A proposal to ban the circumcision of male children in San Francisco has been cleared to appear on the November ballot, setting the stage for the nation's first public vote on what has long been considered a private family matter.
But even in a city with a long-held reputation for pushing boundaries, the measure is drawing heavy fire. Opponents are lining up against it, saying a ban on a religious rite considered sacred by Jews and Muslims is a blatant violation of constitutional rights.
Elections officials confirmed Wednesday the initiative had qualified for the ballot with more than 7,700 valid signatures from city residents. Initiatives must have at least 7,168 names to qualify.
If the measure passes, circumcision would be prohibited among males under the age of 18. The practice would become a misdemeanor offense punishable by a fine of up to $1,000 or up to one year in jail. There would be no religious exemptions.
The proposed ban appears to be the first in the country to make it this far, though a larger national debate over the health benefits of circumcision has been going on for many years. Banning circumcision would almost certainly prompt a flurry of legal challenges alleging violations of the First Amendment's guarantee of the freedom to exercise one's religious beliefs.
Supporters of the ban say male circumcision is a form of genital mutilation that is unnecessary, extremely painful and even dangerous. They say parents should not be able to force the decision on their young child.
"Parents are really guardians, and guardians have to do what's in the best interest of the child. It's his body. It's his choice," said Lloyd Schofield, the measure's lead proponent and a longtime San Francisco resident. He added the cutting away of the foreskin from the penis is a more invasive medical procedure than many new parents or childless individuals realize.
But opponents say such claims are alarmingly misleading, and call the proposal a clear violation of constitutionally protected religious freedoms.
"For a city that's renowned for being progressive and open-minded, to even have to consider such an intolerant proposition ... it sets a dangerous precedent for all cities and states," said Rabbi Gil Yosef Leeds of Berkeley. Leeds is a certified "mohel," the person who traditionally performs ritual circumcisions in the Jewish faith.
He said for the past few months he has been receiving daily phone calls from members of the local Jewish community who are concerned about the proposed ban. But he said he is relatively confident that even if the measure is approved, it will be abruptly _ and indefinitely _ tied up in litigation.
Jews consider religious male circumcision a commandment from God. It also is widely practiced by Muslims, and while it does not appear in the Quran it is mentioned in the Sunnah, the sayings of the Prophet Muhammad. Most Christian denominations neither require nor forbid circumcision.
The initiative's backers say its progress is the biggest success story to date in a decades-old, nationwide movement by so-called "intactivists" to end circumcision of male infants in the United States. A similar effort by the Tarrytown, N.Y.-based group Intact America to introduce a circumcision ban in the Massachusetts Legislature last year failed to gain traction.
"It's been kind of under the radar until now, but it was a conversation that needed to happen," Schofield said of the debate over male circumcision. "We've tapped into a spark with our measure _ something that's been going on for a long time."
Schofield's group calls its initiative the San Francisco Male Genital Mutilation bill, though he said the city attorney has opted to call the measure "Male Circumcision" on the ballot. The group's official website features a picture of a wide-eyed, delighted-looking baby and urges visitors to help "protect ALL infants and children in San Francisco from the pain and harm caused by forced genital cutting."
Female genital cutting, a controversial practice that usually involves the removal of the clitoris, is illegal in the United States. A circumcision ban would simply extend the same protections to males, Schofield said.
International health organizations have promoted circumcision as an important strategy for reducing the spread of the AIDS virus. That's based on studies that showed it can prevent AIDS among heterosexual men in Africa.
But there hasn't been the same kind of push for circumcision in the U.S., in part because nearly 80 percent of American men are already circumcised, a much higher proportion than the worldwide average of 30 percent. Also, HIV spreads mainly among gay men in the U.S., and research indicates circumcision doesn't protect gay men from HIV.
For years, federal health officials have been working on recommendations regarding circumcision. The effort was sparked by studies that found circumcision is partially effective in preventing the virus' spread between women and men. The recommendations are still being developed, and there is no date set for their release, said a spokeswoman for the U.S. Centers for Disease Control and Prevention.
The CDC doesn't have a position on the San Francisco proposal, said the spokeswoman, Elizabeth-Ann Chandler.
The chief of pediatric urology at the University of California, San Francisco Benioff Children's Hospital said he remains neutral on the subject of circumcision when parents come to him seeking advice. Dr. Laurence Baskin said he instead tries to educate them about the medical benefits and potential downsides of the procedure.
In addition to the AIDS studies, Baskin cited published research indicating that circumcision can reduce the incidence of other sexually transmitted diseases, as well as penile cancer and urinary tract infections. He disputed claims that circumcision is mutilation or causes significant pain.
"It has what I would say would be a minimal amount of pain if done properly, so my recommendation is to use anesthesia," he said. However, he noted, "most people aren't circumcised and they do just fine."
Baskin was not neutral on the subject of the new ballot measure, calling it "a bunch of nonsense."
"I'm not going to stop doing circumcisions, and this would never pass the First Amendment test," he said. "The people who are doing this should focus on our budget problems, lack of education _ something that could really help society."
AP Medical Writer Mike Stobbe contributed to this report from Atlanta.