Hospitals slow to offer circumcision

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The Norwegian medical community’s strong opposition to circumcision of baby boys has kept Norway’s state-funded hospitals from offering the controversial operations under a new law allowing them. The government expected demand for around 2,000 circumcisions a year in Norway, but newspaper Dagsavisen reports that only around 30 have been performed since the law took effect January 1.

Norway's first case of ebola will be handled here, at Ullevål University Hospital in Oslo, which has special isolation units and equipment. PHOTO: Wikipedia

Oslo University Hospital Ullevål is among Norway’s state-funded hospitals that are still working to get circumcision programs in place, over the opposition of many doctors and nurses. PHOTO: Wikipedia

The demand estimate was based on the number of births among Muslim and Jewish families in Norway, the majority of which circumcise baby boys shortly after birth in line with religious tradition. Spokespersons for Norway’s relatively small Jewish community had indicated, though, that they would continue to turn to private procedures to circumcise their baby boys.

Now it appears Muslim families are doing the same, given the small number of circumcisions performed at Norwegian hospitals so far this year. Lists obtained by Dagsavisen indicate that only another 115 prospective patients are on waiting lists for the procedure at Norway’s two largest hospitals. No circumcisions have been performed yet at either Oslo University Hospital’s Ullevål or Ahus divisions, where demand from residents of the Oslo metropolitan area was expected to highest.

Massive medical resistance
The low number of circumcisions performed is widely attributed to the resistance mounted by doctors, nurses and other health care personnel. All of Norway’s professional medical associations opposed the law allowing circumcisions to be covered by Norway’s public health service, with only the national midwives’ organization (Jordmorforening) supporting it. The opposition is based on professional views that the procedure is unnecessary, irreversible and performed on patients unable to agree to it because they are so young. Some groups tried to impose an age limit that would prevent hospitals from circumcising boys under the legal consent age of 18 and they haven’t given up their fight to modify the law.

Medical professionals in Norway can reserve themselves against performing the procedure, and many have at hospitals from Østfold in the south to hospitals and clinics tied to the Helse Nord division of Norway’s public health care system in Northern Norway. In Østfold, which has a large Muslim community, hospital administrators were thus obliged to outsource the procedure to the private Ringvollklinikken in Hobøl, which didn’t get its program going until this summer. The clinic intends to set aside one full day a month when it expects to offer between six and 12 circumcisions (with local anesthetic because doctors feel it’s too risky to put small children under full anesthesia), clinic chief Else Marie Skjærengrud told Dagsavisen.

Helse Nord’s solution to the lack of doctors in Northern Norway willing to circumcise babies was to refer cases to St Olavs Hospital in Trondheim. Dagsavisen reported that so far, however, no referrals have been made.

The statistics gathered by Dagsavisen reportedly show that circumcisions so far this year have only been recorded at Sørlandlet sykehus in Kristiansand (five in May and June) and at St Olavs in Trondheim, which couldn’t say how many. At Ahus in the Oslo area, where 13 of its 15 urologists have reserved themselves against performing circumcision, hospital adminstrators are still working on how they can be offered. Officials at Ullevål expect to get a program underway this autumn.

“A demand that only surgeons and urologists can perform a circumcision, and strong opposition within the public health system, has made it difficult to get programs in place,” Dr Trond Markestad, leader of Norway’s medical ethics council (Rådet for legeetikk) and an opponent of circumcision himself, told Dagsavisen. Markestad, who’s also a professor in pediatrics, said more information is also needed on whether parents of prospective young patients continue to have circumcisions performed abroad or privately at their own expense, to better assess expectations and need.

The new law was aimed at preventing non-medical professionals from circumcising babies in Norway, to protect the child’s health. If parents are intent on circumcising their boys, it was thought to be better that they have it done at a state-run hospital in return for paying a portion of the cost. The group Stopp rituell omskjæring av norske barn (Stop ritual circumcision of Norwegian children) claims the low numbers of circumcisions actually performed shows that the law was poorly formulated before it was approved and took effect. Most hospital administrators claim they’re trying to comply with it, though, and are working to get programs in place. Berglund

  • Norway needs to take the next step and ban infant circumcision altogether. It already has a law in place guaranteeing that girls grow up with all of their genital tissue, in spite of parental preference. Why should little boys not be guaranteed the same?

