Protect all children from genital cutting, international NGO urges

Posted: Thu, 5 May 2022 12:13

An international council of experts has called on the United Nations to protect all children from religious and cultural genital cutting.

In a report supported by the National Secular Society, the International NGO Council on Genital Autonomy (INGOCGA) has called on the UN Committee on the Rights of the Child (CRC) to work towards "full, equal protection of all minors" from non-therapeutic genital cutting until they are able to make their own decisions about their bodies.

Both female genital cutting (FGM) and male circumcision are frequently performed for religious reasons.

The report said legal measures against genital cutting upon children have "not happened uniformly" and leave large populations of children "wholly unprotected". While it is generally accepted in legislation that genital cutting of girls is unacceptable in all circumstances, circumcision of male children is "almost wholly unrestrained", it said.

The report said the view that genital cutting of a child is a legitimate exercise of parents' religious freedom is a "misconception", as it violates children's own rights to bodily autonomy and freedom to choose a religion or belief identity. It also said the right to manifest beliefs is qualified, and should be restricted if it violates the rights and freedoms of another person.

The report highlighted the many possible harms resulting from circumcision, including pain, trauma, sexual dysfunction and serious complications including death. It added that male circumcision "provides no benefits sufficient to justify it under normal circumstances."

It said all medically unnecessary child genital cutting "violates several provisions" of the Convention of the Rights of the Child, including the right to protection from all forms violence, the elimination of traditional practices harmful to children, and the child's own right to freedom of conscience, belief and religion.

INGOCGA's recommendations to the CRC included:

• Recommending state parties to the Convention "adopt or amend legislation" with a view to eliminating child genital cutting.

• An inquiry on all forms of medically unnecessary genital cutting of children and "means to eradicate these practices".

• A resolution that non-therapeutic genital cutting is a breach of children's rights under the Convention, and that member states which permit male genital cutting on children while taking steps to eliminate FGM and intersex genital cutting "breach the male child's right to freedom from discrimination".

• Giving priority to regular data collection on medically unnecessary genital cutting.

Report co-author Dr Antony Lempert, who is also chair of the NSS Secular Medical Forum, said: "Genital cutting causes often permanent damage to the genitals, violates the child's right to freedom of religion and belief, and fails to extend to the child the minimum personal rights afforded to adults. As such, it constitutes a harm that is neither justifiable within a modern human rights framework, nor authorised by any qualified rights of the parents.

"The disparity in the legal approach to female and male genital cutting is, from a rights and ethical perspective, an unsatisfactory situation, resulting in unequal treatment of vulnerable citizens, discriminatory legislation offering unequal gender protection, and serious breaches of the rights of millions of children annually.

"We therefore urge the CRC to work to ensure all children, whatever their sex, are equally protected from all forms of non-therapeutic genital cutting, whatever the religious or cultural justification".

The NSS is holding a free online event on June 8 to mark the launch of the report – find and more and book your place.

Notes

• INGOCGA was established to "promote the consistent application of existing human rights principles that every child is an independent holder of rights, and that all children everywhere should be equally protected from medically unnecessary genital cutting to which they are incapable of consenting."

• INGOCGA includes representatives from four nations and works collaboratively with major national and international human rights NGOs. NSS is a member organisation.

Image: esudroff, Pixabay.

Recent studies agree: the risks of circumcision outweigh any benefits. It’s time to rethink our permissive approach to genital cutting.

Posted: Mon, 31 Jan 2022 14:41

Dr Antony Lempert says the findings of two recent medical papers critical of infant circumcision should prompt us to greater protect children from religious and cultural genital cutting.

Two recently published medical articles have highlighted the dangers of the most common surgical procedure worldwide – and one that is performed almost exclusively for religious or cultural reasons on children too young to consent.

Infant male circumcision is widely acknowledged to be a non-therapeutic (i.e. medically unnecessary) procedure which is not actively recommended by any medical association in the world.

