Compare and contrast the attitudes, beliefs and perspectives around a specific health issue amongst two different population groups, and consider the implications of this for clinical or community practice. Introduction A controversial health issue around the world is male circumcision. Male circumcision is the removal of part of or the entire foreskin on the penis and is a controversial topic in many countries and across many different religions. In this essay the beliefs, attitudes and perspectives of South African men will be compared those of Filipino men about medical male circumcision and traditional male circumcision.
Traditional circumcisions are usually performed outside of formal medical settings by providers who have a special training but are not health care professionals. Medical circumcision alternatively is performed by a medical professional in a medical setting. According to the world health organisation (WHO), 30% of men worldwide have been circumcised, mostly in developing countries where it takes place for religious and cultural reasons (World Health Organisation [WHO], 2007a).
Male circumcision is an important issue, especially in South Africa and the Philippines, as third world countries as it can be uses as a partial preventative measure against HIV infection. Description of population groups The two population groups I chose were South African men and Filipino men. I chose South African men as one of my population groups because while studying circumcision I noticed there was a lot of literature on the topic in relation to South Africa and surrounding nations and the effects it has on preventing HIV transmission.
I found this population group interesting because in South Africa even though there is clear benefits in reducing HIV transmission and great publicity around the benefits only 35% of men were circumcised (WHO, 2007a). Furthermore in researching this topic I discovered multiple reasons why men chose to get circumcised, one reason was purely so they weren’t uncircumcised witch I found strange. This was the case in the Philippines, where 90% of all men are circumcised, and most saying there reason for being circumcised was so they weren’t uncircumcised (Lee, 2006).
I found this reasoning interesting and decided to explore this culture for my second population group. If circumcision can reduce the chances of transmitting HIV and other sexually transmitted diseases as well as reduce penile cancer it is important to understand different cultures beliefs and attitudes toward the procedure to encourage circumcision within the culture. It is also good to understand why some cultures have such high rate of circumcision compared to other cultures and countries as it may help develop strategies to promote circumcision countries with lower rates.
South Africa In South Africa 57. 2% of circumcised men had traditional circumcisions and 42. 8% were medically circumcised (Connolly, Simbayi, Shanmugam, & Nqeketo, 2008). Amongst this circumcised population, the majority of the medically circumcised men were white (97. 8%) or Indian (92. 8%), compared with traditional circumcision which was mostly Black South Africans (Connolly et al. , 2008). In South Africa, more specifically within the Black South African community circumcision is done for religious and cultural reasons (Peltzer & Kanta, 2009).
It is seen as a ritual that marks the passage from boyhood to manhood for the adolescent. The process usually requires boys to spend about a month in induction camps in seclusion away from women and outsiders. If they fail there initiation into man hood they are believed to be stuck as a boy for the rest of their life. The ritual is considered by the community as a sacred custom (Peltzer & Kanta, 2009). Traditionally this ritual involved traditional circumcisions and traditional initiation, however more recently some communities have allowed medical circumcision followed by traditional initiation into manhood.
However there is a hostile relationship between men who were traditionally circumcised and men who were medically circumcised. While most men acknowledge medical circumcision is safer and know the benefits it has in helping prevent HIV and sexually transmitted disease, they fear that they will be ridiculed by peers and stigmatised as “cowards” and not viewed as “real men” for having the procedure done under anaesthesia (Peltzer & Kanta, 2009, p. 91). They believe that the pain makes the boys courageous, strong men and is a passage into manhood, where they can have a wife and kids.
Philippines On the other hand, in the Philippines very few men are circumcised for religious or cultural reasons. Boys are usually circumcised between the ages of five and eighteen with most being circumcised between ten and fourteen (Lee, 2006). Most boys report being circumcised just so they are not uncircumcised, to avoid teasing and stigma in the community. Many Filipino men believe women prefer circumcised males, and therefor to be masculine and have a wife and children it is preferable to be circumcised.
Similar to South African beliefs Filipino boys become circumcised because they do not want to be seen as “cowards” for not having the courage to go through the pain and anxiety associated with the process (Lee, 2006, p. 228). Filipino men also report getting circumcised because it was their parent’s orders or they were threatened with a beating if they chose not to or because it was just normal for a boy his age to and his friends were getting it done.
Many men report being nervous for the procedure but excited to achieve the man hood they have anticipated. Most of the Filipino men submit to this social culture because they want to be seen as masculine and not as a coward. It is a social phenomenon, propelled by individuals need to conform and gain acceptance through this procedure by acquiring a range of masculine related traits and opportunities (Lee, 2006). Comparison of population groups
While the two countries have different religions and cultural views, the striking similarity between the two population groups is that they both view the practice of circumcision and the pain and anxiety associated with this process as empowering to the men. Fulfilment of this ritual enhances psycho-social health because it frees them of ridicule and stigma as a “coward” (Lee, 2006, p. 228). Being circumcised means men from both cultures are considered masculine and therefore allows them to carry out tasks that are believed to be masculine such as having a family.
However circumcision in South Africa is seen as a rite of passage and a sacred ritual that allows boys to become me and usually occurs later in life around the age of seventeen to twenty-one but even as late as twenty-six (Mavundla, Netswera, Bottoman, & Toth, 2009). Whereas, in the Philippines the procedure is more of a social trend, done because everyone else is getting it performed. It is also performed much earlier, most commonly between the age of ten and fourteen in the Philippines.
South Africa have a more spiritual and deeper reasoning for having the procedure done, men display a deeper more conscious reasoning for having the procedure compared to Filipino men, who tend to follow the social trend (Mavundla et al. , 2009). With so many Filipino men circumcised (90%) the social trend hold strong and the even with new information about risks and benefits the majority continue to get the procedure done (Lee, 2009), while in South Africa with more information coming out more people are opting for medical circumcision with over 130 000 medical circumcisions being performed in 2010 (WHO, 2011).
There is a growing trend in South Africa to have medical circumcision, whereas in the Philippines the process in considered outside the general realm of medicine and therefore is not performed in medical settings. While they have different culture and beliefs, and go about performing the procedure differently there main motive to be masculine is common amongst both population groups. Conclusion
The advantages associated with being circumcised show great potential to help lower the rates of HIV and sexually transmitted disease in South Africa if more men are circumcised. The cultural transition into manhood is a barrier to overcome as medical circumcision is believed to interfere with this process. If however medical circumcision became more of a social norm as it is viewed in the Philippines, more boys would be inclined to have the procedure to fit in with the rest of the community. The social normality of the process seems to have a greater influence on boy’s preference then cultural or religious reasons, as 90% of Filipino men are circumcised compared to 35% of South African men (Lee, 2006; WHO, 2007a).
Guidelines South Africa: * Conducting community based education and information sessions on the health risks and problems associated with traditional circumcision, and how allowing medical circumcision followed by traditional initiation can reduce these risks. Train more male nurses who can perform the circumcision since most nurses in South Africa are female and boys going through initiation are not allowed contact with women because if they see women during this time they fail there initiation into man hood.
* Understand the community’s rationale for the ritual circumcision and work with the community to find alternative solutions together, and trying to help reduce the stigma associated with men being medically circumcised with alternative ays to prove their strength. Philippines: * Developing circumcision clinics throughout the Philippines where boys can have the procedure performed in proper hygienic conditions. * Giving boys information about the risks and benefits of the procedure so they can more meaningfully decide to have to procedure done * Explain the procedure, and offer pain medication so that boy don’t have to feel so nervous about what is happening and have a better understanding of what going to happen.