







































MALE CIRCUMCISION IN INDIA: SOME CONSIDERATIONS FROM THE WEST


Bangladesh Journal of Bioethics 2013; 4(1):2-8 

 2 

 
MALE CIRCUMCISION IN INDIA: SOME CONSIDERATIONS FROM THE WEST 
  
 
Mirko Daniel Garasic 
 
Centre for Human Bioethics, Monash University, Melbourne, Australia and 
Center for Ethics and Global Politics, LUISS University, Rome, Italy 
Email: mirko.garasic@monash.edu; mgarasic@luiss.it 
 
 
ABSTRACT: In this work, I will analyse why Indian authorities find it so difficult to publicly 
acknowledge the medical benefits of Male Circumcision (MC).  In doing so, the medical evidence 
in favour of the practice, as well as the moral duties that governing authorities have towards their 
citizens shall be taken to the fore. In addition to this argument, a brief explanation of the cultural 
dimension that refuses to evaluate the medical dimension of MC a priori shall be taken into 
account and, in relation to that, a parallel with the past and present Western tradition will be drawn, 
putting forward the conclusion that both contexts do not provide satisfactory justification for 
banning MC nor more relevantly for the Indian scenario can any cultural background represent a 
convincing argument against the public acknowledgement of the medical advantages provided by 
MC. 
  
Key words: Anti-Semitism, HIV, India, Informed Consent, Islamophobia, Male Circumcision, Public 
Policies, STDs   
 
 
INTRODUCTION: The intention of this work is to point out how -in India as well as in a growing 
number of Western countries the hostility against the implementation of Male Circumcision (MC 
henceforth) is not based on medical evidence but rather on religious and cultural grounds. Despite 
the fact that in recent years plenty has been written on the therapeutic value of MC to contrast, 
among others Sexually Transmittable Diseases (STDs), HIV/AIDS

1
 an increasingly worrying 

shadow in Indian society, the practice still finds very little support from the Indian medical 
community. However, as rightly pointed out by Chandhiok and Gangakhedkar in their article “The 
New Evidence on Male Circumcision: An Indian Perspective”,

2
 at the moment the number of Indian 

citizens affected by the HIV virus is relatively low, but, it is reasonable to believe that, if not 
properly contrasted at this early stage, the number will multiply exponentially in the coming 
decades, resulting in a damaging impact not only for the sufferers of the illness and their families 
but also for Indian society as a whole, as this will increase the costs for the Health Care System 
dealing with HIV/AIDS. There is reasonable ground to believe that implementing MC would help 
reducing the risk of a future epidemic in India and, as a recent study underlined,

3
 the disclosure of 

the beneficial feature of MC could indeed increase the level of awareness among people and their 
willingness to adopt such a practice also on nonreligious grounds.  
   
In this work, I will analyse why Indian authorities find it so difficult to publicly acknowledge the 
medical benefits of MC.

4
 In doing so, the medical evidence in favour of the practice, as well as the 

moral duties that governing authorities have towards their citizens shall be taken to the fore. In 
addition to this argument, a brief explanation of the cultural dimension that refuses to evaluate the 
medical dimension of MC a priori shall be taken into account and, in relation to that, a parallel with 
the past and present Western tradition will be drawn, putting forward the conclusion that both 
contexts do not provide satisfactory justification for banning MC nor -more relevantly for the Indian 
scenario- can any cultural background represent a convincing argument against the public 
acknowledgement of the medical advantages provided by MC. 
  
 
POLITICAL UNCERTAINTIES REGARDING MC IN INDIA: IS IT JUSTIFIABLE? In the past 
decade, particularly in Sub-Saharan Africa, MC has been implemented by the local governments 
as an additional measure to prevent the ever-growing number of cases of HIV/AIDS. Policies have 
been used to raise awareness among adult males to undergo the surgical operation for the love of 
their dear ones and their community and the results of these campaigns have been fairly 
encouraging.

