Australia

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Australia and circumcision

Australia, like other English-speaking countries, once had a rather high rate of non-therapeutic neonatal circumcision of male infants, however Australia (2019) now has a very low rate of non-therapeutic neonatal circumcision. Consequently, the circumcised males are concentrated in the older age groups. As they pass away and are replaced by younger intact males, the prevalence of circumcised men is diminishing. Circumcised males are now in the minority in Australia and have been at least since 2011.[1] The percentage of circumcised males in Australia (prevalence) is reported to be 26.6%.[2]

History

The indigenous people of Australia, the Aborigines, have variously practiced subincision and circumcision since before the first contact with Europeans.

The incidence of non-therapeutic neonatal circumcision in Australia approached that of the United States in the 1930s through 1960s.

Douglas Gairdner's famous, classic 1949 paper, The Fate of the Foreskin: A Study of Circumcision,[3] seems to have had no effect in Australia. However, criticism of the practice of non-therapeutic circumcision accelerated in 1967.

Morgan (1967) criticised non-therapeutic circumcision in a letter published in the Medical Journal of Australia.[4]

Wright (1967) slammed the practice of non-therapeutic circumcision.[5]

The Australian Paediatric Journal issue of June 1970, published three articles critical of non-therapeutic infant circumcision.[6][7][8]

The intact, foreskinned boy had already become the norm in Australia when Simpson & Baraclough (1998) published advice on the care of intact, foreskinned boys.[9]

Position statements of medical societies

After considering the three papers published in the Australian Paediatric Journal, the Australian Paediatric Society adopted a resolution on 24 April 1971 that the circumcision of male infants should not be performed as a routine measure. That resolution subsequently was reported in a letter by Bellmaine published in the Medical Journal of Australia on 22 May 1971.[10]

The incidence of non-therapeutic child circumcision in Australia started to decline after the publication of the Belmaine (1971) letter. By 1978, only 50 percent of newborn boys were being circumcised.

The Australasian Association of Paediatric Surgeons (1996) in an official statement, called "routine" (i.e. non-therapeutic) circumcision "inappropriate and unnecessary."[11]

The incidence of circumcision continued to decline, so that by 1996, when the Australian College of Paediatrics issued a statement, it reported that the incidence of "routine" (i.e. non-therapeutic) circumcision was estimated at ten percent of newborn boys.[12]

The Australian Medical Association (2003) issued a warning (based on the Spilsbury paper)[13] that circumcision to treat phimosis in boys is usually unnecessary.[14]

The Australian Medical Association (2007) said it would support laws to ban the non-essential circumcision of infant boys.[15]

Non-therapeutic circumcision and Australian law

International human rights law

Australia is a state-party to the United Nations Covenant on Civil and Political Rights (1966) and to the United Nations Convention on the Rights of the Child (1989), both of which provide various human rights to children, which are violated by non-therapeutic child circumcision.

Australian domestic law

The legality of non-therapeutic circumcision of boys has been considered several times.

The Queensland Law Reform Commission (1993) researched the legality of non-therapeutic circumcision of children. The Commission concluded:

The common law operating in Queensland appears to be that if the young person is unable, through lack of maturity or other disability, to give effective consent to a proposed procedure and if the nature of the proposed treatment is invasive, irreversible and major surgery and for non-therapeutic purposes, then court approval is required before such treatment can proceed. The court will not approve the treatment unless it is necessary and in the young person's best interests. The basis of this attitude is the respect which must be paid to an individual's bodily integrity.[16]

Davis Richards (1996) discussed non-therapeutic circumcision of boys. He concluded:

Ritual male circumcision is non-therapeutic and is not warranted or justified by medical evidence. This form of mutilation should not be legally distinguished from female circumcision which is a form of female genital mutilation presently in the process of being prohibited throughout Australia and the Western world. As ritual male circumcision is non-therapeutic, may be against public policy, and clearly is not in the best interests of the child, a parent's consent may be vitiated, leaving persons involved in the procedure liable in negligence, notwithstanding parental religious beliefs. Alternatively, if a medical practitioner fails to give the parent reasonable information on the risks of and alternatives to ritual circumcision, the practitioner may also be liable in negligence.[17]

Professor Neville Turner (1996) reported that circumcised boys may sue their circumciser.[18]

Boyle et al. (2000) suggested that non-therapeutic circumcision of boys is "criminal assault." They concluded:

Enforced non-therapeutic genital cutting of unconsenting minors is overdue for recognition by the legal community as sexual mutilation. As we enter the 21st Century, appropriate legal action must be taken to safeguard the physical genital integrity of male children.[19]

The Tasmanian Law Reform Institute recommended in a 101-page report that non-therapeutic circumcision of boys be made unlawful in Tasmania.[20]

Grace Gunn (2019) argues that non-therapeutic circumcision of boys should be prohibited in New South Wales.[21]

Despite the criticism in the above referenced papers, there has been no legislative or judicial action to protect boys in Australia from medically-unnecessary, non-therapeutic circumcision.

