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The circumcision rate

February 8, 2020

 

Many people ask about the circumcision rate in the United States and around the world. We have seen claims that the U.S. circumcision rate is as high as 80% or as low as 33%. [1] Although there are no precise figures, some reports and studies can help us reach an approximation.


The U.S. rate: 1979-2010

In 2013 the CDC released a report covering the U.S. circumcision rate for each year from 1979 through 2010. The report estimated circumcisions performed for neonatal boys prior to hospital discharge (normally on the second day after birth). [2]

The report found that the circumcision rate declined by 10% from 64.5% in 1979 to 58.3% in 2010. However this was not a steady decline. Rather the rate fluctuated, declining during the 1980s, rising during the 1990s, and falling again during the 2000s. The AAP's 1999 policy statement, which stated that the current evidence was "not sufficient to recommend routine neonatal circumcision", preceded the reduction in the last ten years of the reporting period. [3]

 

 

The report included the annual circumcision rates for each of four U.S. census regions. Each region reported different rates and trajectories. The Northeast rate was relatively flat (66.2% in 1979 to 66.3% in 2010). The Midwest rate declined by less than 5% from 74.3% to 71.0%. The South rate increased by less than 5% from 55.8% to 58.4%. The West was the only region with a dramatic change, declining from 63.9% to 40.2%.

 

With the South region's increase and the Midwest region's decrease offsetting each other, it appears that the West region accounted for virtually the entire drop in the national rate. [4] The CDC noted that most of the West decline "occurred in the 1980s, with the rate dropping to 41.0% in 1989. Rates continued to decrease ... with a low of 31.4% in 2003." [2] The CDC did not speculate on reasons for the West's dramatic decline. Two factors may be insurance coverage for the procedure [5] and immigration from non-circumcising cultures. [6]

 

 

The CDC cautioned that the report did not count circumcisions performed following hospital release (typically the second day after birth), In others words, the report did not include circumcisions performed during follow up visits in medical clinics, nor those performed in religious rituals (i.e. Jewish brit milah). "Thus, these rates cannot be used as prevalence estimates for all male circumcisions in the United States. [2]

 

 

The U.S. rate since 2010

Until a study documenting the circumcision rate in the U.S. since 2010 is released, one can only speculate on the current rate. The CDC study indicated that rises and drops in the circumcision rate prior to 2010 were correlated with medical organization policy statements and changes in insurance coverage.

 

In 2012 the AAP published a policy statement which declared that the health benefits of newborn circumcision outweigh the slight risks, and that the benefits justified insurance coverage for the procedure. [7] This assessment was more supportive of the procedure than the previous 1999 AAP policy statement, which stated that the existing data were not sufficient to recommend routine infant circumcision. [8] The 2012 AAP policy statement has been quite influential, as government agencies have cited the AAP statement when formulating policy decisions.

 

In 2018 the U.S. Centers for Disease Control published a statement largely in agreement with the AAP. Not only did the CDC support parental choice and insurance coverage for the procedure, the federal agency went a step further. The CDC recommended that medical professionals inform all uncircumcised adult men and teenage boys that circumcision protects against HIV and other sexually transmitted infections. [9]

 

In 2012 Medicaid covered newborn circumcision in 33 states. [10] [11] In the past six years, at least three states have added or reinstated circumcision coverage. They include Florida, [12] Missouri, [13] and Colorado. [14] (There are conflicting reports about whether Medicaid covers circumcision in Louisiana [15] and Oregon. [16])

 

Although we can't say precisely the current circumcision rate, we would estimate that between 60% and 70% of newborn male infants in the United States are circumcised each year.  If position statements and the availability of insurance coverage continue to be influential factors, it seems likely that the circumcision rate is on the rise.

 

 

The global circumcision rate

In 2007 the World Health Organization estimated that about 30% of males were circumcised. [17] A 2016 estimate by pro circumcision researchers offered an approximation of 37.7%. [18]

 

Programs to fight the spread of AIDS over the past two decades have resulted in the circumcision of tens of millions of African males.

 

Hospitals in Beijing are training university doctors to perform circumcision. As of last year more than 5,000 circumcisions had been performed. [19] About 20% of the world's population live in the country. If circumcision becomes popular in China, then at some point in this century, circumcised men will be in the majority.

