The controversial German court ruling on male circumcision has caused concern at home and abroad. In some parts of the world, the practice is a common procedure.
Germany's Chancellor Angela Merkel has told her party that it risked becoming a "laughing stock" after a court in Cologne ruled that religious circumcision was a criminal act.
"I do not want Germany to be the only country in the world in which Jews cannot practice their rites," Merkel was quoted as saying this week. "Otherwise we would make ourselves a laughing stock."
The regional court ruling came at the end of June, but it's only now that reactions are coming in from various groups around the world, especially from the US, where male circumcision is more common. The response from the international medical community has also been fervent, as doctors are keen to stress the health benefits of the practice.
The Cologne case involved a doctor who was taken to court after he circumcised a four-year old Muslim boy, resulting in minor complications. The court acquitted the doctor of causing grievous bodily harm, but it found that "the right of parents to raise their children in a religion does not override the right of a child to bodily integrity."
The ruling has no legal bearing on other cases, but some fear it could be used as a precedent. It may mean that families will have to wait until their sons are over the age of consent before they can be circumcised.
This is something that's worrying Dr. Aaron Tobian, assistant professor of pathology, medicine and epidemiology at Johns Hopkins University in Baltimore.
"There are multiple advantages of neonatal male circumcision compared to adult circumcision," Tobian told DW. "As a neonate there's a tenfold reduction in urinary tract infections. Infants also have reduced penile inflammatory disorders."
He added that it was counterproductive to wait until after the age of consent - as many teenagers become sexually active before that time.
"By waiting for male circumcision until you're an adult, you're not affording that same protection during that period of highest risk sexual activity."
Looking at the statistics, it's clear that the prevalence of male circumcision around the world varies widely - and with it, cultural attitudes towards the practice. Whilst male circumcision is relatively uncommon in Europe, the practice saw a dramatic increase in North America during the 20th century - largely because of its perceived health benefits. Neonatal and childhood male circumcision rates in the US rose to about 80 percent in the 1960s, and remain relatively high today, although they have fallen somewhat in recent years.
"I believe it's primarily for cultural reasons," said Tobian. "However, the rate of male circumcision in the United States has decreased substantially over the last 20 years … The CDC (Center for Disease Control) just published a report saying that only 55 percent of boys in the US are now being circumcised."
Meanwhile, the practice is very common in many African countries - especially in North and West Africa - and it is almost universal in Muslim countries in the Middle East and Central Asia - where it is carried out mainly for religious and cultural reasons.
According to the World Health Organization (WHO), there is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infections in men by approximately 60 percent.
"The WHO has advocated male circumcision to reduce HIV in countries with epidemics," said Dr Tobian. "Male circumcision has been shown … to also reduce genital herpes by about 30 percent, to reduce genital ulcer disease by 47 percent, and also reduce high-risk HPV (Human Papillomavirus - that causes penile cancer) by 35 percent."
"In addition to those benefits for males," he continued, "male circumcision has been shown to reduce high-risk HPV for female partners by 28 percent, so these women have a reduced risk of cervical cancer."
The ruling in Cologne has incensed doctors around the world, who urge parents to make decisions based on medical evidence.
"I think that the ruling is very disappointing," Tobian concludes. "There are risks and benefits to all the choices we make as parents. When we decide whether our kids should be vaccinated, whether our kids should undergo certain medical procedures like orthodontic treatment, there is always some risk to be considered … And we try to do what's in their best interest."
Affront to religious groups
Sacks, front right, was 'appalled' by the Cologne ruling
Unsurprisingly, Jewish and Muslim groups have responded angrily to the ruling, saying it poses a threat to religious freedom. Britain's Chief Rabbi, Jonathan Sacks, wrote in the Jerusalem Post earlier this month:
"It is hard to think of a more appalling decision. Did the court know that circumcision is Judaism's most ancient historical ritual, dating back almost four thousand years to the days of Abraham?"
In the United States, Charles Lane of the Washington Post wrote a blog post on the subject entitled "The stink of Cologne" - in which he took issue with what he called a "blatant affront to the Muslim and Jewish peoples."
Many Germans have also been quick to criticize the court decision, and it is unlikely that it will be allowed to determine national law in the long term. A spokesperson for Angela Merkel's government promised to address the issue, saying that religious circumcision, "when carried out in a responsible manner, must be possible in this country without punishment."
German Foreign Minister Guido Westerwelle has also tried to calm the storm, insisting that "Germany is an open, tolerant country, where religious freedom is firmly anchored and where religious traditions, such as circumcision, are protected as an expression of religious pluralism."
The European Union, meanwhile, seems reluctant to get involved in the debate. A spokesman for the European Commissioner for Health told DW that this was a "national issue."
Author: Joanna Impey
Editor: Gabriel Borrud