Circumcision in the 21st Century

The Sixth International Symposium on Genital Integrity convened in Wesley College at the University of Sydney, Sydney, NSW, Australia on December 7-9, 2000. Professor Gregory J. Boyle gave the keynote address.

The Sydney Morning Herald reported on the decline in non-therapeutic circumcision of boys in Australia early in the 21st Century.[22]

The several Australian states operate public hospitals. By 2008 all public hospitals in all states no longer offered non-therapeutic circumcision to patients.[23]

As the incidence of non-therapeutic circumcision has declined, the incidence of infant deaths and SIDS deaths has also declined, while the overall health of Australia's children has improved.[24]

The former Australian College of Paediatrics was merged into the Royal Australasian College of Physicians (RACP), which has issued a statement on non-therapeutic child circumcision. The statement (2010) states:

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. However it is reasonable for parents to weigh the benefits and risks of circumcision and to make the decision whether or not to circumcise their sons.

But the statement also says:

The option of leaving circumcision until later, when the boy is old enough to make a decision for himself does need to be raised with parents and considered. This option has recently been recommended by the Royal Dutch Medical Association. The ethical merit of this option is that it seeks to respect the child’s physical integrity, and capacity for autonomy by leaving the options open for him to make his own autonomous choice in the future.[25]

The RACP, a medical trade association, retired this 2010 statement in December 2022, when it issued a new statement that was not an improvement.

Darby (2011) collected circumcision statistics from the various Australian states and territories. Darby reported a high rate of 17.3 percent in New South Wales in 2010 and a low of 1.5 percent in Tasmania in the same year. Other states fell in between.[26]

Sliwinski et al. (2014) of the Department of Urology at the University of Melbourne reported a case of Fournier gangrene in a 24-year-old man who had an elective non-therapeutic circumcision for “prophylactic hygiene reasons”. There was extensive debridement of infected tissue, which resulted in deficit of skin which was resolved by the use of a pedicle flap from the anterior abdominal wall, after which the patient recovered.[27]

Na et al. (2015) considered whether Australian boys should be circumcised. They concluded:

In conclusion, although there is a benefit of circumcision in those with urogenital tract anomalies, in a healthy newborn,the disease in the foreskin is non-existent. There is insufficient scientific evidence to support routine newborn circumcision in Australia done for UTI risk and HIV transmission issues alone. Therefore, any surgical complication and financial cost of routine newborn circumcision for these reasons in Australia currently cannot be justified. From a medical point of view, the‘price’ is still too high.[28]

Oddly enough, the federal Medicare programme still pays an inadequate third-party payment of AU$35.45 for non-therapeutic circumcision.[29] This subsidy exists for political reasons, not medical reasons.[30]

Continuing decline in practice of non-therapeutic circumcision

Na, Tanny & Hutson (2015) discussed the matter of non-therapeutic circumcision of children in Australia. They concluded:

There is insufficient scientific evidence to support routine newborn circumcision in Australia done for UTI risk and HIV transmission issues alone. Therefore, any surgical complication and financial cost of routine newborn circumcision for these reasons in Australia currently cannot be justified. From a medical point of view, the ‘price’ is still too high.[28]

The incidence of non-therapeutic circumcision of children in Australia has continued to diminish. Circumcision Information Australia (2017) reported an incidence of infant circumcision of 9.66 percent in fiscal 2015.[31] The majority of living Australian males are intact. The percentage of living intact males increases year-by-year.

