Circumcision in Africa

"The distribution of circumcision and initiation rites throughout Africa, and the frequent resemblance between details of ceremonial procedure in areas thousands of miles apart, indicate that the circumcision ritual has an old tradition behind it and in its present form is the result of a long process of development."[1]

History

Circumcision is prevalent among 92% of men in North Africa and around 62% in Sub-Saharan Africa. In western and northern parts of Africa it is mainly performed for religious reasons, whereas in southern parts of Africa it rarely performed in neonates, instead being a rite of passage into manhood.[2]

African cultural history is conveniently spoken of in terms of language group. The Niger–Congo speakers of today extend from Senegal to Kenya to South Africa and all points between. In the historic period, the Niger–Congo speaking peoples predominantly have and have had male circumcision which occurred in young warrior initiation schools, the schools of Senegal and Gambia being not so very different from those of the Kenyan Gikuyu and South African Zulu. Their common ancestor was a horticultural group five, perhaps seven, thousand years ago from an area of the Cross River in modern Nigeria. From that area a horticultural frontier moved outward into West Africa and the Congo Basin. Certainly, the warrior schools with male circumcision were a part of the ancestral society's cultural repertoire.[3]

Studies evaluating the complications due to Traditional male circumcision have found rates varying from 35% (Kenya) to 48% (South Africa). Infection, delayed wound healing, glans amputation and injury, bleeding, loss of penile sensitivity, excessive removal of foreskin, and death are the major complications reported.[4]

Circumcision to prevent the spread of human immunodeficiency virus in Africa
Main article: Circumcision and HIV

WHO identified 14 countries with high rates of heterosexual human immunodeficiency virus transmission and historically low levels of male circumcision coverage (nationally or sub-nationally), and were priorities for scale-up. They are Botswana, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Uganda, Zambia, Zimbabwe and Tanzania. From 2008 to mid 2014, around 5.8 million men were circumcised as part of an effort to prevent HIV.[5]

PEPFAR (the US President's Emergency Fund for AIDS Relief) supported over 15 million circumcisions in 14 countries in Southern and Eastern Africa from 2007 to 2017.[6][7]

There are some who question the effectiveness of circumcision to prevent infection by human immunodeficiency virus in Africa.[8]

Nations

Algeria

The male child circumcision rate in Algeria is around 97.9%.[9]

Cameroon

The male child circumcision rate in Cameroon is around 90%, in common with other countries of West and North Africa, with operations performed in hospitals and clinics.[10]

Egypt

The male child circumcision rate in Egypt is around 94%.[11]

Ghana

The male child circumcision rate in Ghana is around 95%, with operations performed in hospitals and clinics. However, there are some variations in the country. For example, circumcision is less common in Ghana's Upper West Region, at 68%.[12]

Ivory Coast

The male circumcision rate in Ivory Coast is around 95%,[13] with operations conducted in hospitals and health clinics.

Kenya

The male circumcision rate in Kenya is around 84%, with operations performed in hospitals and clinics.[12]

In traditional circumcisions, often the same knife is used for many initiates.[14][15] This is thought to contribute to the spread of HIV.

In addition to traditional circumcision, the men of Africa enjoyed "benefits" such as young men became members of the warrior class, and were free to date and marry. The graduates became a fraternity which served together, and continued to have mutual obligation to each other for life.

In the modern context in East Africa, the physical element of male circumcision remains (in the societies that have historically practiced it) but without most of the other accompanying rites, context, and programs. For many, the operation is now performed in private on one individual, in a hospital or doctor's office. Anesthesia is often used in such settings. There are tribes, however, that do not accept this modernized practice. They insist on circumcision in a group ceremony, and a test of courage at the banks of a river. This more traditional approach is common amongst the Meru and the Kisii tribes of Kenya.[3] One boy in Meru County, Kenya was assaulted by other boys because they wanted him to be circumcised in a traditional ceremony as opposed to in a hospital.[16] Amongst the Gikuyu (Kikuyu) people of Kenya and the Maasai people of Kenya and Tanzania, male circumcision has historically been the graduation element of an educational program which taught tribal beliefs, practices, culture, religion and history to youth who were on the verge of becoming full-fledged members of society. The circumcision ceremony was very public, and required a display of courage under the knife in order to maintain the honor and prestige of the young man and his family. The only form of anesthesia was a bath in the cold morning waters of a river, which tended to numb the senses to a minor degree. The youths being circumcised were required to maintain a stoic expression and not to flinch from the pain.[3]

