circumcism rates dramtically falling - Page 2

[homebirthing]

I never ever see families choosing circumcision anymore (except my sister of course). I would say the last 80 families chose not to do it if they had a boy.

[Night_Nurse]

Originally Posted by major_mama11

Wow, 33%? Some areas of the country must be darn near zero, because the hospital where I work has a 95% plus circ rate. I've worked here for 6 mos, and have only seen a whopping ONE family that chose not to circ their baby boy, out of over 100 boy babies that I've cared for. ONE!

The hosp. where I worked has a very high circ rate too. I'd guess the overall rate was about 85% or so, and even the majority of our immigrant patients circ.

I'm in the south.

[123]

I'm sorry, but those numbers make no sense to me. Perhaps the author of the article is just confusing numbers but in the first part it says:

[Circumcision rates fell from 56% in 2006 to 33% in 2009.

The review, which included more than 6.5 million U.S. newborn boys during the period, also showed that adverse event rates following newborn male circumcision were “extremely low,” and that the most common adverse events were “mild and easily corrected,” Charbel El Bcheraoui, Ph.D., said at the 18th International AIDS Conference. ]

So they looked at 6.5 million newborn boys to gather this data, right? But then it says:

[In this database, 6,571,500 newborn boys underwent circumcision during 2006-2009. ]

So even if that's just a journalistic error, I still can't understand the 33% thing. The last two years for which I've been able to find US birth data are 2006 (4,265,555 births) and 2007 (4,317,117 births). http://www.cdc.gov/nchs/births.htm and http://www.cdc.gov/nchs/fastats/births.htm

Assuming that 2008 and 2009 have approximate the same birth rate and that half of those babies are boys, you get 8,582,674 boys born from 2006-2009. So if 6,571,500 were cut, that's a 77% circ rate, right? Is there an error in my math here?

So where does the 33% come from?

Personally I don't believe the circ rate is 33% or 77%, but probably somewhere between 45% - 50%. So if the numbers are wonky (and someone correct me if any of my assumptions or math are in error), how accurate is the rest of the article?

[Charmie981]

In this database, 6,571,500 newborn boys underwent circumcision during 2006-2009.

That is the total number over a period of four years, not per year.

[Juvysen]

seems like the 33% figure would be a useful argument for those of us against circ to use on the "locker room" argument, no?

[tennisdude23]

Originally Posted by 123

I'm sorry, but those numbers make no sense to me. Perhaps the author of the article is just confusing numbers but in the first part it says:

[Circumcision rates fell from 56% in 2006 to 33% in 2009.

The review, which included more than 6.5 million U.S. newborn boys during the period, also showed that adverse event rates following newborn male circumcision were “extremely low,” and that the most common adverse events were “mild and easily corrected,” Charbel El Bcheraoui, Ph.D., said at the 18th International AIDS Conference. ]

So they looked at 6.5 million newborn boys to gather this data, right? But then it says:

[In this database, 6,571,500 newborn boys underwent circumcision during 2006-2009. ]

So even if that's just a journalistic error, I still can't understand the 33% thing. The last two years for which I've been able to find US birth data are 2006 (4,265,555 births) and 2007 (4,317,117 births). http://www.cdc.gov/nchs/births.htm and http://www.cdc.gov/nchs/fastats/births.htm

Assuming that 2008 and 2009 have approximate the same birth rate and that half of those babies are boys, you get 8,582,674 boys born from 2006-2009. So if 6,571,500 were cut, that's a 77% circ rate, right? Is there an error in my math here?

So where does the 33% come from?

Personally I don't believe the circ rate is 33% or 77%, but probably somewhere between 45% - 50%. So if the numbers are wonky (and someone correct me if any of my assumptions or math are in error), how accurate is the rest of the article?

Exactly! That's the first thing I noticed when I read this report. Nothing in this piece makes any sense. The circ. rates would not be jumping from 55% in 2005 to 77% or 33% during four years. Those are too big variations in such a short period of time. The original number that the CDC floated around was 43%, which makes a little more sense, and I am sure there is some way they come up with that, but definitely not with the above data. The only way that the 6.5 million number works if there were 6.5 million boys surveyed in total, not 6.5 million circumcised.

