NEW YORK, NEW YORK – The New York City Board of Health unanimously passed a regulation on Thursday that will require consent from parents before an infant can have a form of Jewish ritual circumcision, prevalent in parts of the ultra-Orthodox community, in which the circumciser uses his mouth to remove blood from the incision.
In a morning meeting, the nine-member panel of doctors and public health professionals said that though the regulation had been challenged by some Orthodox Jewish religious authorities as an unconstitutional infringement of their religious freedom, the risk of disease from the ancient procedure was serious enough to warrant action.
Indeed, some panel members said they believed that requiring consent did not go far enough. “It’s crazy that we allow this to go on,” said Dr. Joel A. Forman, a professor of pediatrics at Mount Sinai School of Medicine.
Infectious disease experts widely agree that the oral contact creates a risk of transmission of herpes that can be deadly to infants, because of their underdeveloped immune systems. Between 2004 and 2011, the city learned of 11 herpes infections it said were most likely caused by the practice. Two of those babies died; at least two others suffered brain damage.
While most ritual circumcisers, known as mohelim, no longer use oral contact to pull blood away from the circumcision incision — they use gauze or sterile glass pipettes instead — the practice has been strongly defended by ultra-Orthodox Jewish rabbis who believe the practice is faithful to Talmudic codes. Because they believe it is a mandatory part of the practice of the Jewish religion, more than 200 ultra-Orthodox rabbis have ordered their adherents not to comply with the regulation.
“This process is being created without a shred of evidence,” said Rabbi William Handler, one of a few ultra-Orthodox Jews who gathered outside the meeting in protest. He said that if done properly, the procedure was safe. “The city is lying, and slandering compassionate rabbis.”
In an effort to educate parents about the health risks, the city will now require ritual circumcisers to inform parents in writing that they will have direct oral contact with their infant’s circumcision wound, and receive their signed consent before doing so. The form states that the health department advises against the procedure because of the risk of herpes transmission, which may cause brain damage or death. The mohelim must keep that permission document on hand for one year.
Failure to comply may result in warning letters or fines to the mohelim. Enforcement, though, will be based on investigation of specific complaints and herpes cases, not spot checks or raids, and there are no mandatory punishments, said Dr. Jay K. Varma, the city’s deputy commissioner for disease control.
Orthodox groups, including Agudath Israel of America, have announced that they are exploring the possibility of suing the city to block the regulation, which is scheduled to go into effect 30 days from official publication of the rule.
The Board of Health said 18 people or groups had submitted comments on the proposal — compared with 38,000 comments on its just-approved ban on large sugary drinks. Of those, 11 were for the regulation and 7 against.
The city believes about 3,600 male infants are circumcised with direct oral suction each year. The Centers for Disease Control and Prevention has called the procedure unsafe and recommended against it. Health authorities have estimated the risk of an infant’s contracting herpes through the oral contact ritual at roughly 1 in 4,000.