Friday, December 17, 2010

Are YOU Paying for Infant Circumcision?

By Danelle Frisbie © 2010

According to the American Academy of Pediatrics, routine infant circumcision (RIC) surgery alone costs taxpayers close to $70 million annually. Costs are much greater when payments for post-op complications and extended hospital stays are included in the circumcision surgery figures. (1)

The Centers for Medicare and Medicaid Services (federal program) has defined elective circumcision (ICD-9-CM V50.2) as medically unnecessary - the amputation of the prepuce organ is therefore a cosmetic, irreversible, surgical body modification. And it is one that is being done to infant boys with your tax dollars in 33 U.S. states and among TRICARE covered military families.

A study (2009) published in the American Journal of Public Health demonstrates that infant circumcision declines in those areas where Medicaid no longer covers the surgery (graph below). (2) As a result, many human rights activists believe that the key to granting all boys and men their right to bodily integrity lies in a nation wide end to Medicaid funding of RIC.



Members of GI: Genital Integrity for Military Families Abroad are equally concerned with ending TRICARE's coverage of RIC for babies born to military personnel both in the States and abroad. In the Netherlands, where several GI volunteers work, the national medical society, KNMG, takes a firm stance against infant circumcision:
The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complicationsbleeding, infection, urethral stricture and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence. KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications.
The International Coalition for Genital Integrity and Colorado's National Organization of Circumcision Information Resource Centers offer the following reasons to stop Medicaid funding of RIC:

* Infant circumcision is not recommended by the American Academy of Pediatrics (3) or any national medical organization in the world.
* Circumcision is considered medically unnecessary by all major medical organizations.
* Circumcision does not contribute to health, and deters from health.
* Nearly 70% of American parents do not want their boys (or their girls) circumcised.
* Routine circumcision of newborns has been abandoned in all English-speaking countries. (It has never been customary in most of the world.)
* According to comprehensive analysis, infant circumcision is not cost-effective. (4)
* Those choosing circumcision for themselves may pay privately if they desire as consenting adults.
* Medicaid savings will average $1 million annually for each State.
* Medically necessary programs need this money.


Currently, Medicaid does not cover infant circumcision in the following 17 states. Each state is listed according to the year in which tax payer funding of RIC ended in the state.

California - 1982

North Dakota - 1986

Oregon - 1994

Mississippi - 1998

Nevada - 1998

Washington - 1998

Missouri - 2002

Arizona - 2002

North Carolina - 2002

Montana - 2003

Utah - 2003

Florida - 2003

Maine - 2004

Louisiana - 2005

Idaho - 2005

Minnesota - 2005

South Carolina - 2011

Colorado - 2011


For further information and to become involved see:

Medicaid and Circumcision File (pdf)

Circumstitions: There's Money in Circumcision


ICGI: Medicaid Project

End Medicaid Funding of Infant Circumcision Facebook Page

End Taxpayer Funding of Routine Infant Circumcision Facebook Group

Find Your State's Medicaid Funding RIC Facebook page here 

Medicaid Sample Letters to send (from 4Eric.org)

(TRICARE) GI: Genital Integrity for Military Families Abroad


References:

1. Mansfield CJ, Hueston WJ, Rudy M. Neonatal circumcision: associated factors and length of hospital stay. Journal of Family Practice, 1995;41(4):370-376.

2. Arleen A. Leibowitz, Katherine Desmond, Thomas Belin Determinants and Policy Implications of Male Circumcision in the United States. American Journal of Public Health, 2009;99(1):1–7.

3. American Academy of Pediatrics Task Force on Circumcision. Circumcision policy statement. Pediatrics. 1999;102(3):686-693.

