Elective surgeries under coronavirus and children’s bodily integrity
This interview is part of a feature series exploring how the Covid-19 pandemic and the measures to prevent its spread are impacting the human rights of under-18s.
* * * * *
[23 April 2020] In the United States (US), federal medical bodies and figures have recommended that elective, non-essential surgeries be suspended in order to prioritise the use of healthcare facilities and equipment for treating patients with Covid-19.
The most common elective surgery performed on children in the US is routine neonatal circumcision, which is increasingly recognised as a procedure that is performed for non-medical reasons, without the consent of the individual undergoing the surgery, and therefore is a violation of children’s right to bodily integrity. To learn more about the current situation, CRIN spoke with Marilyn Fayre Milos, a registered nurse in the US and Executive Director of Genital Autonomy - America, an educational and advocacy organisation that promotes the bodily integrity and genital autonomy rights of all children to keep their bodies intact.
With healthcare systems around the world adapting to respond to the Covid-19 pandemic, what measures have been issued in the United States (US) which are relevant to your work?
Although there have been recommendations by the US Surgeon General and the American College of Obstetricians and Gynecologists (ACOG) to suspend elective surgeries, doctors and hospitals in the country have ignored these warnings and continue to circumcise baby boys. We have written to local authorities but have so far received no reply. We work closely with Intact America to gather signatures for its change.org petition to the US Surgeon General, Dr Jerome Adams, to call upon doctors and hospitals to stop conducting elective, non-essential surgeries on infants and children during the pandemic, in order to conserve personal protective equipment and other resources needed to care for patients suffering from Covid-19 and to protect babies from the coronavirus and other infections.
What sort of operations are classed as elective and why? And should they all be considered the same? For example, at least six US states are treating abortion as ‘non-essential’ surgery, contrary to advice by the American College of Surgeons.
The response to the Covid-19 recommendations seem to be left to those interpreting them, but all elective surgeries should be cancelled, including non-therapeutic circumcision. Elective surgeries are basically those planned in advance and scheduled for a later date because there is no medical urgency or emergency situation. And in the case of routine circumcision, there is no medical justification to remove a baby boy’s foreskin. The same goes for surgically altering the genitalia of intersex children. For many, abortion is not an elective surgery, but a matter of life and death for the health and psychological wellbeing of the woman who has been impregnated.
The most common elective surgery performed on infants in the US is routine neonatal circumcision, but the American College of Surgeons hasn’t explicitly included it under its list of surgeries that can be postponed during the Covid-19 pandemic. Meanwhile the American Academy of Pediatrics recently said that healthy newborn boys should be circumcised if parents request it. Why do you think there’s this exception for circumcision even during a pandemic?
Whether circumcisions are done for personal, cultural, medical (assumed and promoted), religious or financial reasons and are accepted as part of cultural rites or rituals, people are attached to it and reluctant to accept it is nothing more than their own belief system, rather than considering whether it is in the best interest of the child. That’s the problem when something like circumcision has been acculturated - people disregard the fact that the children do not consent and are psychologically and physically harmed by the surgery.
Furthermore, what man wants to learn he was strapped down by four-point restraints and, with or without an anesthetic, had the functioning and most sensitive part of his penis cut off when he was too little to consent, resist or escape? What mother wants to learn her precious baby suffered from a painful, unnecessary surgery? And, what doctor wants to admit he has blood on his hands? Fortunately, more and more courageous men are willing to face the harm they suffered, speak out and protect their sons. One man wrote: "What was so difficult in leaving my son intact was not that he would be different in the locker room, but that I would be different from him. Then, I would have to accept the fact that I am an amputee from the wars of a past generation."
Mothers of circumcised children, too, are speaking out. I started my work in 1979 after I witnessed the horror of circumcision and realised my doctor had lied to me years before, saying that "circumcision doesn't hurt, it only takes a minute, and will protect your son throughout life." Then, 21 years after the birth of my first son, when, as a nursing student, I watched a doctor circumcising a baby who screamed for 15 minutes during the painful mutilation, I began to cry. The doctor looked at me and said: "There is no medical reason for doing this." That was the moment I realised my doctor had lied! That was the moment that sparked the anti-circumcision/genital autonomy movement. That was 41 years ago. And I have worked to end circumcision every day since then. I live my life as an apology to my sons and with the hope that my story will keep other mothers from having their sons circumcised and their babies from suffering.
