Neonatal circumcision is no longer a routinely recommended procedure. That is the conclusion of the American Academy of Pediatrics in its first new statement on the issue in a decade.
How do we as Jews react to this report? We, who have been circumcising newborn males for some 4,000 years, may find it disconcerting to be told it is no longer encouraged. On the other hand, circumcision has historically been uncommon in most of the world; in fact, the United States is the only country in which it is routinely performed.
Circumcision has come in and out of favor with the pediatric establishment over the years. In the 1950s and ’60s, 90 percent of American newborn males were circumcised because of the presumption of medical benefit. In 1971 the AAP stated that “there was no valid medical indication for circumcision.” But then, based on a plethora of new data, in 1989 the AAP reversed itself by stating: “New evidence has suggested possible medical benefits” and the chairman of the task force further stated that the benefits far exceed the risks. He added that it may be considered a preventive health measure analogous to immunization. With the current statement, the AAP is reversing its approach to circumcision once more.
As a committed Jew who is trained in ritual circumcision, my first reaction was disappointment.
I am well acquainted with the medical literature detailing the myriad health benefits of neonatal circumcision. Numerous studies have shown that circumcision decreases the risk of urinary tract infections in the first year of life by up to 90 percent.
Cancer of the penis is a rare but serious condition that occurs in less than one per 100,000 males in the United States. However, in countries where circumcision is not routinely performed the rate is five to ten times higher.
Studies also indicate a four-fold higher risk of cervical cancer in women whose sex partner is uncircumcised. Finally, while the greatest risk factor for acquiring HIV infection, syphilis and other sexually transmitted diseases is unquestionably irresponsible behavior, studies have shown that circumcised men are at lower risk than uncircumcised men.
It would have been reassuring to be told that the benefits of neonatal circumcision are enough to recommend the procedure for all newborns. After all, if we were commanded by God to circumcise all males, it is not unreasonable to assume that there is some health benefit?
Brit milah is more than a surgical procedure known to the world as circumcision. This rite was given to Abraham as one of the first commandments in the Torah. It was part of the ritual required before the Exodus from Egypt and the receiving of the Torah. It was the first act performed by the Jews upon entering the Land of Israel under Joshua. It is a religious rite signifying the entry of the newborn into the Jewish fold. It has traditionally been an integral part of the conversion process.
For two very important reasons, knowledge of the medical benefits of circumcision plays little role as far as Jews are concerned, other than as an affirmation of Divine wisdom. Firstly, Jews never have performed circumcision as a medically indicated procedure, but rather as a Divine imperative.
Secondly, Jews have never advocated general circumcision for the non-Jewish public. In reality, the opposite has been true. Jewish tradition has viewed circumcision as a distinguishing feature of the Jewish people. It is a badge of pride worn by the Jew to separate him from the non-Jew.
Circumcision as a discriminator may have been a two-way street. Some historians believe that Paul’s success in making Christianity a world religion was achieved by abolishing the circumcision requirement of Judaism. Hellenized Jews of the Greek period, sought to assimilate into the majority culture by attempting to surgically reverse their circumcisions. Closer to our times, the Nazis treated circumcision as a defining mark of a Jew.
The AAP reviewed the benefits, but also noted the risks and pain of circumcision, which are recognized by Jewish law. Post-circumcision, the infant is considered sick and the Sabbath may be violated on his behalf. And while at happy occasions, the joyous blessing of Shehechiyanu is usually recited, many Jews do not recite this blessing at a brit because the joy is tempered by the knowledge that the infant has experienced pain. In the Jewish communal mind, however, the benefits of circumcision have since time immemorial been viewed as sufficient justification for the pain of the brit. Also, if the parents so desire, Jewish law does not proscribe the use of modern analgesics.
I was very conscious of the small risk and the certain pain involved in circumcision when a little over two years ago I personally circumcised my own son. I partially alleviated the pain with an application of a topical anesthetic. But the knowledge that there was no compelling medical reason to subject him to this procedure, and that I was doing what Jewish fathers had done for generations simply because God had so commanded, greatly enhanced the religious significance of the event.
While the AAP is not suggesting to ban this tradition, it can have an impact on the marginal Jew. If there is a downside to the AAP report, this is it. And this is not merely theoretical. This past week over lunch, a Jewish secretary at work asked if anyone had information she can use to convince her pregnant daughter to circumcise the expected son. Clearly, here is a young, Jewish, mother-to-be who is not moved by tradition to give her son a brit milah. But if the AAP were to strongly recommend it, she most likely would.
Thus, this report will result in fewer Jews being circumcised. That is probably the most significant effect of this report and it leaves me saddened.