5
 Despite this global trend to affirm the medical legitimacy for the establishment, once 

mailto:mirko.garasic@monash.edu
mailto:mgarasic@luiss.it


Bangladesh Journal of Bioethics 2013; 4(1):2-8 

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and for all, of MC as an indisputable form of prevention for one of the most affecting illness in Non-
Western countries, India remains contrary to a public acknowledgement of the constantly 
increasing data that supports the carrying out of MC as a valid form of prevention against 
HIV/AIDS. In fact, as pointed out by Madhivanan and Krupp,  
  
“the Government of India has been reluctant to approach an issue that promises to be 
controversial among conservative Hindus.

6
 It has been suggested that at times, circumcision 

status may even have been used to identify people’s religious affiliation during communal riots.
7
 

Popular wisdom holds that even the mention of MC in some communities will trigger sectarian 
violence. Predictably, some opponents have argued that the greater good of society must be 
protected by withholding information about MC from the population.”

8
  

  
It seems that the Hindus -be it for their political presence (Hinduism is the most prominent religion 
in India) or for their strong historical clash with Islam- are the one group that has raised more 
problems against the adoption of MC as a preventive tool against HIV 

9, 9a 
. For example Kounteya 

Sinha writes: 
  
“Sometime back, when executive director of Geneva-based Global Fund to fight AIDS, Richard 
Feachem, made a statement in Paris that he expected the epidemic to grow faster among Hindus 
because they didn't practise circumcision, he received thousands of hate mails from the Hindu 
community”.

10
  

  
This attitude towards the possible implementation of a procedure that could benefit Indian citizens‟ 
health remains deeply controversial and raises many points that need attention. Due to a lack of 
space, in this work I will not be able to cover all of them, but I shall instead focus only on three of 
them. 
 
The first point underlines the moral duty of authorities. They must do anything in their power to 
avoid the suffering of people and the spreading of the disease. After all, as rightly pointed out by 
Prabhakara in his book Professional Medical Ethics, it should never be forgotten that:  
  
“No groups of individuals should be discriminated in the context of HIV/AIDS.”  
  
And also:  
  
“All individuals and all communities should have availability of information necessary to make good 
and necessary decisions about their health including how to avoid HIV infection.”

11 
  

  
In this light, it would be reasonable to affirm that it is the duty of the authorities (in the specific case 
Indian authorities) to at least acknowledge publicly the preventive value of MC against the 
spreading of HIV. Only once ensured a satisfactory level of awareness among the population, it 
would be possible to consider the decision of the parents or the single individual to undergo -or 
not- the MC procedure as a proper informed choice. 
 
The second point would focus on the traditional Indian non-individualistic perspective in Medical 
Ethics. In his article “Medical ethics in India: ancient and modern”, Francis highlights 
how according to the Vedas (4000 BC to 1000 BC), the call to love your neighbour as yourself is 
  
“because thy neighbour is in truth thy very self and what separates you from him is mere illusion.”

12
 

  
This acknowledgement should perhaps push us to put aside the centrality of autonomy as used in 
Western context by some authors

13
 to justify their prejudice against MC. On the contrary, we might 

be inclined to give relevance to the common outcome of the implementation of MC: allowing 
individuals to undergo the surgery would benefit any member of the Indian society despite his 
religious background (be it Hindu, Muslim, Sikh, and Buddhist, Jewish or of any other faith and 
belief), significantly cutting down costs and -most importantly- risks. Thus, once accepted the 
medical value of MC, it could be argued that, in some sense, this precautionary intervention is 
implicitly encouraged in Indian tradition. 
 
The third and final point would focus on the contrasting attitude that mothers have towards MC 



Bangladesh Journal of Bioethics 2013; 4(1):2-8 

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after having been isolated from that very political indoctrination that deprives them from the 
exposure to the medical benefits of the practice. It is interesting to note that, in a recent study 
conducted in India,

14
 it was shown that, even in a low educated, prevalent non-Muslim community, 

once having received a proper explanation of the practice -including the advantages produced by 
MC and its correlated STDs risk avoidance- the vast majority of mothers (81%) were inclined to 
make their children undergo the operation. Only 1% of the interviewed women were still against 
MC in a convinced way. These are, quite clearly, neat numbers over the importance of informing 
the population on the medical impact of MC but, unfortunately, a more in-depth examination of 
these data goes beyond the scope of this paper. However, I would like to put forward, for what it 
counts, a parallel interpretation of those numbers through an analysis of why the male community 
might be more reluctant to accept the practice. 
 
