Being Pregnant
US Circumcision Rate On The Decline
Circumcision is back in the headlines: According to a federal researcher, circumcision rates in America have gone down from about two thirds of all baby boys to less than half.
Though these data come from the Centers of Disease Control and Prevention (CDC), the organization has stated that the numbers are not definitive.
Yesterday NPR ran a story explaining why the numbers are likely a little exaggerated. Part of the reason may be that circumcisions not covered by insurance and/or performed in religious settings were excluded from the new CDC data. This is significant as Medicaid and some insurance companies stopped covering circumcision after a statement issued about ten years ago by the American Academy of Pediatricians claimed that routine circumcision was not medically necessary.
Even if the numbers are a bit extreme, experts seem to agree there has been a decrease in infant circumcision in recent years.
Speaking to NPR, Dr. Douglas Diekema, a pediatrics bioethicist at the University of Washington said, ”I think all of us agree there probably is a decrease in the number of circumcisions over time…”
He sites the neutral AAP stance, resultant lack of Medicaid/insurance funding for circumcision, and an increasingly Hispanic population– Hispanics traditionally do not circumcise. There’s also the influence of “Intactivists,” vocal opponents of circumcision.
I find it really hard to get good coverage of the issues surrounding circumcision. Even NPRs story came off as a little biased. Dr. Diekema called the anti-circumcision arguments “largely emotional,” but presented a case for circumcision in rational, scientific terms. I have come across intactivists who are largely emotional, so I know what he’s talking about. But I’ve also heard some fairly irrational arguments from circumcision advocates.
In general I try to steer away from advice including words like, “mutilation” (on one side) and “unclean” (on the other). I encourage those of you trying to make a decision about circumcision to read up on both options; there are way too many myths and emotional biases floating around, homework is often necessary.
Still, this can be a hard decision. Making it can involve considerations about religious identity, cultural pressure, family tradition, social norms, parental instincts, fear of doing the wrong thing… which is a lot to put on your plate before you even have a baby! But this topic can also provide an opportunity for parents to have productive, even philosophical conversations. It can even create a useful template for future discussions about parenting.
Read the New York Times coverage here.
Listen to the NPR story here.
photo: Sugar Pond/Flickr
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0 Comments
laura commented on Aug 23 10 at 12:26 pmThanks for the unbiased discussion. We still don’t know what baby 2 is (boy or girl), and our first was a girl so we’ve only discussed it hypothetically. It is hard to balance the research with my emotions, while trying to ignore other people’s emotional arguments. But bottom line, I’ve found it incredibly offensive to hear comparisons made to female genital mutilation. FGM is so tragic and horrific and anyone who makes the comparison cannot truly understand the extend of this practice. And one of the things that annoys me in any discussion is ignorant regurgitation of “facts” – which is precisely what that argument is.
paleo_huntress commented on Aug 23 10 at 2:47 pm@Laura” Google “A rose by any other name circumcision”. In a recent study (thousands of women) where researchers were looking at the effect of FGM on pregnancy, they found that both women who’d had their prepuce and their clitoris (glans, as no woman has her whole clitoris removed, it goes too deep into the body) reported the same levels of arousal, the same frequency of sex, the same enjoyment of sex, and the same frequency of orgasm as intact women. The one argument that people always make when they reject the comparison of MGM to FMG is that men still get erections, have sex and reach orgasm after a circumcision. Well, women who’ve have both type 1 & type 2 FGM can as well. There is DEFINITELY a valid comparison to be made.
~Huntress
EQUAL commented on Aug 23 10 at 6:16 pm@laura; Of course I’m presupposing when I say this, but something tells me laura that your genitals have never been mutilated. Please, allow me to reference Webster’s Dictionary on the word “mutilate:1 to injure or disfigure by removing or irreparably damaging parts. 2 to deprive a living being of a limb or other essential part. to cut – to maim”. I am a young male, with a recently acquired degree and currently enrolled into law school, i guess you could say I’m no dummy and certainly not ignorant. When I was an infant my foreskin was amputated. My proof is in the scars up, down, and around my penis. I have never once experience the protection nor felt the pleasure produced from having the thousands of nerves and other unique skin types found exclusively in my foreskin. If you’re going to brush these facts off as emotional than you are the one who is ignorant, and especially if you think that there are any real benefits that safe sex and antibiotics can’t fix. If you’re curious as to what is typically removed during circumcision google: “what is lost during circumcision” the first three pages should help you at least taste the problem.
Life, Liberty, and the Pursuit of happiness to all those who object to Genital Mutilation regardless of GENDER
DK commented on Aug 23 10 at 8:54 pmSo too, whether parents decide to circumcise their daughter’s vagina is a completely personal decision. I strongly encourage parents to examine both sides of the debate, and acknowledge that religious identity, cultural pressure, family tradition, and social norms affect this decision.
Caroline commented on Aug 23 10 at 9:11 pmI’m an intactivist, and I try my best not to be overemotional.
I don’t really know what to add here, but I do want to thank you for choosing to write about this subject. It is indeed a subject that few people really take the time to research properly.