With circumcision being acculturated in the US, do you think this is a reason why leading US medical bodies support it or fail to challenge it - because the doctors themselves don't see it as a problem or ignore its consequences?
Medical organisations are membership organisations and supported by membership fees. Their members still consist mostly of circumcised doctors since the majority were born into a circumcising culture. Each one has a personal, cultural, religious, medical (assumed and promoted) or financial attachment to circumcision, and the membership organisation is protecting those members and itself. It would be easy and probably not wrong to say that they ‘follow the money trail’, but acculturation, for whatever reason, is deeper than that. And yes, those men who do not have the courage to face their own primal wound and the trauma inflicted upon them, do not see the problem or the harmful consequences to the body and psyche of circumcision's victims.
And again, what doctor or what medical organisation wants to admit they have blood on their hands? You understand the harm done by genital cutting therefore you understand the number of injuries that can be attributed to those who wield the scalpel. The guilt when that is realised may very well be too much to admit or bear.
As an advocate of children’s bodily integrity, you’ve campaigned for decades against surgeries on children’s genitals performed for no medical reason and without consent from the child in question. What are the main arguments against these operations, and have you seen any signs of positive change in the US?
When I began my work in 1979, the circumcision rate was 85-95% in the US. Today it is a little more than 50%. That's in 41 years. I've had to learn that social change takes time, but we are moving closer to critical mass, when circumcision rates should fall at a faster rate. I'm hopeful!
The message needs to get across to more and more people: circumcision hurts a baby even if/when analgesia is used; it leaves physical scars, including the scar on the remnant foreskin and hunks and slices missing from the glans (head of the penis); it can cause curvature and even loss of the penis. It also undermines the baby’s first developmental task of establishing trust, including by interfering with the maternal/infant bond.
Let’s not forget the foreskin exists for a reason. It protects the urinary meatus (the opening of the urethra) and sensitive glans, provides necessary tissue for a full and comfortable erection, provides the majority of erogenous, sensitised nerve endings in the penis, and allows for normal sexual functioning.
From a rights perspective, non-therapeutic circumcision is also a violation of children’s human rights as defined by human rights legislation. Multiple court rulings around the world have recognised that circumcision causes pain and harms a baby; is irreversible; denies a male's inalienable right to his own body (security of person); when performed for religious reasons it denies a boy his independent freedom of religion; and that a child’s right to physical integrity and self-determination trump any personal, cultural or religious preferences of the parents.
No excuse is good enough to excuse non-therapeutic circumcision of non-consenting minors!
A moratorium on elective surgeries that potentially includes non-therapeutic genital surgeries is arguably a silver lining in the Covid-19 pandemic. How do you see it?
Hopefully, when babies are protected from circumcision during this pandemic, parents will come to recognise their babies are born perfect and they'll want to keep them that way. Surely, some fathers who are themselves circumcised will be threatened by not being able to circumcise their sons because it will make them face their own loss. But hopefully by then they will have fallen in love with their sons and want to protect them from the pain of circumcision. Not all will, but we'll be closer to ending the practice.
Once the pandemic is more under control and healthcare starts returning back to normal, what do you hope will change regarding non-therapeutic genital surgeries on children?
My greatest hope is that doctors will get over their compulsion to circumcise, put their scalpels down, educate themselves (many are circumcised themselves and don't know what they're missing or haven’t faced their own pain and trauma), and begin telling parents the truth about the physical and psychological harm of genital cutting.
Here we are talking about baby boys, but all children ─ males, females and intersex ─ need and deserve our protection. The American psychiatrist Karl Menniniger said: "What we do to children, they will do to society." This is crucial because genital cutting affects everyone, and ending these rites will serve us all!
Beyond this interview, are there any resources you’d like to recommend to our readers?
Genital Autonomy - America has a resources page with plenty of materials. I think Brendon Marotta's award-winning 2017 documentary, American Circumcision, is well worth watching! It illustrates what we do and what we've accomplished in the years since the movement began. Unfortunately, on some platforms they've blurred the scenes that should be seen by parents considering cutting off part of their baby's genitals.
Brendon has done a great job and is still working on the issue. He has also taken issue with PEPFAR (President's Emergency Plan For AIDS Relief), which has given millions of dollars for circumcision of boys in Africa.