Explaining the Drop in Circumcision Rates

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In the U.S., fewer newborn baby boys were circumcised before leaving the hospital compared to 30 years ago. What’s going on?

In 1979, close to two-thirds of boys in the West underwent a hospital circumcision after birth, but by 2010 that percentage dropped to around 58%.

The numbers come from the Centers for Disease Control’s National Center for Health Statistics (NCHS) report, which shows circumcision rates have dropped by 10% overall in the 32 year period. And it’s not just the U.S. that is experiencing fewer circumcisions; western nations in general are seeing drops, but  the CDC analysis also shows that rates have fluctuated widely in the U.S., and that there are regional differences in the popularity of the operation.

One reason for the ups and downs in surgery rates may have to do with flip-flopping guidance from experts about whether circumcisions are worthwhile.

(MORE: Why Circumcision Lowers Risk of HIV)

The rates started dropping in the 1980s, but picked back up in the 1990s, only to drop again at the start of the 21st century. Those dips and peaks may reflect the fact that in the 1970s, the American Academy of Pediatrics’ (AAP) task force reported that there was no medical evidence that routine circumcision was needed for newborns. It revised this opinion in 1989, citing some potential benefits for the the procedure. In 1999 the Academy once again released a policy statement summing up the potential benefits of the surgery — lower rates of urinary tract infections as well as sexually transmitted diseases such as HIV — but was still reluctant to advocate circumcision, saying that more evidence was needed to justify such a position from a medical perspective. The AAP advised parents instead to make the decision based on their cultural or religious beliefs.

In August, the Academy confirmed this stance by saying that while the benefits outweighed the risks, the decision should be made by individual parents who consider the medical pluses and the potential side effects, which include bleeding, infection at the circumcision site and irritation of the glans, located at the tip of the penis.

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U.S. Centers for Disease Control and Prevention

“I’ve been in practice for over 40 years and there wasn’t any question about whether to circumcise in the ‘good old days’ because parents were worried about what might happen in the locker room in middle school or high school,” Thomas McInerny, president of the American Academy of Pediatrics, told Bloomberg News. “But circumcision is less frequent in Europe and Asia, so in time as more immigration has occurred, there are more uncircumcised floating around in locker rooms, so you’re not going to get an embarrassing situation.”

(MORE: Study: Women With Circumcised Partners May Have Lower HPV Risk)

But there are may be other factors at work as well. As Reuters reports, a Medicaid program that covers low income patients no longer pays for circumcisions in 18 U.S. states, and insurers are slow to cover it without significant medical justifications. There is also the possibiity that more women are giving birth and having procedures outside of hospital settings; the NCHS report did not include these procedures, nor did it include those done, after discharge, as part of religious ceremonies in the Jewish and Muslim faiths. More women may simply be choosing to give birth outside of the hospital, or shortened hospital stays after delivery may make it easier to perform circumcisions at clinics.

In the developing world in particular, however, circumcision is encouraged as a way to cut down on infectious diseases — specifically, HIV. The World Health Organization includes circumcision as one of the ways to fight spread of HIV, and cite studies that found the operation can lower risk of infection by up to 60%. The most recent, published In April, reported that circumcised Ugandan men harbored less bacteria in their penile environment that can transfer the HIV virus. The men also had 81% less bacteria overall compared to those who weren’t circumcised, and that could dramatically improve their ability to fight infections.

In the U.S., the CDC says circumcision rates are highest in the Midwest, where about two-thirds of newborn boys are circumcised before being discharged, and most varied in the West, where San Francisco and Santa Monica have even proposed banning the procedure. The governor signed a bill prohibiting such bans, and rates have been inching up again since hitting a low of 31% in 2003.

31 comments
ernstfriedrich
ernstfriedrich

In Western Europe where rates of circumcision are below 10% rates of HPV, HIV, STDs are lower than in the USA where 90% of adult males are circumcised.

That is proof enough that the only things accomplished by cutting the healthy flesh off babies is a profit for the doctors a loss of the human right to body integrity for the baby, and an unheathy obsession with a baby boys private anatomy. The only person touching a child's penis should be the kid himself until he grows up and is ready to share sex with another.

Complications from circumcision are common and largely unreported and misunderstood.

Parents, you simply dont have the right to cut part of your son off.

If you believe in God, do you think god made a mistake on every little boy? That's quite an assumption on your part. Assuming you know better than God.

If you believe in evolution, do you think that every male mammal was meant to have foreskin except humans? 

mother nature made a mistake with us did she? We don't circumcise dogs, horses.Whales live a healthy life with their foreskin intact. It's a ridiculous notion you have to cut a part of a body off to make it perform better.

rockycz
rockycz

The male foreskin contains 20,000 specialized nerve-endings.  In comparison, the female clitoris contains only 8,000.  Why would any parent want to rob his child, the future man, of a fully-functioning penis?  His healthy body should be left alone to use and enjoy as God/Nature intended.


