children, and in 2008-2010, there were 274 cancer deaths among children-a rate of 2.2 per 100,000 children. This accounted for around 5% of all child deaths. Additional challenges exist among Aboriginal and Torres Strait Islander children and children living in areas of low socioeconomic status. Aboriginal and Torres Strait Islander children experience higher death rates than the national average. They also had higher smoking rates than the general child population and were less likely to have achieved reading and numeracy minimum standards. Children in the lowest socioeconomic status (SES) areas were less likely to be read to on a regular basis than children living in the highest SES areas, and their parents were more likely to report poorer physical and mental health. <a href="http://aihw.gov.au/publication-detail/?id=10737423343" rel="noopener" target="_blank">The full report can be downloaded from the AIHW website</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Men's health study doesn't mention circumcision darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> The Conversation (Australia) 17 August 2011 by Ryan McAllister, Research Assistant Professor of Physics and Oncology at Georgetown University and John W. Travis, Adjunct Professor of Wellbeing at RMIT University The foreskin is the most sensitive part of the penis. For centuries, children have been subjected to cultural and medicalised practices that were ultimately proven harmful and a violation of basic bodily integrity. Such practices have included foot binding, forehead flattening, scarification and genital cutting. In English-speaking countries, the practice of cutting the genitals of male children was gradually medicalised over a period of 150 years with the benign-sounding label “circumcision.” Today, there is increasing awareness that infant male circumcision – once deemed a “parental choice” – is really an unnecessary, irreversible and harmful bodily modification. With the recently discovered functions of the foreskin and a growth in awareness, we’re fortunately beginning to see the rights and experience of the child become the paramount consideration in discussions about circumcision. <h3>The foreskin: The most alive and sensitive part of the penis</h3> The human foreskin is a contiguous part of the skin system of the clitoris or penis. In infant males, the foreskin is attached to the head of the penis (glans). The outer foreskin protects the more sensitive inner foreskin and the glans from abrasion and injury. The moveable skin facilitates sexual pleasure. In fact, the foreskin is typically the most sensitive area of the penis. When circumcised males lose sensitivity and skin mobility, it’s likely to significantly alter their sexual experience. One <a href="https://www.circinfo.org/news_2011.html#frisch">recent Danish study</a> concluded that male circumcision was associated with sexual difficulties for men and their female partners. <h3>Bioethics of medically unnecessary (cosmetic) surgery on minors</h3> Surgery without consent is ethical only in cases of: (1) incapacitated patients, in order to save their life; (2) minors, with proxy consent from a parent or guardian, but only for surgery that addresses an underlying pathological condition that has not responded to conservative treatment. Excision of an infant’s foreskin for dubious medical or cultural purposes is an anomaly. Because it removes healthy, typically-developed tissue, the procedure fails to meet either of the above conditions. Circumcision of minors also stands in contradiction to other medical ethics principles, including: <ul> <li>avoiding causing needless harm;</li> <li>promoting the patient’s medical well-being;</li> <li>providing information on a procedure that a reasonable person would deem significant.</li> </ul> <h3>Complications and harm</h3> Circumcision can cause skin bridges, haemorrhaging, infection, as well as major penile damage. Dozens of case studies describe severe complications, including penile amputations and death; several infant deaths have been reported in the past few years. A Canadian Coroner’s report, issued in 2007 following the death of a baby in Ontario, recommended the Canadian Paediatric Society conduct a surveillance study on complications. The most detailed assessment of circumcision complications cites meatitis (affecting 8% to 31% of those circumcised), infection (affecting between 0.4% and 10%, age varying) and many other severe complications. A more recent British literature survey estimates complications, including infection and hemorrhage, at rates as high as 10%. Paediatric urologist David M. Gibbons, <a href="http://www.circumstitions.com/Complic.html#urol">commented on MensHealth.com</a>: “in a two year period, I was referred [more than] 275 newborns and toddlers with complications of neonatal circumcision … 45% required corrective surgery (minor as