Interview about Circumcision: Not the Whole Story

Less than two months ago, Ronald Goldman called to complain that NPR "always" adopts a pro-male circumcision stance in its coverage.

The words "NPR always" or "NPR never" always give me pause. It's far more helpful and credible to provide specific examples, rather than offering vague impressions, particularly concerning a subject one feels strongly about.

I thanked Goldman and suggested he contact me again when he found a case in point.

It didn't take long.

Goldman is director of the Boston Circumcision Resource Center, which advocates against circumcising males, arguing there are no health benefits, it's painful and it causes medical and psychological harm.

On Aug. 22, NPR's Weekend All Things Considered ran a story showing circumcision rates are falling fast in the United States. It was based on an Aug. 5, federal research report that hospital circumcision rates had dropped from 56 percent in 2006 to less than a third last year. (The study didn't include religious circumcisions.)

To cover the story, Weekend All Things Considered decided to have substitute host Audie Cornish interview Dr. Douglas Diekema, a pediatrics bioethicist at the University of Washington.

"When the news came out about this startling drop in circumcisions, our intention was to find someone who wasn't a partisan—someone who could present both sides," said Rick Holter," the top editor on the weekend show. "So we decided to go with a bioethicist. And that's how we settled on Dr. Diekema."

Diekema, however, on air didn't turn out to be the non-partisan they intended.

When Cornish asked him why people opposed circumcision, Diekema replied:

"Their arguments are largely emotional. I mean, just the fact that they insist on referring to this as genital mutilation tells you that they're refusing to recognize whether there may be any medical benefit to the procedure. Their use of that term is intentional. I think they're trying to make a point that if its' wrong on girls, it's wrong on boys. But there are some significant differences with boys - the most important of which is that there are, in fact, some proven medical benefits to circumcision.

There is a fairly substantial, important reduction in the risk of contracting many sexually transmitted infections. In newborns, there is a decreased likelihood of getting a urinary tract infection, which for a newborn baby can be a fairly significant illness. It's much different than when an adult gets a urinary tract infection.

And of course, the one most people are now familiar with is that at least three very well-done, randomized control trials in Africa show that in Africa, there's a substantial decrease in the transmission of HIV.

The story prompted phone calls, emails and 253 comments on npr.org.

The debate —and there clearly is one — centers on two strongly differing beliefs about whether circumcision for a baby boy is medically necessary. One side believes that circumcision prevents disease and promotes cleanliness. The other believes that disease prevention is a red herring that is used to perpetuate a social custom and that the lack of circumcision rarely leads to disease.

Listeners did not get both sides of the controversy in this interview.

Diekema also incorrectly said that circumcision opponents regularly use the term "genital mutilation" when referring to the practice. Goldman's website lists over a dozen links about circumcision, but not one uses the term "genital mutilation," a term more commonly used for what is done to young girls, particularly in some cultures.

"There's no balance to this report," said Goldman. "There are plenty of reputable people who can fill in the blanks which Dr. Diekema continues to ignore. I would hope in future stories, NPR would include a perspective to describe the harm. Europeans think we are crazy and they don't have any particular health problems. The U.S. is the only country in the world that circumcises to the degree that we do for non-religious reasons."

["According to Kidshealth.org, approximately 55% to 65% of all newborn boys are circumcised in the United States each year, though this rate varies by region (western states have the lowest rates and the north central region has the highest). The procedure is much more widespread in the United States, Canada, and the Middle East than in Asia, South America, Central America, and most of Europe, where it's uncommon."]

NPR editor Holter said Cornish spoke with Diekema for 20 minutes, but the final taped interview was pared down for time reasons.

"Diekema actually did an okay job of presenting both sides during the 20 minutes or so Audie talked to him," said Holter, "but we didn't cut [edit] it in as balanced a way as we could and should have in the four minutes we had allotted for the story. Also, it became clear that he had a definite opinion and we probably should've either cut it differently or sought another voice."

Either option would have been preferable and provided more balance and context.

There was another problem as well. Circumcision opponents are sometimes referred to as "intactivists." Cornish mentioned this and both she (mostly) and Diekema giggled at the reference, which furthered the perception that NPR may think opposition to this medical procedure is silly.

Male circumcision has always been controversial, and that places an extra burden on NPR to treat the subject fairly and give equal weight to both sides. NPR could remedy what this story failed to do by posting Diekema's full interview, or letting a circumcision opponent write an essay for the Opinion Page that NPR could link to the original story.


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