Aside from the medical aspects, though, it is worth noting that many men who were circumcised are not happy with it. The foreskin is a normal, healthy, functioning, sensitive body part. One that 80% of the world’s men still possess. The United States is the only country in the world that still circumcises the majority of its infants for non-religious reasons.
Lastly, I like how you listed “considerations about religious identity, cultural pressure, family tradition, social norms, parental instincts, fear of doing the wrong thing”. Tell me if I’m wrong, but from my talking to people, these things you listed are usually the reasons (aside from parental instinct) people decide to circumcise. But we have to ask ourselves, are these GOOD reasons to permanently change a person’s body for life? Just a thought.
Frank McGinness commented on Aug 23 10 at 11:13 pmDear Dr. Douglas Diekema,
I read the NPR article covering you and heard your interview. I was
aghast. First, that you are a bioethicist that never brought up the
ethics of male circumcision. Second, you touted only pro-circumcision
rhetoric. Third, you included name calling intactivists “emotional”.
And forth, you put down parents who choose not to circumcise.Further you have said doctors need to be honest with parents about
circumcision yet in the same breath you lied by not saying there are
harms intrinsic to circumcision. Harms that are recognized and
published by the Royal Dutch Medical Association on Circumcision. All
in all, you either are not up to date on circumcision or you have an
agenda to circumcise regardless of all the facts. You can not or are
not objective. Either way you should step down from the AAP’s Task
Force on Circumcision.Sincerely, Frank McGinness
(restoring and I chose circumcision: intactivist)
Hans commented on Aug 24 10 at 12:15 amI’m sorry Laura, but you are so wrong. The simularities between FGM and MGM are much larger than you like to believe. MGM is also horrific and tragic, but you can not see that because your country outlaw the first thing, and embrace the other. It’s just so weird. Anyway, I am a intact male, and just take my word for it: leave your sons intact. They will thank you for it later when they grow up.
By the way, if there should be a cleaning problem with being a intact male, then you intact females have a much larger problem. Just think about it.
Frank McGinness commented on Aug 24 10 at 1:09 amIt is refreshing to see some recognition of children’s rights in this issue. But circumcision is not “chosen by” children, it is imposed on them. It is a permanent modification of the body which is not welcome by all.
New claims that it is efficatious in providing [limited] protection against HIV should not blind us to the fact that cutting off part of a child’s penis is flagrant breach of his fundamental human rights.
Assuming that your child is going to become a promiscuous sex fiend and punishing him on that assumption by amputating parts of his genitals is not only disrespectful to the child but admission of being incapable of parenting.Children are entitled to an “open future,” with no options foreclosed that could not wait for the child’s expressed preference.
Courts pay undue deference to parental discretion – cultural and religious – at the expense of the child’s human rights.
All children, whether female, intersex or male should be allowed to make a personal choice about whether or not to have genital surgery when they are of sufficient age and maturity to make that choice.
Frank OHara commented on Aug 24 10 at 7:56 amI find this writing deceptive from the begining to wit:
The circumcision rate has fallen from about 57%, not 2/3s. It has fallen to less than 1/3 (32.5%) not “less than half.” While “less than half” is accurate, it is also deceptive.
Circumcisions performed for religious reasons would account for only 1.75% of circumcisions. However, this effect is seen in both the before and after numbers and would not affect the differential. This would also be true of circumcisions paid for by insurance companies and Medicaid. The topic of the study is the decline in circumcisions and religious circumcisions and insurance coverage would have no significant effect on the difference .
There has not been a significant increase in the Hispanic population in the past 4 years and thus little if any influence in the DIFFERENCE.
.
Dan Bollinger commented on Aug 24 10 at 9:18 amWe all know that the foreskin is not a birth defect, and that there is so little “medicine” involved in the decision that it really is an emotional decision for many parents. 99 out of 100 parents in the world say “no.” 2 out of 3 American parents are saying “no.” The rates in other English-speaking countries have dropped to near zero on the past forty years. The writing is on the wall, circumcision is old-fashioned. But facts might not help concerned parents wanting to make the right choice. If you are a parent struggling with this issue, visit: http://circumcisiondecisionmaker.com/
Hugh7 commented on Aug 24 10 at 6:57 pmThanks for that, it’s clear you’re thinking the issues through. Diekema did indeed present the case for circumcision, that’s the problem – they should have got someone well-informed to present the case against. He wasn’t altogether rational, though, to mention only the “significance” of urinary tract infections without also mentioning their rarity, less than 1% in boys (about 4% in girls, and of course no question of surgery for them). So more than 99% of circumcisions to prevent UTI are wasted.
Likewise HIV. The trials (far from faultless) were done in three African countries where HIV is rampant and may be largely heterosexually transmitted – unlike the USA. Circumcising US boys has not prevented the epidemic so far, and will not.
Some Intactivists are as mad as hell about what was done to them and they’re not going to take it any more. I’d be emotional too, in that position. That doesn’t make their arguments wrong, though.
And FGC? OK it’s very horrible. MGC is not as horrible, but that’s no reason for doing it or defending it. It is as ethical issues that they are comparable. Boys and girls (and intersexed babies) have the same right to grow up to be men and women (and intersexed people, if that is their choice) free to choose for themselves what parts of their own genitals they may keep and enjoy. They almost always choose to keep them all.
