All about Making Circumcision a Medically Safe Practice

ALL FOR INCLUSION

In the procedure followed by hajams, the foreskin of a male child, between the age group of 5-7 years, is cut from the glans using an unscientifically designed circumcision clamp or a straight razor. To stop the bleeding, these hajams thrust a burnt cotton cloth upon the wound to act as an absorbent. To manage the pain and to accelerate the healing process, children are advised to chew toasted rice grains for two to three days after the procedure. 

According to a survey conducted by Guwahati Municipal Corporation in 2014, the informal settlement population of Guwahati alone stood at 1, 39, 296; with 217 pockets and 26, 090 households in the notified and non-notified categories. If this survey by the Guwahati Municipal Corporation can be taken as a reliable reference point; 52,180 people of this population would be children (if minimum 2 children per household is taken as an optimal estimate). This would mean that Guwahati city alone would have a staggering child population (0-18) of approximately 50,000, living in informal settlements. A large section of people in these settlements constitute Muslim migrant populations, who have moved into the cityfrom rural areas in search of better livelihood opportunities.

My extensive travels across the urban informal settlements of Guwahati city have educated me on diverse child rights issues prevalent across these communities. Apart from the range of vulnerabilities and risks that affect children, a critical issue that has been affecting the survival and protection of children belonging to migrant Muslim communities in the informal settlements of Assam's capital city, is the rampant practice of non-institutional circumcision on male children.

The historical narratives around the practice of male circumcision are varied. Some of the community members, that I have interacted with, have said that: "The procedure is not explicitly mentioned in the Quran. However, it is a custom mandated by the Prophet himself, and so its practice is considered a sunnah (Prophet's tradition), and therefore very important to Muslims."

Though the practice of male child circumcision is not the problem in itself, the method adopted to carry out the procedure in informal settlements is worrisome. According to community elders, 'hajams' visit the communities, from time to time; to perform circumcision drives on children. Hajams are traditionally recognised Islamic barbers and manicurists, who also specialise in performing circumcisions on children.

In the procedure followed by hajams, the foreskin of a male child, between the age group of 5-7 years, is cut from the glans using an unscientifically designed circumcision clamp (a blade held by bamboo handles) or a straight razor (commonly known as cut-throats, used in salons by Indian barbers). To stop the bleeding, these hajams thrust a burnt cotton cloth upon the wound to act as an absorbent. To manage the pain and to accelerate the healing process, children are advised to chew toasted rice grains for two to three days after the procedure. Hajams are compensated with travel fare, hospitality and gifts by host families. During the recovery period, relatives and neighbours call upon the child and shower him withgifts and money as a gesture of affection.

Widespread illiteracy among adults in informal urban settlements, that enhances reliance on harmful traditional religious practices, is one of the reasons for the dependence on pseudo-scientific interventions such as this. The other, more important reason is the lack of accessible alternatives. Since circumcision surgeries are not incorporated into India's health-related social protection policies and children belonging to poorer families cannot afford the high-cost procedure in hospitals. Therefore, the only other option left is to depend on quackery.

This widely prevalent practice of pseudo-scientific circumcision procedures by untrained and incompetent hajams poses severe health risks to children.The sterility of the blades and equipments used by hajams is often questionable and can lead to various kinds of infections in children. Moreover, since hajams do not employ anesthetics, children have to undergo severe intraoperative and post-operative trauma. My conversations with children across these communities have revealed that young children experience excruciating pain during the surgery process and have to endure sustained pain and swelling for weeks after the procedure. Few school-going children term this pseudo-scientific circumcision procedure as a violation of their rights.

Any form of pseudo-scientificintervention that can have a negative impact on a child's health is an attack on the child's right to survival and violates Article 24 of the United Nations Convention on the Rights of the Child (in short, 'CRC') that provides for the right of every child to 'enjoyment of the highest attainable standards of health'.

National and international legal instruments make the Indian State duty-bound to fulfil the rights of all children living in India.

Article 25 of the Indian Constitution bestows to its citizens the fundamental right to freedom of religion; presumably no part of the exercise of such freedom negatively affects the health of its citizens. Therefore, the Indian State has a responsibility of ensuring the fulfillment of the health rights of children, as it is duty-bound towards protecting the rights of citizens to freedom of religion.

Article 4 of the CRC directs the States to undertake all appropriate legislative, administrative and other measures for the implementation of the all the globally-recognised rights of children.

The provisions of the Constitution of India confer powers and impose duties [clause (3) of Article 15, clause (f) of Article 39, and Article 47] on the State to ensure that all the needs of children are met and their basic human rights are fully protected.

In the context of circumcision, it is about time that the Government of India makes institutional and affordable male child circumcision accessible to children, through its incorporation into the National Health Mission (NHM) Scheme. Free or subsidized access to safe and medically supervised male child circumcision surgeries and aftercare, in state dispensaries or health centres, can protect children in low-income groups from harmful, pseudo-scientific, practices.

Writer: Miguel Das

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