Fillers POEM*

Breast feeding is associated with fewer hospitalisations

BMJ 2003; 326 doi: (Published 26 June 2003) Cite this as: BMJ 2003;326:0-e

Avoidance of circumcision plus breastfeeding may produce lowest childhood morbidity and mortality

EDITOR:--Bachrach and colleagues1 have made a valuable addition to the ever-growing evidence that breastfeeding is “primary in achieving optimal infant and child health, growth, and development.”2

Doctors Opposing Circumcision (DOC) has concerns that infant boys are less likely to share in the manifold benefits of breastfeeding because of the continued practice of neonatal male circumcision, especially in the United States. Circumcision’s interference with initiation of breastfeeding is now well documented in the literature,3,4 reported by lactation consultants.5,6 and affirmed by the American Academy of Pediatrics (AAP).7

The lack of medical value of infant circumcision is recognized by the American Medical Association, which describes the surgical procedure as “non-therapeutic.”8 Chessare reported that “the choice of no circumcision yielded the highest expected utility.” Circumcision’s complications of bleeding, infection, surgical mishap, adhesions, meatitis, meatal ulceration, meatal stenosis, and even (rarely) death are well known.9 On the other hand, breastfeeding has multiple benefits.1,2

Based on the foregoing, DOC has recommended that initiation of breastfeeding should be given absolute priority over circumcision, which should be avoided.10 We think that avoidance of circumcision plus breastfeeding is most likely to produce the lowest morbidity and mortality in children and that prenatal parental counseling should include this information.10 This is consistent with the AAP’s advice to promote breastfeeding2 and avoid painful procedures that may interfere with breastfeeding or traumatize the infant.2,11

Unfortunately, it appears that breastfeeding support organizations have been slow to implement this advice into practice. DOC urges family practitioners, paediatricians, obstetricians, hospitals, breastfeeding support organisations, and lactation consultants to include this information in prenatal counseling, so that boys may share equally in the health and child development benefits derived from breastfeeding.

George Hill,
Executive Secretary

Doctors Opposing Circumcision

Suite 42

2442 NW Market Street

Seattle, Washington 98107


Web: http:/


  1. Bachrach VR, Schwarz E, Bachrach LR. Breastfeeding and the Risk of Hospitalization for Respiratory Disease in Infancy. Arch Pediatr Adolesc Med 2003;157:237-243.
  2. AAP Workgroup on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 1997;100: 1035-39.
  3. Marshall RE, PorterFL, Rogers AG, et al.Circumcision: II effects upon mother-infant interaction. Early Hum Dev 1982; 7(4):367-374.
  4. Howard CR, Howard FM, and Weitzman ML. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediatrics 1994;93(4):641-646.
  5. Lee N. Circumcision and breastfeeding. J Hum Lact 2000;16(4):295.
  6. Caplan L. Circumcision and breastfeeding: a response to Nikki Lee's letter. J Hum Lact 2001;17(1):7.
  7. Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics; Task Force on Pain in Infants, Children, and Adolescents, American Pain Society. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics 2001;108(3):793-7.
  8. Council on Scientific Affairs. Report 10: Neonatal circumcision. Chicago: American Medical Association, 1999.
  9. Williams N, Kapila L. Complications of circumcision. Brit J Surg 1993; 80: 1231-1236.
  10. Hill G. Breastfeeding must be given priority over circumcision. J Hum Lact 2003;19(1):21.
  11. Committee on Fetus and Newborn, Committee on Drugs, Section on Anesthesiology, Section on Surgery, American Academy of Pediatrics; Fetus and Newborn Committee, Canadian Paediatric Society. Prevention and management of pain and stress in the neonate. Pediatrics 2000;105(2):454-461.

Competing interests:  
None declared

Competing interests: No competing interests

05 July 2003
George Hill
Executive Secretary
Doctors Opposing Circumcision, Suite 42, 2442 NW Market Street, Seattle, Washington 98107, USA