Marie Stopes International and the Promotion of Magical Thinking

[Edit: It appears Marie Stopes International is no longer in the circumcision business. But the video described here is still available on the organization’s YouTube channel.]

mariestopesinternational A number of readers have emailed me with a tip that Marie Stopes International (MSI), a UK-based family planning NGO, has put up a website [originally linked to kindestcut.org, now a dead link] promoting circumcision in Africa (complete with a circumcisons completed counter dubbed the “MCometer”). From the looks of it, it appears MSI is planning to be a big player in the field of male circumcision. I’ve been mulling over my reaction to this new front of propaganda in light of the previous post about the 20% of all HIV cases in Africa being caused by medical staff failing to use proper medical protocols.

My sense is that if male circumcision were left to the African health systems in place now, it would be a disaster. The circumcision lobby may be interested in circumcision first and HIV second, but I doubt they would promote a policy that will inevitably provide metrics that circumcision harms more than it helps — and significantly so.

MSI’s efforts on this issue provide some evidence that this is a battle over funding for direct involvement in an environment where funding has long had a tendency to disappear down some despot’s bottomless well of graft. Whatever the intentions of African governments in implementing HIV/AIDS policy with foreign dollars, they have competition, and said competition is the NGO with “expertise” to impart or implement.

While the locals can provide culturally sensitive approaches to behavior change, the foreigners’ pursuit of the honey pot only extends to providing the procedure itself, or significant ongoing support. After all, these societies would appear to be already culturally disposed to embrace the magical thinking that surrounds circumcision, and circumcision itself.

The video that MSI has produced embraces this magical thinking by acknowledging that Malawi is a country with high rates of HIV in circumcising districts, but fails to acknowledge that in fact circumcised men have not just high rates, but higher rates of HIV than intact men in that country. Moreover, an unsupported statement that variables other than circumcision make this so, and therefore this difference should be ignored, seeks to gloss over a problem of logic for the circumcision lobby generally.

The video also makes the giant leap that three studies that have produced consistent conclusions makes the science sound. Of course, three flawed studies (not double blind with insufficient follow up, and with vast selection and researcher bias) do no such thing, and certainly do not make the recommendations stemming therefrom unassailable.

The video seeks to appeal to those concerned with the impact on women by making the absurd claim that circumcised men will create a bulwark against HIV in a society where women do not have the negotiating power to insist on condom use. Somehow, men will have less HIV from the already infected store of women and therefore make condoms, what? Less necessary? No mention is made that one study has hinted at a much greater risk to women from circumcised men (See Wawer et al.)

MSI then goes on with the script that circumcision presents a unique teaching moment to impart safer sex messages. It isn’t clear what is more uniquely teachable about the context where removal of healthy, erogenous tissue from a man is the final step. Perhaps it’s Pavlovian in nature? Extreme pain will be associated with the lesson to always wear a condom?

Of course, the arguments for circumcision are also arguments against circumcision. The young men and boys they use in the video are comfortable with the contradictions and probably prefer to accept the script they have been taught. Hence, they dutifully repeat in direct contradiction to the reasons given for parting with a sizable piece of their penis the mantra that one must still use condoms and respect women. For good measure, the de minimis impact of circumcision on cervical cancer and STD rates is blown up into a supporting reason to go for the cut, equivocal evidence notwithstanding.

And then we come to the part where foreigners or foreign trained personnel become indispensable. The video states circumcision is simple and minor, no big deal really, unless it is left in the wrong hands, “traditional healers, for example.” It is also quick, easy, with no or few side effects, and what? It’s cheap, too! And so, here we arrive at our final destination: a veiled plea for money.

MSI concludes the video with a woman stating that Malawi is “tired of HIV” over a scene of coffin makers laboring away to make, one is given to think, yet another coffin for yet another dead Malawian, presumably freshly deceased from AIDS. The woman concludes by stating that if we just inform the public how circumcision works (which nobody in the real world seems to be able to explain) and how good it is and how much it prevents HIV, “everybody will want to be circumcised.”

Clearly, this video is made for an audience in the developed world, most probably for funders and decision makers in the HIV/AIDS industry. Hence, it is not produced in any of the local Malawi languages (at least yet). It seeks to address almost every issue that we in the intactivist community have argued in opposition. And finally, it uses a storytelling style that is sympathetic and benign, i.e. teenage testimonials, wide shots of vulnerable-looking children riding bicycles down dusty roads, and acoustic guitar.

MSI must understand the controversy surrounding this issue and the rapid reaction force deployable against them because they have disabled the comments on YouTube.com. However, you can comment here. Please do so.

