Mother’s Day 2013

My mother passed away 11 months ago, so this is the first Mother’s Day I am spending without her in my life. I miss her so much.

Helen Chapin

Growing up, but especially during my younger adult years, I had my share of grievances against my mother. Over the years, I occasionally confronted her with some of my complaints. Some of her responses satisfied me, while others did not. Sometimes airing my complaints was healing, but in other cases I even got perverse pleasure from seeing that she felt badly about certain parenting decisions she’d made.

A few years ago, though, my grievances against my mother simply dissolved. She was starting to become ill, and – all of a sudden – I saw her not as a formidable figure, one who could give and withhold, one who could shape my happiness and unhappiness, but rather as a woman like me, a mother who made the best choices she could at the time she had to make them. From one day to the next, I realized, truly absorbed, that she loved me, and that she had done the very best she was able to do. I also found that by losing any anger and resentment I held toward my mother, and allowing myself to accept and simply love her, my own life became more peaceful and more purposeful.

Since I became involved in the movement to stop the genital cutting of baby boys, I have heard many maternal remorse and child anger stories.

Mothers have called into radio programs where I was a guest, sobbing from grief and regret about having allowed their baby to be circumcised; some of these have been the mothers of toddlers, but many are recounting stories from 15, 20 or even 40 years earlier. For every one of these mothers, there is a son – a boy or man living with the consequences of a decision he did not make, but that is imprinted on his body and in his brain forever. And I have talked to hundreds, maybe even thousands, of such sons.

Many men struggle to resolve their feelings about having been robbed as babies of their right to a complete body; some struggle with where to place the blame. Some blame the doctors; others take issue with society’s blind acceptance of the ritual, and know they were victims of a terrible tradition. The saddest thing for me, though, is men who continue to blame their mothers; this seems to happen especially if they have attempted to talk with their mothers about their feelings, and have been rejected or told that their anger and feelings of loss are overblown or unimportant or, somehow, illegitimate.

This kind of response is tragic for both parties. While my own sins as a mother do not include acquiescing to the genital cutting of my child, I have done many things I now see were foolish, and I have heard plenty of grievances from my son. I am trying, though, to give myself a break, because while I fully acknowledge his feelings, I know how much I have always loved him, and that I did the best I knew at the time.

I also believe that, with (thankfully) very few exceptions, we mothers love our children and try to do the best for them.

We live in a society that accepts as normal a strange and barbaric ritual promoted as health care, and carried out by authority figures who are promoted (and promote themselves) as healers.  We shouldn’t allow ourselves to lose sight of the power of custom and of authority, especially during those times (such as childbirth) when we are most vulnerable and most desirous of doing what’s right. With circumcision, both new mother and newborn baby are victims.

My Mother’s Day wish is that mothers apologize to their sons and forgive themselves, and that sons forgive their mothers. We can then all work together on fighting the custom and the real perpetrators of this awful legacy called circumcision.

Georganne Chapin

Tell America’s OBs: His Body, His Rights

I’m heading to New Orleans on May 4 to protest outside the annual conference of the American Congress of Obstetricians and Gynecologists (ACOG). As you may have read in Intact America’s last newsletter, we tried to rent a booth in the Exhibit Hall, but were rejected on the grounds that male circumcision is only “indirectly related to women’s health” and “…of only casual interest to members of ACOG.”

Indirectly related to women’s health?  What does that even mean?

Of only casual interest to ACOG members? Now, that would be funny, except for the fact that obstetricians (OBs) perform the majority of the million infant circumcisions that take place each year in the United States!  So why are they cutting babies?

Join our protest in New Orleans and tell OBs to
stop cutting baby boys!

For an OB, circumcision is business. A moderately busy Midwestern doctor can easily make an extra $36,000 in annual income, if he’s good at selling circumcisions to the families of the 200 baby boys he delivers (calculating a 90 percent circumcision rate, and a very conservative $200 per circumcision). If he delivers more babies, and charges more per surgery, the income escalates.

