Hospital circumcisions down 10% over three decades

• Newborn circumcisions performed in hospitals peaked at 64.9%25 in 1981
• The percentage of circumcisions fell to 40.2%25 in Western states
• The American Academy of Pediatrics says health benefits outweigh the risks

In-hospital circumcisions for newborn boys in the USA have fluctuated over the past three decades, but the overall percentage declined by 10% from 1979 to 2010, a new government report shows.

During the 32-year span, the percentage fell from 64.5% to 58.3%, finds the analysis by the National Center for Health Statistics. It was highest in 1981 at 64.9%, and lowest in 2007 at 55.4%. Numbers do not include circumcisions outside hospitals for religious or other reasons, says study co-author Maria Owings.

Circumcision is a surgical procedure in which the foreskin of the penis is removed. About 30% of males worldwide ages 15 and older are circumcised, says the World Health Organization. For most, it's a religious practice: 69% are Muslim; about 1% are Jewish.

Last year, the American Academy of Pediatrics revised its policy on circumcision of newborns, saying that the health benefits outweigh potential risks.

Numbers have gone up and down over the years, Owings says, but there's insufficient data to tell if the most recent uptick, from 55.4% in 2007 to 58.3% in 2010, is significant.

Regional differences are more notable, she says, especially the sharp decline in Western states, where the percentage of circumcisions fell from 63.9% in 1979 to 40.2% in 2010. It was highest in the Midwest, 71% in 2010.

One factor that may account for the overall decline in hospital-based circumcisions may be the decreased time babies now spend in the hospital, says pediatrician Douglas Diekema of the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Research Institute.

"Often they're going home within 24 hours, so in some places, these procedures are increasingly being done by the pediatrician during the follow-up period in the doctor's office or clinic as opposed to the hospital," Diekema says.

The steep decline in the West may be related to higher rates of immigrants from countries where circumcision is less common, he says.

Recent research suggests circumcision does "help prevent certain kinds of infections," says pediatrics group president Thomas McInerny. In particular, "there is some evidence that the cells that make up the inner surface of the foreskin may provide an optimal target for the HIV virus." Research also shows that circumcised males have a lower risk of urinary tract infections and penile cancer, he says.

Complications associated with circumcisions are rare, and include minor bleeding, local infection and pain, says Diekema, but those factors can be easily treated.

A cost study reported last year in the Archives of Pediatrics & Adolescent Medicine said falling infant circumcision rates in the U.S. could end up costing the country billions of health care dollars when men and their female partners develop AIDS and other sexually transmitted infections and cancers that could have been prevented.

The health benefits evidence was not so strong that the AAP felt compelled to recommend routine circumcision for all newborn boys, says McInerny. "We wanted to give parents the information as we understand it from the research and let them make the decision."

Several groups oppose infant circumcision, even for children from families who practice it as a religious rite, because they say it is a medically unnecessary surgery that violates babies' rights. "We believe all babies should have their bodies protected," says Georganne Chapin, executive director of Intact America, which opposes circumcision.

Chapin credits the 10% decline in circumcisions to "parents getting wise that they are being sold a bill of goods" for "a pseudo-medical procedure done for profit."