Changes

[[File:Flag_of_Australia.svg|thumb|150px|Flag of Australia]]== 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 now (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.<ref name="cozijn2013">{{REFweb |url=http://www.circinfo.org/statistics.html |title=Incidence and prevalence of circumcision in Australia |trans-title= |language= |last=Cozijn |first=John |author-link= |publisher=Circumcision Information Australia |website=circinfo.org |date=2013 |accessdate=2020-01-26 |format= |quote=}}</ref> The percentage of [[circumcised]] males in Australia (prevalence) is reported to be 26.6%.<ref>{{REFweb |url=https://circstatistics.github.io/ |title=Global Circumcision Statistics and Estimates |last= |first= |init= |publisher=https://circstatistics.github.io |date=2024-04-01 |accessdate=2024-04-01}}</ref>

The indigeous indigenous people of Australia, the Aborgines[[Aborigines]], have variously practiced [[Religion and culture#Australia| 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 incidence Fate of the Foreskin: A Study of Circumcision'',<ref name="gairdner1949">{{GairdnerDM 1949}}</ref> seems to have had no effect in Australia. However, criticism of the practice of non-therapeutic neonatal circumcision accelerated in Australia approached that of the United States in the 1930s through 1960s1967.

Morgan (1967) criticised non-therapeutic [[Douglas Gairdnercircumcision]]in a letter published in the 's famous, classic 1949 paper, ''The Fate Medical Journal of the Foreskin: A Study of CircumcisionAustralia'',.<ref name="gairdner1949">{{REFjournal |last=GairdnerMorgan |firstinit=Douglas M.WKC |etal=No |title=The fate of the foreskin: a study of circumcisionPenile plunder |journal=British Medical JournalMed J Aust |volumedate=21967 |issuevolume=46421 |pages=14331102-14373 |url=httpshttp://www.ncbi.nlm.nihcirp.gov/pmcorg/articleslibrary/PMC2051968general/pdfmorgan2/brmedj03656-0009.pdf |quote= |pubmedID=154082994226264 |pubmedCID=2051968 |DOI=10.1136/bmj.2.4642.1433 |date=1949 |accessdate=2019-10-2831}}</ref> seems to have had no effect in Australia.

|last=Wright |firstinit=JE |author-link= |etal=no |title=Non-therapeutic circumcision |trans-title= |language= |journal=Med J Aust location= |date=1967-05-27 |volume=1 |issue= |pages=1083-7 |url=http://www.cirp.org/library/general/wright4/ |quote= |pubmedID=6028342 |pubmedCID= |DOI= |accessdate=2019-10-28 }}</ref>

The ''Australian Paediatric Journal'' issue of June 1970, published three articles critical of non-therapeutic infant [[circumcision]].<refname="leitch1970">{{REFjournal

|first=I.O. |author-linkinit=IO |etal=yesno

|first=R.G. |author-linkinit=RG

|first=E.D. |author-linkinit=ED

|accessdate=20192023-1012-2717

After considering the three papers published in the ''Australian Paediatric Journal'', the [http://auspaediatrics.com.au/ Australian Paediatric Society] adopted a resolution on 24 April 24, 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 22, 1971.<ref name="belmaine1971bellmaine1971">{{REFjournal |last=BelmaineBellmaine |firstinit=SP |author-link=

The incidence of non-therapeutic child [[circumcision ]] in Australia started to decline after the publication of the Belaine 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."<ref name=leditschke1996>{{REFdocument |title=Guidelines for Circumcision |url=http://www.cirp.org/library/statements/aaps/ |last=Leditschke |first=J. Fred |author-link= |publisher=Australasian Association of Paediatric Surgeons |format= |date=1996 |accessdate=2021-11-07}}</ref>