well as major, especially for amputative injury) …” Another urologist reported repairing over 1,600 botched circumcisions over a three-year period. Official rates of complications are likely to be under reported. But regardless of the actual complication rate, it is unethical to subject a child to these risks. <h3>Insignificant benefits</h3> While some use medical benefits to justify male circumcision, those gains rarely materialise in the real world, and the damage outweighs any gain. For example, there is evidence from some African countries with very high levels of heterosexual HIV prevalence that circumcion may reduce the risk of female-to-male HIV transmission in unprotected sexual intercourse by somewhere between 38% and 66%. But studies of the general population have failed to find any decrease in HIV infection rates among circumcised men compared with uncircumcised men. HIV rates are three to four times higher in American men (mostly circumcised) than in Europe (rarely circumcised). But factors far more significant than circumcision status determine HIV transmission. While proponents claim circumcision reduces other sexually-transmitted infections (STIs), many other studies, including a 2008 New Zealand birth cohort study, failed to find any such evidence. <h3>Misleading portrayal</h3> Despite potentially severe complications, hospital websites generally portray circumcision as values-neutral and safe. Because most hospitals don’t give parents adequate information on the risks of circumcision to allow for true informed consent, few parents understand the effects their choice will have on their child and the adult he will become. <h3>Parental regret and survivor perspectives</h3> In blogs, vlogs and other online forums, many parents have shared concerns about their child’s circumcision. Experiences range from “If I knew what I know now, I wouldn’t have done it,” to “I will die hearing my baby’s screams”. Many men have also expressed dissatisfaction with their circumcision, including a sense of “being violated,” “being sexually maimed,” and having feelings of anger toward parents or the medico who performed their circumcision. On thousands of websites, Facebook groups and blogs, circumcised men go to share their experiences and support one another. <h3>Society’s role</h3> A cultural framework that considers circumcision ethically neutral and the foreskin “a useless flap of skin” omits important considerations. Before debating supposed benefits, we need to ask why would we ever even consider cutting our children’s genitals. The medical benefits of male circumcision are insignificant: no evidence to date justifies irreversible surgery on children unable to give consent. Society has recognised the inherent right of minor females to be free from unnecessary genital cutting. In the twenty-first century it is time to recognise the same rights of male children. For more of Ryan McAllister’s research in infant male circumcision, watch his recent university lecture <a href="https://www.youtube.com/watch?v=Ceht-3xu84I">Circumcision, an Elephant in the Hospital</a>. Watch John W. Travis' video on <a href="https://www.youtube.com/watch?v=kN0rxo8y6WM">infant wellness and circumcision</a>. <a href="http://theconversation.edu.au/unethical-and-harmful-the-case-against-circumcising-baby-boys-1543" rel="noopener" target="_blank">Click here for original source of article, with links to further information and comments</a>. One of the links is to an article by Brian Morris which describes circumcision of infants as "safe, convenient, cheap and fast". All that could be true, but it would not mean that the operation was necessary, desirable, beneficial, or without harmful effects. In a modern surgical setting the same could be said of nearly any operation on children: clitoridectomy, for example, or cutting off toes, fingers or earlobes. The fact that an operation is cheap and can be done "conveniently" (meaning on a person who lacks the power to resist) is not a reason for doing it. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The Conversation: circumcision unethical and harmful darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> Recent calls by Brian Morris and friends for the introduction of routine circumcision have been dismissed by health experts as nothing more than the “blinkered ideology” that Morris has been “peddling for years.” These were the words of paediatric surgeon Dr Neil Price, commenting on a recent article that collected a pile of pro-circumcision studies in order to attack the recently-released policy of the Royal Australasian College of Physicians. Meanwhile in Sydney the head of the AIDS Council of New South Wales, Nicolas Parkhill, condemned Morris’s call for mass circumcision as a response to Australia’s HIV problem, pointing out that in Australia (unlike Africa) HIV was largely confined to homosexual men and