Circumcision Rates Reflect Cutting-Edge Changes

Sharp drop in the West is the largest trend shift in 20 years, new government report says

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By
HealthDay Reporter

THURSDAY, July 19, 2001 (HealthDayNews) -- The national rate of circumcision in the United States has remained unchanged over the last two decades, a new government report says, but regional and racial differences appear marked.

Far fewer baby boys in the West are having the procedure while Midwestern newborn rates have increased, says the report, which was released yesterday by the Centers for Disease Control and Prevention. And the circumcision gap between black babies and white babies has completely closed.

Overall about 65 percent of all newborn males were circumcised in the United States in 1999, according to the report, about the same as it has been for the last 20 years. But circumcision rates dropped from 62 percent in 1980 in the West to about 37 percent in 1999, and they went up in the Midwest from 76 percent to 80 percent.

"The regional information is the most dramatic change in the past 20 years," says lead statistician Abigail Moss, who is with the National Center for Health Statistics in Hyattsville, Md. "It appears as if the West has a high proportion of Asian-Americans and Hispanics who culturally are less likely to circumcise their children, and there has been an increase in those populations in the West."

Moss says the trends in American circumcision rates are culled from the National Hospital Discharge Survey, which gives reasons for people's short-term stays in hospital. "Short term" means a stay of no more than 30 days.

In the past, more white newborns were circumcised than black infants, the report shows: Between 1980 and 1990, white infants, on average, were 13 percent more likely to undergo the procedure than black babies. But by 1995, the difference had dropped to about 7 percent. And in 1999, circumcision rates for black infants and white infants were about the same.

"The factor that may be in play here is more is known today about the potential medical benefits of circumcision, and that could be reflected in the black [rates] and white rates coming closer together," Moss says.

Moss says she's not sure why newborn circumcisions increased in the Midwest. "What may be reflected here is that parents are really becoming involved in the decision-making process, and that's really showing up in the West where parents have taken over from standard hospital policies. But why it's higher in the Midwest is not known."

Circumcision, the surgical removal of the foreskin of the penis, takes place about 1.2 million times each year. The procedure reduces infant urinary tract infections, penile cancer and various sexually transmitted diseases, the CDC says. Hospitals routinely circumcise boy babies. But because the operation is painful, and has religious and cultural implications, the procedure has become increasingly controversial.

The American Academy of Pediatrics' (AAP) position on circumcision, formulated by a task force in 1999, is that there aren't enough medical benefits to warrant it.

The AAP also feels the decision should be left to the parents', says its 1999 report. "In the case of circumcision, in which there are potential benefits and risks, the procedure is not essential to the child's current well-being, [and] parents should determine what is in the best interests of the child," the report says.

If the AAP statement is followed, there would be more, not fewer, circumcisions in the United States, says Dr. Craig Shoemaker, a member of the AAP's Task Force on Circumcision and the medical director of the Neonatal Intensive Care Unit at the University of California Davis Medical Center in Sacramento.

"These statistics actually demonstrate the importance of allowing parents to actively participate in the healthcare management of their child," he says. "If they receive the proper counseling from their doctor, parents are either going to choose the benefits of circumcision over the risks, or they are going to choose not to have their child circumcised for cultural, religious reasons or because they have been adequately counseled and choose not to do it."

The drop in circumcision rates in the West are not only due to cultural factors, Shoemaker adds. "There are some physicians here in California who are actively discouraging circumcision. And there are managed care organizations that still consider circumcision an elective procedure, and they won't pay for it."

"And there are some doctors who avoid the controversy completely," Shoemaker adds. "They don't discuss the issue at all unless the parents bring it up."

What To Do

Visit the American Academy of Pediatrics to read their 1999 statement on circumcision. And for more details on the trends on circumcision, see the National Center for Health Statistics.

SOURCES: Interviews with Abigail Moss, statistician, National Center for Health Statistics, Hyattsville, Md.; Craig Shoemaker, M.D., medical director, Neonatal Intensive Care Unit, University of California Davis Medical Center, Sacramento

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