  • EuropeanMan

    They need to change the law. Hospitals and doctors should have the right to refuse to perform circumcisions. Norway should use the Italian example where there is one single center in the country near Rome that performs circumcisions. Parents should be informed and strongly discouraged from doing it. A centralized clinic would be better equipped for doing that instead of putting the burden on state funded hospitals. A general ban on circumcision would be better but until then Norway should centralize the efforts. Use information to discourage parents similarly to the advertisement campaigns against smoking. Information is powerful.

    • Nancy Broertjes

      Doctors and hospitals already have the right to refuse.

  • Moomin

    Respect to the medical staff that refuses this. Religion is (or at least should be) a personal choice.

  • ml66uk

    It’s illegal to cut off a girl’s prepuce, or to make any incision on a girl’s genitals, even if no tissue is removed. Even a pinprick is banned. Why don’t boys get the same protection? Everyone should be able to decide for themselves whether or not they want parts of their genitals cut off. It’s *their* body.

    • Nancy Broertjes

      Because it is so heavily linked to the religious beliefs of Jews and Muslims, many governments are reluctant to mess with it. I think they should ban it entirely, worldwide. Even that will have those who defy the ban as do those from African cultures who cut their daughters….even to sending them to a country where it IS done.

  • Adam Cornish

    If only the US could have this problem. Time is changing custom, and the circumcision rates are dropping.
    What an awful body part to lose, one that brings joy and pleasure.

  • dst13

    It is certainly true that boys should be as protected as girls from genital cutting. Unfortunately in the U.S., although changing slowly, the cultural bias towards male genital cutting is still too strong for a legal ban to be even considered. The key is education- people are just plain misinformed and in denial- it takes a brave man to admit a wrong was done to him or to a mother it father to admit that they should not continue the practice even if they had unwittingly done it to an existing child. It’s been my experience that upon learning the facts, the absolute importance of the foreskin to genital and sexual health and enjoyment, the lack
    of necessity of the procedure, the excruciating pain experienced by the infant for no good reason, the way research statistics have been misused- this has led to a change of opinion and behavior in many. It will take time but some day routine infant circumcision will seem as outlandish as footbinding once did.

  • Neil Ramsbottom

    “in line with religious tradition”

    What a barbaric tradition and what an outrageous law to have in a supposedly egalitarian nation. Males may have their genitals mutilated because “tradition” but females may not because…

  • John Dalton

    Medical staff are right to respect children’s right to autonomy and refuse to perform circumcision.

  • Alfred Klose

    Many medical studies are now backing this practice as healthier for male health than non-circumcision. The US Centers for Disease Control and Prevention found that medically performed male circumcision could help decrease the risk of contracting HIV, sexually transmitted infections, as well as other health problems.

    • ml66uk

      In response to the draft CDC guidelines, which the peer review says was written by a “who’s who of circumcision advocates”, 31 senior physicians, around half of them presidents or chairs of national pediatric or urological organisations, wrote the following:

      “However, the way from the background paper to the recommendations is marked by exclusion, omission and minimization of scientific peer evidence that does not support the recommendation. This is very similar to the development of the AAP circumcision policy statement in 2012 in which critical evidence was omitted or downplayed. A group of 38 distinguished physicians from Europe and Canada, comprising several heads and representatives of national medical associations, societies for pediatricians and pediatric surgeons, and medical ethics boards, published a comprehensive and evidence-based reply to the AAP recommendations, which has not been considered by the CDC (Frisch et al 2013).”

      “Health providers, male patients and parents will miss important information for decision making if they follow the CDC proposal.”

    • Bret Furlong

      One of the problems we face as a society today is religious harm, it comes in all forms and is sometimes disguised as science.

      Take the American Academy of Pediatrics, and the Centers for Disease Control recent publications surrounding circumcision.

      The CDC guidelines are based on a sharply criticized 2012 policy statement by the American Academy of Pediatrics. The 2012 statement was condemned by a large group of physicians, medical organizations, and ethicists from European, Scandinavian, and Commonwealth countries as “culturally biased” and “different from [the conclusions] reached by physicians in other parts of the Western world, including Europe, Canada and Australia” (Frisch et al., 2013).

      The new CDC guidelines highlight methodologically flawed studies from Africa that have no relevance to the United States. They chose to ignore studies that were conducted in the United States and show no link between circumcision and the risk of sexually transmitted diseases, including HIV (Thomas et al., 2004).