There is little doubt that -from a strictly physical point of view- fathers share with their sons the very 
part of the body subject to the potential operation, and, as a result, it is understandable to see why 
a father could perceive MC as a way of spacing out himself from his child. After all, the same logic 
(with the reversed argument) is used by the defenders of MC. In addition to the subjective 
perception though, males also do not want to feel the social pressure to be the direct cause for 
change to take place within the community at large. In other words, they do not want to be labeled 
the weak link of the tradition by allowing their own son to undergo an operation that will make the 
child somehow more detached from his ancestors -at least in pure physical terms. Females on the 
contrary, do not undergo this psychological challenge, and thus mothers have a more detached 
and objective view on the medical factors that should indeed be considered for the benefit of the 
individual child as well as the community as a whole. 
  
 
CULTURAL IMPEDIMENTS FOR MC IN INDIA: Despite the considerations highlighted above, in 
the Indian context the main critique moved against the implementation of MC as a therapeutic tool 
capable to avoid the spreading of HIV especially in poorer and less educated contexts- would 
affirm that the problem with this solution is related to its “cultural” threat.

 15
 The defenders of this 

position would argue that by applying MC to all the new borns in India, this will end up undermining 
the cultural identity of the non-Muslims (or non-Jews) Indians. This assertion gives rise to two 
points worthy of consideration: the first point concerns the fact that -differently from the 
acknowledgements reported in this work- the focus of MC is strictly related only to the Muslim 
identity. However, this is a strongly distorted (and scientifically inaccurate) way of categorising and 
defining the practice. I believe that it is so for political reasons that want to prevent the introduction 
of the practice by focusing on the “prevail of the Muslim cause”, initiating in this way a fear in the 
Hindu majority in the country. What could perhaps function as a good viaticum against this fear, 
could be the parallel acknowledgement of the practice as part of the Judaic tradition as well as -
even if in a very limited way- of Christianity.  
 
The second point would make us question to what extent is it possible to assert that the 
implementation of certain features not implicitly prescribed by one culture, can be considered to be 
a way of affirming a loss of one‟s culture instead of a restructure in accordance to more recent 
changes. Today‟s India represents -with its increasingly important visibility and impact at global 
level- an example for many. In this age of confusion and tendency to close up against „the others‟ -
in Europe as anywhere else in the world- India's status of the biggest democracy in the world could 
well function as a way forward for the hopes of humanity. Having the courage to live its 
multiculturalism to the fullest, India‟s politicians should have the strength to implement a policy on 
MC that will pass on the message that India is capable of acting in the best interest of all its 
citizens despite their religious, cultural or ethnical backgrounds. 
  
 
SOME PARALLELISM WITH THE WEST: In relation to the “cultural” aspect behind the refusal of 
a mass-implementation of MC in India, it would probably be interesting to note the different 
treatment that the practice has had in a culturally different setting. In the specific, I shall briefly 
describe the historical attitude towards MC in Europe, and the contemporary stand that the 
Western world has in relation to it; especially in the framework of rising intolerance towards “the 
different” that currently governs Europe. This parallelism of course shall not function as a form of 
enlightenment for the Indian situation, but rather, it should help us putting this delicate debate in a 
wider and more global context. 



Bangladesh Journal of Bioethics 2013; 4(1):2-8 

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In hardcore fortresses of Roman Catholicism such as Italy or Spain -places where the persecution 
of Jews (and in a more limited way that of Muslims) has had a long history based on religious 
grounds MC has never been encouraged and, only recently, it became tolerated. With the 
awareness that ostracism against the different, the other has been a sad but true constant in 
human history in different times and places, it is reasonable to think that, as in the case of Muslims 
in India, ensuring that the procedure was performed “only” by Jewish individuals was a very 
practical way to quickly recognise the Jew from the Christian when some discriminatory practice 
be it expulsion or mockery- had to take place. 
 
