By Laurie Evans, M.A. Former Director of the New York Hudson Valley Center of the National Organization Circumcision Information Resource Centers
This article appeared with minor editing in Journal of Prenatal and Perinatal Psychology and Health, 17(1), Fall 2002, pp. 85-94. This article was previously housed at Jews Against Circumcision.
In countries where circumcision continues to be practiced, expectant parents are often unaware that they have a choice about the circumcision of their children. This is especially true for Jewish couples who are taught that circumcision is required by religious laws. The majority of parents are unaware of the harm of circumcision. Even if parents become educated about the procedure, they may find themselves in disagreement with each other and have difficulty resolving these differences. They need support and time to make this critical decision.
This paper explores why parents might not be educated about circumcision. It gives examples of how educators can provide accurate information and assistance through this confusing and emotional decision-making process.
STATUS OF CIRCUMCISION IN THE UNITED STATES
No national medical association recommends routine neonatal male circumcision, and the United Nations Declaration on the Rights of the Child includes the right to physical integrity. Eighty percent of men in the world are genitally intact, but sixty percent (1,100,000 annually) of newborn males in the United States are subjected to circumcision according to the Health Care Investment Analysts (HCIA, 1999).
During medical training, doctors and midwives receive scant and often inaccurate information about the anatomy and physiology of the foreskin, and they learn to do circumcisions. Many continue to perform this unnecessary cosmetic surgery despite the availability of current data documenting its harm. Most prenatal care providers also receive inadequate information during their training, so they are unable to inform parents about the benefits of allowing their sons to remain intact. Childbirth books, which minimize the dangers and disadvantages of circumcision, leave expectant parents confused, or even convinced that circumcision is desirable.
The situation does not improve after birth. Nurses and doctors may repeatedly solicit a mother during her hospital stay. A mother who has just given birth in the hospital is vulnerable, and not inclined to investigate the issue. Most parents believe in the expertise of the medical community, and expect doctors to make medical decisions for them, trusting these to be in the best interest of the child. These factors explain how easily new parents can 'sign off' on circumcision. After the surgery, parents may be deeply shocked and pained when they see their son's penile wound and realize just what they authorized. Jewish couples often take for granted that their son will be circumcised. Jews are taught that the bris is an essential life-cycle ceremony and the sign of the Covenant between God and Abraham. A bris is a religious ritual for Jewish boys, which must be done eight days after birth. It is held at the newborn's home or a synagogue. At the bris, a mohel, the Jewish religious circumciser, does the circumcision and recites prayers while family and friends watch. Some Jews opt to have their sons circumcised in the hospital without realizing this does not fulfill the religious requirement.
The Taboo Topic
The topic of circumcision brings discomfort to many people. Men do not want to reflect on the pain, trauma, and loss that were inflicted upon them. Women may not want to be reminded that they allowed it for their sons. Doctors and midwives find it uncomfortable to realize that they have caused harm to newborns. Nurses routinely prepare babies for their circumcisions, while inwardly they may question the procedure. Although human rights organizations have made tremendous strides in educational outreach for more than twenty years, cultural resistance in the press and medical associations, have kept many people still unaware of their efforts. Thus, uninformed couples rarely discuss the topic before marriage or pregnancy. This silence perpetuates misinformation and thwarts education, so the cycle continues. Even parents who are aware of the circumcision question before giving birth may have trouble obtaining enough information to make an informed decision. Non-religious Jews in the United States may opt for circumcision, erroneously assuming it to be preferable since it is performed routinely, and they are unaware that it is not a standard procedure in other countries.
Since circumcision has been such an integral part of Jewish religion and culture for millennia, the topic is rarely discussed. Yet, guests at a bris commonly manifest visible discomfort. Jokes are told. Women may stand apart from the area where the circumcision occurs. The mother may cry. Often the baby screams. Excuses are made: he is crying because he is being restrained. The emotions of these people are discounted or ignored, so the tradition continues.
MAKING A CHOICE AGAINST CIRCUMCISION
How is it decided that a newborn male will be left intact? For some parents, once they learn that the procedure causes their sons pain and harm, and that newborns do feel and remember pain, they opt against it. Parents might encounter an article that exposes the harm of the procedure, or see an educational display at a health or baby fair. If they are curious and open-minded, they may then explore the Internet. Expectant parents who see a video of a medical circumcision are often convinced to leave their sons intact. Some parents come from countries where circumcision is not performed, and, therefore, they will not allow it for their sons.
A knowledgeable childbirth educator, midwife, physician, friend, or relative may educate parents. Some medical professionals share with their patients that their own sons are intact or that they have stopped doing circumcisions, and they will not even make a referral to a circumciser. Jews who do not feel compelled to circumcise for religious reasons, and who understand the functional loss, may also opt against circumcision. And finally, couples whose relatives are supportive of their decision find it easier to opt against circumcision.