Add to the money the fact that, once you’ve started cutting babies, it’s really hard to stop. Denial sets in; fear of admitting that you might be doing something wrong takes over; you worry that if you say “no,” you might lose your client (the parent) to another doctor who’ll be happy to trim up her son’s genitals for a fee.

But there is absolutely no excuse for infant circumcision. It’s an outrage that ACOG not only refuses to allow intactivists to distribute educational materials and engage in conversations with its members at their convention, but actually disclaims any responsibility for perpetuating this violation of boys’ rights. And it’s time for America’s OBs—trained to operate on women’s reproductive organs—to stop selling a surgery that will permanently alter the bodies and future sexual experiences of their patients’ sons.

I hope you can join me in New Orleans as we carry the message that, just as a girl is entitled to autonomy and bodily integrity, when a boy is born, it’s HIS body, HIS rights. Obstetricians need to get out of the baby-cutting business. They need to keep their hands off baby boys’ genitals.

Georganne Chapin

Don’t Ask, Don’t Sell

Intactivists often argue about whether or not we should be calling for laws prohibiting infant circumcision, or whether we should pursue interim steps of “harm reduction” in the form of more detailed informed consent, which– in theory at least– would make some parents decide against circumcising their babies.

The merits of a legal ban are a topic for another day. But I argue that efforts spent developing better consent forms are efforts wasted. We know that doctors and nurses spend little time actually informing patients about the risks of circumcision, that patients almost never decide to forego a treatment because of what a consent form says, and that – most important – parental consent, no matter how “informed,” is not valid for a medically unnecessary procedure.

Think of it this way: If you take your daughter to a doctor, and tell that doctor you want your baby to look like you, and that you lost a finger in an accident many years ago, will the doctor say, “No problem – I’ll cut off her finger, so long as you’re willing to sign a consent form detailing the pain and risk of infection from the surgery”? Not likely; chances are better you’d be reported to Child Protective Services.  (Please, please don’t try telling me that cutting off one of your daughter’s fingers is way worse than cutting off the most sensitive part of your son’s penis.)

So, consent forms aren’t the way to go.

But here’s a form of “harm reduction” I can get behind. I’ll call it “don’t ask, don’t sell.”

I just listened to an interview on National Public Radio with Thomas Farley¹, New York City’s health commissioner. Farley was talking about his newest proposal that would require stores to keep cigarettes away from public view – not just in the current Plexiglass cases (which, in my opinion, do more to discourage theft than smoking), but out of sight altogether.

Here’s how it would work for circumcision: Doctors, nurses, midwives, and all other medical professionals and hospital staff would be prohibited from offering circumcision, or even bringing it up. If, as doctors often claim, it’s really the parents who push for the procedure, not mentioning it shouldn’t be a problem. Let the parents raise the topic first; then, and only then, would the doctor be permitted to discuss circumcision. And, of course, the doctor would be required to tell the parents the truth – that it’s not only unnecessary, but painful and risky to cut off a baby’s foreskin.

If this seems like a revolutionary concept, it’s because circumcisions are sold all the time.

A nurse walking down a hospital hallway, peeking into the rooms of new mothers and asking, “Will we be needing a circumcision here?” – that’s selling.

Handing a blank circumcision consent form to a pregnant woman during a prenatal care visit – that’s selling.

Including a circumcision form in the packet of papers a woman is asked to sign when she’s admitted to the hospital or (even worse) when she’s in labor or in a postpartum fog – that’s selling.

Countless mothers have told me they never gave circumcision a thought until their obstetrician brought it up. Countless parents, including Intact America’s founding donor, have told me they were pressured and solicited many, many times – first by obstetricians and later by hospital nurses – to circumcise their sons. Social media (blogs, the Facebook pages of Intact America and The Whole Network, Twitter) is replete with accounts from parents who were lied to; coerced into believing that circumcision is painless, quick and desirable; and harassed into fearing their son would hate them (and live a miserable existence) if they did not have him circumcised.

