10 February 2015
Canadian Paediatric Society
2305 St. Laurent Blvd
Ottawa, ON K1G 4J8
Attn: Fetus and Newborn Committee
cc. Dr. Robert Moriartey, MD, Canadian Paediatric Society President
Dear Colleagues,
As we await the Canadian Paediatric Society’s expected policy statement on neonatal circumcision, we wish to inform you of an important recent development.
You are no doubt aware that in December 2014 the U.S. Centers for Disease Control (CDC) inexplicably decided that they needed to draft recommendations to inform expectant parents about the benefits and risks of newborn circumcision, as well as offering guidance to adolescent and adult males about the procedure. The draft was titled “Recommendations for Providers Counseling Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection, STIs, and other Health Outcomes”.
To its credit, the CDC opened the draft recommendations to public comment for a period of 45-days, terminating on 16 January 2015.
What you may not be aware of is the following:
- The CDC received approximately 2,840 comments. Among the comments received from individuals and organizations, 97% opposed the CDC recommendations. Only 2% of comments expressed support, and 1% could be considered neutral. The comments are logged here: http://cdc.intactivist.net
- Some of the more salient responses from ethicists, attorneys and human rights NGOs are found here: http://www.circinfo.org/Centers_for_Disease_Control.html
- The Children’s Health & Human Rights Partnership provided its comments, which we provide to you as an attachment to this letter and may also be found here:
http://www.regulations.gov/#!documentDetail;D=CDC-2014-0012-1138 - The CDC requested the highly-respected U.S. pediatrician Robert S. Van Howe, M.D. to provide a critique of the recommendations. Dr. Van Howe has now submitted his 208-page critique— containing 1,351 references—which can be reviewed here:
https://www.academia.edu/10553782
We presume that the CPS is still formulating its new statement on this matter and wanted to bring these matters to your attention in a timely manner.
In unity for the children,
Dr. Christopher L. Guest, MD, FRCPC Medical Director
Kira Antinuk, RN, BScN Nursing Director
Tim Hammond Outreach Director
David Saving Technical Director
Dr. Arif Bhimji, MD Advisory Board Member
Dr. Cameron Bowman, MD, FRCSC Advisory Board Member
Dr. Kaleb Montgomery, HBSc, DTCM Advisory Board Member
Jessica Forbes, RM Advisory Board Member
Kerstin Helén, RN, RM, BScN Advisory Board Member
Tony Chacon, RN, BSN, MN(c) Advisory Board Member
Geoffrey T. Falk, BSc, MA Advisory Board Member
Tracy Cassels, BA, MA, PhD(c) Advisory Board Member
Dr. Ali A. Rizvi, MD Advisory Board Member
Jennifer Pinch, RN, BScN, CD(DONA) Advisory Board Member
Attachment
PUBLIC COMMENTS PROVIDED BY
THE CHILDREN’S HEALTH & HUMAN RIGHTS PARTNERSHIP ON DRAFT RECOMMENDATIONS BY
THE U.S. CENTERS FOR DISEASE CONTROL REGARDING MALE CIRCUMCISION
The Children’s Health & Human Rights Partnership is Canada’s premiere not-for-profit group of health care professionals and scholars devoted to protecting the genital health and human rights of Canada’s male, female, and intersex children. We realize that CDC recommendations can influence some Canadians and are pleased to provide public comment on your draft recommendations concerning male circumcision.
In Canada, the practice of infant circumcision was once as widespread as it is now in the U.S. For the past several decades, however, none of our provinces or private health plans pay for infant circumcision, since there is no medical necessity to perform surgery on a newborn male’s healthy penis. That’s why hospital circumcision rates here are less than 10%, compared to the U.S. national average of around 50%.
Like parents in most of the world, we don’t view our newborn sons’ genitals as being somehow defective and in need of immediate surgical improvement. We trust in our parental abilities to teach our children proper hygienic behaviours as well as adoption of safer sex practices to protect themselves from sexually transmitted infections, all while still enjoying intact genitals.
That’s why the vast majority of our intact boys and men do not suffer the laundry list of maladies described in your draft recommendations.
We invite you to review the attached report from the International NGO Council on Violence against Children (2012), which states, “…non-consensual, non-therapeutic circumcision of boys, whatever the circumstances, constitutes a gross violation of their rights, including the right to physical integrity, to freedom of thought and religion and to protection from physical and mental violence” (p. 22). The report also notes, “The WHO review quoted three randomized controlled trials suggesting that circumcision reduces the risk of acquiring HIV infection in males. But this potential health benefit does not override a child’s right to give informed consent to the practice. The decision to undertake circumcision for these reasons can be deferred to a time where the risk is relevant and the child is old enough to choose and consent for himself” (p. 22).
Canadians are very much like Americans in many respects, except that Canada (like every other nation in the world except the U.S.) has ratified the U.N. Convention on the Rights of the Child. Article 24 of the Convention calls on signatory nations to protect their children from traditional practices prejudicial to their health and human rights. Infant circumcision exposes children to unnecessary risk and, by the CDC’s own admission, is a social custom and therefore a traditional practice covered in the Convention.
We call on the CDC to revise its recommendations that appear to condone the practice of infant circumcision and to include unequivocal language urging health professionals to reassure parents that the vast majority of intact men and boys do not suffer foreskin ailments and that in those rare occasions when a medical problem might arise during childhood, it can be conservatively treated medically, and only as a last resort surgically.
They can also offer reassurance that while parents are responsible for making a myriad of decisions on behalf of their child (vaccinations, nutrition, etc), circumcision is not one they need concern themselves with. Indeed, such an intimate personal decision is best left to each individual male to make when he is of an age to have his own reasons (if any), and to understand and give fully informed consent. To usurp such a decision is not within a parent’s responsibilities and is a violation of their child’s inherent human rights.