Should female health providers be involved in medical male circumcision? Narratives of newly circumcised men in Malawi|
Umar, E.; Mandalazi, P.; Jere, D. & Muula, A.
The Malawi government has endorsed voluntary medical male circumcision
(VMMC) as a biomedical strategy for HIV prevention after a decade of
debating its effectiveness in the local setting. The “policy” recommends
that male circumcision (MC) should be clinically based, as opposed to
the alternative of traditional male circumcision (TMC). Limited finances,
acceptability concerns, and the health system’s limited capacity to meet
demand are among the challenges threatening the mass rollout of
VMMC. In terms of acceptability, the gender of clinicians conducting the
operations may particularly influence health facility-based circumcision.
This study explored the acceptability, by male clients, of female clinicians
taking part in the circumcision procedure.
Six focus group discussions (FGDs) were conducted, with a total of 47
newly circumcised men from non-circumcising ethnic groups in Malawi
participating in this study. The men had been circumcised at three health
facilities in Lilongwe District in 2010. Data were audio recorded and
transcribed verbatim. Data were analysed using narrative analysis.
Participants in the FGDs indicated that they were not comfortable
with women clinicians being part of the circumcising team. While few
mentioned that they were not entirely opposed to female health providers’
participation, arguing that their involvement was similar to male clinicians’
involvement in child delivery, most of them opposed to female involvement,
arguing that MC was not an illness that necessitates the involvement of
clinicians regardless of their gender. Most of the participants said that
it was not negotiable for females to be involved, as they could wait until
an all-male clinician team could be available. Thematically, the arguments
against female clinicians’ involvement include sexual undertones and the
influences of traditional male circumcision practices, among others.
Men preferred that VMMC should be conducted by male health providers
only. Traditionally, male circumcision has been a male-only affair shrouded
in secrecy and rituals. Although being medical, this study strongly
suggested that it may be difficult for VMMC to immediately move to a
public space where female health providers can participate, even for men
coming from traditionally non-circumcising backgrounds.