Traditional Circumcision: A Cut Too Deep

In spite of continuous government effort, the number of deaths due to the consequences of traditional circumcision remains high – with no sign of improvement any time soon. 

By Fhumulani Justice Khumela    



For many African boys, manhood is achieved through circumcision. But it must not be just any circumcision, it must be done the traditional way. While cultures like the Tshivenda, Sesotho, Tsonga and Ndebele do not discriminate against boys who choose to get circumcised clinically, for Xhosa people it remains a huge issue.

Within the Xhosa community, circumcision is still profoundly regarded as the ceremonial transition to manhood. Boys who chose clinical circumcision are frowned upon and considered to be less of a man. As the numbers of traditional circumcision deaths continue to rise, some are opting for the safer alternative and even questioning the validity of traditional circumcision.

“I know of about four boys who have died in the mountains [initiation schools] in my area,” Tshebeletso Madolo, a 19-year-old from Cala village, Eastern Cape, says.

A year ago, Madolo together with his parents made the conscious decision that he would rather get circumcised in a hospital than risk his life and health by going to an initiation school. Madolo says he values his culture but refuses to subject himself to the poor health conditions of those schools.

“Growing up, you are told you will only become a man after you get circumcised in the mountains,” he explains. “As much as I would have loved to do it, it is becoming more and more dangerous and unhealthy. The only reason people still do it is because they are afraid of being considered cowards or wimps. I prefer being called names than put my life at stake through those conditions.”

Madolo says that while he has not yet suffered any form of discrimination he would not be bothered by it.

Munthu Langa, 18, from Indwe, 40 kms away from Cala, got traditionally circumcised this year. Langa, unlike Madolo, states that his culture and tradition mean a lot to him. Despite some incidences that have taken place to other boys during their initiations, he is glad he did it.

“I am happy that I can now classify myself as a man,” Lunga says. “There are harsh conditions there [mountains] but it is the path to manhood and I am proud that I made it. When I was there I was not afraid at any point of time, we were told that a man must be able to handle the pain.

“I am glad that I don’t have to walk in the neighbourhood with people calling me a coward. All the people who didn’t go the mountains will always be subjected to criticism, I didn’t want to be part of them,” he added.

Traditional circumcision is usually performed in a non-clinical setting by a traditional provider (surgeon). The procedure is done without pain killers or antibiotics, with the foreskins cut by surgical blades by traditional surgeons.

These surgeons have no formal medical training. The health conditions of initiation schools are very poor and have been criticised for being life threatening.

Dr Tsumbedzo Badugela, a medical doctor at the Department of Health Kimberly Hospital Complex, says that the general set-up of initiation schools is fatal, mentioning that infections are the biggest concern for the initiates.
“Patients get infections which complicate because of the sepsis they are exposed to in the areas [mountains] where the procedures are done. When the boys sit unsterilized for days, the unfortunately complicate.

“The biggest issue is that, in contrast to clinical circumcision, when boys get infected in initiation schools they cannot get treatment. The whole system is based on “manning up” and completing the whole three weeks despite any complications.”

Oscar Mawaza, a Traditional surgeon from Gugulethu, Cape Town, has been performing circumcisions for 17 years and claims there has never been any death at his school. Mawaza has blamed the high deaths in the country on new initiation schools that have very little knowledge into conducting the circumcisions.

“Initiation schools are popping up like it’s a fashion thing,” Mawaza says. “Nowadays, no one starts initiation schools because they care about the boys. It has become a business, and this business is destroying lives because these people are not detected.”

Mawaza says these days anyone can easily become an initiator or start an initiation school. He identified the profits that can be made from the schools as a catalyst for bad practices.

“Some initiation schools are bringing in more than R100 000 in profits,” he says. “This is ridiculous when you consider that at one point initiation was done freely. Yes the time has changed and we all do charge, but some are charging lots of money and also taking in large numbers of boys to increase profits.

“It is like capitalists have taken over the system. People are just exploiting a system that government can’t really control, there are many loopholes and people are using them to make money from it.”

According to the National Department of Health, a majority of circumcision deaths mainly occur in the Eastern Cape and Western Cape amongst the Xhosa people. Mandiso Tau, a former Sesotho healer, has blamed the deaths on the nutrition the new generation takes.

“The food the boys eat these days is not healthy. Their bodies are too weak for the mountains,” Tau explained. “The young boys these days eat junk food, drink too much alcohol and are sexually active at a very young age. That contributes to weak bodies.

“Back in the old days boys in their age worked hard, ate well and didn’t indulge into sexually behaviour. These new boys are weak, their bodies cannot handle the conditions in the mountains. This is sad because traditional circumcision could possibly die out due to these high death rates.”

Tau closed his circumcision school three years back after his school stopped attracting initiates. He blamed this on new initiation schools that were driven by political and royal family connected people that started commercialising initiations schools.

“It’s absurd, people are now advertising initiation schools. Initiation schools were never meant to be advertised, every family knew which school or schools they would like to take their children to even from a very young age. These days people put up advertisement and lobby for customers. These people are the ones killing young boys. They drive fancy German cars because they are running good business.”


The government has found it hard to fully handle and regulate traditional circumcision. There have, however, been improved laws and there continues to be new policies into improving the general safety of traditional circumcision.

Over the years, a number of laws have been put into place, among them is the Children’s Act of 2005 – that makes it unlawful to circumcise children under the age of 16. A 2009 ruling on a case by a young Xhosa boy who was forcibly circumcised, ruled that it is unlawful to circumcise someone without their full consent.

Current new laws being looked into include charging parents who do not take proper care of their children when they come back from initiation schools.

Despite government intervention, there are still reports of deaths and forced circumcisions.

Since the United Nations report backing findings that circumcision lowers risk of contracting HIV, the Government Health Department has identified circumcision as another key mechanism in fighting the HIV epidemic.

Both the President and the Minister of Health have criticised initiation deaths. As the government continues to try and find better regulations of traditional circumcision, realistically, even with all the laws in place, the conditions in the mountains are challenging meaning that even legitimate and good traditional surgeons can still have deaths on their hands.


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