There are nonetheless many claims that it does confer some medical benefit on children and men, or that it is at least harmless. Medical benefit is often hailed as a coincidental advantage by religious leaders who wish to protect their traditional forced genital cutting practices from criticism or limitation.

But these two articles demonstrate otherwise.

The first, by Matthew Deacon and Gordon Muir and published in Nature, analyses the evidence behind the most common claims of the apparent benefits of circumcision, such as preventing urinary tract infections, sexually transmitted diseases and penile cancer. It picks out the flaws in previous studies sometimes cited as proof of these supposed benefits, and finds that most are generally outweighed by risks. Complications that can result from circumcision, the review paper finds, include bleeding, infections and impaired sexual function, in addition to the excruciating pain the procedure inevitably causes.

The article concludes: "From the perspective of the individual boy, there is no medical justification for performing a circumcision prior to an age that he can assess the known risks and potential benefits, and choose to give or withhold informed consent himself."

The second article, published in European Urology Focus, finds from research at a Canadian hospital that the risks of neonatal circumcision are "greater than generally assumed". From 2000-2013, 19 previously healthy newborn babies were admitted for acute complications following circumcision. Eight boys required surgery, three for severe bleeding. Seven were admitted to an intensive care unit, and two of these died.

Because circumcision is unregulated here, little data on complications is available in the UK. But the evidence that does exist is consistent with these findings. In 2011, Birmingham Children's Hospital admitted 11 baby boys to the paediatric ICU with life-threatening complications from circumcision.

The potential for such complications might be considered an acceptable risk of surgery performed to treat medical problems. Yet when the surgery is performed on a healthy, non-consenting child who has not yet had the opportunity to experience sex with intact genitals, there are no substantive arguments to justify placing that child at risk of such serious harm.

It is a singular anomaly that non-therapeutic circumcision continues to take place despite lack of a medical indication or even evidence of overall benefit. This turns medical practice and child safeguarding on its head. Most medical interventions start with an evidence base of benefit before even considering the risk/benefit ratio; the information is subsequently offered to patients who can then make an informed choice.

Children are usually given special safeguarding protections because of their vulnerability. In practice this means parents can consent on behalf of their child, in the child's best interests, to medically necessary procedures recommended by doctors. For obvious reasons, parents do not usually have the right to demand that doctors or others perform medically unnecessary surgical procedures on their children. There is no medical, ethical or child safeguarding reason why ritual genital cutting of male infants and small children should be the sole exception to this rule. Rather, there is every reason to treat ritual male circumcision of non-consenting children as a significant safeguarding concern.

Most people cherish agency over their own body, especially their genitals. Intact men recognise their foreskin as a sensitive, functional, erotogenic intimate part of their body; it would be a serious sexual assault to surgically remove the healthy foreskin from a non-consenting adult man.

That society values autonomy so much that we permit people to refuse even life-saving surgery, for example the removal of cancerous limbs, only serves to highlight the unjustifiable contrast between the rights of adults and the lack of protection afforded to male babies, children and the adults they will become.

These two latest papers add to a large and growing body of evidence that cutting healthy parts off the genitals of non-consenting, vulnerable people is not medically justifiable and can cause serious harm. There can be no justification for more children to be subjected to this procedure, which is usually requested by parents to concord with the parents' religious or cultural affiliations.

Wounding children without an explicit medical reason will usually result in child safeguarding procedures and sometimes to prosecution of the perpetrators. Ordinarily, religious or cultural reasons will not serve as an excuse. The courts have consistently ruled that ritual scarification, flagellation and the cutting of female genitals (FGM) on children cannot be justified even if they are central to the religious or cultural beliefs of the child's parents or community.

Yet no jurisdiction in the world prohibits the painful, risky and permanent procedure that is circumcision from being performed on young male children. While some jurisdictions, notably Iceland, have attempted to ban non-therapeutic infant circumcision, intense lobbying from religious groups has thus far proved an insurmountable barrier.