Secondly, the assumption that falling circ. rates of the past few years are the result of medicaid stopping coverage, increased immigration rates, and the 1999 AAP statement is completely off. In relation to all U.S. families, only a fraction are on medicaid, and most states which stopped covering circumcision under medicaid did so before 2006. Immigrants make up a small percentage of the population as well and their behavior is not likely to drastically change over a short period of time. Lastly, the 1999 statement is not that unique as the AAP has been neutral with regard to circumcision since the 70s.

The adverse rates reported are also underestimated because 90 days post birth is a short period of time. Most circumcision corrections occur later in life, and many problems are not reported.

Anyway, if somebody has more input on the actual numbers here, do share.

[tennisdude23]

Originally Posted by Charmie981

That is the total number over a period of four years, not per year.

The problem is that this makes no sense. If there were 6.5 million circumcisions, that's about 1.6 million per year. If there are about 2 million boys born each year, that's a rate of 80% (1.6/2). That's way too high. Neither the high nor the low makes sense. So, somebody, somewhere made a clerical error, as the CDC did not make up the 43% statistic. There had to be some mathematical basis to it.

[brant31]

Originally Posted by tennisdude23

Secondly, the assumption that falling circ. rates of the past few years are the result of medicaid stopping coverage, increased immigration rates, and the 1999 AAP statement is completely off. In relation to all U.S. families, only a fraction are on medicaid, and most states which stopped covering circumcision under medicaid did so before 2006.

When NOCIRC was working with states back around 7-8 years ago to encourage them to improve their budgets and overall health by eliminating Medicaid circumcision, I recall seeing figures by them that 25-30% of all births in the US were under Medicaid. That would mean that of a national 60% newborn circumcision rate, fully a quarter would be under Medicaid. The national rate without the US government paying (and only a tiny percentage of Medicaid families pay out-of-pocket if it's not covered, as evidence has shown) would therefore be firmly under 50% (42-45%).

The latest figure I read just before the NOCIRC/IntactAmerica Berkeley symposium suggested 40% of all births in the US 2007-2009 were under Medicaid, per the national hospital discharge sample. Maybe the recession is worse than some people realize. But why, oh why, are Uncle Sam and 34 states in fiscal crisis still paying to put even one perfectly healthy American baby boy through painful, unnecessary penile surgery (let alone a quarter million or more a year)? It's insanity. And our tax dollars hurting these boys and their families.

[dmpmercury]

I can actually see the insurance thing being a huge factor. It makes sense that mayb more people are on states medicaid plans now and maybe that accounts for it. The reason circumcism got so big here was it started to be used during the wars and the men who had it done did it to their sons. After World War II employers started covering insurance and the plans all covered circumcism and thats when the rates skyrocketed to 90%. In England it was done for similar reasons as the Us and was done during the wars. After World War II they were in bad shape and they didn't cover circumcisms and it fell out of favor. It is a major factor as sad as it is. So it is really bad they are working on getting it covered again. I really like more and more private companies to drop it and for medicaid to drop it too and the rates would plummet. I think that could be the key.

I like to think people are becoming informed and I do believe a lot of people are. In my area babywearing exploded since 2006 so I do think there is a natural parenting trend going on which is a very good thing. Sadly insurance will probably have the biggest effect.

[mama2soren]

Originally Posted by dmpmercury

Sadly insurance will probably have the biggest effect.

Maybe, but maybe that's not such a bad thing. If fewer boys are being circ'd because of insurance issues, that still results in parents, doctors, and nurses who learn more about intact care out of necessity... and maybe people will start realizing that being intact isn't "gross" or "infection-prone" as they used to believe. Maybe insurance issues will be the catalyst we (as a country) need to start thinking of intact penises as the norm. I'll take that.

[Baby~Braatens~Mama]

I was told that the government is phasing out circumsision (from a very christian-conservative friend of mine). If insurance companies refuse to cover the cost or help cover the cost of circumsision than it makes sense that the amount of people chosing this elective procedure will diminish greatly.

[brant31]

Yes, this is precisely what happened in England, New Zealand, Australia and Canada. Non-religious circumcision is primarily an economic issue, as much as we have been led to believe it is a social issue.

