CIRP

Circumcision vs. Child Health, Breastfeeding and Maternal Bonding

This index page contains links to documents about circumcision versus breastfeeding, the effect of circumcision on mother-infant bonding and interaction, and information about breastfeeding's beneficial effect on reducing the risk of urinary tract infection (UTI) in infancy.

See also The Birth Scene, a site having an excellent discussion of circumcision in seven articles by leading writers.

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Circumcision's Adverse Impact on Breastfeeding Initiation

Medical authorities agree that there are no medical indications for circumcision in the newborn period. Male neonatal circumcision is a non-therapeutic operation, an unnecessary procedure that does not promote child health.

Authorities agree that male circumcision is a painful and distressing event for a baby. Infants have fully functioning pain sensors at birth,2 and the pain of the surgery is severe and longlasting.3

The AAP Policy Statement on Breastfeeding documents numerous significant benefits of breastfeeding for both mother and baby. Breastfeeding is encouraged.

It has been established in numerous studies that circumcision causes changes in infant brain function and behavior. Marshall el al. (1982)1 and Howard et al (1994)5 have studied the effect of the pain, stress, and trauma, of male neonatal circumcision upon subsequent feeding behavior. They each found that male circumcision disrupts feeding behavior. Sometimes the infant is returned to the mother in an exhausted and debilitated state in which he is unable to manage the task of latching-on and feeding.5

Breastfeeding provides many health and developmental benefits to the infant, so clearly breastfeeding failure should be avoided. Traumatic and stressful events in infancy interfere with breastfeeding success. The AAP Policy statement on breastfeeding states that traumatic procedures should be avoided lest they interfere with breastfeeding initiation. Taddio and colleagues report that male neonatal nontherapeutic circumcision causes an "infant analogue of posttraumatic stress disorder."6 Rhinehart has clearly and indisputably documented neonatal male circumcision as a traumatic procedure.7 Parents who intend to provide the benefits of breastfeeding should think carefully before subjecting their new baby to circumcision.

If parents decide to have their son circumcised despite prevailing medical opinion, La Leche League advised that circumcision should be deferred until after breastfeeding is well established.11 See the articles indexed below for more information:

Library Holdings

Medical literature

  1. Marshall RE, Stratton WC, Moore JA, and Boxerman SB. Circumcision: effects upon newborn behaviour. A controlled blind observational study. Pediatr Res 1979;12:334.
  2. Marshall RE, Stratton WC, Moore JA, et al. Circumcision I: effects upon newborn behavior. Infant Behavior and Development 1980;3:1-14.
  3. Marshall RE, Porter FL, Rogers A, et al. Circumcision II: effects upon mother-infant interaction. Early Human Development 1982;7:367-74.
  4. Anand, KJS and Hickey PR. Pain and its Effects on the Human Neonate and Fetus. New Engl J Med 1987;317:1321-29.
  5. Howard CR, Howard FM, and Weitzman ML. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediatrics 1994;93(4):641-6.
  6. Taddio, A., Koren G. et al. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet, Vol. 349: 599-603 (March 1, 1997).
  7. Rhinehart J. Neonatal circumcision reconsidered. Transactional Analysis Journal 1999; 29(3):215-22.
  8. Hill G. Avoidance of circumcision plus breastfeeding may produce lowest childhood morbidity and mortality. BMJ 2003; Rapid Response, 5 July.

Medical Society Policy Statement

The American Academy of Pediatrics now has recognized officially that circumcision interferes with feeding behavior.10 The AAP advises that painful or stressful procedures (such as circumcision) intefere with breastfeeding initation and should be avoided.9,11

  1. Work Group on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 1997;100(6):1035-39.
  2. Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics; Task Force on Pain in Infants, Children, and Adolescents, American Pain Society. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics 2001;108(3):793-7.
  3. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2005;115(2):496-506.

La Leche League International (LLLI)

  1. Elective Surgery for You or Baby. In: The Womanly Art of Breastfeeding, 3rd ed. (Franklin Park, IL: La Leche League International, 1981), 92-93. (ISBN 0-912500-10-7)
  2. [Breastfeeding Problems After Circumcision]. Leaven, September-October 1994:78. (Published by La Leche League International (LLLI) for the training of Leaders)
  3. Frank L. Circumcision and Breastfeeding. Leaven: La Leche League Journal For Leaders 2000:36,(5):94-95.
  4. Mohrbacher N, Stock J. The Breastfeeding Answer Book. Schaumburg: La Leche League International, 2003: pp.27,259.

Journal of Human Lactation, (Official Journal of the International Lactation Consultant Association)

Two mothers and lactation consultants report their observations about the effect of circumcision on breastfeeding initiation in letters to the Journal of Human Lactation.16,17 Hill advises that lactation consultants should tell mothers about the adverse effects of circumcision and that breastfeeding should be given priority over circumcision.18

  1. Lee N. Circumcision and Breastfeeding. [Letter] J Hum Lact 2000;16(4):295.
  2. Caplan L. Circumcision and breastfeeding: a response to Nikki Lee's letter. [Letter] J Hum Lact 2001;17(1):7.
  3. Hill G. Breastfeeding must be given priority over circumcision. J Hum Lact 2003;19(1):21.

Testimonial Letter

The problem of breastfeeding failure due to circumcision is more than theoretical. It is very real as this poignant testimonial letter substantiates:

  1. Beth Long. Testimonial Letter. March 1, 2000.

NOCIRC Position Statement

The National Organization of Circumcision Information Resource Centers has released a position statement on breastfeeding.

  1. Anonymous. The Effects of Circumcision on Breastfeeding. San Anselmo, CA, National Organization of Circumcision Information Resource Centers: 2002.

