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.