injecting drug users, neither of whom could derive any risk reduction from circumcision. “ACON does not support the implementation of male circumcision as a HIV prevention strategy in Australia,” Mr Parkhill said. Other child health experts in New Zealand were equally dismissive. The president of the NZ Paediatric Society, Dr Rosemary Marks, said while there might be “some small benefits” arising from circumcision, they were not enough to warrant funding the procedure. “I think that’s a very long bow to draw.” Compared to the other priorities for health care, this would be very low on the list. Auckland paediatric surgeon James Hamill referred to the policy of the Royal Australasian College of Physicians, that routine circumcision was not warranted in Australia or New Zealand, as the consensus among child health authorities. The benefits of circumcision (if any) had to be viewed in context, he said, remembering that Australia and New Zealand do not have the problems faced by so many impoverished and underdeveloped African countries, and that children do not run the risks encountered by sexually promiscuous adults: “We don’t live in a desert, or in a country with a high rate of HIV, so in different cultural or geographical context it may be different.” The article by Morris and friends was published in an on-line journal called Open Journal of Preventive Medicine – an obscure, low-status publication that nobody had ever heard of until now. The article itself contains little or nothing new, but is merely a rehash of the same material that circumcision promoters have been peddling for the last decade, including totally exploded claims about lack of circumcision being a risk factor for prostate cancer. What next: circumcision as a preventive of epilepsy and a cure for brass poisoning? As one sceptic was heard to remark, just because you call an opinion “an evidence-based policy” does not mean that it is a fair-minded survey of all the relevant evidence, or that it is anything more than the personal opinion of the true believers who put their names to it. References: <a href="http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10791087">New Zealand Herald, 10 March 2012</a>; <a href="http://gaynewsnetwork.com.au/news/northern-territory/5273-circumcision-not-cure-all-for-public-health-acon-says.html" rel="noopener" target="_blank">Gay News Network, 8 March 2012</a>; <a href="http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10790330" rel="noopener" target="_blank">New Zealand Herald, 7 March 2012</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Child health experts slam circumcision proposal darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Sexism and double standards alive and well, as girls get full protection</h3> <h3>while boys are thrown to the wolves</h3> The new policy on female genital mutilation released by the Royal Australasian College of Physician in April 2012 takes a firm stand in defence of the bodily integrity and human rights of girls and women. According to the policy, FGM is an injury to the external genitals; it is usually performed on girls between infancy and 15 years of age; it causes harm; it violates the human rights of the victims; it is wrong because it is performed on minors without consent; it is illegal in all Australian states; and, although it is a practice authorized and recommended by some cultural and religious minorities, it is unacceptable in Australia. Doctors should vigorously oppose any form of FGM and become advocates for girls who are threatened with it, even against their parents and culture of origin. These are very fine sentiments, and one wonders why the same principles have not been adopted in the RACP’s policy on circumcision of boys. Every one of the above objections to FGM also applies to male genital mutilation: circumcision is also an injury to the external genitals (usually more severe than mild forms of FGM, such as a nick); it is usually performed between infancy and 15 years of age; it causes harm; it violates the human rights of the victims; and it is performed on minors without consent. But at this point some striking differences emerge: despite injuring the genitals, causing bodily harm and violating a boy’s human rights, circumcision is apparently OK if a boy’s parents prefer him to be circumcised; the practice is not illegal or even regulated anywhere in Australia; and doctors are not urged to oppose the practice and become advocates for the victims. One can only feels that the RACP is suffering from a certain schizophrenia. If any form of female genital mutilation is a violation of a girl’s human rights, it follows that the right must also apply to boys. A human right is a right that applies to all humans, regardless of gender or age, simply by virtue of their humanity; it has nothing to do with the culture of their parents. For the RACP’s position to be logically