City Health Board Targets Controversial Religious Circumcision Practice

The city health board is poised to approve a new rule next week that would make some ultra-Orthodox circumcisions begin with a warning.

Health officials are concerned that a controversial practice called metzitzah b’peh could be spreading herpes, a common oral virus, from mohels, the men who perform circumcision, to male infants.

In the ritual, after the mohel removes the foreskin, he briefly suctions the blood from the penis to clear the wound, before dressing it. Some Orthodox and ultra-Orthodox Jews use a sterile tube to perform the rite, but many forego it altogether – and it’s not a part of circumcisions overseen by mohels identified with the Reform and Conservative movements, which represent the vast majority of American Jews.

The city has tried to discourage metzitzah b’peh, but doesn’t have the authority to ban it – so the health department wants mohels to give parents a warning about the risk the procedure carries of spreading disease, and make them sign a waiver that they’ve received the information and give their consent.

“When parents are informed of this risk, we hope that many will decide this is not an essential part of the circumcision and that they will choose an alternative,” said Dr. Jay Varma, deputy commissioner for Disease Control.

But supporters of the rite, including some outside the ultra-Orthodox community, maintain the practice is safe and disputed the findings of the health department.

Dr. Daniel Berman, the head of infectious diseases at Westchester Square Hospital, said babies can contract herpes from other sources, and the city hasn’t proved that the small number of cases in the ultra-Orthodox community are definitively connected to the metzitzah b’peh

“The statistical significance is questionable,” Berman said. He noted the city’s finding that there were five ultra-Orthodox herpes cases in 20,000 circumcisions over six years isn’t a much higher rate than the 25 herpes cases the city identified among 350,000 male newborns in the same period.

Some rabbis and mohels argue that asking them to distribute information they don’t believe in would violate their religious liberty – and discourage parents from participating in an essential ritual.

“There are so many practices in our world today which carry levels of risk, and those things are not regulated,” said Rabbi David Zwiebel, from Agudath Israel, an ultra-Orthodox umbrella group. “We allow our children to play football, which can be a violent sport, or riding a bike or cheerleading. Why are we singling out religious activity for this kind of warning and regulation?”

Some ultra-Orthodox leaders are predicting mohels would likely ignore the consent requirement.

City officials say if there’s even one herpes case, and it’s preventable, health authorities are obliged to act. They say there are widely respected Orthodox authorities who disavow metzitzah b’peh or provide a symbolic alternative.

Queens College sociologist Samuel Heilman doubts this argument will persuade most ultra-Orthodox Jews, who are growing in numbers and in their devotion to the most literal interpretation of religious law.

“Part of what’s going on here is the ongoing battle — culture war, you might call it — between the right wing of Orthodoxy and the rest of Jewry,” Heilman said. “What they’re saying is, ‘We  don’t change things.’ Of course they do, but they’re arguing that change is ipso facto problematic.”

If the rule passes, health officials say they won’t go checking for the consent forms – unless they’re investigating a disease transmission or complaints from parents. The Health Department also hasn’t determined what penalty would be imposed for failing to get consent.