Despite the loss of the rites and ceremonies that accompanied male circumcision in the past, the physical operation remains crucial to personal identity and pride, and acceptance in society. Uncircumcised men in these communities risk being "outed", and subjected to ridicule as "boys". There have been many cases of forced circumcision of men from such communities who are discovered to have escaped the ritual. Those who do not want to be circumcised seek refuge in Kenya's police stations.[17]

Liberia

Almost all men (98 percent) in Liberia are circumcised,[18] with operations carried out in hospitals and health clinics.

Malawi

In the South of Malawi, the Yao and Lomwe tribes practice tribal circumcision. There are fears that there is a heightened risk of spreading human immunodeficiency virus as the surgeons use the same blade and encourage boys to have sex with women after the ceremony.[19]

Morocco

Circumcision in Morocco had been performed by barbers. This is now performed by medical surgeons. Circumcision of almost two-year-old at the time prince Moulay Hassan prompted thousands of other young boys to be circumcised. The procedure is considered "purification" (t'hara) by Muslims. [20]

Nigeria

Nigerian culture favours circumcising baby boys when they are aged between eight and forty days.[21] Neonatal (child) circumcision is performed on more than 85% of boys in Nigeria, Western Africa, and majority of the procedure is done by nurses (56%) and doctors (35%) with a small proportion (9%) performed by traditional practitioners (2). The reasons are cultural and religious.[22]

Rwanda

Rwanda previously had a lower rate of circumcision, similar to South Africa. Both nations have been introduced a "safe" PrePex device which claims to involves no pain nor bleeding. The Government Of Rwanda wishes to fight HIV. However, complications have occurred after a few of the circumcisions, including death. Rwanda Ministry Of Health denies that the deaths occurred from the result of circumcision.[23]

Sierra Leone

The male circumcision rate in Sierra Leone, estimated in 2016, is around 96.1%,[24] with operations carried out in hospitals and health clinics.

South Africa

In some South African ethnic groups, circumcision has roots in several belief systems, and is performed most of the time on teenage boys:

The young men in the eastern Cape belong to the Xhosa ethnic group for whom circumcision is considered part of the passage into manhood. ... A law was recently introduced requiring initiation schools to be licensed and only allowing circumcisions to be performed on youths aged 18 and older. But Eastern Cape provincial Health Department spokesman Sizwe Kupelo told Reuters news agency that boys as young as 11 had died. Each year thousands of young men go into the bush alone, without water, to attend initiation schools. Many do not survive the ordeal.[25]

According to one article, as of December 2015, 10 million men have undergone voluntary circumcision in East and Southern Africa. since 2008.[26]

In 2017, celebrities were recruited to launch the "man up" campaign to encourage more men to get circumcised.[27]

Tanzania

In 2015, the Johns Hopkins Program for International Education in Gynecology and Obstetrics, a non profit health association affiliated with Johns Hopkins University, completed a voluntary circumcision project, covering three traditionally non-circumcising Tanzanian regions, Iringa, Njombe and Tabora, which circumcised 400,000 men. It was done in collaboration with the National AIDS Control Programme. They offered the services in 500 health facilities across the three regions.[28]

Mobile health clinics have been launched, funded by USAID, to offer circumcision and sexual health advice to adult men.[29]

Efforts are being made to scale up circumcision where there is low prevalence of circumcision; the areas cited are: Iringa, Tabora, Mbeya, Songwe, Rukwa, Katavi, Shinyanga, Simiyu, Mwanza, Geita, Kagera and Musoma. Following this, Singida, Kigoma, Mara and Morogoro will also see efforts to scale up circumcision[30]