The stigmatisation of the Jewish traditional MC (brit milah) has -among its numerous 
representatives- Justin of Caesarea, a deeply influential figure as a martyr and one of the Fathers 
of the Church. In line with a gradual and often intentional- detachment from Judaism that 
Christianity has increasingly undergone after the death of all its [at least] Jewish born founding 
forefathers, in his Dialogue with Triphone,

16
 he attacks the Jewish MC by contra posing the 

physically circumcised people (the Jews) with the spiritually circumcised ones (the Christians).
17

 In 
a way thus, it could be argued that MC was indeed needed in Europe, but only in order to remind 
Christians to be -in the eyes of some of them- the evolution of an updated creed. In line with the 
intention of not wanting MC to become a popular practice among Christians, since the Middle Ages 
it gained ground in Europe the belief -thanks to the well-fed anti-Judaic paranoia supported, fed 
and spread by the Church- that the Jews needed to sacrifice Christians regularly in order to 
(besides other nonsensical arguments still recycled in nowadays‟ versions of anti-Semitism) stop 
haemorrhages caused by the brit milah.

 18
 This intolerant approach to MC reached its peak when 

the Roman Catholic Church decided to ban it and make it a mortal sin that would result in “loss of 
eternal salvation”.

19
 

 
However, within Western countries where the influence of Roman Catholicism was not as strong 

(particularly in the USA and Australia), towards the end of the 19th Century the practice of MC 
became increasingly common reaching its peak in the 60‟s.

20
 This was due to a number of pseudo-

scientific beliefs concerning MC that ranged from the imaginative claim that it helped prevent 
masturbation (a huge taboo in the Victorian era)

21
, 

21a 
to the more accurate belief that MC had 

hygienic value. Of course not everyone within the Christian-directed Western societies was ready 
to give in to the idea that „dirty‟ people such as the Jews or the Muslims could be systematically -
and convincingly- be practising an hygienic ritual.

22
 Since the 70‟s however, the percentage of MC 

in Australia has dropped significantly,
23

 while the drastic increase of the number of circumcised 
males in Europe -due to the wave of Muslims immigrants- has opened the door to new forms of 
discrimination inexplicitly claiming to preserve the “purity” of the European value through a misuse 
of the notion of rights and autonomy. As a result, in more recent years, MC has gradually come 
under attack as a mere mythological feature that, in truth, does not rely on any medical evidence to 
justify its implementation.

24
 Most notably, the attempted ballot in San Francisco aimed at fully 

outlawing infant MC as well as the temporary dis-allowance for the practice in Germany last 
June,

25
 showed how vivid is this trend. Despite the lack of credibility of such an accusation, this 

“pseudo-cultural” battle has managed somehow to undermine the medical evidence of the efficacy 
of MC as a preventive measure against HIV, contributing most probably to the drastic drop of 
toleration and practice of MC in Western countries.  
  
 
CONCLUSION: To conclude, this paper has drawn a parallel between the East and the West in 
relation to a millenary procedure such as MC. It did so, with the intention of underlining that, what 
is common between all those positions intolerant to MC in both India and the West is their need to 
deal only approximately with the medical evidence that the practice carries with it. On the one 
hand, Indian authorities are sceptical over officially affirming that MC can function as a reliable, 
medically proven preventive against the spreading of deadly illnesses STDs more in general and 
HIV/AIDS more specifically for their fear of the cultural impact that such a claim could produce. On 
the other hand, some of the most fervent attackers of the legitimacy of MC in the Western world 
also (but not as explicitly of course) use a bias “cultural-meter” to affirm that MC is against the 
rights of children for example although forgetting to apply the same principle of uncompromisingly 
preserve the physical integrity of the child in widely accepted comparable practices such as ear-
piercing or vaccination. It seems obvious thus, that these attacks have as their ultimate aim that to 
de-legitimise the non-Christian traditions by redefining “Western values” as only and purely 



Bangladesh Journal of Bioethics 2013; 4(1):2-8 

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ascribable to the Christian rituals.  
  
This commonality between the two situations, with all their unconvincing justifications for not 
accepting MC, should lead us to affirm with no hesitation that given the continuously growing 
medical evidence that shows the direct and indirect advantages produced by having a circumcised 
male population MC should at least be tolerated if not encouraged. Cultural differences cannot be 
considered as a sufficient justification when the health of the population is at stake, and for this 
reason it seems sensible to affirm that (even if the spreading of such news could produce some 
tension) Indian authorities should not delay any further the communication of the MC‟s proven 
benefits to the public. After all, this very delicate issue is related to the health of the whole 
population and therefore, the resulting discussion over its legitimacy should put forward the 
medico-ethical point of view of a nation. In order for such an opinion to be democratically 
expressed, however, the population needs to be given the scientific data. Only in this scenario we 
would be talking about a truly informed choice on the matter.  
 
