- American Academy of Pediatrics says circumcision should be covered by insurance
- Many parents choose the procedure for religious, hygiene or cosmetic reasons
- AAP's previous policy took a more neutral stance on circumcision
Revising its policy on circumcision for the first time in 13 years, the American Academy of Pediatrics now says that the preventative health benefits of infant circumcision clearly outweigh the risks.
The AAP is also emphasizing that the procedure should be covered by third party payers, including Medicaid, so more families have access to it. However, the organization stopped short of recommending circumcision routinely for all infant boys, saying it's still up to parents to weigh the health, cultural, and religious implications to make the best decision for their child.
Circumcision is the surgical removal of the foreskin, a small flap of skin that covers the tip of the penis, generally performed in the days after birth. Many Jews and Muslims circumcise their sons because of their religious beliefs. Other parents choose to snip for hygiene reasons, believing it's easier to keep a circumcised penis clean, or cosmetic ones, wanting junior to "look like dad."
The AAP's previous policy statement, published in 1999 and affirmed in 2005, took a more neutral stance on circumcision, noting "potential medical benefits," but saying it's "not essential to the child's current well-being."
However, an AAP task force formed in 2007 examined scientific studies conducted between 1995 through 2010 to evaluate if a revision was needed. The new, stronger language is a result of emerging evidence that found links between circumcision and decreased risk of urinary tract infections, some kinds of cancer, HPV, HIV, and other sexually transmitted diseases.
"The evidence was becoming clearer, and it's now obvious there's a preventative effect," says Dr. Michael Brady, chairman of the department of pediatrics at Nationwide Children's Hospital in Columbus, Ohio, and a member of the AAP task force.
The circumcision controversy
Once routine, circumcision rates have been declining since the 1980s. The Centers for Disease Control and Prevention estimate that a little more than half of all infant males are circumcised now, although that figure is likely low since it only counts in-hospital circumcisions.
Globally, about 30% of men are circumcised, although rates range drastically from country to country.
Passionate opponents of circumcision, who sometimes describe themselves as "intactivists," call the procedure barbaric and liken it to female genital cutting. The internet, and its increasing use as a resource for medical decisions, has helped anti-circumcision groups get their message out.
"We believe that circumcision of children violates numerous legal rights of the child and is highly unethical, if not unlawful," said a public notice posted by Doctors Opposing Circumcision in anticipation of the AAP's announcement.
Some groups have even tried to make the practice illegal. Activists in San Francisco proposed a measure to ban circumcision, but it was struck down by California Governor Jerry Brown. Courts in Germany recently called circumcision "grievous bodily harm," and ruled that the "fundamental right of the child to bodily integrity outweighed the fundamental rights of the parents."
Because circumcision is such a sensitive issue, moral or religious concerns might be more important than medical studies to many parents. "It's a reduction of risk, not an elimination," says Brady. "We recognize some people have very strong personal feelings about this issue, and those should be used in any decision-making."
What the research revealed
Many studies on the benefits of circumcision have been performed in Africa, where, because of the prevalence of HIV and other STDs, the effect can be seen more quickly. The task force found evidence that circumcision has a preventative effect on:
HIV: Studies in Africa and a CDC math model study found that circumcision reduces HIV infection among heterosexual men.