4. Van Howe RS. A cost-utility analysis of neonatal circumcision. Medical Decision Making. 2004;24:584- 601.


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Thursday, December 16, 2010

Drop-Side Cribs Outlawed: MGM Continues


After 32 infants and toddlers have died over the past 10 years from being left alone in drop-side cribs, without an adult caregiver nearby keeping watch, the cribs will now be outlawed by the U.S. government. The banning comes after a unanimous vote by the Consumer Product Safety Commission. Images of how the cribs have played a roll in these deaths are ubiquitous in the news this month (above, below). Yet somehow, in the midst of all the hoopla over yet another baby-item banned, we continue to overlook the 117-229 baby boys (numbers which are likely on the low end of actual statistics) who die each and every year in the United States from circumcision surgery complications. (1, 2)

In 2010, more infant boys died as a result of unnecessary circumcision surgery in the U.S. than from choking, from auto accidents, from suffocation, from SIDS, from (the recently recalled) sleep positioners, and from drop-side cribs.

The question begs to be answered: Where is this recall?


The Associated Press reports from Washington:
It's the end of the traditional crib that has cradled millions of babies for generations.

The government outlawed drop-side cribs on Wednesday after the deaths of more than 30 infants and toddlers in the past decade and millions of recalls.

It was a unanimous vote by the Consumer Product Safety Commission to ban the manufacture, sale and resale of the cribs, which have a side rail that moves up and down, allowing parents to more easily lift their child from the crib.

The new standard requiring cribs to have fixed sides would take effect in June. The move by CPSC would also prohibit hotels and childcare centers from using drop-sides, though those facilities would have a year to purchase new cribs.

CPSC Chairman Inez Tenenbaum hailed the new standard for cribs as one of the strongest in the world. "I believe these new standards will markedly reduce crib-related hazards and help to ensure that young children sleep more safely in their cribs," Tenenbaum said after the vote.

Around for decades, drop-side cribs have come under scrutiny in recent years because of malfunctioning hardware, sometimes cheaper plastics, or assembly problems that can lead to the drop-side rail partially detaching from the crib. When that happens, it can create a dangerous "V"-like gap between the mattress and side rail where a baby can get caught and suffocate or strangle.
 "These products are deadly"
In all, drop-side cribs have been blamed in the deaths of at least 32 infants and toddlers since 2000 and are suspected in another 14 infant fatalities. In the past five years, more than 9 million drop-side cribs have been recalled, including cribs from big-name companies such as Evenflo, Delta Enterprise Corp., and Pottery Barn Kids.

Michele Witte of Merrick, N.Y., lost her 10-month-old son, Tyler, in 1997 when the drop-side rail on his crib came loose, partially detached and then trapped his neck between the rail and the headboard. "It's been a long 13 years," said Witte. "I feel like it's a celebratory time because things are finally being done about the issue."

Witte appeared at a news conference on Capitol Hill with Democratic Sen. Kirsten Gillibrand of New York, Rep. Jan Schakowsky, D-Ill., and Rep. Joe Crowley, D-N.Y., all of whom have pushed for stronger crib safety rules.

The new standard mandates tougher safety testing for cribs, tests that more closely mimic a child in a crib. As children get older, they can apply more force to the crib — shaking on it, running around in it, jumping up and down. The new tests aim to make sure the cribs can take that kind of pressure.

Better labeling on crib pieces will also be required — a measure that aims to cut down on the misassembly problems that some parents have encountered, problems that can lead to the death of a child.

Parents who lost their children in drop-side cribs say Wednesday's ban couldn't come soon enough. Chad Johns, whose 9-month-old son, Liam, died in a drop-side crib in 2005, said he was a little relieved. "Yes, it's a long time coming," said Johns from Roseville, Calif. "But the fact that it is happening — that's what is important."

Crib makers were already phasing out drop-side cribs over the last couple years, amid increasing problems with them. And last year, the organization that sets voluntary industry standards — ASTM International — approved a drop-side ban.

Many parents, however, still have drop-sides in their homes. They can also be found at secondhand stores. Parents who are using drop-side cribs are advised to check the hardware on the cribs to be certain it's working properly and to make sure their crib has not been recalled. The Juvenile Products Manufacturers Association, which represents over 90 percent of the crib industry, says properly assembled drop-sides that haven't been recalled can be safely used.

Notes:

(1) Baker RL. Newborn male circumcision: needless and dangerous. Sexual Medicine Today. 1979;3(11):35-36.

(2) Bollinger, Dan. Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths. Thymos: Journal of Boyhood Studies. 2010;4(1):78-90.


