References

Alkhenizan A, Elabd K. Non-therapeutic infant male circumcision. Evidence, ethics, and international law perspectives. Saudi Med J. 2016; 37:(9)941-947 https://doi.org/10.15537%2Fsmj.2016.9.14519

Altunkol A, Abat D, Topuz AN, Alma E, Gurbuz ZG, Verit A. Muslim mothers mainly saw circumcision in terms of religion or tradition but wanted it to be carried out medical professionals. Acta Paediatrica. 2020; 109:(2)396-403 https://doi.org/10.1111/apa.15105

Anwer AW, Samad L, Iftikhar S, Baig-Ansari N. Reported male circumcision practices in a Muslim-majority setting. BioMed Research International. 2017; https://doi.org/10.1155/2017/4957348

Awori QD, Lee RK, Li PS Use of the ShangRing circumcision device in boys below 18 years old in Kenya: results from a pilot study. Journal of the International AIDS Society. 2017; 20:(1) https://doi.org/10.7448%2FIAS.20.1.21588

Bawadi H, Al-Hamdan Z, Ahmad MM. Needs of migrant Arab Muslim childbearing women in the United Kingdom. Journal of Transcultural Nursing. 2020; 31:(6)591-597 https://doi.org/10.1177/1043659620921219

BBC News. Manchester baby boy ‘bled to death after circumcision’. 2012. http://www.bbc.co.uk/news/uk-england-manchester-20503660 (accessed 4 March 2022)

Bhopal R, Madhok R, Hameed A. Religious circumcision on the NHS: opinions of Pakistani people in Middlesbrough, England. JECH. 1998; 52:(11)758-759

British Association of Paediatric Surgeons. Religious circumcision of male children, standards of care. 2016. https://www.baps.org.uk/resources/religious-circumcision/ (accessed 4 March 2022)

British Medical Association. Non-therapeutic male circumcision (NTMC) of children-practical guidance for doctors. 2019. https://www.bma.org.uk/advice-and-support/ethics/children-and-young-people/non-therapeutic-male-circumcision-toolkit (accessed 4 March 2022)

Care Quality Commission. Additional guidance and prompts: non-therapeutic circumcision. 2019. https://www.cqc.org.uk/sites/default/files/20190325%20Additional%20guidance%20and%20prompts_non-therapeutic%20male%20circumcision.pdf (accessed 4 March 2022)

Colon-Sanchez K, Middleton T, Ellsworth P. Experience and outcomes for PAs in a neonatal circumcision clinic. JAAPA. 2020; 33:(10)40-43 https://doi.org/10.1097/01.jaa.0000697252.63695.3f

Di Pietro ML, Teleman AA, Di Pietro ML, Poscia A, Gonzalez-Melado FJ, Panocchia N. Preventive newborn male circumcision: what is the child's best interest?. Cuadernos de Bioetica. 2017; 28:(94)303-316

Earp BD. The ethics of infant male circumcision. J Med Ethics. 2013; 39:(418) https://doi.org/10.1136/medethics-2013-101517

Evans M. Circumcision in boys and girls: why the double standard?. BMJ. 2011; 342 https://doi.org/10.1136/bmj.d978

Fox M, Thomson M, Warburton J. Non-therapeutic male genital cutting and harm: law, policy and evidence from U.K. hospitals. Bioethics. 2019; 33:(4)467-474 https://doi.org/10.1111/bioe.12542

General Medical Council. 0-18 years: guidance for all doctors. 2020. https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/0-18-years (accessed 4 March 2022)

Genin B. Ritual circumcision: a society challenge. Revue Medicale Suisse. 2017; 13:(550)411-413

Gibbon K. It's more than just talking.London: Royal College of Midwives; 2010

Harbinson MJ. Helping parents achieve safer male infant circumcision. BJM. 2015; 23:(4) https://doi.org/10.12968/bjom.2015.23.4.245

Heras A, Vallejo V, Pineda MI, Jacobs AJ, Cohen L. Immediate complications of elective newborn circumcision. Hospital Pediatrics. 2018; 8:(10)615-619

International Confederation of Midwives. ICM Definitions. 2018. https://www.internationalmidwives.org/our-work/policy-and-practice/icm-definitions.html (accessed 4 March 2022)

Jimoh BM, Odunayo IS, Chinwe I, Akinfolarin OO, Oluwafemi A, Olusanmi EJ. Plastibell circumcision of 2,276 male infants: a multi-centre study. Pan African Med J. 2016; 23 https://doi.org/10.11604/pamj.2016.23.35.7841

Mielke RT. Counseling parents who are considering newborn male circumcision. J Midwifery Womens Health. 2013; 58:(6)671-682 https://doi.org/10.1111/jmwh.12130

Moosa S, Muhammad AA, Dogar S Implementation of an infant male circumcision programme, Pakistan. Bulletin of the World Health Organization. 2021; 99:(4)250-258 https://doi.org/10.2471%2FBLT.19.249656

Morgan AM, Hu YY, Benin A, Lockwood GM. Decision-making regarding newborn circumcision: a qualitative analysis. Maternal & Child Health Journal. 2021; 25:(12)1972-1980 https://doi.org/10.1007/s10995-021-03228-x

