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Saturday, April 19, 2014

Neonatal Male Circumcision and South African Health Law

A close reading of the Children's Act indicates that it does not prohibit elective neonatal medical male circumcision for medical reasons, and providing all informed consent requirements are met by obtaining consent from the parent or guardian of a newly born boy prior to performing a neonatal male circumcision, the procedure may be carried out.
Section 12 (8) of the children's act regulates circumcision of male children under 16. It states in full:
8 Circumcision of male children under the age of 16 is prohibited, except when –
  1. circumcision is performed for religious purposes in accordance with the practices of the religion concerned and in the manner prescribed; or
  2. Circumcision is performed for medical reasons on the recommendation of a medical practitioner.
The key term here would appear to be “medical reasons”'. The children's act does not provide a definition of medical reasons. Bearing in mind local and international studies that have shown that male circumcision significantly reduces the risks of HIV infection, and that neonatal circumcision carries far lower risks of complications than circumcision in later life, a reasonable practitioner would have sufficient  “ medical reason” to perform circumcision.
As with any medical/surgical procedure informed consent is essential. For infants, consent is governed by sections 6-8 of the National Health Act [1]and section 129 of the children's act:
129 Consent to medical treatment and surgical operation
1.     Subject to section 5(2) of the Choice on Termination of Pregnancy Act, 1996 (Act 92 of 1996), a child may be subjected to medical treatment or a surgical operation only if consent for such treatment or operation has been given in terms of either subsection (2), (3), (4), (5), (6) or (7).
. . .
5.     The parent or guardian of a child may, subject to section 31, consent to a surgical operation on the child if the child is –
a.      under the age of 12 years; or
b.     over that age but is of insufficient maturity or is unable to understand the benefits, risks and social implications of the operation.

In order to obtain informed consent, the practitioner needs to explain the risks of complications as well as the potential benefits of circumcision.

Bearing the above in mind, the Children's Act does not prohibit male circumcision for medical reasons.

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