For years, Jody McLaughlin of Minot, N.D., has been crusading to stop circumcision of baby boys. In her view, it's an unnecessary and harmful medical procedure v that's imposed on helpless infants against their will. But try as she might, she couldn't persuade her state's legislators to take up her cause.
So now, with the help of a Minnesota lawyer, she's trying to get around the politicians: She's challenging a recent North Dakota law that bans female genital mutilation, saying it is unconstitutional because it doesn't protect boys. Today the battle moves to a hearing before the U.S. Court of Appeals in St. Paul, and her lawyer has vowed to challenge similar laws in Minnesota and Congress.
"We cannot protect one gender against something and not protect the other," said McLaughlin, 46, an activist who publishes a natural childbirth magazine called the Compleat Mother.
McLaughlin and her lawyer, Zenas Baer of Hawley, Minn., are trying to force the public to take a fresh look at an emotional issue that touches on law, medicine and religious freedom. Male circumcision-- removal of the penis' foreskin--is both a medical procedure and a 4,000 year-old religious practice sacred to Muslims and Jews.
It's far more common in the United States than elsewhere, largely because of notions that it's a healthy practice. Nationwide, more than 60 percent of newborn boys are circumcised (about the same percentage as in 1979, but down from a high of 95 percent in the 1960s), according to goverment statistics. But only a few percent of boys in Europe and Asia are circumcised.
U.S. doctors have debated the benefits and risks for decades. For the most part they have considered circumcision cosmetic surgery, neither necessary nor harmful. This year--for the fourth time in 22 years--the American Academy of Pediatrics is reconsidering its neutral position in light of new evidence that circumcision could help prevent urinary tract infections and sexually transmitted diseases.
A moral equivalent?
But activists are trying to put male circumcision in a new light by comparing it to female genital mutilation. Sometimes known as female circumcision, it is a widely condemned ritual common in Africa and the Middle East, done to curb women's sexual desire.
"What's good for the girl is good for the boy," Baer said. "In both instances, you have the removal of otherwise healthy genital tissue for a purely social, religious or cultural reason,"
Activists argue that circumcision cuts off some of the male's most sexually sensitive tissue and exposes babies to the threat of unnecessary complications, such as infections. But they also say there's great resistance to change.
"What man wants to admit that the best part of his penis is thrown into a trash can?" asked Marilyn Milos, a nurse who runs the National Organization of Circumcision Information Resource Centers in San Anselmo, Calif. "What mother wants to admit that her precious baby's been harmed needlessly? What doctor wants to admit he's got blood on his hands?"
Even some activists against female mutilation see a parallel.
"I'm also sympathetic to their goals, frankly," said Dr. Nahib Toubia, whose New York-based group, the Research Action and Information Network for Bodily Integrity of Women, campaigns against female circumcison. "A health professional should never touch a child and remove some normal body organ."
But others say it's unfair to compare male circumcision to female genital mutilation. "It is an oppressive practice for females," said Rabbi Jonathan Ginsburg, of Temple of Aaron in St. Paul and coordinator of the Minnesota Rabbinical Association. "The male circumcision . . . we've been doing for 4,000 years, and we're fine. There's not a single Jewish guy who complains about it."
McLaughlin, who has two grown daughters, tried and failed to convince the North Dakota Legislature that the two rituals are linked. She and Duane Voskuil, a philosophy professor in Bismarck, N.D., drafted a law to ban genital alterations in both boys and girls. But when legislators refused to sponsor it, she said, they rewrote it to mention girls only. "We knew at the time that this bill would be unconstitutional, but it passed both houses unanimously," she said.
They challenged own law.
Then she and Voskuil joined with Donna Fishbeck, who had a newborn son, to challenge the law that McLaughlin and Voskuil had written. The North Dakota attorney general's office fought back. "The Legislature did not intend to criminalize neonatal male circumcision," Doug Bahr, an assistant attorney general, argued.
The anticircumcision activists lost the first round in October when a federal judge in Bismarck threw out the case, saying the plaintiffs had no legal standing to challenge the law.
But Judge Patrick Conmy wan't entirely unsympathetic. "This may very well be a worthwhile goal," he wrote, but "the plaintiffs accomplish nothing by this action." If they won, he said, they'd merely invalidate the protection for girls. "This battle is one for the education of new parents and for the legislatures of this [country]-not the courts."
Although today's court hearing is only on the North Dakota law, Baer says he plans to use this as a steppingstone to challenge a similar 1994 Minnesota law and a federal law on female mutilation that took effect in March.
These days doctors find themselves walking a fine line, especially when parents ask for advice. "As pediatricians we're sort of neutral to the idea," said Dr. Mary Meland, a Health Partners pediatrician in Bloomington. "But the fact is, there are some high quality studies showing there is some medical benefit."
More than 25 years ago, the American Academy of Pediatrics declared there were no valid medical reasons for routine circumcision. That changed, somewhat, in 1989 after studies indicated that circumcision reduced the rate of infant urinary tract infections and penile cancer. But those are rare conditions, and the group recommended that parents weigh the facts and make their own decisions.
This year the group's task force is evaluating more evidence of possible benefits, including reduced risk of sexually transmitted diseases. "People feel it's really time to revisit and reconsider," said University of North Carolina pediatrician Carole Lannon, task force chairwoman.
Critics dismiss the benefits as myths and say they don't outweigh the risks, including bleeding, pain and, in extremely rare cases, death.
But Dr. Howard Stang, a Health Partners pediatrician in White Bear Lake, says studies have shown that it's tough to talk parents out of the procedure. "In America, it's such an ingrained type of practice, it basically comes down to a gut feeling," said Stang, whose research helped encourage the widespread use of anesthesia during circumcisions.
"I don't spend a lot of my time trying to talk parents out of it," he said. "But I also applaud them for deciding not to circumcise their baby. I tell them that's fine, too."
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