Because it can be a problem, the news cases
The latest, tragic case is that of Zion, a child of Nigerian origin who died in his home in Genoa just under a month of life, in the night between Tuesday and Wednesday. But a week before the death had been a five-month-old child of Ghanaian origin, residing in Scandiano (Reggio Emilia), and last December the same terrible fate had befallen another two-year-old from a Nigerian family, while his twin brother had been hospitalized in serious condition (in this case the children lived in Monterotondo, near the city).
In common, for all, there had been an intervention by homemade circumcision by unskilled people (for Zion the press spoke of a "holy man") and evidently ended badly.
Read also: Circumcision in childrenFaced with episodes of such gravity, the main medical organizations of Del Paesene immediately moved, which on the other hand have long been thinking about the question of the safety of ritual or cultural circumcision. The National Federation of Orders of Surgeons and Dentists (Fnomceo) and the Association of Doctors of Foreign Origin in Del Paese (Amsi) have requested the inclusion of ritual circumcision in the Lea, the essential levels of assistance, or in any case the approval of an ad hoc law for this practice to be made accessible at controlled prices in public structures, even for babies just a few months old. According to Foad Aodi, founder and president of AMSI, a reasonable ticket should be around 200-250 euro.
And on Social Editor, Simona La Placa, head of the working group for migrant children of the Paesena Society of Paediatrics (Sip), said that "truly accessible paths are needed", to be accompanied by greater awareness on the subject, to inform on the importance of carrying out the practice safely.
Circumcision, what it is and why it is done
Circumcision consists in the total or partial removal of that flap of skin called the foreskin, which lines the glans penis. It is therefore an intervention that concerns only males and absolutely must not be confused with female genital mutilation practices, even though they are sometimes erroneously defined as "female circumcision".
There are three possible reasons that lead to this surgery, for which there are three different types of circumcision:
THERAPEUTIC
it is what is done to correct or treat anomalies or complications. The best known and most frequent example is that of phimosis, a narrowing of the foreskin (the so-called "closed pea"), considered physiological up to four to five years of life. If it does not resolve with age or with the application of specific ointments, it is precisely with circumcision.
Read also: Children and genital problems: 4 answers to the most common doubtsRELIGIOUS
"It's the one planned for ritual reasons within the Jewish and Muslim religion" explains Angelucci, Professor of European ecclesiastical law at the University of Eastern Piedmont and of Islamic law at the Lugano faculty of theology.
"In particular, for the Jewish religion, circumcision is considered mandatory, an initiation rite through which the child becomes part of the Chosen People. In the Islamic context, on the other hand, circumcision is considered mandatory by two of the four legal schools of Islam, while for the other two it is recommended but not mandatory ". And again: "Judaism foresees that circumcision takes place within the eighth day of the child's life, while for Muslims it can be done even later, within the prepubertal age, ie 13-14 years".
According to President Amsi Aodi, however, the great majority of Del Paeseni Muslims would not require circumcision for strictly religious reasons, but more for cultural and hygienic reasons and would require it earlier, in the first months of the child's life.
CULTURAL
is circumcision done for local customs and traditions, perhaps inspired by the idea that it may have hygienic functions, disease prevention. "In this sense it is a widespread practice above all in populations of the sub-Saharan area (Ghana, Nigeria), including Christians (Catholic, Protestant or other)", explains Angelucci. Underlining that circumcision commonly practiced in the United States can also be included in this category, where it is estimated that 70% of the male population is circumcised and where the main reason behind the practice is precisely of a hygienic type. In fact, some studies have shown a protective effect against urinary infections, sexually transmitted diseases, tumors caused by the papillomavirus (HPV).
(However, it should be emphasized that the prevention of these conditions also involves good hygiene practices, the use of condoms during sexual intercourse and vaccination against HPV, even in males).
Non-therapeutic circumcision, the numbers
But how many children are there exactly who undergo circumcision every year for reasons other than therapeutic ones? There are no precise and definitive numbers. "For example, there are no precise numbers as far as the Jewish community is concerned," says Angelucci, who is also the author of the book Behind the circumcision (Giappichelli, 2022).