Morris BJ, Wamai RG, Henebeng EB Estimation of country-specific and global prevalence of male circumcision. Popul Health Metrics. 2016; 14:(4) https://doi.org/10.1186/s12963-016-0073-5

Morris BJ, Krieger JN, Klausner JD. CDC's male circumcision recommendations represent a key public health measure. Global Health Science & Practice. 2017; 5:(1)15-27 https://doi.org/10.9745%2FGHSP-D-16-00390

Myers A, Earp BD. What is the best age to circumcise? A medical and ethical analysis. Bioethics. 2020; 34:(7)645-663 https://doi.org/10.1111/bioe.12714

2011 census: aggregate data.London: Office for National Statistics; 2020

Omole F, Smith W, Carter-Wicker K. Newborn circumcision techniques. American Family Physician. 2020; 101:(11)680-685

Paranthaman K, Bagaria J, O'Moore E. The need for commissioning circumcision services for non-therapeutic indications in the NHS: lessons from an incident investigation in Oxford. J Public Health. 2011; 33:(2)280-283 https://doi.org/10.1093/pubmed/fdq053

Ploug T, Holm S. Informed consent and registry-based research-the case of the Danish circumcision registry. BMC Medical Ethics. 2017; 18:(1) https://doi.org/10.1186/s12910-017-0212-y

Royal College of Midwives. Stepping up to public health: A new maternity model for women and families, midwives and maternity support workers. 2017. https://www.rcm.org.uk/promoting/professional-practice/midwives-public-health/ (accessed 4 March 2022)

Rossi S, Buonocore G, Bellieni CV. Management of pain in newborn circumcision: a systematic review. European Journal of Pediatrics. 2021; 180:(1)13-20 https://doi.org/10.1007/s00431-020-03758-6

Sharara-Chami R, Lakissian Z, Charafeddine L, Milad N, El-Hout Y. Combination analgesia for neonatal circumcision: a randomized controlled trial. Pediatrics. 2017; 140:(6) https://doi.org/10.1542/peds.2017-1935

Van Howe RS, Frisch M, Adler PW, Svoboda JS. Circumcision registry promotes precise research and fosters informed parental decisions. BMC Medical Ethics. 2019; 20:(1) https://doi.org/10.1186/s12910-018-0337-7

Ventura F, Caputo F, Licata M, Bonsignore A, Ciliberti R. Male circumcision: ritual, science and responsibility. Annali Dell'Istituto Superiore di Sanita. 2020; 56:(3)351-358 https://doi.org/10.4415/ANN_20_03_13

Whittaker PJ, Gollins HJ, Roaf EJ. Implementation of a quality assurance process for non-therapeutic infant male circumcision providers in North West England. J Public Health. 2014; 36:(1)156-160 https://doi.org/10.1093/pubmed/fdt040

Zeitler M, Rayala B. Neonatal circumcision. Primary Care: Clinics in Office Practice. 2021; 48:(4)597-611 https://doi.org/10.1016/j.pop.2021.08.002

Helping midwives support families who require non-therapeutic infant male circumcision

02 April 2022
Volume 30 · Issue 4

Abstract

In the UK, the majority of non-therapeutic infant male circumcisions for religious or cultural reasons are performed by private providers in community settings. There have been reports of unsafe practices by some unregulated private providers. The implementation of a voluntary quality assurance process in one region in northwest England has been associated with a decrease in paediatric surgical admissions of infant boys admitted following complications of circumcision in the community. Voluntary quality assurance is a feasible option to implement quality improvement for services outside clinical governance systems. The quality assurance process provides a valuable resource for midwives to signpost families to safely practising providers, potentially reducing the risk of harm to children resulting from families using unqualified providers and safeguarding infant boys from harm becuase of poor practice.

Circumcision is the excision of the foreskin of the penis. Male circumcision is one of the most frequently performed surgical procedures across the world, with an estimated one-third of men being circumcised globally and approximately 10% in Europe (Morris et al, 2016). Although there is some evidence of therapeutic benefit (Alkhenizan and Elabd, 2016) and male circumcision is promoted by the World Health Organization (WHO) for HIV prevention in sub-Saharan Africa (Awori et al, 2017), it is predominantly performed in infanthood for non-therapeutic reasons within the Jewish and Muslim faiths (Morris et al, 2016). Globally, 97% of male circumcisions are performed for cultural or religious reasons (Genin, 2017). The reasons that different communities practice infant male circumcision has been described in the British Journal of Midwifery previously (Harbinson, 2015). The ethics of this practice are contentious and highly emotive and will not be addressed in detail here (Evans, 2011; Earp, 2013). Opponents of non-therapeutic male circumcision have argued that it should be deferred until the boy can make an independent decision (Di Pietro et al, 2017; Myers and Earp, 2020). However, parents may consider circumcision a necessary component of their son's religious upbringing (Ventura et al, 2020). Given that such deep-rooted religious traditions are unlikely to be swayed by ethical arguments or reports of harm, the authors believe there is a need to focus on ensuring that infant male circumcisions are performed as safely as possible (Anwer et al, 2017).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month