consistent there are only two possibilities here: either a girl’s right not to have any part of her genitals injured by FGM is a not a human right at all, but gender-specific right, applicable only to females; or boys are not human. Neither possibility seems very likely, and the shabby truth appears simply to be that the RACP is in the grip of the usual sexist double standard on genital mutilation, whereby the slightest nick to the female genitals is an outrage that must be abhorred and opposed, while the most ruthless and brutal circumcision of a boy is a harmless snip that must be allowed and may be applauded. The RACP’s full policy on female genital mutilation is reproduced below, preceded by the media release that announced it. We urge readers to add the words and male or and boys or and men whenever they see the word female, girls or women. The result will be a non-discriminatory policy statement that shows equal respect for the bodily integrity and human rights of all children, not merely those fortunate enough to have been born without a penis. Why isn’t circumcision also “a child protection issue”? <h2>Media release: Female genital mutilation an unacceptable practice in Australia and New Zealand</h2> Physicians (RACP) today launched the Female Genital Mutilation/Cutting (FGMC) Policy. With increasing numbers of immigrants arriving in Australia and New Zealand, paediatricians may encounter in their practice, girls or women who have undergone FGMC, or are at risk of it, according to Professor David Forbes, Chair of the Policy and Advocacy Committee of the Paediatric and Child Health Division (P&HCD). FGMC is defined as an injury of the external female genitalia undertaken for cultural or non-therapeutic reasons. FGMC is usually carried out on young girls between infancy and 15 years of age. With cultural migration, the practice has moved to Western countries. “FGMC is recognised internationally as a violation of the human rights of girls and women,” Professor Forbes said. “FGMC exposes children and women to significant health risks and has no measurable health benefit. The RACP believes that it is not an acceptable practice.” The P&CHD, through the launch of the policy, is calling for all paediatricians to be aware of the practice and the associated risks, and to seek opportunities for prevention and child protection. “It is important for paediatricians practising in Australia and New Zealand to understand both the cultural context in which FGMC occurs and the clinical implications for patients who have undergone the procedure. Girls and adolescent women may be exposed to the risk of FGMC either in Australia or New Zealand or on return visits to their country of origin. Girls and adolescent women migrating to Australia and New Zealand may already have undergone FGMC or may be at risk of undergoing FGMC on return visits to their country of origin.” All forms of FGMC are condemned by leading health professional organisations. It is illegal in Australia and New Zealand for cosmetic genital surgery of any form to be undertaken on minors. FGMC causes significant short and long-term health risks for girls and women, including acute and chronic infection, infertility, childbirth difficulties, sexual relationship difficulties and significant short and long-term psychological trauma. United Nations organisations report that 140,000,000 women have undergone FGMC and 3,000,000 girls are at risk of the procedure every year. “Paediatricians need to develop the skills to be able to recognise families where FGMC may be practiced and girls are at highest risk, and to discuss FGMC with these families,” according to Professor Forbes. Children and adolescent girls who have experienced FGMC may require long-term care that that necessitates the involvement of a range of different services including mental health and gynecological services. Royal Australasian College of Physicians, 24 April 2012 The full RACP policy on female genital mutilation follows <h2>FEMALE GENITAL MUTILATION/CUTTING</h2> Definition Female genital mutilation/cutting (FGMC) is defined as an injury of the external female genitalia undertaken for cultural or non-therapeutic reasons. The term FGMC is now in use by UNICEF and some other international agencies [1]. FGMC comprises all procedures that involve partial or total removal of the external female genitalia, or other deliberate injury to the female genital organs for non-medical reasons[1]. This includes so-called “nicking” of the external genitalia. Key Points <ul> <li>FGMC is recognised internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women.</li> <li>All forms of FGMC including so-called “nicking” of the clitoral hood are condemned by leading health professional organisations [11, 12]. It is illegal in Australia and New Zealand for cosmetic genital surgery of any form to be undertaken on minors.