The state has been unified in its calls for better monitoring and interventions to improve the outcomes of traditional circumcision. But how can the state intervene in a process on which it does not even have basic data? When the Mail & Guardian canvassed officials for information on the numbers of deaths and mutilations caused by botched circumcisions each year, reporters were sent from pillar to post in search of statistics.
There was national outrage in May when news emerged that 27 boys died during initiation in Mpumalanga province. President Jacob Zuma echoed the national outrage at the unnecessary loss of lives, saying: “It cannot be acceptable that every time young men reach this crucial time in their development, their lives are culled in the most painful of ways in the care of circumcision schools.”
By the time a snap debate on the issue was called in Parliament, the death toll approached 40. MPs defended cultural practices, called for the arrest of those responsible for the deaths, a clampdown on fly-by-night initiation schools and “culturepreneurs”, and demanded better monitoring of the initiation process to ensure safe health practices.
But with poor record keeping at the outset, it’s unclear whether the state has any sort of plan to prevent the death and mutilation of the boys who would be men.
Initiation may be a highly valued cultural practice but there are no indications that government tracks the issue of deaths and mutilations caused during it.
There do not appear to be any reliable national statistics on the number of boys who undergo initiation each year, nor the number who die or are mutilated as a result of traditional circumcision.
According to Health Minister Aaron Motsoaledi, the main medical issues that can cause death in initiates are massive bleeding leading to hypovolemic shock, infection, septicaemic shock, dehydration from being denied drinking water, hypothermia from exposure to extreme weather, and low blood sugar from extreme food restriction. Poor circumcision technique can lead to genital amputation. In some cases, the cause of death is assault.
Of the three provinces in which initiation is most commonly practiced, the M&G was only able to get statistics from one, the Eastern Cape.
In that province, the death toll for the five years from 2008 to 2012 was 323. During that time, a further 126 boys suffered genital amputations.
An effective intervention strategy cannot be put into place unless government has an indication of the state of play in each province where initiation is practiced.
Initiation is most commonly practiced in the Eastern Cape, Limpopo and Mpumalanga.
The Limpopo and Mpumalanga health departments could not provide numbers and referred further questions to traditional leaders and the department of traditional affairs.
Sizwe Kupelo, a spokesperson for the Eastern Cape health department, said that keeping these statistics was possible because the department works together with Eastern Cape House of Traditional leaders, local government and various community structures.
The Eastern Cape has a head start on other provinces – in 2001 it became the first province to introduce legislation regulating traditional circumcision in an attempt to curb deaths and genital mutilation taking place in the bush.
In contrast, Mpumalanga has yet to finalise its initiation Bill.
Ten things about initiation:
1. Last month, 28 youths died of wounds sustained at initiation schools in Mpumalanga. The ritual period can be as long as three months, isolated in a remote area, usually in winter.
2. The origins of circumcision are obscure. The earliest record is from ancient Egypt, 25 centuries ago: a bas-relief in the sixth-dynasty tomb of Ank-Mahor at Saqqara shows what seems to be an adult or adolescent circumcision. About a century later, a written record tells of a mass circumcision (120 men) and the writer’s pride that none showed pain.
3. The ritual still takes this form in East Africa, where boys making the transition to men are circumcised in a public ceremony. They are expected not to flinch or cry out.
4. Jewish people circumcise male children soon after birth, for religious reasons: the founding covenant with Abraham involves circumcision (Genesis 17: 9-14; the same text is treated by Muslims as an injunction to circumcise).
5. Moses also made a covenant with God, but God tried to kill Moses “as they camped overnight” (Common English Bible) and he was rescued by his wife Zipporah, who seized a flint and chopped off her son’s foreskin, throwing it at Moses’s feet (Exodus 4:24-26).
6. There are three forms of Jewish circumcision: milah, periah and metsitzah, in order of increasing amounts of prepuce and surrounding tissue of the penis to be removed in the operation. Milah is the oldest form, with periah introduced in the second century AD. Metsitzah was ordered by the rabbis in the Talmudic period of the sixth century AD, the earlier forms being deemed insufficient.
7. The Catholic Church declared circumcision a mortal sin in 1442.
8. Infant circumcision increased in the Anglophone world in the late 19th and early 20th centuries. It is not clear why. Rationales, later debunked, include the idea that it reduced masturbation (thought to lead to insanity) or risk of disease. As late as the 1890s, it was believed retention of the foreskin could lead to “hernia, bladder infections, kidney stones, insomnia, chronic indigestion, rheumatism, epilepsy, asthma, bed-wetting, Bright’s disease, erectile dysfunction, syphilis, insanity and skin cancer” (Maurice Clifford, Circumcision: Its Advantages and How to Perform It).
9. Today, some studies suggest circumcision may reduce the risk of HIV and other sexually transmitted diseases, but the evidence is uncertain.
10. Circumcision was stopped as a cultural practice by the Zulu king Shaka. He replaced it as a rite of passage with the youths’ graduation through age-grouped regiments (amabutho) of his army. The present Zulu king, Goodwill Zwelithini, recently recommended circumcision for lowering the Aids risk. – M&G