Scientific Advice, Traditional Practices and the Politics of Health-Care : The Australian Debate over Public Funding of Non-Therapeutic Circumcision, 1985

Abstract

ustralia is unusual among comparable developed nations in providing automatic coverage for non-therapeutic circumcision of male infants and boys through a nationally funded health insurance system. This is despite at least one attempt to drop circumcision from the schedule of benefits payable under the scheme (now known as Medicare), and it is surprising given that relevant health authorities have repeatedly stated (1971, 1983, 1996, 2002, 2004 and 2010) that ‘routine’ circumcision has no valid medical indication and should not generally be performed. Since public hospitals in most states do not provide the surgery, it has become the province of private hospitals, general practitioners and, in recent years, specialist clinics, whose activities are subsidised through Medicare. Australian practice is thus very different from that in comparable countries. In New Zealand the government health service has never funded circumcision; and in Canada it is funded only in the province of Manitoba. Even in the United States, where policy on Medicaid coverage is also the responsibility of the states, 17 out of the 50 have dropped circumcision from the list of free procedures, and more are likely to do so as fiscal constraints intensify. The British National Health Service has traditionally not covered non-therapeutic circumcision, though in recent times has come under pressure from Muslim and some African immigrant groups, who argue that publicly funded circumcision of their male children is essential to prevent parents from resorting to the services of incompetent operators. In some areas local authorities do perform the operation as a free service, but the question is unsettled and the focus of controversy. In predominantly Muslim countries, where circumcision is performed as a customary or religious ritual, the state does not fund