Original Research: Making circumcision part of routine training and service delivery

Three interrelated issues coincide to make male circumcision a critical service that needs to be provided as standard care in district health centres in South Africa. One relates to the fact that male circumcision is a long-established social and cultural practice in South Africa, with both traditional and medical antecedents. It is a rite of passage for boys into manhood among the African majority, albeit to varying degrees. Circumcision is common practice among Xhosa, Venda and Sepedi speakers, but only variously practised among Sotho, Ndebele, Shangaan and Zulu speakers. Among the former, the tradition requires full circumcision. Among the latter, the tradition is often one of partial circumcision. It is a birth rite of Jewish and Muslim South African children, and it was the standard of available medical care to male babies born in government hospitals up until the last few decades of the 20th century. Although circumcision is an established medical and traditional practice historically, for more than two decades, there has been an attrition of appropriate healthcare skills and management among both traditional and medical practitioners.