Saturday, March 9, 2013

A Tiny Cut: Male and Female Circumcision in Singapore

Originally written for Poskod.sg.
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In my immediate family, I am the only one uncircumcised.

My earliest memory of encountering circumcision was when I was about six years old. I had to attend a kenduri, or ritual feast, for two male cousins who were recovering at home after undergoing the procedure at a private clinic earlier that day.

Both of them were wearing kain sarong, with the front of the cloth held out and away from their fresh wounds with a clothes hanger bent around their waists. I observed the attention they got around their new bodies: they didn’t shower for days, were supposedly fanned at night to keep the wounds dry, and were not allowed to consume certain foods that could slow down their healing (e.g. prawns, beef). Curious children were not too well tolerated in these events, and only my mother was willing to answer my question, in a hushed whisper, in between Quran recitations and platefuls of food.

“Are girls circumcised too?”

“Yes, but just a little bit… potong sikit aje.”

My mother vaguely explained to my six year-old self that girls were indeed circumcised, but that sunat perempuan (‘female circumcision’) involved only “a tiny cut”. I remember thinking that it must not have been common because there were never any ritual feasts for my female cousins.

Children who grew up in the 1990s commonly encounter male circumcision just before puberty–around the age of eight or nine years old. More commonly known as sunat (Malay for ‘tradition of the Prophet Muhammad’), it represents a rite of passage into adulthood. In the past, male sunat was accompanied with festive ritual feasts and street processions. These cultural performances are less common today, partly due to the use of doctors to perform circumcision with anaesthesia and increasingly, on infants a few days or weeks old.

There are four types of male circumcision, and the most common procedure done in Singapore, as estimated by a doctor, is the Plastibell technique (see video) which aims to completely expose the head of the penis. It is today done on a range of ages, from five to about 15. A newborn, who is born with his foreskin fused to the glans of the penis, must first undergo a forced tearing of the two organs before cutting off the foreskin and sewing the remaining skin together, often without anaesthesia. A boy before or entering puberty may have already experienced retraction of the foreskin, thus needing only the latter part of the procedure and usually with anaesthesia.

Most public hospitals do not encourage this non-essential surgery on very young infants because of the risks involved (since one baby boy died from excessive bleeding and infection). However, parents who want it for their newborns often simply go to certain male Muslim doctors who will do it for around $80 to $100. The rate of male circumcision in the Muslim community is very close to one hundred percent, unlike female circumcision.



A Tiny Cut


Recently my mother revealed that she and her seven sisters had all undergone female sunat in the 1950s. She was too young to remember her own sunat, guessing it was probably when she was a few weeks old. She described that in her time, this involved cutting off a piece of a girl’s prepuce or clitoral hood, making it flat instead of partly draping over the clitoris. I also recently discovered that my older sister had been circumcised also at one week old, although by the time she was born in the early 1980s, she had a symbolic sunat in the form of a scraping of the prepuce using a penknife or scissors. However, a female friend born in the 1980s said that she remembers going for sunat at the age of four or five years at another woman’s house, and experiencing excruciating pain.

In the past, female sunat was done by a mak bidan, or post-partum midwife, whose role was to help mothers to help mothers with bathing and nursing their babies, and also get back into shape after a natural birth with the use of tummy wraps, herbal drinks, herbal applications, massage, and bathing of the newborn baby. Today, it is almost exclusively done by women Muslim doctors, and the process reportedly involves nicking the prepuce with a small pair of scissors, without anaesthesia. Although no comprehensive surveys have been done, a woman Muslim doctor admits to “circumcising five to six patients a day”, mostly babies and prepubescent children.[i]

During my mother’s childhood, undergoing sunat was only a big deal for boys. In contrast, female sunat was usually done without fuss in the presence of the mother. When my mother tried to ask her own mother any questions or to attend the procedure of her sisters, she was dismissed as being mentel, or excessively curious in matters of sexuality. Today, as both female and male sunat are being increasingly performed on infants, it no longer plays a social role.

