Tuesday, August 27, 2013

NEW YORK: Western US circumcision rate falls dramatically

New York Times
August 22, 2013

Circumcision Rates in U.S. Drop Drastically in Western States

by Hope Reeves

¶ The percentage of male newborns who are circumcised in United States hospitals has dropped drastically. Over a 32-year period, the number of male newborns circumcised in the hospital decreased nationally to 58.3 percent in 2010 from 64.5 percent in 1979, according to new data from the Centers for Disease Control and Prevention.

¶ But while that 10 percent decrease over all is statistically significant, the authors of the report say, what leaps out of the data is a 37 percent drop in the West. In that 13-state part of the country, the rate of newborns receiving routine circumcisions at birth fell to 40.2 percent in 2010, by far the lowest rate in the country, from 63.9 percent in 1979. That decline accounts for virtually all of the shift nationwide.

¶ In the Northeast the overall trend was flat across the 32 years, with a high of 69.6 percent in 1994 and a low of 60.7 percent in 2007. Rates in the Midwest had dropped 3.3 percentage points over the period studied, with a high of 82.9 percent in 1998 and a low of 68.8 percent in 2009. The South’s rate increased 2.6 percentage points and ranged between 66.1 percent in 1995 and 53.8 percent in 1988.

¶ The authors cannot explain why the numbers dropped so precipitously in the West, which comprises Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington and Wyoming, because the analysis did not factor in contextual data. (These figures do not represent circumcisions performed outside of the hospital setting — e.g., ritual circumcisions — or any following discharge from the birth hospitalization.)

¶ “That question is beyond the scope of this report,” Maria Owings, the lead author, said.

¶ But it remains an intriguing question. Why would that part of the country differ so much from the rest? Have parents there developed a new attitude toward circumcision and, if so, why?

[What needs to be explained is not why the rate has fallen in the West, but why it has failed to fall in the rest of the country.]

¶ The high-profile 2010-11 attempt to get a bill criminalizing the procedure on a San Francisco ballot might have provided an opportunity for opponents of the procedure to reach parents. The initiative — called the Prohibition of Genital Cutting of Male Minors — was ultimately quashed, but it did get 12,000 supporting signatures.

¶ “San Francisco is a bastion for new thinking and individual rights, which draws many people to the region; however, the entire West Coast — Washington, Oregon — also have very low infant circumcision rates,” said Lloyd Schofield, the leader of the San Francisco movement. “Certainly much of this comes from basic awareness and less insistence on the procedure from the medical industry.”

¶ Mr. Schofield said that “a huge driver of the decline” was the nonpayment for the procedure by private insurers, “but in particular coverage was removed from Medicaid here decades ago.”

¶ “When the money is gone,” he said, “it no longer serves a purpose … funny thing about that!”

¶ Marc Stern, a lawyer for the American Jewish Committee who worked against the initiative, suggested that, among other things, the larger population of immigrants from countries that do not routinely circumcise could account for the low rates in the West. “Different cultures in Asia and the Americas and different attitudes towards circumcision may help explain the West’s differential,” he said.

¶ Douglas Diekema, a member of the American Academy of Pediatrics’ task force on circumcision and a professor of pediatrics at Seattle Children’s Hospital, echoed Mr. Stern’s theory that the difference in circumcision rates could be a result of demographics, but he had another theory, too.

¶ “The West Coast has more immigrants from populations that don’t circumcise as commonly as we do in the U.S.,” he said. “The Hispanic culture is one of those, and since the West and Southwest are taking on” more Hispanics, one could assume there would be a drop.

¶ At the same time, Dr. Diekema said, West Coast residents tend to be more progressive.

¶“Ever since the founding of this country, the West Coast has attracted people who walk to the beat of their own drummer,” he said. “People here are more likely to question the standard and go a different way.”

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