}}</ref> The ''Australian Medical Association'' (2003) issued a warning (based on the Spilsbury paper)<ref name="spilsbury2003">{{REFjournal |last=Spilbury |init=K |last2=Semmens |init2=JB |last3=Wisniewski |init3=ZB |etal=no |title=Circumcision for phimosis and other medical indications in Western Australian boys |journal=Med J Aust |date=2003-02-17 |volume=17 |issue=4 |pages=155-8 |url=https://www.mja.com.au/journal/2003/178/4/circumcision-phimosis-and-other-medical-indications-western-australian-boys |pubmedID=12580740 |DOI=0.5694/j.1326-5377.2003.tb05130.x |accessdate=2021-12-16}}</ref> that circumcision to treat phimosis in boys is usually unnecessary.<ref name="ama2003">{{REFweb |url=https://www.ama.com.au/media/warning-unnecessary-child-circumcision |title=Warning on unnecessary child circumcision |last=Tokley |first=Judith |publisher=Australian Medical Association |date=2003-02-13 |accessdate=2021-12-16}}</ref> == Non-therapeutic circumcision and Australian law ===== International human rights law ===Australia is a state-party to the United Nations ''[https://www.ohchr.org/EN/ProfessionalInterest/Pages/CCPR.aspx Covenant on Civil and Political Rights]'' (1966) and to the United Nations ''[https://www.ohchr.org/en/professionalinterest/pages/crc.aspx 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 [https://www.qlrc.qld.gov.au/ Queensland Law Reform Commission] (1993) researched the legality of non-therapeutic circumcision of children. The Commission concluded: <blockquote>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.<ref name="qlrc1993">{{REFdocument |title=Circumcision of Male Infants Research Paper |url=http://www.cirp.org/library/legal/QLRC/ |publisher=Queenland Law Reform Commission |date=1993 |accessdate=2019-10-31}}</ref></blockquote> [[Davis Richards]] (1996) discussed non-therapeutic circumcision of boys. He concluded: <blockquote>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.<ref name="richards1996">{{REFjournal |last=Richards |first=David |init=D |author-link= |title=Male Circumcision: Medical or Ritual? |journal=J Law Med |date=1996 |volume=3 |issue= |pages=371 |url=http://www.cirp.org/library/legal/richards/ |accessdate=2019-10-31}}</ref></blockquote> Professor [[J. Neville Turner|Neville Turner]] (1996) reported that [[circumcised]] boys may sue their circumciser.<ref name="turner1996">{{REFjournal |last=Turner |first=J. Neville |init=JN |author-link=J. Neville Turner |title=Circumcised boys may sue |journal=The Health Law Update (Australia) |date=1996-02-23 |volume=1 |issue=4 |pages=1-2 |url=http://www.cirp.org/news/1996.02.23_Oz/ |accessdate=2019-10-31}}</ref> Boyle et al. (2000) suggested that non-therapeutic circumcision of boys is "criminal assault." They concluded: <blockquote>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.<ref>{{REFjournal |last=Boyle |first=Gregory J. |init=GJ |author-link=Gregory J. Boyle |last2=Svoboda |first2=J. Steven |init2=JS |author2-link=J. Steven Svoboda |last3=Price |first3=Christopher P. |init3=CP |author3-link=Christopher P. Price |last4=Turner |first4=J. Neville |init4=JN |author4-link=J. Neville Turner |etal=no |title=Circumcision of Healthy Boys: Criminal Assault? |journal=J Law Med |date=2000-02 |volume=7 |issue= |pages=301-10 |url=http://www.cirp.org/library/legal/boyle1/ |accessdate=2019-10-31}}</ref></blockquote> The ''Tasmanian Law Reform Institute'' recommended in a [https://www.utas.edu.au/__data/assets/pdf_file/0006/302829/Non-Therapuetic-Circ_Final-Report-August-2012.pdf 101-page report] that non-therapeutic circumcision of boys be made unlawful in Tasmania.<ref>{{REFnews |title=Tasmania moves a step closer to circumcision ban |url=https://www.smh.com.au/politics/federal/tasmania-moves-a-step-closer-to-circumcision-ban-20120821-24ju9.html |last=Darby |first=Andrew |publisher=Sydney Morning Herald |website= |date=2012-08-21 |accessdate=2021-09-23 |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.}}</ref> Grace Gunn (2019) argues that non-therapeutic circumcision of boys should be prohibited in New South Wales.<ref name="gunn2019">{{REFweb |url=https://www.academia.edu/15677989/SHOULD_NON-THERAPEUTIC_MALE_CIRCUMCISION_BE_PROHIBITED_IN_NSW_WHY?email_work_card=view-paper |title=Should Non-Therapeutic Male Circumcision be Prohibited in NSW? |last=Gunn |first=Grace |website=Academia |date=2019 |accessdate=2019-12-01}}</ref> 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 [https://www.wesleycollege-usyd.edu.au/ Wesley College] at the {{UNI|University of Sydney|USYD}}, Sydney, {{AUSC|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.<ref>{{REFnews |title=You can leave your hat on, boys, but it's not cut and dried |url=http://www.cirp.org/news/smh10-29-01/ |last=Robotham |first=Julie |publisher=Sydney Morning Herald |website= |date=2001-10-29 |formataccessdate=2019-11-06

==Circumcision in the 21st Century== The several Australian states operate public hospitals. By 2008 all public hospitals in all states no longer offer offered non-therapeutic [[circumcision ]] to patients.<ref>{{REFnews |title=Cosmetic circumcision banned |url=http://www.cirp.org/news/theadvertiser2007-11-12/ |last=Pengelley |first=Jill |publisher=The Advertiser |website= |date=2007-12-09 |accessdate=2019-11-06 |quote=CIRCUMCISION will be banned in the state's public hospitals unless it is for medical reasons.}}</ref>

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.<ref>{{REFbook

|author-linkinit=D

|author2-linkinit2=M

|isbn=SBN 978 1 74024 929 4 |quote=9781740249294

The former ''Australian College of Paediatrics '' was merged into the [https://www.racp.edu.au/ [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.