Circumcision Information Australia (CIA) (2018) reported:

According to a report on SBS,[32] Australia’s circumcision rate has fallen by over two thirds over the past decade. According to Medicare figures, there were only 6,309 boys (under 6 months) circumcised in the 2016/17 financial year, compared with 19,663 in 2007/08. SBS quotes Professor Paul Colditz, head of the Paediatrics and Child Health Division of the Royal Australasian College of Physicians, as saying that only about 4 per cent of baby boys are being circumcised these days, “so I guess parents are really making up their own minds on the basis of the available evidence.” He added that there could be some procedures not captured by the Medicare data if performed by religious figures such as Mohels, but that would be a fairly small number in relation to the 6,000 or so babies circumcised in the past year. Professor Colditz attributed the sharp decline to two main factors — better informed parents and more fathers not being circumcised themselves. The number of new fathers (many born in the 1980s and early 90s) who were themselves not circumcised is increasing, and they are deciding that there is no reason why they should circumcise their own sons. Parents were also making up their own minds by researching available evidence. “We've entered an era where everyone is looking at the evidence and asking, ‘Is this operation worthwhile, will it be effective, what are the risks?'" Professor Colditz said. Parents are assessing the balance between the potential for any benefits against the potential for harm and damage. “I think the whole of society is getting more sophisticated in the way they do this.”[33]

Circumcision Information Australia (2020) called non-therapeutic circumcision in Australia "now pretty much a thing of the past."[34]

Circumcision Law Reform (2024) reports that about 22,000 circumcisions are performed in Australia each year, of which 15,000 to 18,000 are performed on minor patients.[35] The Australian Bureau of Statistics reported 154,281 male births in 2022.[36] This provides an estimated incidence of medically-unnecessary, injurious circumcision of 9.7 percent to 11.6 percent.

However, traditional male genital mutilation remains popular among Aborigines in the Northern Territory where it is supported by the local government.[37]

Circumcision death

A Seville Grove, WA Muslim family presented two brothers for elective non-therapeutic circumcision surgery at Gosnells Medical Clinic (A medical clinic populated by Muslims) on 7 December 2021. The healthy two-year-old was circumcised at Gosnells Medical Clinic in Gosnells, WA, on 7 December 2021. His healthy seven-month-old brother also had a non-therapeutic circumcision on the same date. The two circumcisions were performed by family doctor and general practitioner Dr. Raad Hassan. Opinions about Dr. Hassan are mixed.[38]

The two boys were discharged to their home after their circumcisions. St. John Ambulance Service was called to the home for the two boys in the evening. A spokeswoman from St John Ambulance confirmed the toddler was in a ‘critical condition’ when emergency workers arrived at the home at about 6:30 pm.[39][40] The two boys were transported to nearby Armadale Hospital.

The seven-month-old boy narrowly survived hemorrhage after emergency surgery at Perth Children's Hospital and spending the night in intensive care.[41][42]

The two-year-old toddler died from complications of a non-therapeutic circumcision operation. He was declared dead-on-arrival at Armadale Hospital in the late evening of of 7 December.

His younger brother was transferred to Perth Children's Hospital for emergency surgery to stop the hemorrhage.[41]

The homicide police have referred the death of the two-year-old toddler to the coroner for investigation.[41]

AMA warns against circumcision

Dr Mark Duncan-Smith, the president of the AMA (WA), issued a warning to parents on 10 December 2021 regarding non-therapeutic child circumcision. Dr. Duncan-Smith said parents should only "follow through with the procedure if there is a valid medical reason." According to Dr Duncan-Smith only about ten percent of boys in Western Australia are now being circumcised.[43]

RACP issues new circumcision statement

The RACP, a medical trade association, issued a new 18-page promotional policy statement, entitled Circumcision of infant males, in December 2022.[44]

The statement failed to mention the circumcision death in Perth, nor did it mention the advice of Dr. Mark Duncan Smith, then President of the Australian Medical Association that infant circumcision should be done only when a medical indication is present.[45]

Doctor-mohel amputates the penis of two boys

Jewish doctor & mohel Hershel Goldman has amputated the penis from two boys while performing a Brit Milah in Victoria. The Medical Board of Australia (2024) has now banned him from performing circumcision.[46]

The current situation in Australia

The Australian Pædiatric Association resolved in 1971 "that newborn male infants should not, as a routine, be circumcised." This decision was announced in a letter published in the Medical Journal of Australia.[10] The Australian Pædiatric Association published a second explanatory letter in July 1971.[47] As stated above, the incidence of non-therapeutic circumcision of boys declined precipitously after the publication of these letters, so most men under forty-eight are intact. These foreskinned men are now becoming fathers. They are aware of the value and functions[48] of the foreskin so these intact fathers usually do not want any son to be circumcised. Moreover, public hospitals in Australia do not permit the performance of non-therapeutic circumcision.

As a consequence, it appears that the efforts of the RACP to revitalize the circumcision industry in Australia[44] may have scant success. The incidence of non-therapeutic circumcision of boys recently has been variously reported to be 4-10 percent.

