What are all of your thoughts on Intactivism as a potential Effective Altruist cause area? Intactivism, for those who are unfamiliar, is the movement to abolish neonatal male circumcision. In his lecture Sex and Circumcision: An American Love Story, Eric Clopper goes deep into detail discussing the origins of male circumcision, namely that it was designed to damage men’s sexuality, and the common arguments people use in favor of it, such as whether it prevents STDs. He also discusses the fallacies and flawed science often used to defend the practice. Ryan McAllister’s lecture Child Circumcision: An Elephant in the Hospital discusses many similar topics.
Intactivism seems to satisfy all of the 80,000 Hours criteria for cause prioritization, in the sense that the issue of reducing neonatal circumcision is important, tractable, and uncrowded.
Intactivism is important. In the United States and Israel, the majority of the male population has been circumcised at birth. In the 20th century alone, over 120 million circumcisions were performed in the United States, most of which on non-consenting infants, with a circumcision happening every 17 seconds at its peak during 1955-1965. The procedure itself is extremely traumatic, and greatly reduces sexual pleasure for both sexes. In his book Circumcision: The Hidden Trauma, Dr. Ronald Goldman, PhD argues that circumcised men may also be at increased risk for mental illness. In the United States, only about 45% of physicians that perform circumcisions use any form of anesthesia. There are also a number of complications that can result from the procedure, such as skin bridges, infections of the circumcision wound, and amputation neuromas. Circumcision is also practiced among Muslims, Africans, and South Koreans, but is typically performed relatively later in life, rather than in infancy. Circumcision is also multi-generational in scope, with the practice existing for millennia in many cultures. It has been practiced in the United States since the late 1800s, and will only continue if nothing is done about it.
Intactivism is tractable. In the Anglosphere countries besides the United States, circumcision was once widespread, but has since declined precipitously. Routine circumcision in Australia reached its zenith in the 1950s with a rate above 80%, but has since declined to a rate of less than 20% for children born today. In Canada, the circumcision rate has declined from 48% in 1970, to a newborn circumcision rate of 31.9% in 2009. In the United Kingdom, the proportion of English boys who were circumcised fell from 35% in the early 1930s to 6.5% by the mid-1980s. South Korea has also experienced a significant decline in their national circumcision rate, declining from 86.3% for males aged 14-29 in 2002, to 75.8% a decade later. Circumcision rates in the Western United States have also declined, with roughly two thirds of boys in Western states were circumcised in 1979, declining to only 40% in 2010. In the US, states where neonatal circumcisions are not covered by Medicaid have significantly lower circumcision rates compared to states where it does. Thus, efforts to end Medicaid coverage for circumcisions may prove highly effective at reducing the circumcision rate in the US. There is also a company called Foregen, which is doing research in regenerative medicine in order to regenerate the foreskin so that formerly circumcised men can once again have complete penises.
Intactivism is uncrowded. Almost all of the effort put into ending genital mutilation is focused on female genital mutilation, rather than male genital mutilation. Circumcision generally seems to attract little media attention, and seems to be discussed infrequently.
One of the common arguments in favor of male circumcision is that it prevents STDs. The evidence for this seems to be questionable at best. Europe has a significantly lower rate of HIV infection than the US, despite having a population that is almost entirely genitally intact. The AIDS incidence rate for men in the United States is fourfold that of the incidence rate of Switzerland, the European country with the highest rate. There were a number of African studies that supposedly provided evidence that circumcision reduces the risk of HIV in Africa, but these studies had a number of methodological flaws. In Africa, there is a possibility that mass adoption of circumcision may actually increase HIV rates, due to factors such as risk compensation and the circumcisions being performed in unsanitary conditions. In any case, there is little reason why circumcisions should be performed on non-consenting infants rather than on consenting adults, since infants and children are generally not at risk for STDs.
As a side note, there is some debate as to whether infants are sentient. Since there is some evidence that circumcised infants may experience levels of pain consistent with torture, this issue is of particular importance. If infants are not sentient, they are incapable of experiencing suffering by default. However, this is balanced by the fact that there is still a >0% chance that infants are sentient, and that this is an issue that affects tens of millions of people.