Things need to change. While we continue to give free rein to individuals to perform circumcision on babies without medical need, we're failing the thousands of boys who would have otherwise refused this lifelong modification to their bodies.

And, saddest of all, we'll continue to see babies die wholly preventable deaths from a wholly unnecessary procedure.

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Image: StockSnap, Pixabay

All children should have the right to refuse circumcision

Posted: Fri, 25 Jun 2021 12:50

A judge has ruled that a boy who was taken into care shouldn't be subjected to non-consensual, non-therapeutic genital cutting. This is welcome, says Megan Manson - but every child should have similar rights.

A court has just ruled that a toddler taken into care should not be circumcised, despite the wishes of his Muslim parents.

A one-year-old boy known as "P" was removed from his parents at birth, following concerns about abuse. He was placed in the care of his maternal aunt and uncle, who are not Muslim and who have agreed to look after P throughout his life. In November, P's mother, with his father's support, sought the court's authorisation to have P circumcised before his second birthday. However, the local authority and the child's carers disagreed.

Justice Cobb concluded that the decision to circumcise P should be deferred until he is "able to make his own choice, once he has the maturity and insight to appreciate the consequences and long-term effects of the decision".

This ruling is very welcome. The judge has thankfully protected P's bodily integrity and his personal freedom of religion or belief, rightly siding with the local authority and P's aunt and uncle who think this decision should be for P alone when he is ready.

But there are some troubling elements in the judgment that suggest, had some of the circumstances of the case been different, the decision may have gone the other way. While it's a relief that the judge ruled in favour of P's human rights, parts of the ruling indicate the need to reconsider the place of infant circumcision in law and society.

#1 Why use a pro-circumcision doctor for expert evidence?

The judge used expert evidence from consultant urologist Altaf Mangera. Mangera is himself a Muslim, and it appears he was chosen specifically because he could "speak as to the religious importance and timing of the procedure". Unsurprisingly, Mangera gave the opinion that if the court feels P "should be raised as a Muslim child", his parents "should be given the same rights as all other Muslim families; which is to have a circumcision at a young age". Mangera also referred to the "suggested benefits" of circumcision.

To his credit, Mangera also acknowledged that there is "divided medical opinion" about the supposed benefits of circumcision, and said that if there was any doubt as to whether or not P would be raised Muslim, the court "may wish to delay the procedure".

But the fact that a urologist appears to have been chosen as an expert on the basis of his Islamic faith is a problem. Surely a urologist consulted to provide a medical opinion on circumcision should give just that, without any religious ideology attached?

It appears medical advice given to the local authority was rather different. The LA said it "defers to the medical advice in that unless it is medically necessary that [circumcision] is something that we would not support". This would suggest the local authority's advice took a considerably less favourable stance on infant circumcision.

#2 To what extent should the "strongly held views" of parents be considered?

The mother's representative argued that the parents' "strongly held views" should carry "considerable weight", which formed part of the judge's guiding principles in his ruling. But to what extent should these override the interests of the child?

As the judge pointed out, it is hard to ascertain P's wishes and feelings on the matter given that he is only a toddler. And yet we can draw reasonable conclusions from Mangera's description of circumcision as to how he would be likely to feel about the procedure.

Mangera said circumcision for young children requires them to be restrained; not something you would require in a painless and risk-free procedure, one imagines. The judge acknowledged that circumcision would be "painful and distressing to P for a number of days or weeks". For the operation typically used for children older than two, the "most difficult factor" to deal with is "fear of the injection or the procedure", and the recovery period "would be longer".

Furthermore, both parents expressed that they would like P to be circumcised now because later he may choose not to, as he would be "deterred by the likely pain and discomfort". The judge also acknowledged that circumcision later in life would "require greater cooperation from P".

It isn't hard to conclude from this that even though P is incapable of truly understanding the implications of circumcision or communicating his feelings, he would be unlikely to want to go through with it. It's also not hard to conclude that the parents want P to have the procedure now partly because he is incapable of resisting.