Male and female circumcision is often given differential treatment. At the international level, the biggest opponent to female circumcision is the World Health Organisation. This international organisation has launched a zero-tolerance worldwide campaigns to eradicate female genital mutilation (FGM/the term preferred by its opponents), classified into four categories–the first and last of which describe the kind of sunat being carried out in Southeast Asia. Predictably, some Muslims see this ban as a form of Western cultural imperialism. Proponents of female sunat prefer the term ‘female circumcision’ or ‘female genital cutting’ to maintain a sense of medical neutrality (even though ‘female circumcision’ is not technically accurate as circumcision means ‘to cut around’), and will cite religious and social reasons.

In contrast, there is no large and unified movement against male circumcision, only a handful of groups mostly based in the United States or Canada, including online support groups. The global debate on female circumcision often frames it as being more harmful than male circumcision, which is often said to have medical benefits. Even Islamic debate has resulted in ambivalent and contradictory fatwa (religious rulings) on female circumcision in Egypt, Malaysia, and Indonesia–which allows it if no harm is done–while male circumcision carries on, undisturbed. In Singapore, there is no such debate on either kind of circumcision. What role do these practices play in today’s Singaporean Muslim community?


Overt arguments: Religious and medical

The Quran, the first source of Islamic law, mentions neither male nor female circumcision. Some can quote verses 2:124 or 16:123 from the Quran, which only indicate Abraham as a model for Muslims. They then argue that circumcision was one of the commands given to Abraham as a test of his faith, as mentioned in some of the hadith, or sayings of Muhammad. The logic, then, is that male circumcision becomes an act of faith. However, this logic cannot be extended to a child who is not old enough to be accountable for his or her own actions.

The logic of female circumcision is slightly different. Some women who find support from textual religious sources usually quote a hadith that describe the historical existence of the practice and how Muhammad did not forbid the practice but only warned the women involved to not do it excessively. Thus, those who follow it do it purely to fulfil a religious norm because the alleged benefits cannot be proven.

Religious arguments for circumcision often fall in between religious and medical reasons, because ritual cleanliness is closely related to physical cleanliness. In classical fiqh or jurisprudence, acts of worship require both physical and ritual purity, although the former can be exempted in certain cases of emergency. Being ritually pure determines when you can pray, fast, or do other acts of worship. Being physically clean is important as part of keeping good hygiene and thus a healthy body.

Thus, the most common religio-medical reason for circumcision is to ensure the penis or vulva is clean, so that acts of worship are valid. Another popular hadith that exhorts gender-neutral circumcision as part of physical hygiene, alongside the trimming of the moustache, pubic hair and nails, is used by supporters of male circumcision (it’s part of hygiene) as well as surprisingly, both the supporters (no gender differentiation) and opponents (‘moustache’ indicates reference to only men) of female circumcision.

Without the foreskin of the penis or the clitoris, there is no need to actively ensure that the area underneath is clean and free of smegma (combination of sebum and shed skin cells). However, this is not because “the foreskin is dirty”, as one young mother put it, but because parts of our bodies simply get dirty with use. What is not well-known is that these secretions are only produced after puberty–thus being “dirty” is certainly not a reason to circumcise newborns.

Educated parents of some circumcised newborns today (and in the recent past) often cite medical arguments, assuming that the natural penis is impossible or very difficult to keep clean. As circumcision is a given, what some young mothers are concerned about is the time taken for the wound to heal. They explained that it’s easier to circumcise someone that is relatively immobile and will not scratch the wound (“babies sleep all day”) and that according to folk knowledge of wound healing, having a diet of breast milk will help the wounds heal faster.

However, perhaps because they are not exposed to non-Malay Muslims, many are not aware that converts to Islam (whether male or female) are not required to undergo circumcision in order to be socially accepted as Muslims. While for men this is sometimes a point of humour, among women it is almost unheard of. In any case, they would have surely learnt by this age to keep themselves clean–physical cleanliness is thus clearly possible without circumcision.

Those who oppose circumcision in a religious sense emphasise the perfection of the design of God. As another male friend put it, “If one believes in God, then it would make sense that God designed it that way.” If God had made us “in the best of moulds” as mentioned several times in the Quran, then every part of our body serves a physical and divine purpose. According to this line of thought, the sensitive head of the penis and the clitoris are certainly meant to be partially protected most of the time, and only fulfil their erogenous functions in their original sensitive and supple condition when needed during sexual arousal.