 

 

 

[1] Some intactivists claim that the circumcision rate fell from a high of 80% in the 1980's to 33% by 2008. They cite a 2010 New York Times article which reported a drop to just 32.5% in 2009. (Roni Caryn Rabin; Steep Drop Seen in Circumcisions in U.S.; New York Times; August 16, 2010.) The article refers to a slide presentation at the 2010 International AIDS Conference in Vienna. by SDI Health, a Pennsylvania company that analyzes health care data. A spokeswoman for the Centers for Disease Control (CDC) disavowed the alleged rate. "C.D.C. was not involved in the collection of the data that was cited, nor has C.D.C. undertaken any review of this particular data for the purpose of calculating rates. As such, we cannot comment on the accuracy of this particular estimate of infant male circumcision.” The figure in the slide show did not refer to the overall circumcision rate.

[2] Maria Owings PhD et al; "Trends in Circumcision for Male Newborns in U.S. Hospitals: 1979–2010"; Centers for Disease Control and Prevention - National Hospital Discharge Survey; August 22, 2013

[3] Carole M. Lannon, MD et al; "Circumcision Policy Statement"; Pediatrics; March 1999

[4] "Table. Estimated number of male newborn infants discharged from short-stay hospitals, and percentage circumcised during birth hospitalization, by geographic region: United States, 1979-2010"; Centers for Disease Control - National Hospital Discharge Survey; August 22, 2013

[5] California eliminated Medicaid coverage for circumcision in 1982. The rate in the West dropped from 57.2% in 1981 to 41.0% in 1989 a decline of 28% in just eight years. As of the 1990 census California represented 56% of the population in the West region. In other words, the elimination of Medicaid funding in California would have eliminated insurance coverage for circumcision for more than half of Medicaid recipients in the West. 

[6] Possibly the large number of immigrants from traditionally non-circumcising cultures might account for the drop. In 2009 Mexican nationals accounted for 30% of all foreign born residents, of which 37.% settled in California. Jeanne Batalova, Aaron Terrazas; "Frequently Requested Statistics on Immigrants and Immigration in the United States"; Migration Policy Institute; December 9, 2010. Second generation immigrants are more likely to circumcise their sons. "Circumcision's decline pinned on immigration"; NBC News; June 8, 2007.  "Experts say immigration patterns play the biggest role in the decline, which is steepest in Western states with big populations from Asian and Latin American countries where circumcision is uncommon."

[7] Susan Blank MD et al; Circumcision Policy Statement - Task Force on Circumcision; Pediatrics; September 2012

[8] Carole M. Lannon MD et al; Circumcision Policy Statement - Task Force on CircumcisionPediatrics; March 1999

[9] "Information for Providers to Share with Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection, Sexually Transmitted Infections, and other Health Outcomes"; Centers for Disease Control and Prevention; August 2018

[10] Some anti-circumcision websites have indicated that Nevada does not cover the procedure. In fact Medicaid covers circumcision in Clark County (Las Vegas) and Washoe County (Reno), which represents 88% of the state's population. "Medicaid managed care plans in two urban areas cover routine newborn male circumcision." (Source - footnote [16], p 69)

[11] The United Healthcare Services website confirms that newborn circumcisions are included in a list of covered benefits. (Accessed December 28, 2019)

[12] Florida reinstated coverage in 2014. "Florida Managed Medical Assistance Program 2013-2014 Financial Annual Report", p. 13; Florida Agency for Health Care Administration. "The following is a list of the expanded services offered by the capitated Reform health plans of which the over-the-counter drug benefits and adult preventive benefits were the most frequently offered: ... Circumcisions for male newborns"

[13] Missouri reinstated coverage in 2014. Provider Bulletin; Missouri Department of Social Services; Volume 36, Number 31; June 12, 2014. "Effective June 15, 2014, MO HealthNet will pay for elective circumcisions for all newborn infants less than 28 days old using Current Procedural Terminology (CPT) codes 54150 and 54160.

[14] Colorado reinstated coverage in 2017. Provider Bulletin; Colorado Department of Health Care Policy & Financing; September 2017. "Beginning July 1, 2017, circumcision is a benefit of the Colorado Medicaid program. The following procedure codes are covered services and can be reimbursed: 54150, 54160 or 54161. There are no prior authorization requirements for this service."

[15] We have found conflicting information about Medicaid coverage in Louisiana. We have reached out to the Louisiana Department of Health and will update this post when we receive clarification.

[16] We have found conflicting information about Medicaid coverage in Oregon. We have reached out to the Oregon Health Authority and will update this post when we receive clarification. OHA Health Evidence Review Commission meeting, October 4, 2018

[17]"Male circumcision Global trends and determinants of prevalence, safety and acceptability"; World Health Organization; 2007

[18] Brian J. Morris et al; "Estimation of country-specific and global prevalence of male circumcision"; Popular Health Metrics; March 1, 2016

[19] Yang Wanli; "Circumcision to be promoted at Beijing universities"; China Daily; April 26, 2019

 

 

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