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The decline in US circ rates

post #1 of 11
Thread Starter 

Unless i'm mistaken, here are some national circ rates for the USA:

 

It started to become commonplace in the 1800s, yet many of the WWI and WWII era men weren't circ.

In the 1950s and 1960s, it was at an all-time high around 90%

In the 1980s, it was still around 85% or so.

In the late 1990s, it was around 55-65%

In 2011, it seems to be around 35%

 

My question is what the heck happened between 1998 and 2011? Immigrants and the birth of the intact movement?  There's got to be more to the steep decline than just that.

post #2 of 11

Nobody knows the real rate as statistics were never kept.  The percentages available are from studies and surveys, each of which suffers from drawbacks when it comes to accurately assessing national rates.  Basically, circumcision has been in decline since the early 70s, when the AAP first came out with a statement saying it was not necessary.  Interestingly, this was the first time it ever made a statement on the issue.  It actually never recommended the procedure.  Over the years, with more information available, more focus on the patient as an "informed consumer," and perhaps some changes in demographics (although this reason has very little do with it), the circumcision rate has gone down.  However, the real number of circumcisions is almost impossible to assess. 

post #3 of 11

And the internet.  It's so much easier for people to make informed decisions. 

post #4 of 11

I suspect all of these things contribute but I still question that the decline is that steep. I'd say overall we're still around 50/50. But I agree with PuppyFluffer, the younger people are the more open they are about it and the less likely they would circumcise, based on conversations I've had and things I've read here and there, so I would expect a continued slow but steady decline going forward. It will become generational, the cat really is out of the bag.

post #5 of 11

I think that some of the experts around here would say that the overall rate in the US, including those who are circ'd at home/in a religious ceremony, and those who are circ'd in a doctor's office (versus at the hospital immediately following birth) is more like 60-65%. Higher than I would like it to be for sure, but certainly a substantial drop over 95% in the 1980s. Obviously there are significant variations by geography, ethnicity/religion/culture, and socioeconomic status. But, as states increasingly drop Medicaid funding for RIC, I think we will see the neonatal hospital circ rate (that's the 32% number that's sometimes quoted) drop even further. Whether that means that circ doesn't happen, or whether it moves to a different location, time will tell. While I believe that there are a few pediatricians out there who will provide circ for free (in cases where it is not covered by Medicaid/insurace), I think that will NOT happen very often due to malpractice concerns, etc. Then it's down to ritual circumcisers, whom I believe account for a smaller percentage of the overall puzzle nationally (again, with obvious variations in geography/religion/etc.)

 

I think the next big issue is going to be how to protect babies who are not circ'd at birth (for many/various reasons) from being referred for circ at 6 months for "medical reasons" -- when it *will* be covered by Medicaid/other insurers. Sigh.

 

Change is slow on this, in part due to what I call the "why not?" phenomenon -- rather than asking "why?" parents debate "why not?" so babies end up circ'd for reasons that are largely psychological ("looks" and "feelings") rather than facts (real scientific studies). One of my approaches to discouraging circ in families where it's "under discussion" is to consider the question from the "Why?" point of view -- on other words, make a list of real benefits versus real costs. If the parents can get to that level of rational discussion, I think the rate drops substantially. When they never get past the "why not?" argument, it's almost always a sure thing that the baby will be circ'd. SIGH.

 

It's a frustrating battle to me sometimes. Maybe I'm just having a half-empty morning, though. Someone, please encourage me! help.gif

 

Edited for typos. Sorry.

post #6 of 11

I would question your numbers of the all time high being in the 1950-60s  I think the all time high came later in the 1980s and fell from there.

 

The reason why the rates began falling after the 1980s is because (this is my theory) because of a brand new idea in the medical world- "Informed Consent"  Now you must understand- the informed consent process with circumcision even to this day is HORRIBLE- I am not crediting the "information" provided in the process for the drop- I am crediting the revolutionary idea that parents were ***allowed*** to REFUSE circumcision for the drop.  Do not assume that the high rates you see in the past were the result of "parental choice"... only a few decades ago parents were NOT given any choice- they were not asked- hospitals just instituted routines and if they wanted to- they could circumcise all the babies and you really didn't have any say in the matter.  I have spoken with many older women who were under the impression that it was illegal to leave the hospital without getting your baby circumcised! My own husband was circumcised without parental consent in 1964.

