8 Oct 2014

The Case of Medical Male Circumcision, Lost Lives and Cultural Hegemony

by Khomotso Ntuli

The time of the year in which a number of South African communities send their young males to traditional initiation schools so that they may come back as “men”, brings about a great deal of questions and commentary. Government, NGOs and civil society have all raised concerns over the number of lives that are lost annually through the traditional initiation practices.

According to an article by Sapa that appeared in The Times on 16 July 2014, the following statistics were reported for the winter initiation season: “Over 180 boys have been admitted to hospital and 35 have died so far since the initiation season started".
Furthermore, a report by the Commission for the Promotion and Protection of the Rights of Cultural, Religious and Linguistic Communities indicated that the 2013 death toll at initiation schools in Eastern Cape was 83 fatalities. A further 54 565 initiates were hospitalised due to botched traditional initiation surgeries. Limpopo province reported just over half the number of hospital admissions compared to the Eastern Cape at 35 621.

Some people may ask: What is it exactly in this day and age that makes young males resolute on undergoing circumcision without anaesthetic for example, or antibiotics and general medicinal intervention when infection occurs? Well, there are a number of reasons why some people would continue doing this, in the same way as the Jewish communities would have reasons around the practice of circumcision. These reasons may not be embraced by some the people living outside these cultural settings, but they have a historical basis nonetheless. One of the recent arguments advocating for the continuation of circumcision has been that circumcising reduces chances of sexually transmitted infections, which is a much needed intervention in the context of our country’s HIV and AIDS prevalence. One would however argue that there is more to this than the health aspect, which is usually brought up in a relatively secondary manner of these discussions.

Worth noting for anyone about to engage in the male traditional circumcision versus the medical alternative debate, are the historical contexts and the clarity needed in handling such a debate. Traditional circumcision is not just a surgical procedure, but part of an important and long standing cultural ritual that different communities go through as rite of passage into manhood.

Historical context

One has always found it interesting to note that some rituals that are found in the bible, made their way to a number of countries in which they are either not clearly documented or recorded at all. Circumcision for boys is obviously one of these rituals. Circumcision for women, or what tends to assume the genital mutilation tag, is an equally important issue, but one to be discussed another day. So why did men need to be circumcised in the past?

Before I respond to the question, I would like us to look at the current meaning of circumcision. One stands to be corrected on this point. In the South African context, there are very few places where the importance of male circumcision as the rite of passage to manhood is as vital as in the culture of amaXhosa, baPedi, maTsonga and amaNdebele among others. Not only it is important for the young boys’/men’s esteem to undergo the ritual, it also helps them find a place in their community. Having gone through the traditional initiation process gives the initiates a kind of stature that allows them to participate in important family issues among other things. If a young man has not gone through this ritual, marriage to a girl that is umXhosa for an example, tends to also be a bit difficult as he is not seen as complete man.

Our minister of sports, Fikile Mbalula, had to go through the initiation process at a relatively advanced age of 34 amid taunts. Mbalula, the former ANC Youth League leader, may be comforted by the fact that God’s covenant with the biblical Abraham required that all male Jewish children be circumcised. This meant that Abraham also had to undergo this ritual at the very advanced age of 99. So, late circumcision is not bad.

The reasons for Minister Mbalula’s need to undergo initiation at the time he did may be known only to him. It would be fair to respect the choice he made around this matter. There is however something worth learning from the response by president of the Congress of Traditional Leaders of South Africa, Patekile Holomisa, to a Sowetan article by Zenoyise Madikwa where he said the following of the minister: "In the Xhosa tradition boys are not allowed into positions of leadership. They are not even allowed to sit with men. I am puzzled that he [the minister] was allowed to get married."
On the contrary, the case of Zulu men not undergoing this ritual after inkosi uShaka ruled it out as one that contributed to temporary loss of men for war purposes, is one that may bring an alternative view to the notion of manhood.

Why cultural hegemony is a necessary lens to look through

Taking into account the fact that there have been a number of deaths related to circumcision that take place in traditional initiation schools, some may suggest Medical Male Circumcision as the best way forward, without of course taking into account the fact that this plays into the continuous undermining of African culture and traditions. Specifically here, is one’s view that it’s important to respect people’s cultural preferences, when it’s said that traditional circumcision as a rite of passage is not the same as medical male circumcision.

Perhaps it’s important to be cognisant of the fact that it is almost impossible to critique the flaws of black cultural practices without running into some problems. There is a potential threat that such a critique may play into a discourse that finds a lot that is wrong in African culture, without the same kind of critique being applied to other cultures, especially European ones. It is clear that there are a number of people who do not appreciate the importance of traditional institutions that are tasked with the initiation of young boys into manhood. The fact that institutions responsible for this traditional practice are not appreciated in the face of a predominantly Eurocentric-oriented country, and that deaths of initiates occur, simply adds fuel to the fire.

One is of the view that there is obviously a lot in our traditional practices that is patriarchal and that there are other issues that need to be looked at through a contemporary lens. But one should warn against the views of those who make it to the “thought leader” status of newspapers, who by virtue of such a big platform, tend to shape popular opinion which should not necessarily be used to decide the courses that communities are to take.

It is with this in mind that one would challenge those who may be quick to wish to replace traditional circumcision practices with medical ones, to first take note of the fact that communities have the right to practice traditional rituals as they are part of their culture. These are rights protected by the Constitution of our country and are worth respecting. If we, as a society or as government wish to help, especially in curbing the number of deaths, it is important to engage with traditional leaders with a view to collaboratively arrive at a solution. There are clearly issues of accreditation that are crucial in preventing bogus iiIngcibi (traditional circumcision surgeons) from exacerbating the issue.

One would suggest that it is not fair that those who do not understand the need for traditional circumcision simply propose that people get surgically circumcised and then continue with the other part (which has to do with teachings personal conduct of manhood and other responsibilities of an initiate towards his community) in the bush. Circumcision is not an isolated surgical operation, but an integral part of a people’s way of life. Whether it is a concept of manhood that adds or takes away appreciation for gender equality is an issue for a different piece of writing. What is important here is to reiterate that with our wish to curb the loss of lives due to illegal activities and not the circumcision practice itself, we may do well if we could engage with traditional leaders. This way we would guarantee that we put in place measures that will ensure that only accredited traditional surgeons get to circumcise our youth. This intervention may help a lot of us avoid falling into a view that has ready-made solutions for people’s cultures and traditions, simply because we feel they are “outdated”.




About the Author: Khomotso Ntuli is the founder and facilitator of Bush Dialogues, a dialogue platform that looks at issues around human rights and active citizenship. He can be reached at mmotsodemi(at)gmail.com

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