Without a doubt, these shameless, financially motivated  sales tactics – as opposed to some innate desire of parents to see their newborn sons surgically altered – are what drives the demand for circumcision in this country.

You don’t need to look too hard to find support for the “don’t ask, don’t sell” concept. Here’s what Opinion 2.19 of the Code of Ethics of the American Medical Association² says:

Physicians should not provide, prescribe, or seek compensation for medical services that they know are unnecessary.

Nobody, not even the AAP in last year’s scientifically and medically bankrupt Task Force Report on Infant Circumcision, dares to claim that routine infant circumcision is medically necessary.

Of course, “don’t ask, don’t sell” won’t wipe out circumcision overnight. Some parents will still ask doctors to surgically reduce their son’s penises. If that occurs, it’s a doctor’s duty to inform those parents that circumcision is not necessary; that it causes the baby pain and distress; that it interferes with breastfeeding and maternal-infant bonding; that it can cause infection and hemorrhage; and that a number of babies die each year as a result of having been circumcised.

But it’s a safe bet that many others won’t even think to bring it up, any more than they would ask the doctor to remove their daughters’ labia—or finger. And more and more boys will grow up intact, so that, just one generation later, the argument for looking like Dad can have a new, natural result!

Primum non nocere (“first, do no harm”) hasn’t gotten us very far in ending circumcision. So let’s try this:

Ne quaeras noli vendere. Don’t ask, don’t sell.

Georganne Chapin

 

1. http://m.npr.org/news/Health/175119412?start=90
2. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page
 

“I’ve Been Doing My Part to Stop Circumcision” – Anonymous

Here is a quote from an email forwarded to me last week from a man who—at the Massachusetts legislature MGM hearing in 2010—had given me both his email and snail mail address.

I received a donation envelope [from Intact America] at my home address today and it’s started a riot with my family. [Now], we’re not on speaking terms and the big Christmas get together … is not going to happen … How one stupid little envelope can cause so much embarrassment and shouting matches … is mind boggling!

… I’ve been doing my part to stop circumcision… But I’d like to stay anonymous because my family is ignorant.

For me, by far the greatest leap forward in 2012 has been the growing public face of intactivism—in particular, the willingness of men to declare publicly their circumcision status, and declare publicly the way they feel about that. In response to Intact America’s Men Speaking Out campaign, dozens of men submitted photos of themselves as they are today, holding photos of themselves as babies. In comments posted along with the photos, more than a few of these men remarked that they have fallen out with their parents or other family members, because they chose to give voice to their feelings of having been maimed as babies. See for yourself.

Most poignant for me, of course, were Intact America’s press conference and demonstration, held in October during the annual convention of the American Academy of Pediatrics in New Orleans. Shortly before the event, IA was informed that the AAP would not allow us into their exhibit hall, unleashing a chorus of men’s (and women’s) voices directed at doctor who refuse to acknowledge their complicity in American medicine’s biggest rip-off.

As a 60-year-old American woman, my intact genitals are pretty much taken for granted—this despite the fact that some of my contemporaries, victims of a medical system that into the 1970s occasionally gave the nod to clitorectomy-as-a-cure for masturbation or unacceptable emotionality, are not so fortunate.  Nonetheless, for me even to write this paragraph might cause others to think about my private body parts—a somewhat discomfiting thought, at best, for me. I can only imagine the courage it takes for a circumcised man to come out not just with the fact that he was genitally altered as a child, but that he still feels angry, humiliated, and grief-stricken as a result.

What I witnessed in 2012, however, was a transformation. Men who previously spoke of circumcision as an “issue”—something carried out by doctors or religious practitioners, a procedure done to babies or children, a cultural phenomenon, a medical practice, even a human rights violation—have now begun to speak their personal truths. Many of those statements bring tears to my eyes, no matter how many times I read them.

