Sunday, August 15, 2010

What is really going on with US newborn circumcision rates?

Now is an odd time if you care about newborn circumcision rates, or conversely, genital integrity rates in the United States. Here's why:

Zoler filed a news report from AIDS2010 stating the 2009 newborn circumcision rate is 33%. Zoler correctly states that the review includes "more than 6.5 million U.S. newborn boys during the period," but erroneously reports the same number, 6,571,500, as the total number of circumcisions in 2007, 2008, and 2009. Therefore, Zoler does not report the actual number of circumcisions in those three years. Zoler discusses a "dramatic decline" in rates, but no more specifics.

Sanchez, similarly, gives no details but mentions "a decrease."

Note that there are essentially two distinct studies discussed in the same presentation. One is a study of circumcision rates, the other of complication rates.

Abstract addresses only the complication rates study. There is no data relevant to circumcision rates. Abstract describes its sample of circumcised newborns as "12% of 1.4 million circumcisions annually," thus giving an estimate of the sample size for the study of circumcision complications. It is, however, not an indication of the number of circumcisions per year in any particular year, or the two year period of this study, or of any grouping of the years 2007, 2008, and 2009.

Sanchez and Abstract have no data on circumcision rates from 2007, 2008, and 2009. Zoler has data only for 2009, citing a 33% newborn circumcision rate. Unfortunately due to an error, Zoler does not report the total number newborn circumcisions in one or more of the years 2007, 2008, and 2009.

Thus far, the only data we have is "33% in 2009" from Zoler.

A photograph of a slide from the presentation on which Zoler and Sanchez reported and which included the study in Abstract provides more data.

The slide corroborates Zoler by depicting a "32.5% in 2009" on its graph. The slide also corroborates the total number of newborn boys in 2007, 2008, and 2009 (6,571,500). The slide reports the total number of circumcisions in 2007, 2008, and 2009 to be 2,834,849. The slide calculates and reports that the average newborn circumcision rate in 2007, 2009 2008, and 2009 was 43.13% (by dividing two previously reported numbers). The slide depicts but does not state the circumcision rates in 2007 and 2008. They appear approximately equal and just below 50%. The average rate in 2007 and 2008 is therefore 48.45% (which is consistent with the graph) as calculated by applying the 2009 rate (32.5%) and the overall rate 2007-2009 (43.13%).

All together, the picture is clear. On a year-over-year basis, newborn circumcision was down 13.8% in 2007 (56.2% to 48.45%), flat in 2008, then down another 33% in 2009 (48.45% to 32.5%). The latest rate is 32.5% in 2009.

Which brings us back to why this is such an odd time. This is a dramatic change with major social implications that is highly newsworthy, but no mainstream news media have reported it. This cannot be due to the significance of the new circumcision rates and is probably due to the narrow and indirect sourcing of this information. Although CDC researchers gave the presentation, CDC has not released this data directly to the public, and has made no public comment on it.

But thanks to Zoler and to the slide photograph, the cat is out of the bag. CDC needs to publicly comment on this information so that the public will be informed. For those of us who care about America's rate of genital integrity, or conversely circumcision, this is a very important statistic as it is for anyone who places importance upon "the norm" when contemplating circumcision. Silence by the CDC on this matter is a disservice to the public.

A CALL TO ACTION: Lobby the CDC to release the numbers on neonatal circumcision


  1. Very good summary of the currently known facts about the CDC announced circumcision rate. You have a typo in your sentence: "The slide calculates and reports that the average newborn circumcision rate in 2007, 2009, and 2009 was 43.13% (by dividing two previously reported numbers)." The first 2009 should 2008.

    It is not surprising that the CDC is not publishing the circumcision rate information. Many in the CDC are blatantly pro-circumcision. I am sure that they are not happy with those numbers.

  2. I've long wondered what the tipping point number would be. After all, there's got to be a point where parents who don't think about the issue very much, and who just like to follow the herd, will flip; and then circumcision becomes the province of an increasingly desperate hard-line minority (and after that, only a matter of time before legally speaking, it goes the way of FGM).

    I don't think that tipping point is necessarily reached right when circ drops under 50 percent, due to the compensating factors of "matching Daddy" (ugh), and the pure inertia of all those circumcised men already in the population. However 33 percent is another story.

    There is bound to be a geographic lag, though. I would love to see the data broken down regionally, as I'm fairly sure that the Midwest/"heartland" where I live is still stuck in a "Mad Men" era time warp when it comes to circ (and some other things around birth for that matter). But there is much more geographical mobility than there used to be; and at a certain point I don't think Midwesterners will want their sons to be marked (literally) as being from a region of the country that lags behind the others.

  3. The biggest problem here is that the "newborn circumcision rate" only takes into account a tiny proportion of all the circumcisions performed in the first few months of life and also totally ignores the growing number of circumcisions that are being performed in childhood or teens as a result of the boys not having been done in infancy.

    No account is taken of neonatal circumcisions performed after the boy has left the maternity unit. With shorter and shorter stays in hospital by mothers after giving birth, many more boys are being taken home uncircumcised and then subsequently circumcised at a week or so old in the doctor's office or even the hospital - but these operations are not included in the 'official' national statistics.

  4. Anonymous,

    Any of the issues you presented would have similarly influenced the numbers in other years, too. So the dramatic drop from 2006 to 2009 is not changed by the potential issues you've raised.

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