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Israel To Warn Against Metzitzah Rite in Breakthrough Circumcision Pamphlet

The Health Ministry plans to issue a detailed pamphlet on the medical pros and cons of circumcision, after years of avoiding the issue.

The pamphlet, to be given to all new parents, will advise against the oral suction method (“metzitzah b’peh”) used by some mohels (ritual circumcisers) to draw blood from the wound after the foreskin is cut off. Doctors say this method makes it 3.5 times as likely that the baby will contract herpes.

The document also discusses issues ranging from who is a qualified mohel to how to ease the baby’s pain. It will be distributed by hospitals to new mothers and by well-baby clinics to parents of newborn babies.

Every year, some 70,000 Israeli babies are circumcised, including Muslims (who also sometimes use Jewish mohels). About 70 circumcisions per year result in medical complications, though usually not serious ones. But because circumcision is defined in Israel as a ritual practice rather than a medical one, the health system has long preferred to avoid the issue.

“There’s a lack of uniformity and big information gaps on everything to do with circumcision, a ceremony that usually isn’t performed by medical practitioners, and therefore, this information is relevant to everyone involved in the process, especially parents,” said Prof. Eli Somekh, chairman of the Israel Pediatric Association.

The process of drafting the document has taken years, and representatives of both the medical profession and the Chief Rabbinate were involved.

Prof. Francis Mimouni, chairman of the ministry’s National Council for Pediatrics and Child Health, was one of the people involved in the drafting. He said there were many controversies along the way, and the document still isn’t finalized.

“The document talks about the entire procedure, describing it from start to finish, including advantages and disadvantages, possibilities for anesthesia, easing pain, bandaging, bleeding, complications and more,” he said.

The ministry said the draft is currently being discussed by the national council and the pediatrics association, and once they have agreed on the wording, it will be sent to the rabbinate for comments.

The document was spurred in part by doctors’ fears that babies could get herpes from mohels who use oral suction. According to pediatrics association data, 8.4 Israeli newborns out of every 100,000 get herpes, and 10 percent of these cases result from oral infection by a parent, caregiver or mohel. But the risks of oral suction aren’t well-known outside the medical and religious communities.

In 2002, the Chief Rabbinate announced that if there was a risk of infection, it was religiously permissible to use a sterile tube to draw the blood instead of oral suction. In 2012, the issue hit the news when a criminal investigation was launched in Brooklyn into whether a baby who died of herpes in September 2011 had contracted the disease from a mohel who used oral suction. In 2013, the pediatrics association urged all parents to choose a mohel who doesn’t use oral suction, but it’s not clear how many parents ever heard this warning.

A study conducted among newborns in the Wolfson Medical Center in Holon, which did not include any ultra-Orthodox babies, found that 49 percent of circumcisions involved oral suction, while in another 13 percent of cases the mother had no idea how the circumcision was performed. Somekh said his conclusion from this study was that many secular parents simply aren’t familiar with the details of the ceremony and therefore don’t pay attention to whether or not the mohel uses oral suction.

Though oral suction isn’t recommended, many studies have found that circumcision itself is medically beneficial, as it seems to offer protection against certain diseases. In 2012, for instance, the American Academy of Pediatrics said the medical advantages of the procedure outweighed the risks, and while the advantages weren’t sufficient for it to recommend the procedure for all male newborns, they were certainly sufficient to justify making circumcision available to families who want it.

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