But not everybody is so emboldened, so liberated to speak out.

While I cannot presume to condemn a person who is afraid to speak publicly about something that has impacted him so intensely, I can ask this question: How is circumcision ever going to end, if we are afraid to talk about it, if we are afraid that, by speaking out against this horror inflicted on babies behind closed doors—and which then continues to haunt the men those babies become—people won’t like us, anymore? What is the value of peace among family or friends, if that peace is purchased with silence or hypocrisy on a matter of such importance? How are we to educate the ignorant, if we are intimidated into silence?

To be clear, I do not expect every person in the world to speak out against every single unjust cause. But no cause was ever won by people keeping silent!  In the case of circumcision, being embarrassed to come out, to speak out, only serves to empower those who cut or those who want to deny the damage.

My New Year’s wish is for everyone affected by genital mutilation—everybody who is suffering himself or herself, or who loves somebody who has suffered from being overpowered and genitally disfigured—to find the courage to speak out.

To this end, please consider making a donation to the Intact America end-of-year campaign. Your help will help us to create ongoing public opportunities for men and women who are willing and anxious to make their voices heard. That is the way we are going to overcome.

Georganne Chapin

Giving Thanks – 2012

His Body His Rights Button

With another Thanksgiving upon us, I have a long list of people and organizations that I want to thank. Here goes.

To Amy, Jennifer and Ted – your day to day support means more to me than you’ll ever know.

To Marilyn – my humble thanks for trusting me to carry on the work you and others began.

To the informal but dynamite Intact America steering committee, whose members contribute their expertise, opinions, criticism, labor and love to this movement – I am sure you know I use you all for brains and strength.

To the kick-ass intactivist community, growing in number, depth, insight and commitment – you know we’re winning, right?

To Intact America’s donors and action-takers – keep it up!

To Dean Pisani – on behalf of the boys and men you are helping, thank you for your generosity. And thank you for your trust in me.

To the American Academy of Pediatrics – thank you for issuing a report so blatantly self-interested and unethical as to reveal your true colors as a money-grubbing trade association that wants to ensure that its members continue to get paid for carrying out painful, risky surgery on children who do not need it and cannot consent.

To the New Orleans Police Department – thank you for the respect. discipline, and guidance you showed with regard to Intact America’s demonstration in front of the Ernest N. Morial Convention Center, during the AAP convention. Thank you for telling the AAP representatives who asked you to make us go away that we were within our rights to protest, and that we were not breaking any laws. And thank you for your interest in our message; we were so privileged to share it with you.

To members of the press whom I will NOT name here, but who have moved from the “skeptical” or even “hostile” column to the “hmm, maybe they’ve got a point column,” and now to the “intactivist sympathizer” if not the “flat out intactivist” column – thank you for being open-minded, and for listening.

To my immediate family – Pablo, Ernesto, Hank, Julia, Chip, Nick and Paul – and to my extended family and friends who have inspired, in one way or another, my passion for this all-important human rights issue.

Above all: To the men who are speaking out, claiming the stage to express their pain and outrage at having been violated as children – it takes a brave man to defy the cultural bias that, first, applies a sexist double standard to genital mutilation and, second, denies the legitimacy of boys’ and men’s protests. I am honored to be at your side.

Thank you all. Again, you know we are winning, right?

Georganne Chapin

“A Human Rights Violation on a Massive Scale”

I need your help.

Last week, the Huffington Post published “First, Do No Harm,” an article I wrote in response to the American Academy of Pediatrics’ recent endorsement of routine infant circumcision. I am so grateful for the supportive and heartfelt feedback I’ve received from so many.

Judging from the dozens of  comments posted publicly and sent to me privately, it seems that my statement calling circumcision a “human rights violation on a massive scale” was a consciousness-raising tipping point for both readers new to the issue, and those already familiar with it.

