Male newborn circumcision rate falls to lowest level

The proportion of newborn boys circumcised in U.S. community hospitals is at its lowest level, 54.5%, since the federal government starting tracking the statistic in 1993.

The rate has fallen from its peak of 62.7% in 1999, when the American Academy of Pediatrics adopted a neutral position on the procedure.

However, the academy's stance, which many credit as a factor in the decline of circumcision, is being revisited in light of new evidence about the potential health benefits of circumcision. Since the AAP took its position, evidence has mounted that links higher prevalence of circumcision to lower rates of penile cancer, urinary tract infections, phimosis, balanitis and meatitis, as well as HIV and other sexually transmitted diseases.

"I don't doubt that the academy's position is influential," said Douglas S. Diekema, MD, MPH, a member of the academy's Task Force on Circumcision that is re-examining the policy. "When the neutral policy came out, more pediatricians changed their tone to a more neutral tone with parents."

In 1999, the academy said existing scientific evidence was "not sufficient to recommend routine neonatal circumcision," a position that was reaffirmed in 2005.

According to a statistical brief released in February by the Agency for Healthcare Research and Quality, the rate of male newborn circumcisions sunk to 57.3% by 2001. In the ensuing years, the rate hovered between 54.9% and 57.9%, until falling to a low of 54.5% in 2009, the latest year measured.

The AHRQ brief cited the AAP's position as a factor in the decline of male newborn circumcisions.

Another factor was the rising population of Hispanics, who are less likely than other racial or ethnic groups to have their baby boys circumcised. Also, 18 state Medicaid plans now refuse to pay for routine nontherapeutic circumcision, with Western states such as California, Oregon and Washington among them.

Circumcision rates vary dramatically by region, with 75% of Midwestern newborns undergoing the procedure, compared with less than 25% of boys born in the West, said the AHRQ report (link).

Experts said the AHRQ figures may under-represent the prevalence of circumcision, because some circumcisions take place outside the hospital as part of a religious ceremony or in a physician's office. Nonetheless, the data can accurately show which way the trend is going.

Growth of anti-circumcision advocacy

Opponents of circumcision have become more vociferous in the last decade, said Dr. Diekema, director of education at the Seattle Children's Hospital Treuman Katz Center for Pediatric Bioethics.

"The rise of the anti-circumcision groups on the Internet is another influence," he said. "That's a voice that's very loud and very prevalent on the blogs. Every news article on circumcision that appears prompts hundreds of comments and blog responses, and parents read those things."

The rising tide of opposition to circumcision is not limited to the Internet. In 2011, anti-circumcision activists collected enough signatures to place on the San Francisco ballot a measure that would have banned circumcision for males younger than 18 unless medically needed.

But County of San Francisco Superior Court of California Judge Loretta Giorgi struck the measure from the ballot in July 2011, ruling that it would have interfered with religious freedom and illegally regulated medical practice. In October 2011, Democratic Gov. Jerry Brown signed legislation supported by the California Medical Assn. that prevents local authorities from prohibiting or restricting male circumcision.

Dr. Diekema said it is important for pediatricians to talk with parents about the risks and benefits of circumcision and take into account parents' religious or cultural beliefs about the procedure.

The AAP's Task Force on Circumcision has submitted its report to the academy's board of trustees, which is likely to act by the end of 2012, Dr. Diekema said. He could not divulge specifics on the task force's work because it is under embargo while the board considers it.

However, Dr. Diekema said the policy on routine circumcision will probably shift away from strict neutrality because of new data about the procedure's health benefits.