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[This corrects the article DOI: 10.1371/journal.pone.0160207.].
The study took the form of a qualitative empirical case study in order to carry out a critical analysis of the shortcomings of existing policy pertaining to traditional male circumcision (TMC) in the Eastern Cape province of South Africa. Interview guides were developed to conduct in-depth interviews and focus group discussions with 28 participants...
Citations
... Other publications predicted that an extensive practice of VMMC in sub-Saharan Africa would prevent almost six million HIV infections over 20 years, as would three million deaths among both men and women [11]. Three randomised controlled trials (RTCs) conducted in different African countries involving predominantly young, HIVnegative adult males found conclusive evidence that male circumcision has a protective effect against HIV infection in men [12]. ...
... Radio and television were the most cited sources of information on VMMC as an HIV prevention intervention at 55% and 58%, respectively. This resonates with findings by Spyrellis et al. [11], Hatzold [22], and Chikutsa [23] who all previously reported that the primary source of information about VMMC in South Africa is the radio and television. Evidence-based approaches should be used to develop health promotion strategies and marketing using these media platforms. ...
Circumcision is a long-standing and frequently performed surgical procedure which holds significant cultural significance among AmaXhosa people in South Africa. Due to cultural reasons in some parts of Africa, the integration of medical male circumcision with traditional manhood initiation rituals still lacks acceptance. This study examined the level of knowledge and acceptance of voluntary male medical circumcision (VMMC) among young males in a selected high school in the Nyandeni District of the Eastern Cape Province, South Africa. A descriptive, quantitative, cross-sectional study was conducted, and a self-administered questionnaire was used to obtain information on sociodemographic characteristics, knowledge of VMMC, perceptions of VMMC, and circumcision practices. One hundred participants were recruited from both grades 11 and 12, and 82% of the participants indicated that they had received information about VMMC. Most of the respondents (88%) preferred traditional male circumcision (TMC), and only 12% of respondents preferred VMMC. The participants displayed a good understanding of the distinction between VMMC and TMC. However, results from the study showed that most respondents exhibited low acceptability and knowledge towards VMMC. These findings highlight the need to develop evidence-based strategies to enhance learners’ knowledge and acceptance of VMMC.
... In a Malawian study, Chilimampunga et al. (2017) found that cultural and traditional concerns are major barriers to the uptake of circumcision services. Spyrelis et al. (2013) contended that communities in their study conducted in South Africa, did not approve or accept ICMC, due to TMC practices and perceptions about pain and adverse events. ...
South Africa's 2016 medical male circumcision (MMC) guidelines ("the guidelines") provide direction for the MMC programme's implementation in South Africa. The aim of our document analysis was to assess the guidelines, particularly in lieu of changing guidance from WHO and PEPFAR. We then assessed how the guidelines might be applied to infant and child male circumcision (ICMC). The analysis was performed by reviewing South Africa's guidelines, along with international documents used in developing those guidelines, to identify the historical development of the guidelines, as well as the implications for MMC and ICMC decision-making within the South African context. The following principles were analysed within the context of South Africa's guidelines: (1) quality and safety; (2) informed consent; (3) confidentiality; (4) human rights; and (5) accessibility of services. Tthe document analysis also identified ambiguities that exist in the guidelines, particularly regarding consent, recognising religious or cultural exemptions, and guaranteeing the best interests of the child. South Africa's MMC guidelines could benefit from incorporating common definitions to assist with interpretation and understanding, thus preventing confusion and controversy among programme planners, parents and boys. The guidelines were made available in 2016 and recommendations for circumcision have evolved as new research and information has become available. South Africa's National Department of Health should review and update these guidelines, with a focus on both MMC and ICMC issues, so that they reflect the most up-to-date, accurate information available, to avoid inconsistent practices, risks, and litigation in the management of the programme. This study was situated within a qualitative paradigm and applied a social choice theory perspective to make sense of the MMC guidelines. The study concludes that future policy revisions should develop a broader understanding of the complex medical male circumcision decision-making process, particularly faced by parents.
... The research on the role of women in the decisions about ICMC points to the influence of multiple factors, such as the father's circumcision status, health and hygiene, the cost of the procedure and religious practices (Justman et al., 2013;Mavhu et al., 2014;Spyrelis et al., 2013). In a study in Eswatini, women described their consultation with their fathers as an important step in decision-making (Jarrett et al., 2014). ...