Surely the topic is sensitive and some politically related problems might arise from the disclosure 
of the medical evidence related to MC. However, if some protests might occur as a result of this 
political decision, the competent political authorities will have to face it and deal with it only as a 
political problem, because the potential political impact of the revelation of the medical evidence 
highlighted in this work cannot represent a sufficient reason to refrain from communicating vital 
information to the Indian people, who deserves to know all the available data to then be able to 
truly make a free and competent choice with their lives. Thus, the Indian Government may inform 
the public of benefits of MC and give the public an option for it. 
  
  
 
REFERENCES: 
 

                                                 
1. WHO and JOINT UN PROGRAM ON HIV/AIDS. Male Circumcision: Global Trends and 

Determinants of Prevalence, Safety and Responsibility. (December 2007) Report. Available at: 

 http://whqlibdoc.who.int/publications/2007/978924156169 eng.pdf 

 

2. Chandhiok N and Gangakhedkarb R. The New Evidence on Male Circumcision: An Indian 

Perspective, Reproductive Health Matters 2007, 15& 29: 53. 

 

3. Dandona L, Dandona R, Kumar GA, Brahmananda GR, Abdul AM, Mushtaq GA, Ramgopal 

SP, Akbar M, Sudha T and Lakshmi V. Risk factors associated with HIV in a population-based 

study in Andhra Pradesh state of India. International Journal of Epidemiology 2008, 1-13. 

 

4. Circumcision: It suits Hindus also, available at:  

http://articles.timesofindia.indiatimes.com/2005-08-04/india/27843351_1_circumcised-men-hiv-

rates-richard-feachem 

 

5. Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, 

Uganda: a randomized trial. The Lancet 2007, 369: 657-666. 

 

6. It is important to point out that, even if in a less harsh and direct way until now, Sikhism has an 

even higher potential of resistance towards MC on religious ground. In fact, while Hindu’s sacred 

tests do not explicitly ban the practice of MC, in the Guru Granth Sahib, an explicit restriction 

against it is written. Available at: 

http://www.srigranth.org/servlet/gurbani.gurbaniAction=Page&Param=477&english=t&id=21608#

l21608. 

In particular p.140 and p.477.  

 

7. Chandhiok N and Gangakhedkarb R, Op. Cit. 

 

http://whqlibdoc.who.int/publications/2007/978924156169%20eng.pdf
http://articles.timesofindia.indiatimes.com/2005-08-04/india/27843351_1_circumcised-men-hiv-rates-richard-feachem
http://articles.timesofindia.indiatimes.com/2005-08-04/india/27843351_1_circumcised-men-hiv-rates-richard-feachem
http://www.srigranth.org/servlet/gurbani.gurbaniAction=Page&Param=477&english=t&id=21608#l21608
http://www.srigranth.org/servlet/gurbani.gurbaniAction=Page&Param=477&english=t&id=21608#l21608


Bangladesh Journal of Bioethics 2013; 4(1):2-8 

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8. Madhivanan P and Krupp K. Doesn’t the public have the right to know that male circumcision 

protects against HIV?  Indian Journal of Medical Ethics 2009, 6(1):5. 

 

9. Moses S, Bailey RC and Ronald AR. Male circumcision: assessment of health benefits and 

risks. Sex Transm Infect 1998, 74: 368-373.  

 

9a. Castellsagué X, Xavier Bosch F, Muñoz N, Meijer CJLM, Shah KS, Silvia de Sanjosé S, Eluf-

Neto J, Ngelangel CA, Chichareon S, Smith JS, Herrero R, Moreno V and Franceschi S. Male 

Circumcision, Penile Human Papillomavirus Infection, and Cervical Cancer in Female Partners. N 

Engl J Med, 346(15): 1105-1112. 