If evidence suggests that P is more likely than not to be distressed by a medically unnecessary and permanent procedure, and to refuse it as soon as he is old enough to do so, should the feelings of the parents really trump the child's?

#3 Does the Children Act need some revising?

Much of the judge's decision appeared to hang on Section 33 of the Children Act 1989, a piece of legislation designed to protect children's welfare. The specific section of the act quoted by the judge says:

"While a care order is in force with respect to a child, the local authority designated by the order shall not cause the child to be brought up in any religious persuasion other than that in which he would have been brought up if the order had not been made."

This is no doubt intended to prevent children from being indoctrinated into a religion different to that in which they were raised, which could create tension and hostility between parents and carers. However, P's case highlights problems with this law.

Although P has lived with non-Muslim carers since birth, Section 33 appears to place a duty on local authorities to ensure the carers raise P within his parents' Islamic religion. The carers have in fact been doing this; in contrast, P's parents have done nothing to support raising P in their religion, apart from insist that he be circumcised.

The judge said it is "important that P retains, and is allowed to develop an interest in, the profound and rich tenets of the Islamic faith". The word "retains" here in particular raises eyebrows. It assumes that P has somehow internalised the tenets of Islam by virtue of being born to Muslim parents. And what if, at a young age, P decides he isn't interested in Islam, or he prefers to emulate his aunt and uncle's beliefs? Does Section 33 still compel the local authority to continue teaching him about Islam, and prohibit the carers from letting P share in their beliefs? This would effectively inhibit children in care from exploring different beliefs and making up their own minds about what to believe.

Thankfully, the judge determined that Section 33 does not require the local authority to hand P over for circumcision. But things may have been different if P's parents were Jewish. The judgment noted that although P's circumcision may represent an important component of his religious heritage, circumcision is "recommended not obligatory" in Islam.

While circumcision may not be a central requirement in Islam, most Jewish sects consider it an obligation to circumcise baby boys, preferably when they are eight days old. Had P's parents been Jewish, would Section 33 have compelled the judge to rule differently?

It would be concerning if the degree to which circumcision is considered a requirement in a religious or cultural tradition is a factor in deciding whether parents should be permitted to circumcise their children. It would lead to people of different faiths being treated differently before the law. And it could potentially open the door to other harmful religious practices being permitted, if it can be demonstrated those practices are sufficiently central to religious teachings.

#4 The bigger picture: All children should be protected from non-consensual circumcision

P has escaped a painful, permanent and medically unnecessary procedure that is also risky. In the US, where most circumcisions are performed under clinical conditions, over 100 babies die from circumcision complications every year. And in 2011, nearly a dozen infant boys were treated for life-threatening haemorrhage, shock or sepsis as a result of non-therapeutic circumcision at a single children's hospital in Birmingham.

There's a deep disparity in the relevant laws protecting children. Girls are protected from all forms of genital cutting, even forms less invasive than typical male circumcision, by the Female Genital Mutilation Act 2003. But there are no laws that protect boys from unwanted cutting to their genitals.

This disparity even led to contradictory remarks in the judge's ruling. He said the court will be "slow to conclude that a parent faithfully striving to follow the teachings of their religion is acting unreasonably", but also said it "can never be reasonable parenting to inflict any form of FGM on a child". Parents who do cut their girls' genitals frequently cite perceived religious obligations as the justification. So why do we treat male and female genital cutting differently?

The bottom line is this: nobody, regardless of sex or religious background, should be subjected to non-therapeutic genital cutting without their express consent. Certainly, no child should undergo such a procedure while they are too young to give informed consent.

P has been allowed to grow up and make the decision to retain or lose his foreskin when he is old enough to do so. All boys should be allowed the same choice. We shouldn't question the right of parents to circumcise their children only when a dispute arises – we should question it in every single case.

Image by Esi Grünhagen from Pixabay.