</li> <li>FGMC violates basic human rights, exposes children and women to significant health risks and has no measurable health benefit. The RACP believes that it is not an acceptable practice.</li> </ul> Background FGMC is a cultural, but not religious, practice of groups from Saharan Africa, parts of East Africa, Asia and South America. It is believed to have arisen in Africa and to pre-date Islam. It is not restricted to Islamic populations, is not supported by Islamic doctrine and has been condemned as an unacceptable practice by Islamic groups [1, 14]. United Nations organisations report that 140,000,000 women have undergone FGMC, and 3,000,000 girls are at risk of the procedure every year [1]. Traditionally FGMC was performed to safeguard family honour and social position, and to prevent female promiscuity and rape [3]. FGMC is sustained by the belief that it is in the best interest of the child and that failure to participate may place the child at risk [1, 4], although this justification is no longer considered valid. FGMC is usually carried out on young girls between infancy and 15 years of age [2]. It is typically carried out by traditional circumcisers, but is now performed by health care providers in some countries. With cultural migration the practice has moved to Western countries and has been documented in North America and a number of European countries [5, 6]. It is not clear that FGMC is practiced in Australia and New Zealand [7], although press and legal reports suggest that it is being undertaken in these countries. [8] FGMC causes significant short and long-term health risks for girls and women, including acute and chronic infection, infertility, childbirth difficulties, sexual relationship difficulties and significant short and long term psychological trauma. There are higher rates of Caesarean section for women who have undergone FGMC, and increased infant death rates [9], 10]. FGMC is illegal in Australia and New Zealand and in most other western countries. [8] It is also illegal to send girls and young women overseas for the purpose of genital surgery. In some Australian and New Zealand jurisdictions it is a requirement that children who are perceived to be at risk of FGMC or have ever experienced FGMC are to be notified to child protection services. Western custom and practice appears inconsistent in relation to genital surgery, by tolerating and even facilitating cosmetic genital surgery that includes piercing and labioplasty. Key differences are that genital cosmetic surgery is usually performed on consenting adults, while FGMC is performed without consent on minors. Paediatricians and FGMC FGMC is relevant to paediatricians in Australian and New Zealand, and it is important that paediatricians are aware of the practice and the risks associated with it, and the opportunities for prevention and child protection: Girls may be exposed to the risk of FGMC either in Australia and New Zealand or on return visits to their country of origin. Girls immigrating to Australia and New Zealand may already have undergone FGMC or may be at risk of undergoing FGMC on return visits to their country of origin. Paediatricians need to develop the skills to be able to recognise families where FGMC may be practiced and girls are at highest risk, and to discuss FGMC with these families (See Royal College of Nursing educational resource [13]). The RACP has a role in ensuring trainees and practising paediatricians have access to training regarding cultural awareness and specific aspects of recognition and management of FGMC. In clinical settings with potential high prevalence of FGMC this should be routinely, but respectfully, inquired about in order to avoid missing girls at risk. Care must be taken to avoid stigmatizing particular ethnic groups. Paediatricians working with communities that traditionally practice FGMC should seek opportunities, in conjunction with other health and child protection services to raise awareness that FGMC is not an acceptable practice in Australia, and to educate community leaders regarding healthy attitudes to female sexuality and to the dangers of FGMC. FGMC is a child protection issue, and paediatricians need to be prepared to advocate for girls and young women with their families and communities, and if necessary with the agencies charged with child protection. Paediatricians may be required to collaborate with other health and non-health professionals to advocate for and protect girls at risk. Service providers need to be aware that in protecting girls from FGMC they may expose them to risk of becoming ostracized within their families and communities through not participating in cultural rituals, and they may need special intervention to minimise this risk. Children and adolescent girls who have experienced FGMC are at risk of a range of serious, long-term physical and psychological problems. They will require long-term care that may require the involvement of a range of different services including mental health and gynaecological services. Royal Australasian College of Physicians, April 2012 References 1. OHCR, et al., Eliminating female genital mutilation: An interagency statement, 2008, World Health Organization: Geneva. 