... In a South African study, women indicated that ICMC excluded important traditional practices embedded in their cultural beliefs (Phili & Karim, 2015). Black women's male circumcision objections were influenced by their perceptions that male circumcision programmes could lead to cultural erosion and the destruction of customary practices (Spyrelis et al., 2013). ...
... Women in both a South African and a Zimbabwean study indicated that friends play an important role in women deciding to accept or reject EIMC (Mavhu et al., 2012;Spyrelis et al., 2013). Despite using social networks as sources of information, they often do not have accurate medical information about neonatal male circumcision (Pruenglampoo, 2015). ...
Objective The objective of this article was to analyse women’s perceptions of ICMC and to propose a framework for ICMC
decision-making that can inform ICMC policies.
Method Using qualitative interviews, this study investigated twenty-five Black women’s perceptions of ICMC decisionmaking
in South Africa. Black women who had opted not to circumcise their sons, were selected through purposive and
snowball sampling. Underpinned by the Social Norms Theory, their responses were analysed through in-depth interviews
and a framework analysis. We conducted the study in the townships of Diepsloot and Diepkloof, Gauteng, South Africa.
Results Three major themes emerged: medical mistrust, inaccurate knowledge leading to myths and misconceptions, and
cultural practices related to traditional male circumcision. Building Black women’s trust in the public health system is
important for ICMC decision-making.
Conclusions for Practice Policies should address misinformation through platforms that Black women share. There should
be an acknowledgement of the role that cultural differences play in the decision-making process. This study developed an
ICMC perception framework to inform policy.
... The research on the role of women in the decisions about ICMC points to the influence of multiple factors, such as the father's circumcision status, health and hygiene, the cost of the procedure and religious practices (Justman et al., 2013;Mavhu et al., 2014;Spyrelis et al., 2013). In a study in Eswatini, women described their consultation with their fathers as an important step in decision-making (Jarrett et al., 2014). ...
... In a South African study, women indicated that ICMC excluded important traditional practices embedded in their cultural beliefs (Phili & Karim, 2015). Black women's male circumcision objections were influenced by their perceptions that male circumcision programmes could lead to cultural erosion and the destruction of customary practices (Spyrelis et al., 2013). ...
... Women in both a South African and a Zimbabwean study indicated that friends play an important role in women deciding to accept or reject EIMC (Mavhu et al., 2012;Spyrelis et al., 2013). Despite using social networks as sources of information, they often do not have accurate medical information about neonatal male circumcision (Pruenglampoo, 2015). ...
Objective
The objective of this article was to analyse women’s perceptions of ICMC and to propose a framework for ICMC decision-making that can inform ICMC policies.
Method
Using qualitative interviews, this study investigated twenty-five Black women’s perceptions of ICMC decisionmaking in South Africa. Black women who had opted not to circumcise their sons, were selected through purposive and snowball sampling. Underpinned by the Social Norms Theory, their responses were analysed through in-depth interviews and a framework analysis. We conducted the study in the townships of Diepsloot and Diepkloof, Gauteng, South Africa.
Results
Three major themes emerged: medical mistrust, inaccurate knowledge leading to myths and misconceptions, and cultural practices related to traditional male circumcision. Building Black women’s trust in the public health system is important for ICMC decision-making.
Conclusions for Practice
Policies should address misinformation through platforms that Black women share. There should be an acknowledgement of the role that cultural differences play in the decision-making process. This study developed an ICMC perception framework to inform policy.
... This study provides community and healthcare provider-side insights to help policy-makers in Zambia and Zimbabwe strategize and design programs to sustain the impact of the current VMMC services (as part of the "catch-up" phase), especially relating to the choice of the appropriate age cohort to prioritize. Our findings are in line with much of what has been uncovered on EIMC acceptability by previous research studies, but also provide new insights [19]. To the best of our knowledge, this is the first study that directly compares the attitudes towards EIMC and EAMC of parents of infants, as well as their decision-making processes for these procedures at the time of their boys' infancy. ...