See also: Circumcision and Breastfeeding (link to www.circumstitions.com)

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Circumcision and Mother-Infant Bonding

Generally, the post circumcision infant, who is in pain, traumatized, and exhausted post-circumcision infant, may be less available for mother-child interaction for a period of several days to a week. The following indexed articles discuss the effect of the stress and trauma of circumcision on the infant and on mother-infant bonding:

  1. Emde RN, Harmon RJ et al. Stress and neonatal sleep. Psychosomatic Medicine, Vol 33, No. 6 (November-December 1971), Pages 491-497.
  2. Anders TF, Chalemian RJ. The effects of circumcision on sleep-wake states in human neonates. Psychosomatic Medicine, Vol. 36, No. 2 (March-April 1974), 174-179.
  3. Richards MPM, Bernal JF, Brackbill Y (1976). Early behavioral differences: gender or circumcision? Developmental Psychobiology 9: 89-95.
  4. Marshall RE, Stratton WC, Moore JA, Boxerman SB. Circumcision I: effects upon newborn behavior. Infant Behav Dev 1980;3:1-14.
  5. Marshall RE, Porter FL, Rogers A, et al. Circumcision II: effects upon mother-infant interaction. Early Human Development 1982;7:367-74.
  6. Anand KJS, Hickey PR. Pain and its Effects on the Human Neonate and Fetus. New Engl J of Med 1987;317:1321-1329.
  7. Laibow R. Circumcision: Relationship Attachment Impairment. Second Int'l Symp. on Circumcision., San Francisco April 1991:14
  8. Taddio A, Koren G. et al. Effect of Neonatal Circumcision on Pain Responses at Vaccination in Boys. Lancet, Feb. 1995;345:291-292.
  9. Taddio A, Koren G. et al. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet, Vol. 349: 599-603 (March 1, 1997).
  10. LeBoyer, Frederic. Birth Without Violence: The Book That Revolutionized the Way We Bring Our Children Into the World. Inner Traditions International, Ltd. (ISBN 089281540). 1995 Reprint of 1975 Classic.
  11. Birth Scene http://www.birthpsychology.com/
  12. Pyterek AV. Circumcision: The Roof of Misogyny.
  13. Mary Kroeger with Linda J. Smith. Circumcision. In: Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum. Sudbury, Massachusetts: Jones and Bartlett Publishers, 2003: pp. 197-8. (ISBN 0-7637-2481-5)
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Breastfeeding and UTI reduction

Some methodologically-flawed studies that were published in the mid-1980s suggested that male neonatal circumcision may provide some protection against urinary tract infection.

Later information that was published in 1990-1992 show that breastfeeding provides a three-fold reduction in the incidence of urinary tract infection (UTI) in the first year of life as compared with bottlefeeding. The earlier studies had no control for the variable of bottlefeeding or breastfeeding (amongst other methodological problems) so they have become invalidated by the later information. There is now no reliable evidence that male circumcision offers any protection against UTI.

The following articles indicate that breastfeeding can protect infant boys from urinary tract infections:

  1. Coppa GV, et al. Preliminary study of breastfeeding and bacterial adhesion to uroepithelial cells. Lancet 335 (March 1990), 569-571.
  2. Mårild S. Breastfeeding and Urinary Tract Infections. Lancet, 336 (October 1990), p. 942
  3. Pisacane A, Graziano L, Zona G. Breastfeeding and urinary tract infection. Lancet 1990;336:50.
  4. Pisacane A, Graziano L, Mazzarella G, et al. Breast-feeding and urinary tract infection. J Pediatr 1992;120:87-89.
  5. AAP Workgroup on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 1997;100: 1035-39. (link to AAP website)
  6. Outerbridge EW. Decreasing the risk of urinary tract infections. (Letter). Paediatr Child Health 1998; 3(1):19.
  7. American Academy of Pediatrics Task Force on Circumcision. Circumcision Policy Statement. Pediatrics 1999;103(3):686-693.
  8. Anonymous. The Effects of Circumcision on Breastfeeding. San Anselmo, CA, National Organization of Circumcision Information Resource Centers: 2002.
  9. Mårild S, Hansson S, Jodal U, Oden A, Svedberg K. Protective effect of breastfeeding against urinary tract infection. Acta Paediatr 2004;93(2):164-8.
  10. Hanson LÅ. Protective effects of breastfeeding against urinary tract infection. Acta Paediatr Scand 2004;93(2);154-6.
  11. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2005;115(2):496-506.

See also: Circumcision and Breastfeeding (link to www.circumstitions.com)

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General Information About Breastfeeding

A general discussion of breastfeeding is outside the scope of this website. For more information on breastfeeding the following links are provided:

  1. ProMom (Link to www.promom.org)
  2. The Compleat Mother (Link to www.compleatmother.com)
  3. La Leche League International
  4. Australian Breastfeeding Association (Link to www.breastfeeding.asn.au/)
  5. INFACT Canada (Link to www.infactcanada.ca)
  6. Prescott, JW. Breastfeeding: Brain Nutrients in Brain Development for Human Love and Peace. Touch the Future Newsletter, Spring 1997. (Link to www.violence.de)
  7. Health Policy Unit. Breastfeeding. Sydney: Royal Australasian College of Physicians. April 2001.
  8. Breastfeeding, Canadian Paediatric Society. 2204 Walkley Road, Suite 100, Ottawa, Ontario K1G 4G8 (link to www.cps.ca) Phone: 613-526-9397, fax: 613-526-3332.
  9. A Woman's Guide to Breastfeeding. The American Academy of Pediatrics, 2000. (Link to parentingthoughts.org)


(Last revised 30 December 2007)

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