2. World Health Organisation, Female Genital Mutilation: Fact Sheet, 2012, World Health Organisation: Geneva. 3. Shell-Duncan, B., et al., Dynamics of change in the practice of female genital cutting in Senegambia: Testing predictions of social convention theory. Social Science & Medicine, 2011. 73: p. 1275-83. 4. Alo, O.A. and B. Gbadebo, Intergenerational Attitude Change Regarding Female Genital Cutting in a Yoruba-Speaking Ethnic Group of Southwest Nigeria. J Womens Health (Larchmt), 2011. 20: p. 1655-61. 5. Davis, D.S., Ritual genital cutting of female minors. Pediatrics, 2010. 125(5): p. 1088-93. 6. Jaeger, F., M. Caflisch, and P. Hohlfeld, Female genital mutilation and its prevention: a challenge for paediatricians. Eur J Pediatr, 2009. 168(1): p. 27-33. 7. Grover, S., Female genital mutilation. J Paediatr Child Health, 2009. 45(10): p. 614-5. 8. Matthews, B., Female genital mutilation: Australian law policy and practice challenges for doctors. Med J Aust, 2011. 194: p. 139-41. 9. Chibber, R., E. El-Saleh, and J. El Harmi, Female circumcision: obstetrical and psychological sequelae continues unabated in the 21st century. J Matern Fetal Neonatal Med, 2011. 24(6): p. 833-6. 10. Merritt, D.F., Genital trauma in children and adolescents. Clin Obstet Gynecol, 2008. 51(2): p. 237-48. 11. American Academy of Pediatrics, Policy Statement- Ritual cutting of female minors. Pediatrics, 2010. 12. Royal College of Obstetricians and Gynaecologists Joint RCOG/RCPCH statement on the AAP policy statement on FGM. 2010. 13. Royal College of Nursing, Female genital mutilation. An RCN educational resource for nursing and midwifery staff, 2006, Royal College of Nursing,: London. 14. WISE Muslim Women’s Shura Council, Female Genital Cutting: Harmful and Un-Islamic. 2010. Accessed 5 March 2012: http://www.wisemuslimwomen.org/images/uploads/WISE_Shura_Council_FGC_DigestStatement.pdf_.pdf </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource RACP's policy on female genital mutilation darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> A report by the Tasmanian Law Reform Institute has condemned the open slather approach to non-therapeutic circumcision of male minors and recommended much tighter regulation of the practice. The report analyses the borderline legal status of circumcision in Australia and the risks this uncertainty creates for both boys and circumcision practitioners, and makes fourteen recommendations for reform. These include a proposal for the outright prohibition of medically unnecessary circumcision of “incapable minors” (infants and young boys), with an exception for recognized religious and ethnic groups who traditionally practise circumcision (Jewish, Muslim and some Aboriginal communities). The report also recommends that circumcision always require the authorization of both parents, and that if parents disagree about whether a boy should be circumcised the operation may not be performed unless authorized by a court. It also proposes uniform standards of competence, disclosure and operational procedure for providers of circumcision services. The report has been hailed by child health and human rights experts as an impressive first step towards giving boys some degree of protection against needless destruction of their foreskins. Dr Robert Darby told Circumcision Information Australia that the report was a trailblazing effort that raised the discussion of non-therapeutic circumcision of minors to a new level. “For its scientific precision, its comprehensiveness, its human rights and bioethical awareness, and the good sense and practicality of its recommendations, the report could hardly have been bettered”, Dr Darby said. “Even though the recommendations apply only to Tasmania, any reforms there will set a new benchmark that other states will have to consider, and by which their own efforts at child protection will be judged. Coming on top of <a href="https://www.circinfo.org/Circumcision_and_law.html">the Cologne decision</a> that non-therapeutic circumcision is bodily harm, the TLRI report further revolutionizes the debate: the issue is no longer whether circumcision has so called “health benefits”, but whether it is legally and morally permissible.” Dr Darby said that a particularly valuable recommendation was to extend the time allowed for an individual who believes he has been harmed by circumcision to bring a legal action for damages against his circumciser. "This proposal recognises the sad (but often suppressed) truth that many men resent having been circumcised and would have preferred to go through life with an entire penis, or at least to make their own decision on such a personal matter. Existing legal rules, however, make it very difficult for them to seek legal redress, leaving the false impression that most men "don't mind" one way or the other. You can be pretty sure that if the playing field is made a little bit more level, the lawsuits will start to flow thick and fast." <h2>Non-therapeutic male circumcision: Recommendations for reform</h2> The recommendations of the Tasmania Law Reform Institute report on circumcision are as follows. 