The Yale Journal for Humanities in Medicine

III. Khitan (Circumcision):

A Helpful Practice Against AIDS and Other STDs

          As far as the health and the well-being of child are concerned, we found that one of the religious and commonly practiced among Muslim families, after the birth of the child, which is considered as the important means to preserve man’s health, is circumcision (khitan); the removal of the foreskin or loose sleeve of skin covering the end of the penis so as to permanently expose the glans (or knob).[28] Besides, khitan is described in the hadith as being “according to nature (al-fitrah)”, Islam considers this practice as one of the great traditions inherited from our honorable Prophet Ibrahim, peace be upon him, who circumcised himself.[29] Emphasis on this practice, we were reported in many traditions that during the time of Prophet Muhammad (s.a.w), khitan was performed on boys simultaneously with their ‘aqiqah.[30] Of course, if necessary, circumcision may be delayed, however, it should be done before puberty for the purpose of health measurement as well as taharah (cleanliness). In relation to taharah, which is considered an important factor for human health,[31] Islamic law (shari‘ah) rules that Muslims have to wash with water to remove what is impure (najas); otherwise wudu’ and salah are not acceptable. In this regard, circumcision is considered as important means for bodily cleanliness. It has been proved that when the foreskin is not removed or being only partially removed, urine and other ejections can accumulate under the folken skin. This area can be infected due to accumulation of germs or bacteria. Thus, the minor operation of circumcision greatly simplifies basic hygiene for children.

In regards to female circumcision, the hadith does not clarify clearly whether female circumcision is obligatory or not. However, according to Shafi‘i’s school of law, khitan is compulsory for both males and females.[32] They supported their views from the hadith: “Fitrah (that is, the pure, correct human nature) are five: circumcision, shaving the pubic hair, trimming the moustache, clipping the nails, and removing the underarm hair.”[33] Imam al-Nawawi, the follower of Madhhab Shafi`i, while mentioning this hadith in his Sahih Muslim bi Sharh al-Nawawi, comments that circumcision is obligatory (wajib) according to al-Shafi`i and many of the Muslim scholars. On the other hand, it is sunnah (recommendable) according to Malik and the majority of them. It is further, according to al-Shafi`i, equally obligatory for males and females. As regards males, it is obligatory to cut off the whole skin which covers the glans, so that this latter is wholly denudated (al-hashfah). As regard females, it is obligatory to cut off a small part of the skin in the highest part of the genitals. The sound (sahih) view, according to our madhhab, which is shared by the large majority of our scholars, is that circumcision is permissible (ja’z), but not obligatory in a youthful age (hal al-sighar), and one of special views is that wali is obliged to have the child circumcised before it reaches the adult age. Another special view is, that it is prohibited to circumcise a child before its tenth year. The sound view according to us, is that circumcision on seventh day after birth is mustahabb.[34]

It is clear from the above discussion that Islam strongly recommends Muslims to perform circumcision. Nevertheless, performing circumcision among Muslim families is not only as a result of following the practice of Prophet Muhammad (s.w.s), believing him to be, as the Qur’an says, sent as a healing and a mercy to mankind, but also as a result of their belief that it is the most easiest method to prevent HIV infection as well as other sexually transmitted diseases (STDs). At the time when governments, national and international institutions spend huge sums of money on research with the aim of finding cures, they are advised to encourage people to perform circumcision to prevent HIV infection as well as other sexually transmitted diseases.[35] In one of the important studies conducted by the Islamic Medical Association of South Africa, was found that AIDS is less spread among African tribes, which observe male circumcision in comparison to tribes in which circumcision is not performed. This fact is not only applied to the Muslims in Africa who strictly observe male circumcision, but there is evidence of the fact that even among non-Muslim African tribes, circumcision proves its value with respect to HIV infection. For example, it was found that the African Xhosa tribe, in which male circumcision is an observed practice, has less spread of AIDS than that of the Zulus, who do not circumcise. Both tribes are not Muslim, and they live in similar environmental conditions.[36]

          Again, the study had been conducted in Uganda upon the couples living in similar environmental conditions. The study found that in many cases the woman was HIV positive and her male partner was not. Surprisingly enough, no new infections occurred among any of the 50 circumcised men over 30 months, whereas 40 of 137 uncircumcised men became infected during this time. Both groups had been given free access to HIV testing, intensive instruction about preventing infection, and free condoms but 89% of the men never used condoms and condom use did not seem to influence the rate of transmission of HIV. This leads the researchers to conclude that male circumcision has contributed effectively towards the prevention of HIV infection.[37] Furthermore, in an interesting scientific study entitled “Circumcision lowers Risk of cervical cancer” which was published in The New England Journal of medicine, proves beyond any doubt the role of performing circumcision to prevent from the risk of cervical cancer. As the title suggested, women whom sexual partners are circumcised are less to develop cervical cancer than the partners of uncircumcised men. In this article, the researcher had studied 1,913 couples in five countries and they were married and had in a stable relationship. After carefully counting the number of sexual intercourse between the partners, the researcher found that circumcision minimizes the area of the penis vulnerable to Human Papilloma Virus (HPV) infection that helps to reduce the risk of cervical cancer. The finding also shows that partners of circumcised men were about 25% less likely to have cervical cancer than partners of uncircumcised men, while among women in relationship with circumcised men were 80% less likely to have cervical cancer. [38]

