The circumcision rate for newborn males in the U.S. dropped 10 percent in the past three decades, amid fluctuating medical guidelines, changes in the immigrant population, and a growing movement that opposes the practice.
From 1979 to 2010, the rate of newborn circumcision declined to 58 percent from 65 percent, according to a report today by the Centers for Disease Control and Prevention. The rate was the highest in 1981, with 65 percent of male infants circumcised, and lowest in 2007, at 55 percent, the CDC said.
The removal of the foreskin from the tip of the penis is prevalent in the U.S., as well as in Israel and in Muslim countries because of the religious laws of Judaism and Islam. In the U.S., where medical guidelines have fluctuated, doctors currently don’t recommend the practice for medical reasons.
“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,” said Thomas McInerny, president of the American Academy of Pediatrics, in a telephone interview. “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.”
What’s more, the days when doctors said “do this” and patients didn’t question them are over, said McInerny, who wasn’t involved in the CDC study.
Shared decision-making between patients and doctors means that parents often get the drawbacks and benefits, and may choose to forgo the procedure, for which there are “small risks,” mostly bleeding, McInerny said.
The AAP, an organization of more than 60,000 pediatricians, said there was no medical indication for routine newborn circumcision in the 1970s. In 1989, the group revised its position, saying there were potential medical benefits. Then in 1999, the group said there was insufficient evidence to recommend routine circumcision. The most recent policy statement, released in September 2012, says that the benefits aren’t great enough to recommend routine circumcision of newborns, though third party payers should reimburse the cost.
“Parents ultimately should decide whether circumcision is in the best interests of their male child,” doctors wrote in the statement. It said parents should weigh medical information with their religious and cultural beliefs and practices, since the medical benefits may not outweigh those considerations.
Rates of circumcision in Western U.S. states dropped the most in the 32-year period studied. In that region, 40 percent of newborns were circumcised in 2010, compared with 64 percent in 1979. Rates in the Northeast remained unchanged, with about two-thirds of infants undergoing the procedure. In the Midwest, the rates followed the national pattern. That’s likely due to demographic changes from immigration, McInerny said.
Some patient and parent groups argue that circumcision is an unnecessary medical procedure and should be avoided, and Medicaid, the joint U.S.-state health program for the poor, has stopped funding the procedure in 18 states.
“It’s a brutal and unnecessary procedure to inflict on a baby that can’t consent,” said Georganne Chapin, the executive director of the anti-circumcision advocacy group Intact America, in a telephone interview. “The biggest reason people have moved from circumcising their children, moving toward leaving their children as they’re born, is they’ve realized circumcision isn’t necessary and it’s painful.”
There is evidence that circumcision may have medical benefits. Research suggests circumcision leads to fewer cases of HIV, herpes, genital warts and genital cancers among men and their sexual partners, and has garnered support from groups such as the Bill & Melinda Gates Foundation for use in Africa.
In a study published in August 2012, researchers said reduced rates of circumcision may boost U.S. health-care costs by $4.4 billion if rates plunge to levels seen in Europe, where only 10 percent of boys are circumcised. The study, published in the Archives of Pediatrics and Adolescent Medicine, was led by Aaron Tobian, a health epidemiologist and pathologist at Johns Hopkins University in Baltimore.
“The advocacy against circumcision has been highly vocal, and they have done a better job of communicating to the lay public than scientists have,” Tobian said. He wasn’t involved in today’s study.