About David Wilton

fronterizo, defense lawyer, intactivist
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6 Responses to Marie Stopes International and the Promotion of Magical Thinking

  1. KOTFrank says:

    Volume 74, Issue 1, Pages 1-3 (January 2010)
    2 of 69
    First and second things, and the operations of conscience in science
    Bruce G. Charlton (Editor-in-Chief – Medical Hypotheses)
    published online 07 September 2009.
    Summary
    Why is modern science less efficient than it used to be, why has revolutionary science declined, and why has science become so dishonest? One plausible explanation behind these observations comes from an essay First and second things published by CS Lewis. First Things are the goals that are given priority as the primary and ultimate aim in life. Second Things are subordinate goals or aims – which are justified in terms of the extent to which they assist in pursuing First Things. The classic First Thing in human society is some kind of religious or philosophical world view. Lewis regarded it as a ‘universal law’ that the pursuit of a Second Thing as if it was a First Thing led inevitably to the loss of that Second Thing: ‘You can’t get second things by putting them first; you can get second things only by putting first things first’. I would argue that the pursuit of science as a primary value will lead to the loss of science, because science is properly a Second Thing. Because when science is conceptualized as a First Thing the bottom-line or operational definition of ‘correct behaviour’ is approval and high status within the scientific community. However, this does nothing whatsoever to prevent science drifting-away from its proper function; and once science has drifted then the prevailing peer consensus will tend to maintain this state of corruption. I am saying that science is a Second Thing, and ought to be subordinate to the First Thing of transcendental truth. Truth impinges on scientific practice in the form of individual conscience (noting that, of course, the strength and validity of conscience varies between scientists). When the senior scientists, whose role is to uphold standards, fail to posses or respond-to informed conscience, science will inevitably go rotten from the head downwards. What, then, motivates a scientist to act upon conscience? I believe it requires a fundamental conviction of the reality and importance of truth as an essential part of the basic purpose and meaning of life. Without some such bedrock moral underpinning, there is little possibility that individual scientific conscience would ever have a chance of holding-out against an insidious drift toward corruption enforced by peer consensus.
    Professor of Theoretical Medicine, University of Buckingham, United Kingdom
    PII: S0306-9877(09)00557-X
    doi:10.1016/j.mehy.2009.08.017
    © 2009 Published by Elsevier Inc.

  2. James Loewen says:

    Thanks for this post and the link to the video. Your synopsis of this slickly produced video is very clear. It is deeply disturbing to see this kind of money being spent on promotion of male circumcision, and people dutifully repeating what they’ve been taught. Circumcision for “medical reasons” is medical fraud, the whole history of medicalized circumcision show us that.
    Promoting circumcision to adults who may have a say in their own bodies is one thing, the next is to impose this in infants and children, and that is already happening in Africa. Neil Pollock a Canadian “doctor” whose business is cutting the genitals of children has travelled to Rwanda to teach the hospital there how to cut infants. Pollock has never shown interest in HIV/AIDS before, his enthusiasm for circumcision is foremost in everything he has ever published. In fact Pollock has had so many complaints made about his misinformation campaign that the BC College of Physicians and Surgeons issued a new policy statement in 2004 strongly cautioning doctors in the province of British Columbia not to circumcise.
    The promoters of circumcision do not take the risks and casualties of circumcision into account, other than to say it must be done by a “skillful operator.” However even “skillful operators” bungle circumcisions and the results can be horrific and even deadly. These factors are never taken into account when the “60% reduction” is being touted. Somehow penile amputations and death are acceptable casualties to those who promote circumcision.
    One of the truths about circumcision is that once someone has been persuaded to give up part of their normal genitals they become enthusiastic about encouraging or forcing others to do so.
    This video is very disturbing on so many levels.

  3. Joe says:

    I noticed all the other videos they’ve posted accept comments. Clearly they are aware of the ton of bricks that would come down on them if they allowed comments to this video. They are clearly cowards.

  4. Joseph says:

    What about us? What are we doing to challenge big-time organizations like these? What doctors are getting together to challenge the WHO, UNAIDS, and UNESCO?
    Is the truth being suppressed by a price? Does “who’s right” really depend on who has the most money to garner publicity? How depressing.

  5. Joseph says:

    For what it’s worth, if you click on “flag” in the video, and you choose “promotes hate and violence,” you’re given a window to complain about the video.
    Would it do any good if a bunch of us told YouTube to take down the video on the grounds that it promotes violence against males using flat out lies?
    Truth of the matter is, if this were a video promoting FGM for the same purpose it wouldn’t last a day.
    For what it’s worth I flagged this video. I hope others do too.

  6. Joseph says:

    My bad, to get the window you have to click “flag” and then choose “Hateful or Abusive content,” THEN “Promotes Hatred or Violence”.

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