As countries approach their scale-up targets for the voluntary medical male circumcision program for HIV prevention, they are strategizing and planning for the sustainability phase to follow. Global guidance recommends circumcising adolescent (below 14 years) and/or early infant boys (aged 0–60 days), and countries need to consider several factors before prioritizing a cohort for their sustainability phase. We provide community and healthcare provider-side insights on attitudes and decision-making process as a key input for this strategic decision in Zambia and Zimbabwe. We studied expectant parents, parents of infant boys (aged 0–60 days), family members and neo-natal and ante-natal healthcare providers in Zambia and Zimbabwe. Our integrated methodology consisted of in-depth qualitative and quantitative one-on-one interviews, and a simulated-decision-making game, to uncover attitudes towards, and the decision-making process for, early adolescent or early infant medical circumcision (EAMC or EIMC). In both countries, parents viewed early infancy and early adolescence as equally ideal ages for circumcision (38% EIMC vs. 37% EAMC in Zambia; 24% vs. 27% in Zimbabwe). If offered for free, about half of Zambian parents and almost 2 in 5 Zimbabwean parents indicated they would likely circumcise their infant boy; however, half of parents in each country perceived that the community would not accept EIMC. Nurses believed their facilities currently could not absorb EIMC services and that they would have limited ability to influence fathers, who were seen as having the primary decision-making authority. Our analysis suggests that EAMC is more accepted by the community than EIMC and is the path of least resistance for the sustainability phase of VMMC. However, parents or community members do not reject EIMC. Should countries choose to prioritize this cohort for their sustainability phase, a number of barriers around information, decision-making by parents, and supply side will need to be addressed.
... A South African study found that parents have distinct preferences regarding the age of circumcision for their infants-based on their perceptions of factors such as wound healing, pain, and caretaking-and that the majority of the mothers and fathers were willing to circumcise their infants during the first week after birth. 16 Our findings revealed that, although rural parents were more likely to seek EIMC before the infant was 2 days old, the majority of parents (73%) brought their child for circumcision between 8 and 60 days, meaning that the parents brought them back to the facility rather than having the infant circumcised before discharge from delivery. Despite WHO's recommendation that the infant stay in the health facility for 24 hours after birth, 17 anecdotal evidence suggests that, because of crowding in health facilities, mothers and infants are often discharged prior to 24 hours, making the male infants ineligible for circumcision. ...
Iringa region of Tanzania has had great success reaching targets for voluntary medical male circumcision (VMMC). Looking to sustain high coverage of male circumcision, the government introduced a pilot project to offer early infant male circumcision (EIMC) in Iringa in 2013. From April 2013 to December 2014, a total of 2,084 male infants were circumcised in 8 health facilities in the region, representing 16.4% of all male infants born in those facilities. Most circumcisions took place 7 days or more after birth. The procedure proved safe, with only 3 mild and 3 moderate adverse events (0.4% overall adverse event rate). Overall, 93% of infants were brought back for a second-day visit and 71% for a seventh-day visit. These percentages varied significantly by urban and rural residence (97.4% urban versus 84.6% rural for day 2 visit; 82.2% urban versus 49.9% rural for day 7 visit). Mothers were more likely than fathers to have received information about EIMC. However, fathers tended to be key decision makers regarding circumcision of their sons. This suggests the importance of addressing fathers with behavioral change communication about EIMC. Successes in scaling up VMMC services in Iringa did not translate into immediate acceptability of EIMC. EIMC programs will require targeted investments in demand creation to expand and thrive in traditionally non-circumcising settings such as Iringa.
... 14-16 Six studies, all theoretical, looked at EIMC acceptability in the absence of current EIMC services. [17][18][19][20][21][22] One study, conducted in 2014, was a systematic review and thematic synthesis looking at factors associated with parental decisions not to use EIMC services. 23 Although this literature review was not comprehensive, common themes emerged. ...
To maintain high circumcision prevalence, voluntary medical male circumcision programs in Eastern and Southern Africa need to plan for sustainability and conduct transition assessments early on, rather than waiting until the saturation of priority targets at the end of the program.
Parental decision-making in infant and child male circumcision is influenced by complex, interrelated factors on many levels. Several studies have highlighted reasons for the acceptance and non-acceptance of child male circumcision. This study investigates the factors that influence parental decision-making in this matter and proposes a parental decision-making framework. The study was conducted in the townships of Diepsloot and Diepkloof in Gauteng, South Africa, using 48 in-depth interviews with parents, grandparents and uncles of the boys, as well as government officials and members of civil society as part of an explorative case study. Purposive and snowball sampling were used to select the participants. Thematic analysis was used to analyse the data by applying the conceptual framework of Bronfenbrenner’s ecological systems theory. Three main themes emerged from the data: microsystem factors related to health and hygiene, the father’s circumcision status, cultural expectations, pain, the child’s autonomy and the extended family; mesosystem factors related to early childhood development centres; and exosystem factors related to circumcision policies and financial considerations.