See also:

Death From Circumcision

Intact vs. Cut Outcome Statistics

Another Baby Dies After Circumcision Surgery


Better baby sleep options:

Healthy Infant Sleep: A Review of Research

Turn your crib into a co-sleeper

Time to Abolish Cribs?

A collection of quality, helpful baby sleep books is located here.


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Sunday, December 5, 2010

Ready to Talk: A Jewish Mother's Change of Heart

By Rebekah Costello
More from Costello at Thoughtful Momma


I’m coming out of the closet! I am strongly anti-circumcision and I’ve given a lot of thought to talking about it now. It’s such an important issue and I truly feel as though I have a responsibility to raise awareness.

Circumcision is one of those issues that has moms flaring at the nostrils and screaming in protest, regardless of how they personally feel about the issue. I remember the first time someone challenged me on the topic and how furious I was when she suggested I was advocating for infant mutilation. I was, to put it blandly, enraged.

I grew up being raised in a blended faith. My family are Messianics: Jews who embrace Jesus as the Messiah promised in the Tenach. I remember my youngest brother’s Bris quite well but because his Bris was a reception only (the actual procedure was done in the hospital), and the only other one I’d attended occurred when I was so young I couldn’t really remember it. I had no idea, really, what circumcision entailed other than my parents' sublime explanation: “It’s when a little flap of skin is cut off as a sign…”

Years later, I married a man who is intact. Not to go into too much private detail, but I will tell you that I thought it was so COOL. I had this idea that it made him unique, almost exotic. I laugh a little at myself now, of course. I have only ever “been with” my husband so it’s not as if I had anything at all to compare it to and now it seems ridiculous to consider something entirely normal as “exotic.”

However, as we talked here and there about our faith, future children, that sort of thing, circumcision came up a lot. At that time in my life, I truly believed that our son(s) needed to be circumcised. That not doing it to him would be a sin. For me. Not for my son, but for me and for my husband.

I am explaining this to demonstrate the backward and completely blinded point of view I had at that time. When I conceived my first child, I still felt that circumcision was just something I had to do. Thankfully, she came out without a penis! I deeply cared about my child and had she been a boy, I would have had her circumcised believing I was doing the very best thing for her physically and spiritually. I wasn’t any less of a loving person then. I haven’t become more intelligent over the last six years, either.

That said, I was definitely thinking backward. See, I would never have dreamed of asking my husband to be circumcised. If asked, I would have explained that it was his body, not mine, and that the decision to cut himself was between him and God alone.

Are you catching the discrepancy here? It wasn’t okay for me to ask a grown man to circumcise himself, but it was entirely okay for me to make that decision for my defenseless baby?!

Then, one day, when my oldest was about a year old, I become involved (to my embarrassment, now) in a flame-war going on in a wonderful little Yahoo-group that revolved around birthing. As I’m sure you can imagine, people can be vicious at times and don’t really pull any punches when they are advocating their choices for their children. This little war was epic... Someone had posted an informative link regarding circumcision awareness and someone else had immediately retorted about being judged and it went off from there. I kept my mouth shut at that point as my personal opinion was that circumcision for any reason other than religious was stupid.

But then, the fateful words hit my inbox: “Mutilating your son in the name of your god is still wrong, regardless of your religion.” Ooh I was hot! So angry. It was like someone punched me in the stomach. How dare this woman comment on something so intimate and personal as another person’s religious beliefs! I’m afraid I wasn’t even really hearing her point. I was just pissed she presumed to know another person’s heart when making decisions like this. Looking back on it, she did not say anything cruel or intentionally insulting - she was just speaking truth. But it was ON in that moment. I wrote a lengthy, heartfelt, passionate response. She returned it with one of her own. She made me look like a complete idiot without even trying because she had all this “information” about what was done and its life-long implications and I realized I had no idea what I was talking about! So I set about researching her claims, intent on digging up the opposite research to shut her up.

Only, that isn't what happened. I had been told growing up that the intactivist movement was “the Enemy’s” attack on God’s people. That it was anti-Semitic, etc. And I was convinced that I could prove her wrong by going to science. After all, wasn’t it true that being circumcised was healthier? I mean, obviously she was just bigoted or misled…right? RIGHT?

