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closeWhy did male circumcision rates increase in Kinshasa?
Posted by DALNWICK on 14 Apr 2010 at 09:37 GMT
2007 DHS surveys conducted in Democratic Republic of Congo and in Zambia (1,2), show that HIV prevalence in men in Luapula Province, Norhern Zambia is 15.3%, compared to only 0.9% in ‘centre sud’ the area of south eastern DRC containing Katanga Province. In ‘centre sud DRC’, 98% of men are circumcised, in Luapula less than 10%. These two geographic areas border each other, and many of the inhabitants are from closely related ethnic groups with similar cultures. The DHS survesy also show that the HIV ‘risk factors’ normally studies in such survesy are all higher in DRC than in Zambia. JD de Sousa et al show that male circumcision rates in Kinshasa, DRC, increased from around 75% around 1912 to over 95% in recent years. But similar increases in male circumcision rates did not take place in Zambia. It would be interesting to learn if the authors gained any insight into the reason for the increase in male circumcision rates in DRC in the early to mid- 20th Century that they document. This information might be useful in our present efforts to design programmes to increase the uptake of male circumcision in countries such as Zambia which have at present low rates. Was the increase in the male circumcision rate in Kinshasa for example a result of a deliberate effort by the colonial medical authorities to promote male circumcision surgery, in response to the high rates of GUD that the article documents, or did the ethnic groups with low circumcision rates simply copy the practices of the groups with high circumcision rates?
References
1. Enquete Demographigue et de Sante, Republique Democratique du Congo, 2007, Ministere du Plan avec la collaboration du Ministere de la Sante, Kinshasa, Republique Democratique du Congo. Macro International Inc, Calverton, Maryland,USA, Aout 2008. (Partially funded by UNICEF).
2. Zambia Demographic and Health Survey, 2007, Central Statistical Office, Lusaka, Zambia. Ministry of Health, Lusaka, Zambia, Tropical Diseases Research Centre, Ndola, Zambia, University of Zambia, Lusaka, Zambia. March 2009. (Partially funded by UNICEF).
The main process was circumcision copying within each colony
jdsousa replied to DALNWICK on 20 Apr 2010 at 05:57 GMT
Thank you for raising this question. It is relevant not only to our paper, but also to the understanding of modern HIV prevalences in Africa.
The short answer is the second you write in your last statement: ethnic groups not practicing male circumcision traditionally until the end of the 19th century started to do so, simply to copy groups that already did it. We explain this general trend (which was massive) in our Supplementary Text S2. Major sources describing this process in the Orientale and Équateur provinces of the Belgian Congo are Friedrichs (1924), Halkim (1911), Callone-Beaufaict (1921), and Burssens (1958). The trend became massive with colonialism, because the latter promoted ethnic mixing in cities, towns, mines, and enterprises. The men belonging to non-circumcising groups who were recruited to cities were side by side with women belonging to circumcising groups (the majority), who categorically refused to have sex with them (in these groups people were indoctrinated to think that a non-circumcised man is “dirty” and also “just a boy”). This caused many men to do the operation even in late adulthood. Another process seems to have been that women belonging to non-circumcising groups started to demand circumcision from their men, after contacting circumcising groups (e.g., the Mangbetu of the Orientale province) (Friedrichs 1924; Halkim 1911; Burssens 1958). Our survey identified similar processes in other Central and West African countries (Text S2). Hence, the Kru of Liberia are nowadays universally circumcised (DHS Liberia 2007) and they were not in the past. The Sara of northwest Central African Republic were not circumcised by tradition, but those living in Bangui, in mid 20th century, were performing circumcision (Lebeuf 1954).
It is not surprising that, in countries where circumcision was performed by a minority of groups before colonialism (e.g., Zambia, Rwanda, Burundi), it continued minoritary, because the above cited social pressures (e.g., female rejection of the uncircumcised men) did not exist in the majority of communities. Most peoples of the extreme south of Katanga, and of Zambia (including the Bemba) were not circumcised in 19th century (Frobenius 1929; Baumann and Westermann 1962; Dataset S1).
As you write, current circumcision rates in Katanga are 98.1%, which is the same as the DRC average (DHS DRC 2007). In neighboring Luapula, Zambia, circumcision is minoritary. Clearly, for the groups living in both areas (e.g., the Bemba), their sub-populations living in Katanga gradually adopted circumcision during 20th century, presumably because of the social pressures exposed above. It would be interesting to check whether their Zambian counterparts adopted circumcision, following their fellows across the border, or instead followed the national norm, and remained uncircumcised, as most Zambians are.
Anyway the finding of a 15-fold difference in HIV prevalence between the two bordering regions is quite impressive, and suggests that the effects of lack of circumcision in current HIV epidemiology are still underappreciated.
The references cited here are listed in Text S2.