“religious identity, cultural pressure, family tradition, social norms, parental instincts, fear of doing the wrong thing”? What Caroline said. Remember, this is a decision that is pushed on US parents. In the rest of the developed world it’s simply not offered, and outside the English-speaking world, never has been. Taking the whole baby home is simply taken for granted. That’s how it should be.
FredR commented on Aug 25 10 at 10:43 amThe procircs use the anti semetic race card to promote RIC. Now they are using the anti illegal immigration hispanic race card to explain why RIC is being rejected by educated parents. They are preying and playing on the young and uneducated to to promote RIC superstitious beliefs that circumcision lessens the chance that a man using an HIV+ whore, of acquiring HIV.
Mark Lyndon commented on Aug 25 10 at 10:05 pmI thought Dr Diekema’s comments were outrageous. Does he think these organizations are “largely emotional”?
Canadian Paediatric Society
http://www.cps.ca/english/statements/fn/fn96-01.htm
“Recommendation: Circumcision of newborns should not be routinely performed.”http://www.caringforkids.cps.ca/pregnancy&babies/circumcision.htm
“Circumcision is a ‘non-therapeutic’ procedure, which means it is not medically necessary.”
“After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.”Royal Australasian College of Physicians
http://www.racp.edu.au/index.cfm?objectid=B5610716-9E3E-6C97-A8D87880FD002E3B
“After extensive review of the literature, the Paediatrics & Child Health Division of the Royal Australasian College of Physicians has concluded that there is no medical reason for routine newborn male circumcision.”
(almost all the men responsible for this statement will be circumcised themselves, as the male circumcision rate in Australia in 1950 was about 90%. “Routine” circumcision is now *banned* in public hospitals in Australia in all states except one.)British Medical Association
http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp#Circumcisionformedicalpurposes
“to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.”The Royal Dutch Medical Association
http://knmg.artsennet.nl/Diensten/knmgpublicaties/KNMGpublicatie/Nontherapeutic-circumcision-of-male-minors-2010.htm
“The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complications – bleeding, infection, urethral stricture and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence. KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications.”
Lawn Griffiths commented on Aug 28 10 at 5:10 pmWhat is so astounding is the cavalier attitude of some of these blogs that, “Well let’s see, should we circumcise him or not? Come see, come so,” as if it is a flip of the coin. One has to wonder whether these people have a modicum of humanity or compassion or empathy. We aren’t talking about whether to clip toenails or not. Circumcision is a forever body-altering action that fundamentally changes mechanics and sensitivity of sexuality. How a parent can think it should be in his or her power to order a healthy, living body structure lopped off of a child is just staggering and smacks of arrogance. Where are parental instincts? Once I learn what circumsion was and saw what I no longer had, I developed a deep resentment. So when we had a son and grandsons, we ensured there would be no violations of their human rights. So many parents I know fail to investigate and are driven by family traditions. They show caring in other areas, but their laziness on this issue means baby boys get cut. Certainly, like all human rights movements, we will wonder someday why we didn’t end our cruelty and madness sooner. The last males that have to be circumcised are like those last soldiers that have to die in wars wrapping up. Circumcision just cannot be defended because it is perverse, medically unethical and evidence of horrible parenting choices.
Iconoclastist commented on Sep 10 10 at 12:21 pmGenital mutilation is yet another LIE along with history, science, religion, government, and culture perpetrated by a dominate class over their subjects.
Victor Hugo coined the term “Comprachicos” for people who mutilate infants for profit and I can’t think of a better term than Dr. Comprachico for any MD who advocates genital mutilation.
Although the practice is waning, taxpayers still pay for the mutilation of infants born under medicaid. Hospitals charge for the “procedure” then profit further from selling stolen foreskins to pharmaceutical and cosmetic companies (directly or through middlemen)! Oprah Winfrey even pushed a $200 per oz. face cream made from the unique foreskin tissues!
Culture/religion/ideology is not your friend!
“Medical Science,” (the same as the rest of the so called “experts”) is replete with unethical, sycophantic sociopaths who lie, cheat, and mutilate in order to profit and gain positions of authority. Sociopaths populate most of the centers of “authority” in the US.
“Medical Science” grew out of a cadre of “experts” who found they could get rich by naming symptoms and calling them diseases–just to sell their “treatment.” The medical industry is what it is today because of the rise of the cattle industry at the end of the 19th century; high protein diets were most common among the wealthy east coast elites who could afford medical treatment for their growing heart diseases.Medical doctors were never even involved with childbirth until they realized the potential profit in “family practice.” Just look up the mother mortality rates once doctors got involved in delivery despite midwifery’s 5000 year history.
Medical “experts” own words from the late 19th century portray the real intent behind genital mutilation….”A remedy for masturbation which is almost always successful in small boys is circumcision. The operation should be performed without administering anesthetic, as the brief pain attending the operation will have a salutory effect upon the mind, especially, if it is connected with the idea of punishment, as it may well be in some cases.”
What happened to “Do no harm?” Dr. Comprachico?
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