The New York Board of Health has voted unanimously to require parental consent for a controversial circumcision practice.

The board on Thursday voted 9-0 to require parents to sign a consent form in order for a mohel, or ritual circumciser, to use direct oral-genital suction, known as metzitzah b’peh. The form would indicate that parents are aware of the risk of infection.

Metzitzah b’peh is not used in most Jewish circumcision ceremonies, but many in the Haredi community still adhere to it. Ultra-Orthodox leaders have resisted calls to replace direct oral suction with the alternative approaches.

The Health Department says there have been 11 confirmed cases of herpes simplex since 2004 in newborn boys after circumcisions that likely involved direct oral suction. Two of the infants died.

Defenders of the practice said they will ignore the new rule.

Rabbi William Handler of Brooklyn said the circumcision ritual is 3,000 years old and is safe.

The health department’s vote represents the culmination of a year of debate surrounding the practice, which was sparked by the death of an infant in Brooklyn last September and the subsequent revelation that a mohel who performed the ritual on the infant had tested positive for herpes. In June, New York City Health Commissioner Dr. Thomas Farley condemned the practice of direct oral suction.

Some 200 Haredi Orthodox rabbis in New York signed a statement last week accusing the health department of “spreading lies” in order to pass the waiver measure.

The Conservative movement’s Rabbinical Assembly applauded the health commissioner’s push for parental consent, while the Rabbinical Council of America expressed discontent with the prospect of regulation on the matter.

The Haredi Orthodox Agudath Israel of America reportedly is planning to sue the city of New York over the requirement.