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