 

The reason why the rates began to PLUMMET after the mid-1990's are because of the internet- that information about the anatomy is available to people in a way it has never been (since we had the actual anatomy erased from our cultural landscape fro decades)  The privacy and the availability of the internet is helping people overcome inhibition in order to get information- the new world of debating with strangers- blogging- and probably YES acess to pornography too...  even if their doctors and parenting books still supress the most important and intimate details. The internet has also made the world a lot smaller and people who have not traveled and are never exposed to other cultures- can begin to learn that we are perculiar in this- and that other people who don't circumcise are not all "national geographic" savages- but people just like them.

The second half of the steep drop I think has to do with state medicaid dropping funding for circumcisions- I think that makes a big impact on the circumcision rates in those states.

 

 

post #7 of 11

Informed consent for all procedures, including circumcision, was standard practice by the 1970s.  This is one of the reasons why circumcision probably peaked in the 60s and has been in decline ever since.  By the 1980s, my generation, the rates were already falling, though obviously the rates in the early 80s were higher than those in the late 80s. 

post #8 of 11
Quote:
Originally Posted by tennisdude23 View Post

Informed consent for all procedures, including circumcision, was standard practice by the 1970s.  This is one of the reasons why circumcision probably peaked in the 60s and has been in decline ever since.  By the 1980s, my generation, the rates were already falling, though obviously the rates in the early 80s were higher than those in the late 80s. 

 

Agreed regarding informed consent being standard by the 1970s. I think that in the US we won't see really declines though until those who are teens now start having families. The reason being is that although people, mostly, now know it's an issue it's still an issue that was mostly relatively recently introduced to them and so they're still a bit uncomfortable with it. Those who will have essentially grown up knowing it isn't necessary (even if they themselves are circumcised) will be much more comfortable declining it. So we're talking about those individuals who are probably in their teens now. The issue will have been well known for them because they always had access to information and they would have had it from an early age so it doesn't seem uncomfortable as compared to someone thinking about this pre 80s when even a picture might have been hard to come by for most Americans. It's all about knowledge that's what will end it.
 

 

post #9 of 11
Thread Starter 
So I'd imagine someone born in Ohio in 1983 probably was the only one out of 10 to be intact, and if he had an intact friend, that would have been extremely rare?

The hospital must have freaked out when the mother said "no" to circ?

What about 1986? Same situation?
post #10 of 11
Quote:
Originally Posted by bugmenot View Post

So I'd imagine someone born in Ohio in 1983 probably was the only one out of 10 to be intact, and if he had an intact friend, that would have been extremely rare?

The hospital must have freaked out when the mother said "no" to circ?

What about 1986? Same situation?


Saying no to circumcision in the 1980s was no big deal, and many parents did so.  One out of ten would indicate a 90% circumcision rate, which again was not the case nationally.  These things varied and still vary from hospital to hospital.  The type of situation you are describing might have been more common in the 1960s when circumcision was pretty much routine and not questioned by the vast majority of parents or health care professionals.  Still, even then, if a parent did not want a circumcision, he/she just had to indicate that.  No hospital could force a circumcision on a parent, and indeed in the more culturally diverse areas of the country, every male child was not leaving the hospital circumcised.  Basically, in the 50s and 60s, circumcision was "the modern thing to do" in the U.S.  It was almost like a trend; like it was modern to use Nestle baby formula.  As the culture and people's attitudes changed in the 70s, more and more parents began to question standard practices, which in the case of circumcision coincided with the AAP's position that the procedure was not necessary.  Subsequently, the rates began to decline and the rest is history. 

 

post #11 of 11

The US infant circumcision rate peaked in 1979, according to Wallerstein's book. It has been in steady decline ever since. No one know why it has been declining. Perhaps due to sympathy with other human rights movements, perhaps because of the back to nature movement, or because dads are getting more involved with their kids again. What we know is that the 2009 rate was 32.5% according to the CDC.

 

The recent plunge is easier to figure out. Organizations like Intact America brought the issue to national attention. The Internet made it possible for parents to get high quality information from websites like Circumcision Decision-Maker You can see this effect at work. For instance, "The Week" magazine called circumcision the #1 parental controversy in 2010.

 

I think of it as a slowly passing fad, it is your parent's body mod.

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