While some educated Muslim parents prefer to give the hygiene argument, because it does not seem logical to them to follow a norm without reason, there are as many who have never questioned this religious norm because of how they perceive themselves in relation to their religion.

Covert arguments: Power and identity issues

Why do so many young parents circumcise their newborn boys? Some can vaguely mention some parts of thehadith mentioned above, but there is the complete acceptance of sunat as a socio-religious norm, without necessarily knowing the rationale. As one male friend said simply, “It is commanded” and as one young mother said after circumcising all her sons “I never thought of why we [did it]”. Only one young mother stated that she did not circumcise her daughter because she was concerned about medical consequences, as she was exposed to the global debate on FGM. However, I’ve never met any parents who had thought twice about male sunat.

For older boys who are circumcised, the practice is bound up with rites of passage into adulthood and Muslimhood. A male friend who was circumcised at 11 years old (slightly later than his friends) confided that he was “scared” but that he knew he had to do it eventually, especially after other Malay boys were “taunting him for still having a foreskin”. Additionally, new fathers perhaps cannot imagine their sons looking different. More importantly, the myths of a “dirty” foreskin prevent them from imagining an intact penis and a different hygiene routine.

For the parents who follow this norm and know that it causes pain, they are thinking about how to reduce their child’s pain or make them forget it, but not eliminate it. Hence, doing sunat at a very young age, or hoping for anaesthesia (but not necessarily checking). At times it seemed more like they did not want the trauma of realising their child was in pain–this would be more obvious in the form of sobbing and suffering toddlers or teenagers, than a sleeping or crying baby (they cry anyway for everything else, right?).

Unfortunately, this represents larger attitudes around religious issues in Singapore. Religious norms, by virtue of having lasted thousands of years, must be true. Myths are created to support it, such as “the foreskin re-grows at the age of 35” from a new mother. When religious norms are questioned, the debate often stops in the intellectual dead-ends of either “the Prophet is infallible”, or “beware of unscrupulous scholars”. There is no effort for independent thinking, which is condemned for its selfish nature. Often, such arguments are pre-emptively dismissed by phrases such as “only God knows best” and “everything the Prophet said is truth”. But isn’t there is a difference between truth and claims for truth?

Living in an era of science and technology, we also have the tendency to justify religious norms with reason, conferring beneficial results (whether real or fictitious) upon them. For example, when I used to work at a mosque, we often explained that Muslims could not eat pork because of the viruses in it, wilfully ignoring all our healthy, pork-eating Chinese friends. Likewise, we confer medical benefits on routine circumcision (i.e. without medical necessity) such as reducing chances of penile cancer (which is already extremely rare), HIV transmission, and other sexually-transmitted diseases.

As for identity issues, we sometimes twist ourselves with circular arguments to confirm to ourselves the superiority and rightfulness of our religion and culture. Almost all public hospitals in Singapore do not allow routine infant male circumcision, with a prominent doctor stating that she “does not support any GP who runs into complications”, and a woman Muslim doctor even says “there is no medical rationale” for female circumcision (although she still continues it, perhaps to prevent unsanitary alternative options). Despite this, the practice still continues because since we believe Islam as we know it is perfect, everything that is said to be in the name of Islam should be correct.

My family has all been touched by sunat: my father, my mother, my sister and my brother. When I asked my mother why I had not been circumcised, she replied that “it’s a sunnah, it’s optional.” She didn’t think it was such a big deal if it was not done.

When my Dutch husband converted, my father sweetly convinced him to sunat his “small banana”. Although he could have sidestepped the issue by pointing out that he had, in fact, done a small procedure for a tight foreskin, he refused to do so on the principle that it was an unnecessary mutilation of the body, an idea echoed by the Islamic taboo on tattoos and plastic surgery.

Being forced to think about circumcision on adults made me think about the issue differently. Since I believe God made us, I firmly believe that we are created perfectly, and that every part of our bodies have a specific function. Like any other surgery, circumcision could be necessary for those with medical issues (and even then, there are minor procedures to solve certain problems). But for the vast majority of men and women who had sunat without their knowledge or informed consent as a child, I salute their faith if they would do it again today.

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