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. However, deferring the decision may not always be the best option. As noted earlier, the psychosocial benefits of circumcision (e.g. full inclusion in a religious community) may only be obtained if circumcision is done in infancy. Waiting until the boy is twelve years old or more (i.e. old enough to make his own decision) may mean losing benefits that circumcision was intended to produce.<ref name="racp2010">{{REFdocument

|contribution= |last= |first= |publisher=The [[Royal Australasian College of Physicians]]

The [[RACP]], a [[medical trade association]], retired this [http://www.intactaus.org/wp-content/uploads/2016/01/RACP-statement.pdf 2010 statement] in December 2022, when it issued a new statement that was ''not'' an improvement. [[Robert Darby|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.<ref>{{REFjournal |last=Darby |first=Robert |init=R |author-link=Robert Darby |etal=no |title=Infant circumcision in Australia: a preliminary estimate, 2000–10 |journal=Australia and New Zealand Journal of Public Health |location= |date=2011 |volume=35 |issue=4 |pages=391-2 |url=https://onlinelibrary.wiley.com/doi/full/10.1111/j.1753-6405.2011.00746.x |quote= |pubmedID=21806736 |pubmedCID= |DOI=10.1111/j.1753-6405.2011.00746.x |accessdate=2011-11-02}}</ref> Sliwinski et al. (2014) of the Department of Urology at the {{UNI|University of Melbourne|UM}} 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.<ref>{{REFjournal |last=Sliwinsk |init=A |last2=Kavanagh |init2=LE |last3=Bolton |init3=D |last4=Lawrentschuk |init4=N |last5=Crock |init5=JG |etal=no |title=Fournier’s gangrene - delayed pedicle flap based upon the anterior abdominal wall |journal=Int Braz J urol |date=2014 |volume=40 |issue=3 |pages=423-6 |url=https://www.scielo.br/j/ibju/a/TC3tkRhqGS8577ywNNkJ8dj/?lang=en |pubmedID=25010310 |pubmedCID= |DOI=10.1590/S1677-5538.IBJU.2014.03.18 |accessdate=2022-01-18}}</ref> Na et al. (2015) considered whether Australian boys should be circumcised. They concluded: <blockquote>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.<ref name="na2015">{{REFjournal |last=Na |first=Angelika F. |init=AF |last2=Tanny |first2=Sharman P.T. |init2=SPT |last3=Hutson |first3=John M. |init3=JM |etal=no |title=Circumcision: Is it worth it for 21st-century Australian boys? |journal=J Paediatr Child Health |date=2015 |accessdate=2019-10-29 |volume=51 |pages=580-3 |url=https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.12825 |pubmedID=25683279 |DOI=10.1111/jpc.12825}}</ref></blockquote> Oddly enough, the [https://www.humanservices.gov.au/organisations/health-professionals?utm_id=9 federal Medicare programme] still pays an inadequate [[third-party payment]] of AU$35.45 for non-therapeutic circumcision.<ref>{{REFweb |url=http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=30654&qt=item |title=Medicare Benefits Schedule - Item 30654 |accessdate=2019-11-02}}</ref> This subsidy exists for political reasons, not medical reasons.<ref name="darby1985">{{REFjournal |last=Darby |first=Robert |init=R |author-link=Robert Darby |etal=no |title=Scientific Advice, Traditional Practices and the Politics of Health-Care: The Australian Debate over Public Funding of Non-Therapeutic Circumcision, 1985 |journal=Hygiea Internationalis |date=2011 |volume=10 |pages=53-73 |url=https://docplayer.net/5261996-.html |accessdate=2019-11-02}}</ref><!-- This information is dubious. On 18 September 2020 the Department of Health announced changes in the Medicare medical benefit schedule. Effective 1 November 2020, claims submitted for circumcision must be for "clinically relevant" circumcision. In other words, non-therapeutic circumcision will no longer be covered and no payment will be made.<ref name="medicare2020">{{REFdocument |url=http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/1C7B3AED38006462CA2585E80009D95C/$File/factsheet-Circumcision-20200918.pdf |title=Circumcision on the MBS |publisher=Australian Government Department of Health |format=PDF |date=2020-09-18 |accessdate=2020-09-27}}</ref>-->===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: <blockquote>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.<ref name="na2015"/></blockquote> The incidence of non-therapeutic [[circumcision ]] of children in Australia has continued to diminish. [[Circumcision Info Australia| Circumcision Information Australia ]] (2017) reported an incidence of infant circumcision of 9.66 percent in fiscal 2015.<ref>{{REFweb

|init=H |author-link=Hugh Young

|transaccessdate=2019-10-28}}* {{REFweb |url=http://www.intactaus.org/ |title=Intact Australia |last=Hely |languagefirst=Lou |website=Intact Australia |date=2014-08-01 |accessdate=2019-11-17}}* {{REFweb |url=http://www.foreskinrevolution.com/ |title=Foreskin Revolution |last=Winnel |first=Michael |accessdate=2019-11-06}}* {{REFweb |url=https://15square.org.uk/2019/07/16/circumcision-in-australia/ |title=Circumcision in Australia |last=Smith |first=David |init=D |author-link=David Smith |publisher=15 Square

|date= |update=2019-07-16 |accessdate=2019-1011-2806