For some reason we're stuck at only 16 states that have eliminated Medicaid payment for routine circumcision. The first batch of states, in the West, eliminated the coverage many years ago. The next batch eliminated coverage in the first decade of this millennium. Does anyone have any ideas how to make inroads with the remaining 34 states? It is incredible that many states are slashing teacher, police and firefighter funds while not touching the million or so they spend every year to provide infant circumcision.

Most private insurance plans and HMOs still routinely cover infant circumcision. It's a holdover from when they were fiercely competing for patients 40 and 50 years ago and aimed to cover every little thing. Oddly, as benefits have been reduced across the board infant circumcision remains untouched. Does anyone have ideas how to get private medical intermediaries to drop cosmetic penile surgery of newborns?

In areas where routine (automatic) circumcision coverage disappears, rates drop from 80% to 20% very rapidly. It's the subsidy that keeps it going, even when folks use the "locker room" or "look like daddy" argument. In almost all cases, those arguments are secondary to the fact that the circumcision would be "free". Take that away and suddenly most parents have little objection to having an intact son.

[SeekingJoy]

I have no idea, but would love to learn how to sway the major insurance companies.

[dmpmercury]

Maybe we can get a letter writing chain going.

[QuietTempest]

I had seen the same on Facebook and came here to find out if there was any truth to it. I have no doubt that RIC rates are on the decline but 30-some percent can't be right. Can it?

[MyBoysBlue]

My guess is the 33% is in hospital before the baby is released. In Canada if you look at just the in hospital rate it is 9% but if you look at the maternal survey rate it is at 30%.

[Papai]

Sorry, but I'm suspicious. There's no way the numbers are THAT low nationwide. Even 50 percent I'd have a hard time swallowing. And even if this is just in-hospital data, I can't imagine THAT many people are scheduling a circ that much later after birth, except for religious reasons.

[kittywitty]

Originally Posted by minkajane

And of course, no mention of meatal stenosis - something that is quite common in circ'd boys and pretty much unheard of in intact boys. If they reported that they could never say that adverse events were rare.

Exactly. My ds is one of those who basically don't exist according to this even though the urologist says rates are almost 10%.

Honestly, it sounds good, but I don't believe the rates are that low. Circing here is like breathing-if you don't do it, you're very much in the minority. I don't know anyone IRL except one family in this state who kept their sons intact.

[brant31]

As I mentioned elsewhere, the 33% US circumcision rate does not have data to back it up. The gentlemen from the CDC whom I spoke with both referred to a 43% figure, which was the average over the 3 years studied. While they did claim this represented a decline from 56% to 33%, no data to support the high point and low point were released. As such I think the ethical thing to do is to go no farther than the CDC's own claims, which are for a specific rate over a specific period. The 33% number is meaningless without hard data to support it.

My colleague was in the presentation where the figures were released to the public and discussed. I have jpegs of the 2 relevant slides, but I don't know how to post them here for all to see. Any ideas?

The gist is this: the CDC stated that in a 3-year period it studied from 2006 to 2009, there were 6,571,500 live male births in the US. Within the first 28 days/4 weeks after birth (the neonatal period), exactly 2,834,849 of these boys were circumcised. This is a 43.1385% circumcision rate.

This works out to:

2,190,500 boys born p.a. in the US during 2006-2009, on average
944,950 boys circumcised p.a. in the neonatal period, on average

There are 2 milestones here:

1. This is the first time in many years that fewer than 1 million American boys were circumcised annually, and

2. This is the first time in at least 60 years that the US neonatal circumcision rate has fallen below 50%.

Perhaps just as importantly, the CDC reported that among American males outside the neonatal period, total circumcisions performed between 2006-2009 were 258,189. These are circumcisions for ALL reasons, including medical need, perceived medical need, perceived prevention, convenience, peer pressure or vanity. According to the CDC, this works out to a 00.08% rate. It is unclear from their presentation whether this means under 1% of the total intact male population or under 1% of the total US male population. Either way, it shows how rare later circumcisions are, even in a population reported to have tremendous peer pressure to "get it done" to be "like the other guys". That seems to have been another bogus reason to cut a boy early.

If anyone knows how I can attach jpegs of the slides to a post here, please let me know. They would be small but clear, about 100K each.

[Fellow Traveler]

Originally Posted by brant31

If anyone knows how I can attach jpegs of the slides to a post here, please let me know. They would be small but clear, about 100K each.

No jpgs here. Lower left corner of the forum:

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