As for citizens of foreign origin who live in Del Paese, according to data elaborated by AMSI in collaboration with the Medical Association of the city, about 11 thousand ritual circumcisions were carried out in a year: of these, 5000 in the our country, the rest in the countries of origin. Of the 5000 performed in the country, 35% would be practiced in "clandestine" circuits, at home or in unprotected environments, and not by doctors.
Where can non-therapeutic circumcision be done
There is no doubt about therapeutic circumcision, performed on precise medical indications: it is performed in the hospital, by pediatric surgeons. But what about those performed for religious or cultural reasons? We often hear about homemade interventions: is it really possible to do it?
"According to the Del Paesena law, religious (and also cultural) circumcision is always lawful, as an exercise of religious freedom"explains Angelucci." However, two conditions must be met:
- il parental consent
- e execution in a hospital setting, where adequate hygiene and safety standards are guaranteed".
On the other hand, even if it is a simple operation (especially if performed on newborns), complications are always possible. "These include bleeding and infections, which can lead in the long run to chronic difficulty urinating or having erections," says Aodi.
Therefore the family that for religious, ritual, traditional or other reasons wants to have a child circumcised should go to a hospital. Members of the Jewish community are an exception, because in this case the ritual circumcision is regulated by a special agreement between the State and the Union of Jewish Communities, which recognizes the possibility of carrying out circumcision within the community itself. It must be said that in this case the circumcision is performed by a "authorized ritual circumciser"called mohal (plural mohalim), who to become such must follow a training course dedicated both to the religious aspects of the practice, and to the fundamental rules of hygiene and safety. There is also a national register of mohalim, for registration to which being a doctor is considered a preferential (but not necessary) title.
On the other hand, already in 1998 some members of the National Bioethics Committee, in an opinion on circumcision, believed that in the case of newborns, given the elementary nature of the operation, this can be carried out by "ministers in charge, provided they have adequate and recognized competence ".
Before performing the circumcision, the mohal undertakes to obtain the informed consent from the parents and to inform the child's pediatrician that it will be performed shortly, to "check together the health conditions allowing the intervention". He is also required to implement all the rules and precautions necessary to ensure the safety of newborns, to use sterile or disposable instruments, to follow the newborn until complete healing and to keep a record of all circumcisions performed and any complications. .
Therapeutic circumcision in the hospital: under what conditions?
Outside the Jewish community, therefore, the legal indication is to turn to health facilities. The problem is that we generally speak of interventions that must be done privately, and therefore cost: "From 500 to 2000 euro, but we have had news of circumcisions costing up to 4000 euros "says Aodi. Much, and probably too much for many families interested in the issue. That even for this reason they may end up turning to unqualified personnel, or choose to have the child circumcised in the country of origin, in which they periodically return to visit their family.
At the moment, in fact, circumcision for religious or cultural reasons is not included in Lea, essential levels of assistance ("and moreover, it would be difficult to justify an insertion, at least in the current state of jurisprudence, given that it is not a useful practice for safeguard people's health "comments Angelucci). However, this does not mean that solutions cannot be found that can bring together all the needs in the field, from safeguarding the secular principles of the state to that of children's health.
Some regions have acted autonomously with projects that allow the execution of religious or cultural circumcision in public hospitals. "This happens, for example, at the Policlinico Umberto I in the city, where a protocol has been launched that provides for this type of circumcision outside working hours, at a cost of 400 euros. Or at the Regina Margherita Hospital in Turin, where, on the other hand, circumcision is done during working hours, upon payment of a ticket equal to 280 euros, which the hospital deemed sufficient to cover the costs ".
In practice, this is the direction in which the Association of doctors of foreign origin in the country is pushing, with an appeal to the Ministry of Health: ritual or cultural circumcision in the hospital, with a ticket of around 250 euros, so as not to burden the state coffers, while ensuring the maximum possible safety for the little ones to whom the intervention is carried out.
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- circumcision
- ritual circumcision