CDC: Why Are U.S. Circumcision Rates Declining?

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Why are newborn circumcision rates dropping in the U.S.? In a report released Thursday, the Centers for Disease Control and Prevention (CDC) said that hospital circumcisions had declined over the past 10 years, after more than a decade of increase.

The rate of in-hospital circumcision rose from 48.3% in 1988-91 to 61.1% in 1997-2000, the CDC reports. To gauge current rates of circumcision, the researchers looked at numbers from three large, independent data sources, all of which collect discharge data on inpatient hospitalizations.

Every data set showed a decline. For example, the 1999-2010 National Hospital Discharge Survey showed that fewer than 12 million of nearly 20 million newborn boys were circumcised over the past decade. The survey showed that the rate of in-hospital circumcisions dropped from 62.5% in 1999 to 56.9% in 2008.

The other two measurements showed similar drops. But the CDC noted that all three data sources underestimate the actual rate of newborn circumcisions in the U.S., since they don’t take into account circumcisions performed outside the hospital. The ritual is strictly observed in certain religions; Jewish families, for example, often have a mohel perform the bris at home.

Still, what would explain the overall declining trend? The CDC suggests many factors, including insurance coverage. The report says that circumcision rates in hospitals in states where Medicaid routinely covers it were 24% higher that hospitals without the same coverage.

In addition, reports WebMD:

In 1999, the American Academy of Pediatrics declared that there was not enough data to recommend the routine circumcision of baby boys. They reaffirmed their position in 2005.

That position, according to the CDC, may have contributed to the current drop in circumcision rates. For example, the position may have had an influence on whether insurance companies reimburse for the procedure. It also may have altered decision-making by parents on circumcising their sons.

However, the authors of the CDC report prefaced their findings by noting that recent evidence shows that circumcision greatly reduces the risk of HIV transmission through heterosexual sex.

Data also suggest that lack of circumcision is associated with other sexually transmitted infections, including Chlamydia, genital ulcer disease and human papillomavirus, or HPV. Women who have sex with uncircumcised men appear to be at higher risk of cervical cancer, which can be caused by HPV.

Debate over circumcision continues to swirl: last spring, an anti-circumcision activist group tried to get the practice banned in San Francisco, saying that baby boys should be afforded the same protections as baby girls against circumcision.

For more information on the new CDC report, click here.