Conclusion

The above study reveals to us that Islamic family law (al-Qanun al-Ahwal al-Shaksiyyah) plays an important role in imposing the parent to fulfill the rights of the children most notably the rights of rada‘ (suckling), hadanah (custody) and khitan (circumcision), which play an important role in preserving the health and the well-being of children. In regard to male circumcision, which is, no doubt, an important means to prevent people from sexually transmitted diseases (STDs) in general and AIDS in particular, Islamic family law takes reasonable and preventive measure by suggesting that male circumcision should be performed as early as possible, as commanded by Prophet Muhammad (s.a.w) that khitan should be performed simultaneously with the ‘aqiqah of child. This command can be considered as preventive measure because the performance of circumcision before puberty would be the most suitable and effective measure for reducing HIV transmission since after puberty many young men are likely to become sexually active. Next, findings from this study show that suckling the child by his/her mother, both when the marriage between parents continues and when such marriage ends in divorce, is not only crucial for bodily health, it is also vital for child’s psychological and spiritual health and well-being. Finally, while Islamic family law imposes that providing material necessities is the right of child upon the father, it seriously takes a necessary measure to make sure that this right can be fulfilled. Therefore, according to Islamic family law, when the child is a shapeless fetus in mother’s womb, after 120 days, it regards the fetus, in this condition, as a human being, so that it grants a share and the right of inheritance for the fetus, which will be enforced upon the child’s delivery.

[28] ‘Ali Ahmad al-Jurjawi, Hikmah al-Tashri‘ wa Falsafatuhu, 2 vols. (Beirut: Dar al-Fikr, n.d), 2: 47-57; Muahammad Nazim al-Nasimi, al-Tibb al-Nabawi wa al-`Ilm al-Hadith, 3 vols. (Beirut: Mu’assasah al-Risalah, 1991), 1: 381-6; Vardit Rispler-Chaim, Islamic Medical Ethics in twentieth Century (Leiden: E.J. Brill, 1993), 84-93.

[29] Bukhari, Sahih Bukhari, Kitab Ahadith al-Anbiya’; Zainuddin Ahmad b. ‘Abdullatif al-Zubaidi, Mukhtasar Sahih al-Bukhari al-Musamma al-Tajrid al-Sarih li Ahadith al-Jami‘ al-Sahih, trans. into English by Muhammad Muhsin Khan (al-Riyadh: Maktabah Dar al-Salam li al-Nashr wa al-Tawzi‘, 1996), hadith no: 1411.

[30] Shah Wali Allah al-Dahlawi, Hujjat Allah al-Balighah (Cairo: Dar al-Turath, 1978), 2: 144-5; Mustafa al-Khin and Mustafa al-Bugha, al-Fiqh al-Manhaji ‘ala Madhhab al-Imam al-Shafi‘i (Damascus: Dar al-Qalam,1986), 3: 63.

[31] Ali Ahmad al-Jurjawi, Hikmat al-Tashri wa Falsafatuhu, 2 vols (Beirut: Dar al-Fikr, n.d), 2: 48-50.

[32] Muhammad b. ‘Abd al-Rahman al-Dimishqi al-‘Uthmani al-Shafi‘i, Rahmat al-Ummah fi Ikhtilaf al-A’immah, ed. ‘Ali al-Sharbaji and Qasim al-Nawari (Beirut: Mu’assasah al-Risalah, 1994), 32; al-Zuhayli, al-Fiqh al-Islami wa Adillatuhu, 1: 306; Abu Bakr al-Azraq, Tashil al-Manafi‘ fi al-Tibb wa al-Hikmah (Istanbul: Kakikat Kitabevi, 1990), 150,

[33] Muslim, Sahih Muslim, Kitab al-Taharah, Bab khisal al-fitrah, hadith no 257; Bukhari, Sahih al-Bukhari, Bab Taqlim al-Azfar.

[34] Nawawi, Sahih Muslim bi Sharh Nawawi (Beirut: Dar al-Kutub al-`Ilmiyyah, 1995), 3: 126-7.

[35] Furthermore, in order to be able to appreciate the Islamic family law in prevention the sexual transmitted diseases (STDs) in general and AIDS in particular, it is essential to study the prohibition of unlawful sexual intercourse because it is one of the most effective methods of avoiding the risk of infection with AIDS and other sexual transmitted diseases. The researchers proved that the diseases transmitted through sexual contacts, weather between heterosexuals or homosexuals, are the most common communicable diseases in the world. The World Health Organization (WHO) of the United Nations has estimated that 250 million people are infected annually with gonorrhea, and over 50 million with syphilis. The Center for Disease Control (CDC) in Atlanta, Georgia, estimated in 1976 that there were close to 3 million cases of gonorrhea, and over 400,000 cases of syphilis needing treatment in the USA. As for the AIDS, the American Center for Disease Control and Prevention (CDC) announced in February 1995 that AIDS is the leading cause of death among American aged 25 to 44. It has surpassed cancer, heart diseases, and murder. (Reuters “The HIV Curve is going straight up like the side of a mountain”); A.H. Sakr, Matrimonial Education in Islam, 57. Allan M. Brandt, “Sexually Transmitted Diseases” in Companion Encyclopedia of the History of Medicine, 2 vols. ed. W.F. Bynun and Roy Porter (London: Routledge, 1993), 1: 562-584.

[36] Malik Badri, The Aids Crisis: an Islamic Socio-Cultural Perspective (KL: ISTAC, 1998), 224.

[37] Robert Szabo and Roger V Short, “How does Male Circumcision Protect Against HIV Infection?, in http://bmj.bmjjournals.com/cgi/content/full/320/7249/1592

[38] Rita Rubin, “Circumcision Lowers Risk of Cervical Cancer” in http://www.geocities.com/HotSprings/2754/cervical042002.htm