      But what does this have to do with religious harm, Dr. Tom Frieden, Director of the CDC since 2009, is Jewish. Prior to his role at the CDC, he was New York City’s Health Commissioner. In this role, he refused to take a strong stance against metzitzah b’peh, the practice among some Jewish communities of the mohel (ritual circumciser) sucking the blood from the wound with his mouth, during these rituals some babies contracted STIs and have lifelong damage a couple even died from disease.

      4 of the 7 members of the AAPs Taskforce on Circumcision are Jewish, not believing these members are not only culturally but religiously biased would be naïve: It is inconceivable that the AAP could have objectively concluded that the benefits of the procedure outweigh the risks when the ‘true incidence of complications’ isn’t known.” Instead, as the AAP stated in a later publication—after drawing considerable fire from pediatric and statistical experts —their main conclusion was based on a “feeling.” One of the authors of this statement, Dr. Andrew Freedman, revealed in an interview that he had previously circumcised his own son on his parents’ kitchen table. “But I did it for religious, not medical reasons,” Freedman reported. “I did it because I had 3,000 years of ancestors looking over my shoulder.” So we can see that both scientific and non-scientific factors can influence people’s attitudes toward circumcision—including people who are charged with setting policy.

      We have a duty as Christians and even Atheists and Agnostics, to not fall for pseudoscience, and keeping archaic blood sacrifice rituals away from our children.

    • Cailin

      Great! As soon as the child is old enough, he can decide on his own whether or not he wants to cut off part of his penis. Until that time, the parents should not force this procedure on him.

  • Muhammed

    My son was denied the procedure despite the constant pain every time he urinates, and a clair medical reason. True the parents are muslim But in our case, there was a real medical need, several Dr. relinctently but firmly recomanded it, the surgent at the hospital refused. We could not operate our son at private clinique in Norway because the offer is so limited. Not standing seeing our son in pain, and worsning, we took him out of the country where he had this relatively easy procedure. We understand the medical staff is against it for cultural reasons, but denying service to a patient in pain was in our case discriminatory and unhumaine. The boy was not faeking it!

    • There is other ways to solve this problem. The foreskin can be widened with gradual stretching, aided with the help of some topical medication. Also there is surgery to reshape the foreskin. The doctors should have offered the other effective treatments, not circumcision, because circumcision always creates problems.

      • frenk

        Hi – thanks for the ‘foreskin’ update!

  • Nathan

    It is a terrible and wicked shame that Norway has refused to accept that males have the same human rights as females to be free of any form of genital mutilation. It is a disgrace that they care not for the human rights of males simply because of their sex.

  • Nicole

    Genital mutilation is a disgusting violation of basic human rights no matter what form your genitals take. Why is it so hard for society to accept that girls AND BOYS need to be protected from this?? To say that FGM is worse than MGM is ridiculous. There are varying degrees of both, from the extremely damaging to the so called “benign.” Yet even a ceremonial pin-prick is illegal and socially condemned when performed on females. For males, there is no law against any form, and the most common is a traumatic removal of the entire foreskin. Her Body Her Rights. HIS BODY HIS RIGHTS!

  • Bryan Scandrett

    Religion has no say over the autonomy of the childs body. To end this, it needs a case of an adult suing parents and hospital for damages as the legislators won’t protect male infants.
    History will judge us all with shame and rightly so.

  • Nancy Broertjes

    The UK stopped paying for it under the National Health and it almost stopped overnight.

  • Kalia

    Circumcision is cosmetic surgery and fine for adults desiring it. When done on infants it is unpredictable in quality and often performed by unqualified persons. Some circs take off ten times more than others. it is difficult to control the amount taken off when using devices like the Gomco clamp. Cutting off TOO MUCH and cutting crooked are very common. Perforated urethra is not unknown. Sure, infant circumcision is “easy” to do. Even easier to botch. Repair of botched circs is technically difficult and not always satisfactory. A man has to live with a ruined organ for life.

  • Lawrence Newman

    No, it’s been proven almost all erogenous nerves are in the foreskin. There are no doubts. IF there were, you could link me to one histological analysis disproving this.

    • Stephen Moreton

      No it has not been proven. I have repeatedly pointed you to histological work by multiple workers spanning decades proving the glans is key, not the foreskin, and you just ignore it all or dismiss it on ad hominem grounds, whilst parroting the same tired old article by Cold & Taylor which lumps all nerve types together and makes wild speculations. You are what psychologists call “in denial”.

      • Lawrence Newman

        There isn’t one histological analysis in existence that shows the glans to have any significant erogenous properties. FACT