A Difficult Decision for Jewish Parents
Now that the topic of circumcision is being discussed more frequently in the press and childbirth classes, some expectant Jewish couples are suddenly faced with a dilemma. Once they learn that circumcision causes pain and lasting harm, they may be torn between observing the religious ritual and not wanting to inflict trauma on their son. Those who dare to broach the topic with other Jewish colleagues, friends, family, and medical professionals are often disappointed that their views are not shared. They may even be condemned for their concern over their child's welfare. Grandparents may threaten to sever relations. Some parents succumb to these pressures and later regret it. Jewish parents struggle with the following questions:
- Will my son still be considered Jewish?
- Will he feel different in a predominately Jewish neighborhood?
- Will he be allowed to have a bar mitzvah?
- Will a Jewish woman want to marry my son?
- How do I clean my young son's intact penis?
- What if his foreskin gets infected?
- Who can I turn to for answers to these questions?
Where To Go For Information
Many parents who are grappling with these issues are turning to the following organizations. These groups work to ensure the bodily integrity of all non-consenting minors worldwide. The National Organization of Circumcision Information Resource Centers (NOCIRC) has the most comprehensive and multidisciplinary information on the benefits of being intact and care of the intact penis. With over one hundred centers in fifteen counties it hosts biennial international symposia and publishes the proceedings. The organization can also refer parents to knowledgeable professionals for any medical, ethical, or legal question.
Doctors Opposing Circumcision, (DOC) educates medical professionals on the anatomy and physiology of intact genitalia. One of their goals is to have this information included in medical textbooks. DOC can suggest non-surgical alternatives when a circumcision is erroneously recommended for an older boy. (Fleiss, 2000). Nurses for the Rights of the Child is an organization of conscientious objector nurses who refuse to participate in the circumcision of babies. They educate nurses, parents, and doctors.
The International Coalition for Genital Integrity is a coalition of organizations, professionals, and activists working to protect males, females, and intersex children from unnecessary genital surgery.
Attorneys for the Rights of the Child (ARC), an international network of attorneys, encourages professionals in various fields, including medical ethics, psychology, and children's rights to incorporate genital integrity awareness into their work. In addition, they assist in legal cases when a baby is circumcised without the consent of the parents or when there is a complication or death due to a circumcision.
Jewish Associates of the Circumcision Resource Center and NOCIRC are also a source of information and support for Jewish parents. Expectant parents can learn about Jews in the United States and Israel who are not allowing their sons to be circumcised. Some of these parents belong to synagogues and their sons have bar mitzvahs. Educators are able to put expectant parents in touch with other Jewish couples who have left their sons intact. Some Jewish couples elect to have an alternative bris, a Bris Shalom (Covenant of Peace), a welcoming ceremony where prayers are recited and the circumcision is omitted. Instead of a mohel, a rabbi, relative, or friend of the family conducts the ceremony. Educators can supply a variety of texts for the ceremony. Educators share stories of Jewish couples that have encountered extreme disapproval from their parents. By responding with empathy, not anger, many have healed the rift. Grandparents may, once they see their grandchild, fall in love with him and never discuss the topic again.
WHEN PARTNERS REACH AN IMPASSE
A problem arises when the parent who insists on the circumcision is so adamant that he or she will not discuss the issue. The parent opposed to the circumcision often does not know how to get beyond this impasse. Fathers may be in denial about the harm that was done to them. Mothers, despite their instinct to protect their child, may be unwilling to exert their influence in a male-dominated ritual. If one spouse is not Jewish, he or she is often hesitant to challenge this Jewish custom. The decision causes them immense pain and conflict because they do not wish to hurt their spouse in the process of protecting their child. Unfortunately, at a time when the family needs to be close and in harmony to welcome their newborn, parents may find themselves in agonizing disagreement. The parent opposed to the circumcision worries:
- How will this affect my relationship with my partner?
- Will I ever be able to forgive myself if I allow my son to be circumcised?
- How can I ensure that my son will be left intact?
My own personal experience led me to become a director of a regional NOCIRC center so that I could assist other Jewish parents who find themselves in this dilemma. When a parent who wishes to protect his or her child from circumcision calls for support, we discuss their specific situation.
Then, if it is the mother who is opposed and the father who is circumcised, I suggest she say to him, "I wish I could have been an advocate for you when your parents were making their decision." This should be discussed when there are no time constraints and only if she is willing to be very empathetic. For many men, this leads them to reflect, for the first time, on their own circumcision.
Another important question to ask the parent is, "What are you afraid will happen if you leave your son intact?" If the parent who opposes the circumcision feels discouraged, I ask him or her to imagine, "If you were the unborn boy, what would you want your parent to do to protect you?"
