Synthesis of Women's Voices in Traditional Male Circumcision in South Africa: Do Their Voices Really Matter?

Abstract

Traditional Male Circumcision (TMC) remains a culturally significant rite of passage in South Africa, particularly in the Eastern Cape, despite rising concerns about morbidity and mortality associated with unsafe practices. This narrative literature review synthesises the largely overlooked voices of women—central caregivers, cultural stakeholders, and key observers of initiation outcomes—to examine their roles, perspectives, and influence within the TMC continuum. Five dominant themes emerged. First, women act as cultural custodians who strongly support TMC for its role in identity formation, yet fear that biomedical alternatives threaten cultural continuity. Second, women express deep anxiety about escalating health risks, including deaths, amputations, and psychosocial trauma arising from botched procedures. Third, entrenched patriarchal norms and ritual secrecy systematically exclude women from decision-making, limiting their agency despite their substantial caregiving responsibilities. Fourth, women highlight heightened vulnerability to post-initiation harms, including increased male aggression, risky sexual behaviours, and associated HIV risks. Lastly, pervasive medical mistrust and misinformation reinforce women’s preference for traditional practices over safer medical circumcision options. The findings demonstrate that women’s voices are critical yet marginalised components of TMC governance. Meaningfully integrating women’s perspectives is essential to advancing culturally grounded, gender responsive, and health-protective reforms.