Tradition of Male Circumcision Exists in Rite of Passage Ceremonies

MOCHUDI - Researchers are waking up to new evidence showing male circumcision as a powerful HIV prevention tool, but the procedure is nothing new to many tribes of Botswana who have long practiced it for cultural and traditional reasons.  

Circumcision has been used for hygienic purposes or as a form of protection against the hot and sandy desert environment, but for most tribes in Botswana it was once considered a rite of passage for young boys entering manhood.  

"It 's your identity. It 's about becoming part of something," says Sandy Grant, the founding secretary of the Phuthadikobo Museum in Mochudi, a village known for having a strong tradition of initiation ceremonies. "The chief once told me that women would turn their backs on uncircumcised men."  

Circumcision was mostly abandoned in Botswana during the 19th and 20th centuries through the influence of European missionaries, who discouraged the practice as primitive. However, studies show that male circumcision remains well accepted among the Batswana and tradition in some tribes has kept the practice going.  

With recent research showing that safe male circumcision can reduce a man's risk of acquiring HIV by more than 50 percent, international health organizations are now urging African countries to expand access to the procedure. Tribal leaders may be asking one question: what took so long?

A History of Circumcision
Kgosi Linchwe II, the recently deceased paramount chief of the Bakgatla tribe, revived circumcision in Mochudi in 1975 as part of a traditional rite of passage ceremony called "bogwera." The ceremony is an elaborate and lengthy series of rites for young men and boys. Until he had passed through them, a male, no matter how old, was not allowed to marry, attend and speak at tribal meetings, or even sit with other men at the same fire.

It was during the months-long ceremony that young men and boys would get circumcised as part of the initiation, which would also include teachings on the tribe's history, traditions and values. In the early days of bogwera, circumcision was performed by an operator called "Rathipana" or "Father of the Little Knife."

"He (Rathipana) had to be of Kgatla stock and fairly old, and was specifically chosen for his known skill and good fortune in castrating cattle. If he proved unlucky in his work (of circumcising boys) he would not be used again," according to the book, Bogwera: Kgatla Initiation, a detailed description of a Mochudi initiation ceremony in 1902 by Professor Issac Schapera.

Each boy, starting with the chief 's son if nobody senior was among them, was led in turn to the Rathipana. A traditional doctor would smear medicinal paste on the boy's forehead and temples so that "he must no longer think of his home or mother, or be afraid." Meanwhile, men standing around would shout or sing loudly so that the other boys could not hear his cries.

Schapera wrote: "Rathipana put aside the severed prepuces (foreskins) one by one. They were afterwards gathered by the doctor, who burned them all together and ground the ashes to powder, which he mixed with fat. The resulting ‘tshitlho' (sooty paste) was put into a medicine horn for the chief who was thus given control over the whole of the new age-set."

Under Kgosi Linchwe II, the revived bogwera and practice of circumcision did not include use of the Rathipana. Instead, the young men and boys would find their way to a hospital to get circumcised. During the 1982 ceremony, a team of medical students from the Medical University of South Africa (MEDUNSA) in Pretoria was recruited to assist with an estimated 615 circumcision operations carried out in Mochudi, according to records kept by Grant, the museum secretary.

"I found nothing wrong with using the modern method or using medical doctors instead of the old way of using bo-Rathipana," Kgosi Linchwe said in a 2005 article in Flair Magazine.

But the practice lost momentum among the Bakgatla in the late 1980s, this time due to it being costly and time consuming. "You need lots of doctors to perform the circumcision and they don't come cheap," the chief said.

Despite the loss of the ceremony, Linchwe said he still believed in the value of circumcision. "One becomes clean and not easily susceptible to diseases," he explained.

Circumcision and Respect
In Bikwe, a small Xhosa community in the South East District of Botswana, one is not considered a man until he goes through the rite of passage. Here, girls customarily shun men who have not been through the rite because they are still considered boys, even by their peers.

Part of the rite of passage is undergoing circumcision, training and endurance tests. Most aspects of the initiation are kept secret, and only those 18 years and above can go through the ceremony.

"Due to many diseases and fear of infection, circumcision is done at a hospital unlike in the past," Kgosi Thanda Ntaba Mngquibisa told the Midweek Sun newspaper in a recent interview. He noted that circumcision also reduces risk of infection and disease, like HIV.

Boys undergoing the bogwera ceremony in Bikwe are also taught how to treat and respect women. "In our village we don't have many assault cases because the men are taught at initiation school that women are not punching bags," the chief said. 

Circumcision in Health Care Settings
Other tribes known to practice circumcision as part of cultural ceremonies include Balete and Babirwa. But as a whole, there are few circumcisions happening in Botswana today as part of tribal ceremonies. What about in health care settings?  

Circumcision is not routinely offered in clinics, and according to the 2004 BAIS II national household survey, less than 10 percent of Botswana males claim to be circumcised. A spot check around the country found that between January and September this year, there were 23 circumcisions at the hospital in Kasane, 27 in Ghanzi, 61 in Selebi-Phikwe and none in the Okavango District. The small numbers may be due to a lack of staffing and knowledge of the procedure, according to health officials in the districts.  

Still, previous work has shown that women and men in Botswana find male circumcision to be an acceptable HIV prevention strategy. A 2001 survey of people from 29 ethnic groups in Botswana showed that 68 percent of respondents would definitely or probably circumcise a male child if it was offered free of charge at a hospital.  

The acceptability of circumcision may have something to do with its history in Botswana. What is needed now is more information on public readiness and cost infrastructure before Botswana considers scaling-up the practice in health settings, says Dr. Poloko Kebaabetswe, a senior researcher at BOTUSA.  

"Of course, a number of challenges have to be addressed, such as who will do the circumcision - nurses or doctors? Where should circumcisions be done - clinic or hospitals? Who will be offered circumcision - babies, newborn, teens, or adults?" Kebaabetswe says.  

Some of those questions may be answered soon. The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) in 2008 will support a Botswana-Harvard Partnership project to conduct a pilot test of an expanded infant male circumcision program in four hospitals. The evaluation will identify medical, cultural, economic and ethical issues to consider in scaling up infant male circumcision for HIV prevention in Botswana Special thanks to Peace Corps volunteers Brian Wittnebel, Paula Kaye, Chami Arachchi and Emilee Quinn, and Dr. Molly Smit of BOTUSA, for help in compiling circumcision statistics in health settings.