I want to ask all of you— if you haven’t already done so—to share your thoughts directly on the Huffington Post’s website, which reaches millions of readers. In addition to me wanting to know what’s on your mind, it’s really important for the media, Huffington Post in this case, to see firsthand the breadth of conviction and the diversity of support that exists for keeping baby boys intact. Of course, your positive comments also serve as important information and validation for casual readers who are newcomers to the intactivist cause.

After you’ve commented, I’m hoping you’ll show your support in another way: by donating to Intact America. On October 20, I will be flying to New Orleans with Intact America staff members Amy Callan and Joe Jensen to join other intactivists for the AAP’s annual conference.

We’re working on an Open Letter for the New Orleans Times Picayune, which costs beaucoup bucks, as well as educational handouts and fliers, banners, and much more.

We need your help to carry all of this off. Thanks to a matching pledge from a prominent intactivist, all gifts will be matched dollar for dollar, up to $10,000. This means your donation will have twice the impact. I know money is tight—but it is really critical that we have a strong presence in New Orleans.

Both the Intact America booth inside the Convention Center and the activities taking place outside promote the intactivist message in a whole new way, featuring the photos and stories of brave men who are speaking from their hearts about how circumcision has affected them. Here is the awesome, 10-foot banner that doctors will see when they walk by our booth. To those men who sent photos for this (ongoing) project: thank you, thank you, thank you!

This is why we have to be in New Orleans—to give voice to all the babies who are at risk of being cut, and to protect the bodies and rights of these babies and the men they will become.

Thank you so much.

Georganne Chapin

My Letter to the American Academy of Pediatrics

On August 29, Intact America launched an email campaign, inviting our followers to tell the American Academy of Pediatrics what they think about the new Circumcision Task Force’s Technical Report on Circumcision. The Report, which concedes that the purported health benefits of infant circumcision are not great enough to justify recommending it, and that the risks of circumcision have not been adequately documented, somehow concludes that the “benefits” outweigh the risks. The Report also states that the decision to circumcise baby boys, who cannot consent to have this unethical, medically unnecessary surgery performed on their bodies, should be left to the parents, and, that parents’ non-medical decision to have their child’s genitals unjustifiably altered should be abetted by having Medicaid and private insurance companies pay doctors to do the cutting.

Here’s my letter:

Dear AAP Leadership,

What were you thinking?

How can you approve a report that extols the benefits of removing the foreskin, a normal body part, without one single word devoted to the function of that body part, or why it’s there in the first place? How credible is such a report, which neglects to mention that the vast majority of the world’s men are intact (or as the report says, “uncircumcised”), and that these men do just fine?

What were you thinking when you deputized as co-author of the report a doctor who has openly boasted about circumcising his own son?  The American Medical Association’s code of ethics (AMA E8.19) states: “Physicians generally should not treat themselves or members of their immediate families” … “In particular, minor children will generally not feel free to refuse care from their parents.” In 2009, the AAP’s own Committee on Bioethics clearly stated that pediatricians who treat their own children “violate a fundamental professional obligation.”* How can we trust the neutrality or the ethics of a Task Force member who so flagrantly violated his own organization’s bioethical principles?

What were you thinking when you named a specialist in adult sexually transmitted diseases to chair a Task Force to examine infant circumcision? Babies and children don’t have sex, and thus they are not at risk of contracting an STD. It seems to me, by selecting this individual as chair, the Task Force already knew what it was looking to conclude.

Would it not have been relevant for the Task Force to mention the limitations of its recommendations? Specifically, even if circumcision were to confer some protection from HIV for adult heterosexual men, as claimed by the studies cited, it was found to confer none for women, or for men having sex with men, or for intravenous drug users. And, again, it confers no protection for babies and children. Furthermore, shouldn’t the Report have mentioned that if or when an adolescent or adult becomes at risk, there are other nonsurgical ways of avoiding sexually transmitted diseases? Shouldn’t the words “safe sex” or “condom” or “abstinence” have appeared at least once in the Report?