1. The Institute supports the enactment of legislation to reform the law governing circumcision. 2. The Institute recommends reform to provide a clear legislative basis for the legality of circumcision performed at the request of an adult or capable minor. 3. The Institute recommends the enactment of a new and separate offence generally prohibiting the circumcision of incapable minors in Tasmania. The new legislation ought to create an exception for the performance of some well-established religious or ethnicity motivated circumcision on incapable minors. 4. The Institute recommends the enactment of legislation to require joint parental authorisation for the circumcision of an incapable minor. 5. The Institute recommends the enactment of a law to require court authorisation for a circumcision whenever parents disagree about the desirability of performing a circumcision. 6. The Institute does not recommend the enactment of legislation mandating court authorisation for the circumcision of minors. 7. The Institute recommends the enactment of a law to require that all circumcisers provide accurate information as to: <ul> <li>the financial cost of the procedure;</li> <li>the non-therapeutic nature of the operation;</li> <li>the purpose and function of the foreskin;</li> <li>the procedure itself;</li> <li>the procedure’s effect on the functioning of the penis;</li> <li>the risks of the procedure;</li> <li>the nature and significance of the evidenced prophylactic benefits of circumcision in an Australian context;</li> <li>the potential for children to grow up into adults who resent their circumcision (this may include a discussion of the common rationales and prevalence of circumcision);</li> </ul> <ul> <li>the availability of the procedure in adulthood;</li> <li>the legality of the procedure.</li> </ul> 8. The Institute recommends that health policy, community and industry leaders use non-legislative avenues of reform to improve the dissemination of accurate information on the known and potential effects and significance of circumcision. 9. The Institute recommends the enactment of a criminal law that sets general principles against which to judge the acceptability of a circumciser’s practice. These principles should set minimum standards that all circumcisers of incapable minors must meet in the provision of their service. Parliament should give an existing health regulatory body the responsibility of formulating regulations to qualify the general standards set in statute. The Institute recommends the setting of standards as to matters such as: <ul> <li>the pain relief provided;</li> <li>the instruments used;</li> <li>the skill of the person performing the operation;</li> <li>the skill with which the procedure is performed;</li> <li>the adequacy of the wound care and post-procedure monitoring.</li> </ul> The standards set by statute and in regulations ought to reflect the minimum standards the community would expect circumcisers to meet at the time of the operation in the circumstance in which they are operating. In particular, the standards should ensure that no minor be put at a needlessly high risk of pain or complication from a circumcision. 10. The Institute recommends further investigation into whether the law governing the use and sale of human tissue would benefit from reform. 11. The Institute does not recommend reform to the law regulating the commercial aspects of a circumciser’s service. 12. The Institute recommends the enactment of reform to create a uniform period in which individuals harmed by a circumcision as a minor may bring an action against their circumciser. This period should extend for an appropriate time after the harmed person has reached the age of majority. This new limitation period should be enacted in a provision in a new Circumcision Act. 13. The Institute recommends the enactment of legislation to require circumcisers to transmit information relevant to actions that may be brought for harm they cause to a minor to an appropriate government authority. 