Nope.

In fact, every click I made drew me further and further into an education I didn’t even know I needed.

I learned, for the first time in my life, what a foreskin really was and how it compared to female anatomy. I also learned about other forms of ritual genital mutilation (FGM) that are not socially acceptable, but defended with the exact same arguments that I was using!

I watched circumcision videos (not for the faint of heart, let me tell you! I cried…a lot). I read medical websites devoted both to defending the practice and ousting it as an outdated, unnecessary, and yes, harmful procedure. I learned things I never dreamed could be true, including that just as many baby boys die during the neonatal period of their lives from being circumcised as those who die from SIDS. That interesting fact spurned me to learn even more, and by the end, I was a changed person. I was humbled and I had some serious thinking and soul-searching to do.

I, like so many others, looked for ways around the religious “need” without actually denouncing circumcision. I researched “gentler” ways to remove the foreskin from the son I hoped for, even going so far as to consider doing it myself so that it was done “Biblically” and with the least amount of harm possible!

It was then, when considering doing it myself, that I realized that I had lost my friggin’ mind! I mean, I’m sitting there, considering cutting a piece of my son off myself in order to protect him from harm!? What was wrong with me?

I came to the conclusion that there was something seriously flawed with my thinking. My husband, of course, had been going through his own thoughts and research, and being intact himself, came to the same conclusions. It was a relief, in a way, but posed other issues for us. Concerns about “sin” and about rejection from my family (who still see this as something sacred and necessary). I’ll come back to my thoughts on that at a later time.

I’m happy, and even proud, to say that I now have a 13 month old baby boy who is happily and blissfully ignorant of what he’s been spared. His body was left intact, as it was designed, and functions normally. It may be that someday he’ll grow up and, for his own reasons, decide to get circumcised. I admit that as his mother I hope he doesn’t: I think he’s perfectly created just the way he is and it would be a real shame to mutilate a part of his perfect little body. But it’s his decision ultimately, and that’s what matters. HIS choice. Not mine.

I share all of this because I want people to understand that I get it. I know how complicated and difficult this “choice” feels because I’ve been there. I’ve agonized over it, defended it, and seethed when anyone contradicted my perceptions of reality.

I really want to talk about this more - it’s a subject I’ve come to feel very passionate about. I want to help stop this horrible practice and enable other parents to wake up and see what it is that we are doing! I realize this topic may piss people off at Thoughtful Momma. For a long time I hesitated to write about it because I don’t really like intentionally offending people. Unfortunately, though, the truth is the truth. Sometimes hearing it angers people. That’s okay. If someone hadn’t offended me, my son’s little penis would be mutilated today, and I sincerely hope that I can share that gift of enlightenment with someone else.


Costello is a mother and gentle parenting advocate who has been blessed with three amazing children. She likes to think of herself as an instinctual mother. She's a home-birthing, child-led breastfeeding, cloth-diapering/ECing, baby-wearing mom who also formula fed her youngest son due to life throwing some curve-balls her way. Her greatest passion is empowering and supporting mothers in raising and protecting the precious lives they bring into this world. Read more from Costello at Thoughtful Momma.


Additional resources on Judaism and circumcision here.

Additional resources on Christianity and circumcision here.

Additional research (scholarly books, websites, articles) on the prepuce, intact care, and circumcision: Are You Fully Informed?


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Thursday, December 2, 2010

Foreskin: It's Not 'Icky'

By Audrey Bryk © 2010



One of the most shocking, upsetting, and frustrating things I deal with as an intactivist on a constant basis is the incredible number of expectant parents I encounter who are determined to have their sons circumcised because they think the foreskin must be "icky."

Now, as frustrating as this is, I must admit that I can empathize with the myth. A few years ago I was there too, and not surprisingly as I was a product of U.S. culture – a cutting society where the foreskin has been vilified in popular television shows, parenting circles, and locker rooms alike. Where intact men have been made, at times, to feel embarrassed about the natural state of their body. Where we consider a normal body part that every single mammal is born with to be some sort of defect.

