National Journal, Washington,
Saturday, 29 June 2002.

Lobbying & Law

Activists Fight Circumcision

For years, opponents of male circumcision were laughed at as quacks by some, viewed as troublemakers by the medical establishment, and scorned as anti-Semitic by others. But following a string of small victories, anticircumcision activists are becoming difficult to dismiss.

Earlier this month, for example, Arizona quietly eliminated Medicaid funding for the procedure, which removes the foreskin from the penis. Poor Arizonans who want their child circumcised will now have to pay for it. Lawn Griffiths wrote in his column for Arizona's East Valley Tribune that the move means "as many as 12,600 more Arizona newborns per year likely won't suffer genital mutilation."

Arizona is the seventh state to bar Medicaid funding for the procedure, joining California, Mississippi, Nevada, North Dakota, Oregon, and Washington. Missouri is considering following suit as a budget-cutting move. In the midst of a fiscal crisis, North Carolina ended Medicaid funding for circumcision last November only to reinstate it after Democratic Gov. Mike Easley raised concerns. In a letter to constituents, Easley explained: "People should not be indelibly branded as economically disadvantaged because their parents could not afford this simple procedure."

Anti-circumcision activists such as Marilyn Milos, director of the National Organization of Circumcision Information Resource Centers, believe the procedure violates the human rights of boys. She insists that circumcision is painful and prone to mishaps. Milos and her fellow activists go so far as to argue that circumcised boys are far more likely to suffer post-traumatic stress disorder, the same illness observed in war veterans.

Since starting her organization, Milos has seen it grow to 102 regional affiliates in the United States and to 18 affiliates abroad. She says that 10,000 people subscribe to her newsletter, and that she receives 400 e-mails a day.

Other anti-circumcision groups include Attorneys for the Rights of the Child; the International Coalition for Genital Integrity; Doctors Opposing Circumcision; and the National Organization to Halt the Abuse and Routine Mutilation of Males. One group -- Nurses for the Rights of the Child -- was started in 1995 by a group of nurses at St. Vincent Hospital in Santa Fe, NM, who have refused to assist with circumcisions.

Meanwhile, an entire cottage industry is offering to restore circumcised foreskin., for example, offers to customers a narrow metal tube with a bulbous opening on one end that the Web site claims will "naturally restore your foreskin." Cut/ says that its guidebook and silicone rings will do the trick. Men interested in foreskin restoration can even join a support group, the National Organization of Restoring Men.

Circumcision is a sacred ritual in the Jewish and Islamic faiths. It became popular in the United States in the late 19th century when physicians touted it as beneficial for good health. Thirty years ago, 85 percent of American males were circumcised.

Since then, the medical literature has grown iffier, and no major U.S. medical association today recommends circumcision. In 1999, the American Academy of Pediatrics adopted a policy that states: "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision." Changing attitudes and the immigration of many non-Europeans--who don't traditionally perform circumcisions--has reduced the percentage of circumcision in this country to about 55 percent.

But circumcision still has medical advocates. Dr. Thomas Wiswell, a professor at the State University of New York (Stony Brook), points to studies showing that circumcised males face slightly lower risks of penile cancer and have fewer instances of urinary tract infections. He also argues, more controversially, that uncircumcised males are more likely to contract sexually transmitted diseases.

Dr. Edgar J. Schoen, the longtime chief of pediatrics at Kaiser Permanente in Oakland, touts on his Web site,, the "lifetime of medical benefits" provided by circumcision. "I think these state governments should look at the long-term consequences" of cutting Medicaid funding, says Wiswell. "The ultimate health costs will be greater than the costs of circumcising every boy."

Milos and other anti-circumcision activists support a complete ban on the procedure except for consenting adults. But in 1999, they launched the Medicaid Project in an attempt to achieve some incremental gains. Activists called every state Medicaid office to find out whether the state reimbursed doctors for performing circumcision, how much each state paid, and the number of yearly procedures done in the state. They found that circumcision rates were greater in states with higher reimbursement rates.

In April 2001, shortly after the report was completed, activists came to Washington to present it to members of Congress. The activists have named the first week of April "Genital Integrity Week," and they gather annually in Washington for congressional lobbying, symposia, and a march on the Capitol.

But the activists admit that the effort has yet to make any headway in Washington. "Our job is education," Milos says. "We're trying to sell a normal human body part to a sexually repressed, foreskin-phobic society. It isn't easy."