 

10. See for example: Circumcision can control AIDS, but is India ready?, available at: 

http://timesofindia.indiatimes.com/NEWS/India/Circumcision_can_control_AIDS_but_is_India_re

ady/articleshow/msid-1670374,curpg-1.cms 

 

11. Prabhakara GN. Professional Medical Ethics. Paras Medical Publications 2006, 195.  

 

12. Francis CM. Medical ethics in India: ancient and modern. Indian Journal of Medical Ethics, 

selected readings 1993-2003, November 2005, p.17. 

 

13. Hellsten SK. Rationalising circumcision: from tradition to fashion, from public health to 

individual freedom. J Med Ethics 2004, 30:248-253. 

 

14. Madhivanana P, Krupp K, Chandrasekaranb V, Karatc SC, Reingolda AL and Klausner JD. 

Acceptability of male circumcision among mothers with male children in Mysore, India. AIDS 

2008, 22: 983-988. 

 

15. See note 2 above. 

 

16. Justin Martyr, Dialogue with Trypho. In particular, Chapters 16 and 19. Available at: 

http://www.ccel.org/ccel/schaff/anf01.toc.html 

 

17. I will not be able to analyse this aspect further here, but it is interesting to note the escamotage 

that Justin found in order to preserve a continuity with the past of Christianity -Judaism- and yet be 

able to detach itself from it in the most productive way in terms of guaranteeing a neat separation: 

by accusing the rest of not being following God’s will anymore. For more information on the 

subject see among others: Livesey NE, Theological Identity Making: Justin’s Use of Circumcision 

to Create Jews and Christians, Journal of Early Christian Studies 2010, 18(1):51-79. 

 

18. Böner K (ed.) Ausserlesene Bedenken der theologischen Facultät zu Leipzig, Leipzig, 1751. I 

have used the italian version: Parere della facoltà teologica di Lipsia dell’8 maggio 1714, L’Eco 

dei Tribunali: XIII Supplemento al Rovigo, 1856, n. 461, p.53. 

 

19. Ecumenical Council of Florence (1438-1445) Available at: 

http://www.ewtn.com/library/councils/Florence.htm#5. “Therefore it strictly orders all who glory 

in the name of Christian, not to practise circumcision either before or after baptism, since whether 

or not they place their hope in it, it cannot possibly be observed without loss of eternal salvation.” 

 

20. King PA, Caddy GM, Cohen SH, et al. Circumcision-maternal attributes. Pediatr Surg Int1989, 

4:222-226. 

 

21. Hodges FM. The history of phimosis from antiquity to the present. In: Denniston GC, Hodges 

FM, Milo MF, eds. Male and female circumcision: medical, legal and ethical considerations in 

pediatric practice. New York: Kluwer Academic, 1999, p.37-49. 

http://timesofindia.indiatimes.com/NEWS/India/Circumcision_can_control_AIDS_but_is_India_ready/articleshow/msid-1670374,curpg-1.cms
http://timesofindia.indiatimes.com/NEWS/India/Circumcision_can_control_AIDS_but_is_India_ready/articleshow/msid-1670374,curpg-1.cms
http://www.ccel.org/ccel/schaff/anf01.toc.html


Bangladesh Journal of Bioethics 2013; 4(1):2-8 

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21a. Miller GP. Circumcision: cultural-legal analysis, Virginia Journal of Social Policy and the 

Law, 9, 2002, p.497-585. 

 

22. Among the supporters of such a view there was Herbert Spencer who, in relation to the hygiene 

argument wrote that: “while the usage does not prevail among the most cleanly races in the world, 

it is common among the most uncleanly races.” Principles of sociology, 1, Westport, Connecticut, 

Greenwood press, 1975, p.67. 

 

23. Hutson JM. Circumcision: a surgeon’s perspective. J Med Ethics 2004, 30: 238. 

 

24. DeLaet DL. Framing Male Circumcision as a Human Rights Issue? Contributions to the 

Debate over the Universality of Human Rights. Journal of Human Rights 2009, 8: 405-426. 

 

25. Germany to introduce circumcision law, 

http://www.guardian.co.uk/world/2012/oct/05/germany-introduce-circumcison-law 

 

http://www.guardian.co.uk/world/2012/oct/05/germany-introduce-circumcison-law