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NSS urges rethink of laissez-faire approach to male genital cutting

Posted: Wed, 5 Aug 2020 10:32

The National Secular Society has urged the children's commissioner for England to encourage child protection agencies and the government to rethink their approach to male circumcision.

In a letter to Anne Longfield, the NSS has said all children should be protected from non-therapeutic genital cutting, regardless of the religion, belief or traditions of their parents.

The letter comes in light of an acclaimed recent academic article which argued that the UK's legal approach to male genital cutting was "indefensible" and "must be changed" to protect children.

Contents of NSS letter

In the letter, the NSS said:

• Forced genital cutting of boys is "an irreversible, gross violation of their human rights" which is "largely dismissed as inconsequential or falsely claimed to have therapeutic value";
• Children, and particularly young infants, are incapable of consenting to medically unnecessary and harmful procedures;
• The right to practice religion under article nine of the European Convention on Human Rights is a qualified right, which is subject to the "rights and freedoms of others";
• The permissive attitude to forced genital cutting on boys is in breach of the UN convention on the rights of the child. The convention recommends respect for children's rights to freedom of thought, conscience and religion, and advises that traditional practices prejudicial to the health of children should be abolished.

NSS comment

NSS chief executive Stephen Evans said: "The children's commissioner has a vital role to play in ensuring children's best interests are properly considered.

"We're therefore urging her to use her position to help to tackle a widespread and significant violation of many children's basic rights. Children should have the ability to grow up in their own bodies and make their own decisions about altering them.

"Child safeguarding must take precedence over adults' wishes to express their beliefs through the cutting of children's genitals."

Support for change

The NSS's letter also highlighted growing criticism of the current laissez-faire approach to male circumcision:

• Recent court rulings in the UK have recognised that the best interests of children would best be guaranteed by deferring any operation until they were old enough to participate in the decision-making process.
• In 2018 the Child Rights International Network, an advocacy group, called the ritual circumcision of infant males for non-medical reasons a "violation of bodily integrity" which "unnecessarily" exposes children to risks.
• A joint statement by the Nordic children's ombudsmen in September 2013 condemned non-therapeutic infant circumcision as violating fundamental medical-ethical principles.
• In January 2015, the head of the family division of the High Court in England and Wales said non-therapeutic infant male circumcision caused "significant harm" to boys.
• International human rights bodies such as the Council of Europe, doctors, medical ethicists and lawyers are also among those who have recently questioned the historic carte blanche afforded to infant male circumcision.

Image by PublicDomainPictures from Pixabay.

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UK’s approach to male genital cutting is “indefensible”, says expert

Posted: Fri, 3 Jul 2020 11:55

The UK's legal approach to male genital cutting is "indefensible" and "must be changed" to protect children, a legal expert has argued in an acclaimed academic article.

Dr Kai Möller, associate professor of law at the London School of Economics, said genital cutting is wrong "as a matter of principle" in the Oxford Journal of Legal Studies.

His intervention has been called "the most important legal and philosophical article on this topic to come out in years" by a fellow academic with extensive expertise in the field.

Möller criticises arguments that suggest male genital cutting (often called 'circumcision') and female genital cutting (often called 'female genital mutilation' or FGM) should be treated differently based on a child's sex.

He writes: "The currently dominant view, according to which the common law creates an exception for the case of male genital cutting, has been shown to be arbitrary and indefensible."

He says both male and female genital cutting should be rejected based on children's rights to have their bodily integrity "respected and protected".

'Religious freedom' arguments

Möller says the argument that male genital cutting should be allowed because it is often performed for religious reasons while female genital cutting has no religious basis is "unconvincing".

He says neither form of genital cutting can be justified from the perspective of religious freedom because the "right to manifest one's religion can, and in some scenarios must, be limited when this is necessary to protect the rights of others".

He also notes that female genital cutting is "in many contexts seen as a religious duty".