When my first son was born, I honestly was not fully informed on the issue. And I'm not sure what I was expecting. I had never actually seen an intact penis in my entire life – not on a baby, not on a man. I guess I was expecting it to be gnarly, or to somehow look wrong. I expected there to be an obvious part of the penis that looked as if it did not belong - one which begged to be cut off.

The reality was that my baby was perfect just the way he was. Nothing looked out of place and I wasn’t grossed out. It was kind of shocking, actually. I hadn’t been educated on the foreskin and I didn’t realize that it would be tightly fused to the head of the penis in infancy. I was fortunate to learn from our foreskin-friendly pediatrician that I should just leave it alone and never try to retract it. This was a relief! When we said “NO” to the circumcision question I thought I might have a long road ahead of me having to retract and inspect and be some sort of detective to seek out any dreaded smegma. Instead, I learned I would never have to do any of that – just leave it alone you say? Wipe like a finger? AND I don’t have to deal with caring for a festering surgical wound on the most sensitive part of my baby’s body? WIN!

For those who've never seen the difference between a perfectly intact baby boy vs. a circumcised newborn, here is one example:


intact
vs.
circumcised



Later on, in my first son’s toddlerhood we moved to Europe, where I learned that routine infant circumcision is not performed outside the USA. I began talking to European mothers about the issue and found out they were literally shocked that Americans would do such a thing to their babies – just as shocked as we are that knives are needlessly taken to girls’ genitals in other countries. But what was more surprising than this was when the discussion would turn to the subject of circumcision status on adult males. Their eyes would get big and wide and they would say things like, “I have never even seen a circumcised penis! What does it look like? Is there a scar? What does it feel like?”

This got me thinking about how the appeal of such things really just comes down to one very simple factor: what we are accustomed to. Everything about the discussions are exactly the same no matter which side of the pond you’re on – the only difference being which state of the penis is being talked about.

A comparison that comes to mind is that we are accustomed to all other mammals remaining intact. Consider how people giggle or get silly when they see a dog's "red rocket" for example (an internal organ typically hidden by the foreskin)... Wouldn’t it be strange if it was always just hanging out there? Scarred and callused for the world to see? This is how I’ve come to think of the human body. It is so utterly strange to see tiny penis heads just hanging out there…exposed. Wounded.

At the time, with nothing to compare it to, I couldn’t really enlighten my European friends. But I looked into the subject a bit further and discovered that a study in New Zealand found that 9 out of 10 women who had experience with both intact and circumcised male partners prefer sex with an intact man. Reading this absolutely stunned me. Wasn’t it just a "useless flap of skin?" Apparently not. I learned that it provides a gliding motion and a rippling effect. It keeps things soft and supple. The head of the penis is meant to be internal – not exposed to the elements, not rubbing against fabric all day, every day for years as it calluses over (the circumcised penis builds up layer upon layer of skin thickness due to callusing in an effort to protect itself). The glans (head) becomes dry and the skin becomes thick, and it loses sensitivity and natural reflex. The result is that the circumcised man needs to work harder to feel something good, and has less control over how things happen. This is a simplified version of the mechanics of natural sex. For more information, please see Marilyn Milos’ video, Penis 101, here.

As I read about this, and began to talk to women who have had intact partners, my ideas about foreskin began to change. Foreskin wasn’t so icky anymore. It was becoming…alluring. There also grew a bad nagging feeling in the pit of my stomach. What are we doing to our boys? To our girls? I have heard the line so many times in online debates: “His wife will thank me someday.” I wouldn’t be so sure. I’m not thanking my mother-in-law! And I’ve begun to understand the sense of loss that the thousands of men who have gone through foreskin restoration must feel. There are millions of us who will never know what sex is supposed to feel like - the way it was designed perfectly to be.

If there is anything I would like today’s parents to know it is that the U.S. circumcision rate has dropped so low in recent years (32.5% in 2009) that by the time today's babies are sexually active, this will all be common knowledge. The functions of the foreskin are already making their way into American consciousness. By the time they are adults, boys who were circumcised at birth today will understand what they are missing. And so will their partners.




Read more from Bryk:

Why All the Circumcision Posts?

Boys

For additional resources on the prepuce (foreskin), circumcision, and intact care see: Are You Fully Informed?


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