New research about a steep drop in circumcisions made headlines this past week. According to one federal researcher, circumcision rates in U.S. hospitals slid from 56 percent in 2006 to fewer than a third of boys born last year.
Doctors caution that those numbers aren't definitive — for instance, they don't include circumcisions not covered by insurance policies or circumcisions performed in religious settings.
But Dr. Douglas Diekema, a pediatrics bioethicist at the University of Washington, tells NPR's Audie Cornish there's no doubt about the overall trend.
"I think all of us agree there probably is a decrease in the number of circumcisions over time, and that's probably a result of a number of factors," Diekema says.
"About 10 years ago, the American Academy of Pediatrics came out with a policy statement that was fairly neutral on whether circumcisions should be recommended for newborns or not," says Diekema. "And that probably changed the way physicians were talking to their families."
In many states, Medicaid stopped covering the procedure as a result of that policy statement. And many insurance companies followed suit, meaning that more and more families might have decided to forgo circumcision just because of the expense.
"It's also worth pointing out that our population is becoming increasingly Hispanic," says Diekema, "And that's a population that has not traditionally circumcised their babies."
'Intactivists'
Another possible explanation for the decrease might be the anti-circumcision advocates known as "intactivists." They've lobbied forcefully against circumcision for years now, and some people compare them to anti-vaccination advocates. But Diekema criticizes their tactics.
"Their arguments are largely emotional," says Diekema. "Just the fact that they insist on referring to this as 'genital mutilation' tells you that they're refusing to recognize whether there may be any medical benefit to the procedure."
And the benefits are large, he says.
"There is a fairly substantial, important reduction in the risk of contracting many sexually transmitted infections," says Diekema. "In newborns, there is a decreased likelihood of getting a urinary tract infection, which for a newborn baby can be a very significant illness."
And, he says, "at least three well-done, randomized control trials in Africa show a substantial decrease in the transmission of HIV [due to circumcision]."
Ultimately, in spite of arguments on both sides of the issue, Diekema says that male circumcision is a decision that families should make on their own. He says a doctor's role is to make sure the family is aware of the risks and benefits of the procedure.
But, he says, "the risks of circumcision are considerably lower in the newborn population than they are if that child is older."
source: http://www.npr.org/templates/story/story.php?storyId=129362160&ft=1&f=1001
