Members of the de Blasio administration have conferred about half a dozen times over the last year with Orthodox leaders about the issue and are now close to a compromise agreement, said Avi Fink, the mayor’s deputy director of intergovernmental affairs, an Orthodox Jew involved in the discussions. The goal of the new rule would be to better educate parents about the ritual’s health risks, while respecting their right to have it done, he said.

“You can have something on paper that seems robust, and maybe even seems invasive and strong,” Mr. Fink said of the consent requirement. “But part of how the mayor is going to ensure success in this is how many people are we actually touching and communicating with, and how much awareness and education can we actually accomplish.”

Metzitzah b’peh is a regular part of the circumcision ceremony within some branches of Orthodox and ultra-Orthodox Judaism, but is rare among other Jews. In 2012, a report by the Centers for Disease Control and Prevention estimated that it was conducted on about 3,600 New York City newborns each year. The researchers advised against the practice, warning that it raises the likelihood that an infant will get herpes by 3.4 times that of other male newborns.

Image Yehoshua Setareh after his circumcision ceremony at Congregation Ahaba Ve Ahva in Ocean Parkway, Brooklyn on Dec. 10.



Credit Michael Nagle for The New York Times

In September 2012, city health officials mandated that every Jewish ritual circumciser, known as a mohel, collect consent forms. The form must state that the city advises against oral suction because it “exposes an infant to the risk of transmission of herpes simplex virus infection, which may result in brain damage or death.” Mohelim should retain the signed forms for a year, in case of an investigation.

Soon after the rule’s passage, more than 200 ultra-Orthodox rabbis ordered their followers not to comply. Orthodox leaders also sued the city in federal court, arguing the regulation was unconstitutional. While a district court sided with the city, an appeals court in August expressed concern that the rule could indeed curtail freedom of religion. Its judges directed the lower court to start over, using a stricter legal standard.