Tunisia

The male child circumcision rate in Tunisia is around 99.8%.[31]

Uganda

In Uganda, circumcision is performed for religious, cultural, and medical reasons. Medical related circumcision is mainly to reduce the transmission of human immunodeficiency virus and sexually transmitted illnesses. It is performed by non-physicians, including for infants and neonates.[32]

In Uganda, Sebei, Bagisu, Baamba, and Bakonzo ethnic groups practice TMC. As of 2012, 70% of Ugandan men are not circumcised. Around 10% of Ugandan men belong to groups which practice traditional male circumcision. The age range for eastern Ugandan candidates is relatively older (14–18 years) than that of western Uganda (2–15 years). The cost of TMC varies from UGX 5,000 to 40,000, or approximately US$2.00 to 16.00 (Uganda GDP per capita is US$1,300.00). The candidate's parents are responsible for the payment, although the price is negotiable and depends on the family's financial ability. Those who undertake a hospital circumcision rather than a traditional circumcision are said to be shunned by their community.[4]

Zambia

In Zambia there is a circumcision programme underway because some believe it could reduce the transmission of human immunodeficiency virus.[33]

Tribes

Bukusu

Traditional circumcision is practiced among the Bukusu people of Kenya.[34][35][36][37] Ceremonies usually take place in August. They involve the use of mud. This is used to prevent excessive bleeding after the cut, to prevent wincing, and to commemorate a traditional legend.[38]

Gisu

The Gisu people of Uganda are closely related to the Bukusu and also practice circumcision. In Uganda, a circumcision ceremony is called Imbalu.[39][40]

Massai

Amongst the Maasai people of Kenya and Tanzania, male circumcision has historically been the graduation element of an educational program which taught tribal beliefs, practices, culture, religion and history to youth who were on the verge of becoming full-fledged members of society. The circumcision ceremony was very public, and required a display of courage under the knife in order to maintain the honor and prestige of the young man and his family. The only form of anesthesia was a bath in the cold morning waters of a river, which tended to numb the senses to a minor degree. The youths being circumcised were required to maintain a stoic expression and not to flinch from the pain.[3]

Bantu

Bantu circumcisions have been declining.[41]

Dinka

Agar Dinka do not circumcise.[42]

Luo

The Luo do not circumcise.[3]

Turkana

The Turkana tribe do not perform ritual circumcision.[17]

Other measures

South Africa refuses infant circumcisions, but with mixed reception.[43] Additionally, they have boycotted "Do-It-Yourself" Circumcision devices, but only the ones made in Israel which was part of an already-existing boycott of Israel.[44]

gollark: Still at 300 or so. 6 slots is not enough!
gollark: I thought people wanted those things.
gollark: Does nobody want 2G PB aeons or something?
gollark: Well, probably some hatchlings, but I think value dropped (blame the market).
gollark: (periodic table codes! though technically under my scheme it doesn't count as one)

References
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  3. Marck, Jeff (1997). "Aspects of male circumcision in sub-equatorial African culture history" (PDF). Health Transition Review. 7 Suppl (7 Supplement): 337–359. PMID 10173099. Archived from the original (PDF) on 2008-09-06. Retrieved 2015-08-03.
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  5. "Nearly 6m circumcised in pan-African push against Aids". 24 July 2014..
  6. Stephanie Davis et al. (1 September 2018). "Progress in voluntary medical male circumcision for HIV prevention supported by the US President's Emergency Plan for AIDS Relief through 2017: longitudinal and recent cross-sectional programme data". BMJ Open. 8 (e021835): e021835. doi:10.1136/bmjopen-2018-021835. PMC 6120649. PMID 30173159.CS1 maint: uses authors parameter (link)
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  35. "Bukusu Post-Circumcision Rites Continue 3 Months After 'Cut'". Youtube. K24. 21 December 2014.
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