When there seems to be no possible resolution, some parents consider giving up. At this point, I share stories of parents who deeply regret relinquishing their input. One woman told me that only after the circumcision did her husband admit he had been waiting for someone to stop him. Unfortunately, in our culture it is rare that someone will intervene to stop a circumcision, especially if the parent is Jewish. Therefore, each person has to take responsibility for the consequences of his or her decision.
I also share the thoughts of others who have been through the process:
- What if the opposing parent changes his or her mind?
- Do not do what you cannot undo.
- First, do no harm.
- Do unto others, as you would have others do unto you.
- If Jewish women are considered Jewish without having been circumcised, why must it be different for Jewish men?
Ideally, the spouse who wanted the circumcision will understand the harm, and agree not to allow it. Sometimes, the parent in favor of the circumcision, has a change of heart after the birth of the baby. If the parents remain in disagreement, it is in the best interest of the child to postpone the bris. A delay may ensure that the boy will be left intact. During this time, the parent who desires the circumcision may change his or her mind and be grateful the baby was not cut. Once done, it cannot be reversed. Sometimes the disagreement is resolved in favor of circumcision. In this situation, the resistant parent feels remorse for failing to protect the child, and may harbor resentment towards his or her spouse. Of course, if the baby is left intact, the parent in favor of circumcision also may harbor resentment.
Sometimes the mother is so opposed to the circumcision that she decides to be with her son twenty-four hours a day to ensure that no one will circumcise the baby without her consent. She has decided to stand by her instinct to protect her child, even if this places a strain on the marital relationship.
When a mother unwillingly consents to have her son circumcised, she experiences tremendous inner turmoil. If she opts not to allow her son to be circumcised, she may encounter disapproval or rejection by her spouse or close friends and relatives. It seems unjust that a religious requirement should place the family in such a dilemma.
SHATTERING THE SILENCE
When Jewish women learn about my work, they often confide in me and share stories they have never told anyone else. One woman told me that, at her son's bris twenty-five years before, as she stood weeping outside the room where her son was being circumcised, a female relative remarked, "Get a grip. We've all been through this." A mother with a five-year-old son told me her son's circumcision was so botched; that a pediatric urologist recommended reconstructive surgery. She refused, not wanting to cause him further trauma. She wanted to sue, but did not know whom to ask to represent her.
Yet another mother told me she was not given the information for care of the wound until after the bris. No mention was made of it during her conversation with the mohel when the time and place of the bris was arranged. In addition, none of the friends she had asked to recommend a mohel mentioned post-circumcision care. She was shocked when she saw her son's raw penis, and felt deep remorse that he was circumcised. Unfortunately, this mother, like many Americans, was not taught that the foreskin is attached to the glans at birth and its amputation is similar to removing a fingernail from its nail bed. Many erroneously think a circumcision is like having an ear pierced. Some mothers tell me of their son's extensive bleeding. Others say they will never forget their baby's screams.
When I am exhibiting at booths, Jewish parents stop by and share their stories. For many, it is the first time they have been heard and understood. Some reveal their own pain about their son's circumcision. Others share that their sons are intact.
Impact on the Individual, Marriage, and Family
As parents begin to explore this issue, long buried feelings may surface. Couples are faced with conflict resolution. Some parents emerge stronger having been able to assert themselves. Others may feel disempowered, guilty, ashamed, resentful, or angry. From a psychological perspective, questions emerge:
- How does this tension impact the marriage?
- What affect does it have on the father's relationship to the child?
- How is the mother's relationship with the son affected?
- How does it alter the life of the boy and the man he will become?
- How will it affect the future relationships he has with women?
One of the first books to explore the generally unrecognized psychological and social consequences of the procedure is Circumcision: The Hidden Trauma by Ronald Goldman (1997). More parents will be helped when counselors recognize the necessity for followup support. There is also a need to acknowledge and examine the impact on the maternal infant bond as well as male and female relationships and sexuality.CHANGING TRADITION FROM BRIS MILAH TO BRIS SHALOM
As the discussion of circumcision becomes commonplace, and more Jewish parents are open about their decision not to circumcise, Jews will become aware of their choices before they are married. The opportunity for unhurried communication diminishes potential marital conflicts, and hopefully ensures that more Jewish boys will be left intact.
When parents choose not to have their child circumcised, they are being courageous in challenging a rarely questioned ritual. Those who opt for an alternative bris are creating a new tradition; one that affirms that our religion is manifested in our hearts and souls and not in the genitals of our newborn sons.
Suppressing the anguish and pain of both the parents and the circumcised infant negatively impacts family relationships. By creating a beautiful welcoming ceremony, that unites the family and focuses on the well being of newborns; the couple's relationship will be enhanced instead of strained. Since the family is so important for the passing on of Jewish traditions and values to future generations, rituals should help to maintain family closeness; the alternative bris, Bris Shalom, does just this. Although some people fear this change, parents who have chosen this option feel joyful that they are at the forefront of a cultural shift, which acknowledges the bodily integrity of our precious newborns.
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