My two sons were born in Southern California in the early 80's.  Thanks to my European-born husband's insistence and my rudimentary (pre-internet) research, they left the hospital WHOLE.  They have never suffered from these much-feared "infections", they have no problems getting girls, and they are extremely grateful to us that we left them intact.


Civilized countries around the world look upon us Americans, still routinely mutilating our newborn boys, with the same horror and disgust with which we look upon cultures who mutilate their girls.


"When it comes to holding down perfectly healthy babies and severing flesh from their bodies, how much can you cut away before it becomes morally wrong?"



RomeoAure
RomeoAure

Here in our country (Philippines), being uncircumcised is a lifetime embarassment for men. Here, the ideal time for circumcision is when you're 10 to 11 years old.

Louisnyc
Louisnyc

The truth of course is that parents -finally- little by little are getting smarter about those pediatric smarty pants with their constraints and lancets ready, and they are realizing that  being born "whole" is the way to be.

EastForestPark
EastForestPark

@justinford81 ahh welcome back to twitter. Cider is fairly large in the UK, stronger than most ales. I'll agree AO isn't that great.

XavierVega
XavierVega

There, I fixed that for you:

"rates have been inching DOWN again since hitting a low of 31% in 2003."

HansCastorp
HansCastorp

End genital mutilation NOW, for boys as well as girls.

There are various forms of female genital mutilation, one of the most common of which is the removal of the clitoral hood (prepuce). This is completely analogous to male circumcision (the removal of the p*nile prepuce), and and is banned by law.


Protection of genital integrity should obviously apply equally to both sexes.

aliberaldoseofskepticism
aliberaldoseofskepticism

I love how after de Witt discredited the "epithelial Langerhans cell" hypothesis by demonstrating that those same cells produce langerin, which is very hostile to viruses such as HIV, they've changed hypotheses AGAIN. But why not? I suppose homeopaths have given us fifty different ways water has memory, each more insane than the last.

Sources:

http://www.ncbi.nlm.nih.gov/pubmed/17334373

http://www.ncbi.nlm.nih.gov/pubmed/10661407

http://www.ncbi.nlm.nih.gov/pubmed/18277880

Previous hypotheses included that the foreskin didn't have ENOUGH epithelial Langerhans cells, and that keratinization of the glans protects the penis (but doesn't reduce sensation, oh no, can't have that). Worse, the initial claim from Fink comes from the spurious notion that uncircumcised men are less likely to be exclusively heterosexual, even though HIV spreads more rapidly among gay men because you can be a receptive partner, a 'bottom', one day; and an insertive partner, a 'top', the next. More recent claims have focused on the claim that men in sub-Saharan Africa are less likely to be circumcised, though most men in sub-Saharan Africa are circumcised! (HIV in sub-Saharan Africa is largely explained by the great deal of HIV denial in sub-Saharan Africa.)

Now they've gone to the bacterial flora on the penis. No explanation as to which bacteria, much less how this would work. It's not even wrong.

GregHartley
GregHartley

This is what passes for journalism?!  This article covers the alleged "benefits" of male genital cutting (euphemistically called circumcision) and links to two references in support of the practice, while including a brief mention of opposition to the procedure.  There is nothing about functions of the prepuce (foreskin) or the ethical implications of removing healthy, functional erogenous tissue from a non-consenting minor.  Nothing about the benefits of being genitally intact.  The cultural bias of the American medical community and American journalists on this topic is stunning - they are firmly plugged in to "The Matrix."  Readers should seek out non-American media articles to have an unbiased view of this issue. 

Bugdog
Bugdog

I hope this heinous practice is put to a halt!  The problem is the medical community is in bed with the drug

companies!  I had a boy baby and never realized until later this is selective surgery!!  I have yet, found a mother

who was talked to by a doctor or nurse about this procedure. The permission form is place under the breakfast tray

and there  is no professional to ask about this.  My husband was a young doctor at the time of our son's birth, so I

ask him about it.  We made a discussion to do it based on the lie he was told as a junior medical student.  The lie being

that it decreased A MALES CHANCE OF CANCER.  I AGREE WITH Brother K below; it is rare to none existence in Europe

and guess what, they do not have more cancer of the penis nor more HIV because nobody is getting circumcised.  My

daughter lives in Europe and is a research scientist and European people frequently ask her if Americans are still doing

this heinous practice.  In case you haven't had a male baby in USA this is how it goes; your ob/gyn does not bring it up,

the morning after you have your male baby someone with no education brings you your breakfast tray and there is the

form to sign.  Nobody with an education is around and the sad thing is most USA parents think it is part of the process

of birth.  They don't know it is selective surgery!!!!!!  Here is the sad part, many males babies are maimed each year in

the USA, needlessly.  My high school boyfriend was cut to the point he couldn't have children, he has finally got therapy

and maybe his 4th marriage will work out.  My friend was so excited when they found out that they were going to have

a boy baby only for his circumcision to be messed up and he had to have 2 surgeries before he was 10 months to repair it.

