4 Reasons the Circumcision Rate Has Declined Over 30 Years

The rate of circumcisions performed on newborn boys in US hospitals has steadily declined over the last three decades, the US Centers for Disease Control (CDC) has said in a new report. Overall, the national rate dropped about 10 percent, but the numbers varied dramatically by region.

The CDC's report looked at rates of newborn boys circumcised in hospitals from 1979 to 2010. It's important to note that since it only includes hospital circumcisions in its figures - and not any performed outside hospitals, such as those done in religious ceremonies - it doesn't give a complete picture of the rate of circumcision in the US.

In 1979, 64.5 percent of newborn boys were circumcised in hospitals, the report says.

Overall, circumcision rates were the highest in the Midwest, with a high of 82.9 percent in 1989 and a low of 68.8 percent in 2009. While the rate stayed flat in the Northeast, the decline was especially steep in the West. Over the 32-year period studied, rates in the West dropped 37 percent, from 63.9 percent in 1979 to 40.2 percent in 2010. The lowest rate recorded over the three decades was in the West, where only 31.4 percent of newborn boys were circumcised in hospitals in 2003.

Let's take a look at some of the reasons for the decline.

1. The AAP's position on circumcision has changed a few times over the last 30 years.
In general, the national trend reflected the position of the American Academy of Pediatrics (AAP), the CDC said. In the 1970s, the AAP's stated there was no medical indication for routine circumcision of the newborn. The AAP revised its position in 1989, stating there were potential medical benefits to newborn circumcision. In 1999, the AAP revised its stance again, stating that despite potential medical benefits of newborn male circumcision, there was insufficient evidence to recommend routine circumcision of newborns.

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Most recently, in August 2012, the AAP stated:

"Since the last policy was published, scientific research shows clearer health benefits to the procedure than had previously been demonstrated. According to a systematic and critical review of the scientific literature, the health benefits of circumcision include lower risks of acquiring HIV, genital herpes, human papilloma virus and syphilis. Circumcision also lowers the risk of penile cancer over a lifetime; reduces the risk of cervical cancer in sexual partners, and lowers the risk of urinary tract infections in the first year of life.

"The AAP believes the health benefits are great enough that infant male circumcision should be covered by insurance, which would increase access to the procedure for families who choose it."

"Ultimately, this is a decision that parents will have to make," said Susan Blank, MD, FAAP, chair of the task force that authored the AAP policy statement and technical report. "Parents are entitled to medically accurate and non-biased information about circumcision, and they should weigh this medical information in the context of their own religious, ethical and cultural beliefs."

2. Many parents have to pay out of pocket for the procedure.
As the AAP says, insurance is also a factor in many parents' decisions. Circumcision isn't covered by state-funded Medicaid in at least 18 states, reports the Baltimore Sun. Those policies may play a significant role in the CDC's regional trends: only two states (Wyoming and New Mexico) in the US West region do cover circumcision under their states' Medicaid plans. The others - Arizona, California, Colorado, Idaho, Montana, Oregon, Nevada, Utah, and Washington - don't cover it.

Private insurance company policies vary, but often follow the lead of state Medicaid in terms of what will or won't be covered.

3. Moms and babies are sent home from the hospital sooner.
Another factor that could be influencing the data in this report is when the circumcisions are performed. This data only includes circumcisions performed in the hospital during their birth hospitalization. Now that moms are booted out of the hospital so quickly, it could be that babies are having the procedure done in an outpatient setting, Seattle Children's Hospital professor of pediatrics Douglas Diekema told NBC News.

4. Social changes affect parenting choices.
Social preferences (and pressures) have changed in the last thirty years with regard to all kinds of parenting choices, and things that used to be reserved for private conversations are now publicly debated in the blogosphere, on Facebook, and on Twitter. For better or worse, all that media focus does make it easier to talk about certain things with other parents. Websites for anti-circumcision organizations like NOCIRC are easily searched and shared, and have a social media presence.

Many parents want to keep things as "natural" or "organic" as possible for their kids. At the same time that circumcision rates were declining, breastfeeding rates were increasing. In 1986, for example, 54.1 percent of US babies were breastfed. By 2002, the rate had jumped to 73.3. The CDC says that in 2013, the number is 76.5. At the same time, organic food sales continue to increase. Since circumcision is an elective procedure, it may not mesh with many parents' desires to keep things natural.

Photo credit: CDC/NCHS, National Hospital Discharge Survey

-By Joslyn Gray

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