14. The Institute does not recommend the enactment of a no-fault compensation scheme for harm caused by a circumcision performed upon an incapable minor. <a href="http://www.utas.edu.au/law-reform/publications" rel="noopener" target="_blank">The full report is available from the TLRI website</a> <a href="https://theconversation.edu.au/tasmanian-report-calls-for-groundbreaking-reform-of-circumcision-law-9105" rel="noopener" target="_blank">Warwick Marshall summarises the TLRI report at The Conversation</a> <a href="http://eprints.utas.edu.au/11729/" rel="noopener" target="_blank">Warwick Marshall, Master of Laws thesis on legal status of circumcision in Australia</a> <a href="http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2276538" rel="noopener" target="_blank">Dr Robert's Darby's submission to the TLRI circumcision inquiry at SSRN network</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Tasmanian law report recommends regulation of circumcision darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> A Canberra doctor has been disciplined and subjected to practice conditions by the <a href="http://www.ahpra.gov.au/">Australian Health Practitioner Regulation Agency</a> – the Commonwealth authority that replaced the State medical boards a few years ago. The following conditions have been imposed on Dr Timothy Dermott O’Neill, a general practitioner in Dickson: 1. Will not undertake circumcision without the use of adequate analgesia in accordance with the Royal Australian College of Physicians (RACP) guidelines. 2. When performing a circumcision he will only use the appropriate equipment required in each specific case. 3. That he provides the Board every 12 months with a statement of the number of circumcisions he has performed and details of the anaesthetic procedure used in each of the circumcision procedures. This monthly notification is to continue until December 2013. In addition, O’Neill is required: 1. To see a Board appointed psychiatrist, at the Board’s expense, within three months of the publication of this decision. 2. To attend a mentor of his choice, for supervision, once a month for six months. For the mentor to prepare a written report at the end of this period, as to his progress, to the Board. APHRA has not provided the reasons for these conditions, but we may infer from the requirements that when O’Neill performed circumcisions he did not provide an appropriate, adequate or recommended anaesthetic; and that he used inappropriate instruments. The implication is that he was causing an unacceptable level of pain, injury and surgical complications in the unfortunate boys brought to his surgery. The requirement that he see a psychiatrist has disturbing implications, and one would like to know what factors led AHPRA to impose such a condition. When the AHPRA decision was reported in the <a href="http://www.canberratimes.com.au/act-news/unkindest-cut-restrictions-placed-on-doctors-20130216-2ekkn.html">Canberra Times</a> (17 Feb 2013), the name of the offending doctor was suppressed, and the journalist declined to give it to an inquiry from Circumcision Information Australia. Likewise, a request to AHPRA for his name was met with a refusal, and the useless advice that the presence of conditions or other disciplinary action on doctors could be checked on the AHPRA website – but to do this you need the name of the doctor. These obstructive attitudes suggest a greater interest in protecting the business interests of medical practitioners than the health and welfare of the public. Further questions leap to mind. Why is O’Neill performing circumcision operations at all, when Australian medical policy since 1971 has consistently stated that routine circumcision is certainly not necessary and probably undesirable? Is somebody who graduated as long ago as 1973, and who is now required to see a psychiatrist, really the sort of person who ought to be performing delicate surgical operations on small and highly sensitive body parts? We calculate that if O’Neill was 25 when he graduated he must now be 65, an age at which he (like most people) might be expected to be thinking of retirement. Finally, we note the presence of the usual sexist double standard. Why is somebody who damages the genitals of boys treated so much more leniently than somebody who damages the genitals of women, such as Graeme Reeves, widely denounced as a mutilator and recently gaoled in Sydney. (<a href="https://www.circinfo.org/Genital_mutilation_doctor_guilty.html">See report of Reeves’ trial on this site</a>.) No doubt the harm inflicted by O’Neill was less than that inflicted by Reeves, but the principle is not so different, and the judge in Reeves’ appeal case – increasing his gaol sentence – laid great stress on the lack of informed consent on the part of the patient. How many baby boys consent to have part of their penis cut off? Details of the registration of medical practitioners <a href="http://www.ahpra.gov.au/Registration/Registers-of-Practitioners.aspx">may be searched at the AHPRA website here</a>. You will need the name of the doctor and the state in which he/she practices. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Canberra circumcision doctor disciplined darby