(Can you really repair a messed up penis?)  In my home town our major hospital had a medical board meeting and the

pediatrians were forbid to perform any more circumcisions in that hospital as of early 1980!  I also remember the trauma

I went through the day of my son's circumcision.  The RN told me to be outside my door with a bottle and that after my

son had his circumcision he would need it as he would be hungry.  Being young and not knowing to ask question, I

waited for them to circumcise him.  They brought him down the hall screaming like you never want to hear, hardly

able to catch his breath.  The RN handed him to me and say put the bottle in his mouth.  I then realized what pain

he must have gone through!   Five years later I worked in a nursery and the LVN and I helped comfort the babies

after they were circumcised. This was a horrible experience, but the lie was still going around that your baby might

get cancer later in life if he didn't have this procedure.  Now that the lie has been exposed, the medical community

uses the scare tactic of your male baby's chance of getting HIV is increased.  This is a bunch of lies.  People find

out it is selective surgery when they try to leave the hospital and they say you must pay $420 for the circumcision.

My brother and my friends said, "Isn't this covered by insurance." Their reply is no, this is selective surgery!"   Then

 Yep, the hospital and the drug companies are the big winner here and you better pray you son didn't get messed

up during it.  How many divorces has it caused? How many suicides are committed because of it?  How many

FAMILIES AND MEN HAVE TO LIVE WITH a messed up penis?  Bugdog

BrotherK
BrotherK

Friends, the president of the American Academy of Pediatrics made a deliberately deceptive statement to Time Magazine for its Aug. 22, 2013 article about the decline of genital surgery in the United States. Why can I state that it was DELIBERATELY DECEPTIVE with such certainty? Here's his quote: "Thomas McInerny, president of the American Academy of Pediatrics, told Bloomberg News. “But circumcision is less frequent in Europe and Asia..." Pardon me, Thomas McInery, it's rare to non-existent, and you could not phrase it that way without being very conscious of your own misstatement. Intactivists will see you in Orlando, Florida, buddy.

united_we_stand
united_we_stand

Its about creating a permanent tribal bond. Parents must hand over their child to authorities for sexual mutilation out of fear their child will be a societal outcast. This creates allegance to a larger social structure rather then to the family. It is similar to hazing. Its a form of stockholm syndrome. The idea there is more health risks to not doing it is to doubt evolution and/or creation. Many people have issues from fungus / atheletes foot growing under their toenails. There can be a better health benefits case made for removing humans toenails. There is nothing going on under a foreskin that is not going on in a vagina. Its not surprising the cultures which brought us and continue to advocate this ritual are patriarchial and look down on woman. To these cultures woman is unclean, just like the uncircumcised is. 

scuba7jb
scuba7jb

How is this ethical or moral to do?? You're performing an unnecessary, irreversible, cosmetic "procedure" on an un-consenting patient? 

Usually the parents don't have the courage to even watch it get done. Absolute cowards.

RebeccaFine
RebeccaFine

And now that the new 2012 AAP report said the benefits of circumcision outweigh the risks, will the rate  start going up nationally again?

RebeccaFine
RebeccaFine

The last time the rates were published in 2012, they were said to about 55%.  So if it's 58%, isn't that an increase?

SusanT.
SusanT.

I stand corrected -- the author did mention Medicaid funding births as a factor. Good for her and it proves it is time for me to go to sleep!

SusanT.
SusanT.

It was an interesting article but one thing that was not covered, which could contribute, perhaps a lot, to the falling rate is that in nearly 20 states, Medicaid has stopped funding circumcisions. And nearly half of all births in the U.S. are Medicaid-funded. 

dgibb
dgibb

Circumcision is nothing more than cosmetic surgery on babies without anesthetics. Cruel and unusual punishment, not unlike what they do in the middle east to female babies.

aliberaldoseofskepticism
aliberaldoseofskepticism

@RebeccaFine The AAP report was taken to task by the KNMG, among other European medical associations. tl;dr they hired people who were so fanatically pro-circumcision that one actually denied the connection between metzitzah b'peh and herpes in New York's Haredi community, while another was pro-clitoridectomy. We have more effective preventive measures, such as condoms and vaccines, for every disease they claimed is prevented by circumcision.

Trigger warning below this

The people advocating circumcision creep me out personally. Daniel Halperin (who wrote a wonderful bit of Mary Sue fiction called Tinderbox, in which our hero, a Latin American studies PhD, teaches all us poor medical researchers how benighted we are for saying "abstain, be faithful, or use condoms") recommends people go to a site all about the "erotic" aspects of circumcision to learn more about the procedure.

romano70
romano70

@SusanT. Where do you get that nearly half of all births are covered by Medicaid? Sounds like a number you pulled out of your rear

aliberaldoseofskepticism
aliberaldoseofskepticism

@dgibb They also circumcise boys. Actually, many Muslims claim clitoridectomy is just so girls can participate in Abraham's covenant.