Parental information

Raisingchildren.net.au provides excellent information on the care of intact, foreskinned boys.[49]

Video

Circumcision in modern Australia with John_Adkison

See also

External links

References

  1. ↑   Cozijn, John (2013). Incidence and prevalence of circumcision in Australia, circinfo.org, Circumcision Information Australia. Retrieved 26 January 2020.
  2. ↑   (1 April 2024). Global Circumcision Statistics and Estimates, https://circstatistics.github.io. Retrieved 1 April 2024.
  3. ↑   Gairdner DMT. The fate of the foreskin: a study of circumcision. British Medical Journal. 1949; 2(4642): 1433-7. PMID. PMC. DOI. Retrieved 28 October 2019.
  4. ↑   Morgan WKC. Penile plunder. Med J Aust. 1967; 1: 1102-3. PMID. Retrieved 31 October 2019.
  5. ↑   Wright JE. Non-therapeutic circumcision. Med J Aust. 27 May 1967; 1: 1083-7. PMID. Retrieved 28 October 2019.
  6. ↑   Leitch IO. Circumcision: the continuing enigma. Aust Paediatr J. March 1970; 6(1): 59-65. PMID. Retrieved 27 October 2019.
  7. ↑   Birrell RG. Circumcision. Aust Paediatr J. June 1960; 6(2): 66-7. PMID. Retrieved 27 October 2019.
  8. ↑   Smith ED. Another view of circumcision. Aust Paediatr J. June 1970; 6(2): 67-9. PMID. Retrieved 27 October 2019.
  9. ↑   Simpson ET, Baraclough P. The management of the paediatric foreskin. Aust Fam Physician. 1998; 27(5): 381-3. PMID. Retrieved 17 December 2023.
    Quote: Minor foreskin related complaints are very common in the first few years of life. Most of these can be managed with advice and reassurance, or with medical treatment alone. Circumcision is very rarely indicated in young boys, particularly under the age of 5 years.
  10. ↑ a b   Bellmaine SP. Circumcision. Medical Journal of Australia. 22 May 1971; 1: 1148. Retrieved 28 October 2019.
  11. ↑   Leditschke, J. Fred: Guidelines for Circumcision, Australasian Association of Paediatric Surgeons. (1996). Retrieved 7 November 2021.
  12. ↑   Statement (27 May 1996). Routine circumcision of normal male infants and boys, Australian College of Paediatrics. Retrieved 28 October 2019.
  13. ↑   Spilbury K, Semmens JB, Wisniewski ZB. Circumcision for phimosis and other medical indications in Western Australian boys. Med J Aust. 17 February 2003; 17(4): 155-8. PMID. DOI. Retrieved 16 December 2021.
  14. ↑   Tokley, Judith (13 February 2003). Warning on unnecessary child circumcision, Australian Medical Association. Retrieved 16 December 2021.
  15. ↑   Anonymous (9 December 2007)."Doctors back call for circumcision ban", Australian Broadcasting Corporation. Retrieved 27 July 2024.
  16. ↑   Circumcision of Male Infants Research Paper, Queenland Law Reform Commission. (1993). Retrieved 31 October 2019.
  17. ↑   Richards D. Male Circumcision: Medical or Ritual?. J Law Med. 1996; 3: 371. Retrieved 31 October 2019.
  18. ↑   Turner JN. Circumcised boys may sue. The Health Law Update (Australia). 23 February 1996; 1(4): 1-2. Retrieved 31 October 2019.
  19. ↑   Boyle GJ, Svoboda JS, Price CP, Turner JN. Circumcision of Healthy Boys: Criminal Assault?. J Law Med. February 2000; 7: 301-310. Retrieved 29 May 2024.
  20. ↑   Darby, Andrew (21 August 2012)."Tasmania moves a step closer to circumcision ban", Sydney Morning Herald. Retrieved 23 September 2021.
    Quote: Costs of the procedure included significant pain, and a potential reduction in sexual pleasure.…"Trauma from circumcision in childhood can also have a long lasting and significant effect on a person's mental health," the report said.
  21. ↑   Gunn, Grace (2019). Should Non-Therapeutic Male Circumcision be Prohibited in NSW?, Academia. Retrieved 1 December 2019.
  22. ↑   Robotham, Julie (29 October 2001)."You can leave your hat on, boys, but it's not cut and dried", Sydney Morning Herald. Retrieved 6 November 2019.
  23. ↑   Pengelley, Jill (9 December 2007)."Cosmetic circumcision banned", The Advertiser. Retrieved 6 November 2019.
    Quote: CIRCUMCISION will be banned in the state's public hospitals unless it is for medical reasons.
