Assessing the knowledge of male circumcision among pregnant women attending the Chris Hani Baragwanath Academic Hospital Antenatal Clinic

Background Human immunodeficiency virus (HIV) remains hyperendemic in South Africa (SA). Circumcision reduces the risk of HIV transmission from female to male by 60% and is considered a mainstay in the public health attempt to prevent the spread of HIV. Neonatal Male Circumcision (NMC) is recommended by the World Health Organisation (WHO) alongside Voluntary Male Medical Circumcision (VMMC) in HIV hyperendemic areas due to benefits including ease of procedure, decreased complication rates and decreased cost. The WHO considers knowledge regarding circumcision a human right and recommends that education around circumcision begins with pregnant women at antenatal clinics. This study aims to assess the knowledge of pregnant women attending an antenatal clinic regarding circumcision. It explores knowledge surrounding religious, cultural and medical reasons for circumcision, costs, legislation, autonomy and the associated risks and benefits of NMC and VMMC. Methods A prospective cross-sectional study was conducted using a digital close-ended multiple- choice questionnaire. A pilot study was conducted to refine the questionnaire. The final calculated sample size was 408 participants. Data was analysed using Power Bi and Stata 17. Knowledge was assessed by comparing assigned knowledge scores to the median for each question, with a score above or equal to the median considered good knowledge. Results There was good knowledge regarding religious and medical reasons for circumcision, safety and complications, but poor knowledge regarding accessing VMMC. There are multiple common misconceptions regarding legislation in SA. There is a common misconception that circumcision cannot be performed in neonates, however, knowledge of the benefits of NMC was good. Conclusions Although knowledge surrounding circumcision is good, several common misconceptions exist, compounded by confusion brought about in SA legislation. There is ethical debate around the public health benefits of NMC in opposition to child autonomy and decision making. However, overwhelming benefits of NMC compared to VMMC necessitate further research regarding ethics, acceptability and accessibility of NMC as well as knowledge in the physician population treating these patients. Education surrounding circumcision in the antenatal population needs to be improved in line with the WHO recommendation that this is a human right.