A clear North/South divide is emerging in attitudes towards male circumcision. In May the Dutch Royal Medical Association became the first national medical group to declare that the procedure is both medically unnecessary and an abuse of the rights of the child, in the same way as female circumcision, or female genital mutilation.

However, the Dutch have decided to actively discourage circumcision rather than to ban it, as that could drive the procedure underground. About 15,000 boys are circumcised each year.

On the other hand African countries are actively encouraging circumcision because trials in 2007 in Kenya, Uganda and South Africa showed that it dramatically reduced the risk of infection with HIV/AIDS. According to a report in the BMJ, 14 countries in southern Africa are promoting circumcision with radio and television campaigns.

In Swaziland, where HIV prevalence is 45%. circumcision is even regarded as “crucial to the survival of the state”. Botswana plans to circumcise all boys by 2012. Even Rwanda, where HIV prevalence is only 3%, is promoting it as a cost-saving public health measure.

However, the Dutch doctors are sceptical of the African data. They believe that while it might delay infection, it will not prevent it. They also say that there are some complications which cannot be ethically justified for a “medically futile” procedure.

In the UK, Australia and the US, the trend is away from circumcision. The Australasian Association of Paediatric Surgeons,  for instance, describes circumcision as "inappropriate and unnecessary" but allowable in children over 6 months old when parents "hold a very strong opinion.” ~ BMJ, Aug 17