Given the Task Force’s unequivocal conclusion that the “health benefits of newborn male circumcision outweigh the risks,” are you not concerned by the Report’s utter failure to address the risks? Specifically, how do you justify the contradictions and doublespeak in the following statements?

The true incidence of complications after newborn circumcision is unknown, in part due to differing definitions of “complication” and differing standards for determining the timing of when a complication has occurred (i.e., early or late). Adding to the confusion is the comingling of “early” complications, such as bleeding or infection, with late complications such as adhesions and meatal stenosis…. (p. 772)

Based on the data reviewed, it is difficult, if not impossible, to adequately assess the total impact of complications, because the data are scant and inconsistent regarding the severity of complications. (p. 775)

The majority of severe or even catastrophic injuries [such as] glans or penile amputation, … methicillin-resistant Staphylococcus aureus infection, urethral cutaneous fistula, glans ischemia, and death are so infrequent as to be reported as case reports (and were therefore excluded from this literature review).  (p. 774)

Did you not notice any potential liability problems for the AAP and for pediatricians who circumcise that might arise as a result of the Report? For example, while discussing the Mogen clamp in its review of complications from particular circumcision techniques and tools, the Report says:

There were no specific studies of complications … because complications are rare; thus, one can only rely on available case reports of amputation. (p. 775)

No note is made of the fact that the manufacturer of the Mogen is bankrupt, due to lawsuits resulting from these “rare” complications and amputations, and that any doctor sued for an adverse outcome from a Mogen will be on his own (unless, of course, he can implicate the AAP for failing to inform him of the facts).  Also, the review of techniques and tools neglects to cross-reference a mention elsewhere of “devastating burns” that can occur when electrocautery is used in conjunction with the metal Gomco clamp. Sloppy, at best.

Did anybody think to ask why no data has ever been found in the developed world showing a correlation between circumcision and disease? Since when is sub-Saharan Africa, with high rates of poverty, illiteracy, and disease, the gold-standard comparison population for American pediatrics? Did anybody wonder how it can be that Europe, where very few men have been circumcised, has lower rates of STDs and HIV than the U.S. and better overall health status, along with lower per capita health expenditures?

Has the leadership of the AAP, knowing that a Task Force was preparing recommendations about infant circumcision, noticed that medical associations in European countries are increasingly calling for doctors to refuse to perform this surgery, on the basis that it is risky, medically unnecessary, and a violation of the child’s rights? How can you completely ignore the principles and actions of your learned colleagues in other countries?

Did anybody ask the Task Force to make sure its Report was consistent with other AAP policies, including the statement by the AAP’s own Committee on Bioethics on “Informed Consent, Parental Permission, and Assent in Pediatric Practice”? The policy, still in effect, states in part:

Proxy consent poses serious problems for pediatric health care providers. Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses… [The] pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent. (p. 315)

In placing the burden of deciding whether to circumcise their sons squarely on the shoulders of parents (who are not medical professionals), is the Task Force Report on Circumcision contradicting this statement on Informed Consent? By referencing religion and culture as valid elements in parental decision-making (p. 759), is the Report attempting to give doctors a free pass? Religion and culture (in the American context) generally lead to circumcisions, but human rights, medical ethics and the mandate to doctors to do no harm clearly lead to leaving a boy intact.

Most important, have you not noticed the growing outcry among parents, complaining that they were duped by doctors into agreeing to allow harmful surgery to be performed on their baby boys? Are you ignoring the growing body of complaints from adult men protesting that they were robbed of an important part of their sexual anatomy, without their consent?

Are any of these considerations not relevant to the pediatrician who would strap down a helpless, screaming baby and cut off part of his penis?

I look forward to your response.

Sincerely,

Georganne Chapin, MPhil, JD
Executive Director
Intact America

* Committee on Bioethics, Pediatrician-Family-Patient Relationship: Managing the Boundaries. Pediatrics 124(6), Dec. 1, 2009: 1685-88.