"Insufficient" justification for treating male genital cutting differently

Möller says legal justifications for treating female and male genital cutting differently which have been provided by courts are "insufficient".

In the UK, female genital cutting is a criminal offence while male genital cutting is in principle legal and may even be ordered by a court, he says.

Möller says some forms of male genital cutting are more harmful than forms of female genital cutting that are prohibited. In 2015 a judge observed that some practices considered to be illegal FGM, "for example, pricking, piercing and incising", are "much less invasive than male circumcision".

By implication, he says, male genital cutting "must be treated as a criminal act under the ordinary provisions of the criminal law".

Other key arguments

Möller challenges the argument that male genital cutting confers health benefits whereas female genital cutting does not, saying there is an "obvious disproportionality between harms and benefits" in the case of male genital cutting.

He says arguments that female genital cutting is less acceptable than male genital cutting because the former is done in order to oppress women are "highly controversial".

He argues many women who have undergone female genital cutting dispute this claim, and that "any argument that relies on the idea of patriarchal oppression works only if we accept that there is something wrong with male and female genital cutting in the first place."

Reaction

Brian Earp, a researcher at the Oxford Uehiro Centre for Practical Ethics, called Möller's article a "must read" and "the most important legal & philosophical article on this topic to come out in years" in a recent Facebook post.

Dr Earp has also criticised non-consensual genital cutting, including in speeches to National Secular Society conferences in 2018 and 2019.

NSS head of policy and research Megan Manson said: "This article makes a solid case for treating religious and cultural genital cutting in infants and children as impermissible under UK law, regardless of a child's sex.

"Dr Möller dispels many of the myths and presumptions that have led to the current inconsistency in how we protect the bodily integrity of girls and boys. He makes it clear that religious beliefs, no matter how strongly held, can never justify the permanent and painful alteration of a child's genitals, regardless of their sex.

"Policy-makers concerned with protecting the rights of children must take note."

Image by StockSnap from Pixabay.

Protect all children from ritual genital cutting, NSS tells UN

Posted: Tue, 17 Mar 2020 12:09

The National Secular Society has formally called on the UN Human Rights Council to ensure that protections from forced genital cutting encompass all children equally.

In a written submission to the HRC, the NSS said the right to grow up in an intact body "must not be overridden on the grounds of religion, tradition or culture".

The submission said: "Child safeguarding must take precedence over the desire of adults within a community to express their own or their child's presumed belief through forced cutting of their child's genitals."

The NSS also noted that the norms around genital cutting are often subject to a gendered double standard because of the claim that male circumcision is integral to Jewish and Muslim culture.

The society urged the HRC and the Office of the High Commissioner for Human Rights to recognise the "irreversible gross violation" of cutting boys' genitals. It described forced genital cutting of boys as "an anomaly in that it is allowed despite the lack of evidence of benefit".

"The surgical assignation of a child's genitals with his parents' beliefs is a human rights abuse taking place on an industrial scale in most countries, so much so and for such a long time perhaps that some find it difficult to see."

The submission also said:

• Forced genital cutting of children infringes on their ability to form their own beliefs – a right enshrined in the UN convention on the rights of the child.
• There is a lack of medical evidence that forced cutting of boys' genitals has medical benefits.

• The penile prepuce is "one of, if not the most" sensitive parts of a man's body, providing numerous functions in intact men and boys.
• Victims of forced genital cutting are increasingly speaking out and asking why the practice largely goes unchallenged.
• The forced cutting of children's genitals denies those who wish to undergo reassignment surgery of tissue which may be needed in the procedure.

Explaining the NSS's position, a spokesperson said: "The ritual cutting of children's genitals is an abusive practice which should be challenged and brought to an end. But too often a blind eye is turned on the grounds that genital cutting holds a religious significance for parents or those within religious communities.

"Governments and the UN should recognise this and place the rights of the child first, so children have the ability to grow up in their own bodies and make their own decisions about altering them."

Image by StockSnap from Pixabay.

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