  24. ↑   Eldridge D, Macdonald M (2009): 4, in: A Picture of Australia's Children 2009. Canberra: Australian Institute of Health and Welfare. Pp. 12-16. ISBN 9781740249294. Retrieved 19 October 2019.
  25. ↑   Circumcision of Infant Males  , Royal Australasian College of Physicians. (1 September 2010). Retrieved 28 October 2019.
  26. ↑   Darby R. Infant circumcision in Australia: a preliminary estimate, 2000–10. Australia and New Zealand Journal of Public Health. 2011; 35(4): 391-2. PMID. DOI. Retrieved 2 November 2011.
  27. ↑   Sliwinsk A, Kavanagh LE, Bolton D, Lawrentschuk N, Crock JG. Fournier’s gangrene - delayed pedicle flap based upon the anterior abdominal wall. Int Braz J urol. 2014; 40(3): 423-6. PMID. DOI. Retrieved 18 January 2022.
  28. ↑ a b   Na AF, Tanny SPT, Hutson JM. Circumcision: Is it worth it for 21st-century Australian boys?. J Paediatr Child Health. 2015; 51: 580-3. PMID. DOI. Retrieved 29 October 2019.
  29. ↑   Medicare Benefits Schedule - Item 30654. Retrieved 2 November 2019.
  30. ↑   Darby R. Scientific Advice, Traditional Practices and the Politics of Health-Care: The Australian Debate over Public Funding of Non-Therapeutic Circumcision, 1985. Hygiea Internationalis. 2011; 10: 53-73. Retrieved 2 November 2019.
  31. ↑   Cozijn, John. Incidence and prevalence of circumcision in Australia. Retrieved 28 October 2019.
  32. ↑   Yosufzai, Rashida (19 February 2018). Why is the number of male circumcisions declining in Australia?, SBS. Retrieved 8 November 2021.
  33. ↑   (2018). Foreskins rule! Australians rush to abandon circumcision, Circumcision Information Australia. Retrieved 6 November 2019.
  34. ↑   Circumcision in Australia. Retrieved 14 December 2020.
  35. ↑   Anonymous. CLR, Circumcision Law Reform. Retrieved 3 February 2024.
  36. ↑   Anonymous (18 October 2023). Births, Australia, Australian Bureau of Statistics. Retrieved 3 February 2024.
  37. ↑   Hermant, Norman / Alison McClymon (22 January 2014)."Anger in NT community after circumcision rite ends with three boys airlifted to hospital", ABC News. Retrieved 19 November 2021.
  38. ↑   Dr. Raad Hassan, Rate MDs. Retrieved 2 February 2024.
  39. ↑   Foster, Ally (10 December 2021)."Likely cause of WA toddler’s death after circumcision revealed", news.com.au. Retrieved 16 December 2021.
  40. ↑   (9 December 2021)."A two-year-old child from Seville Grove in Perth, Western Australia, died after a failed circumcision", Olx Praca. Retrieved 16 December 2021.
  41. ↑ a b c   White, Nic (8 December 2021)."Toddler, 2, dies and his baby brother is fighting for life 'after botched circumcisions' as homicide cops are called to investigate", Daily Mail. Retrieved 8 December 2021.
  42. ↑   (8 December 2021)."Toddler dies, baby fighting for life after allegedly botched circumcision at Perth medical clinic", news.com.au. Retrieved 8 December 2021.
  43. ↑   Wondracz, Aidan (9 December 2021)."Parents are warned against circumcising their children after a toddler, 2, died 'of a reaction to anaesthetic' and his baby brother almost bled out", Daily Mail. Retrieved 12 December 2021.
  44. ↑ a b   RACP: Circumcision of Infant Males  . (December 2022). Retrieved 17 November 2023.
  45. ↑   Wondracz, Aidan (9 December 2021)."Parents are warned against circumcising their children after a toddler, 2, died 'of a reaction to anaesthetic' and his baby brother almost bled out", Daily Mail. Retrieved 20 November 2023.
  46. ↑   Lackey, Brett (24 May 2024)."Top circumcision doctor is banned from performing the operations after amputating two little boys' penises, tribunal hears", Daily Mail. Retrieved 25 May 2024.
  47. ↑   Hall G, Bellmaine SP. Circumcision. Med J Aust. 24 July 1971; 2(4): 223. PMID. Retrieved 18 November 2023.
  48. ↑   Helard, Lou (1 August 2014). Functions of the Foreskin, Intact Australia. Retrieved 29 May 2020.
  49. ↑   Anonymous (21 December 2021). Foreskins and foreskin care. Retrieved 2 September 2024.
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