# Is the Circ Rate really only 32%?



## Lory (Mar 19, 2011)

I read around and it seems like the percentage of boys born today who are kept intact is 68%? If this is true, it's a big difference than before, because in 2005 I thought it was about 50/50... almost 70% instead of the 10% just a couple decades ago... wow. Kinda hard to believe!


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## philomom (Sep 12, 2004)

I think it varies highly by region. The Northeast is a high circ area still but I'm in the Pacific Northwest and its a rare thing to see a cut little fellow in the family changing rooms at my YMCA.


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## MsFortune (Dec 5, 2010)

That seems really high. I'd say more than 1/2 of the boys where I live are circed. But my perception could be colored because I have a lot of jewish friends.

I think it really depends on region, but that seems really high amount of uncirced.

I'm from the midwest and I think they are ALL circed there. It's not really considered an "issue" there.


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## tammylsmith (Jul 11, 2008)

It will be interesting to see how quickly this trend moves. I'm in NYC area, and both my doc and my son's pedi confirmed that more and more are choosing to remain intact, but I'd still say the rate is more 50/50. That number probably varies widely in any given state/county/city.

Given the extreme adverse reaction we informed parents have to this operation... I hope that the circle of informed parents will just keep getting wider and the number will be closer to 0% circ'd. The only way circumcision can be perpetuated in our culture is for parents and doctors to remain in the dark. It seems to me that as information gradually spreads, then it will be harder and harder to justify. I don't think that 32% is very accurate for the whole US though.


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## Lory (Mar 19, 2011)

I found a list of circ rates in all the regions of the U.S. and the lowest one was in the west, which was something like 31%, with the highest being something like 62% in the east as philomom said.

"The CDC data, reported by the _New York Times_, showed that the incidence of circumcision declined from 56 percent in 2006 to 32.5 percent in 2009. According to these statistics, non-circumcision or genital integrity has become the normal condition among newborn boys in the United States."

http://www.cirp.org/library/statistics/USA/

So if that's accurate then it explains the sudden drop I was talking about between '05 and now. Interesting!


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## capretta (Mar 23, 2010)

From the Times article cited:

"The slide portrays a precipitous drop in circumcision, to just 32.5 percent in 2009 from 56 percent in 2006. The numbers are based on calculations by SDI Health, a company in Plymouth Meeting, Pa., that analyzes health care data; *they do not include procedures outside hospitals (like most Jewish ritual circumcisions) or not reimbursed by insurance*."


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## vachi73 (Mar 26, 2009)

Quote:


> Originally Posted by *capretta*
> 
> From the Times article cited:
> 
> "The slide portrays a precipitous drop in circumcision, to just 32.5 percent in 2009 from 56 percent in 2006. The numbers are based on calculations by SDI Health, a company in Plymouth Meeting, Pa., that analyzes health care data; *they do not include procedures outside hospitals (like most Jewish ritual circumcisions) or not reimbursed by insurance*."


Yeah, this is correct. The 32.5% is the rate of boys who are circ'd *in the hospital* before discharge. So it does not include any baby boy who is cut in a bris (or other religious rite), nor any boys who are cut by a doctor (OB, ped, urologist, etc.) outside the hospital setting.

Two things --

1. I think that the "true" rate is more like 50% intact and 50% cut. If you take the 32.5%, and add a chunk who would be circ'd during a bris ... say, 3% of babies in the US (that's a pretty high estimate, since in the US, Jewish people make up 2.2% of the total population; and some % of Jewish parents do circ in hospital versus at home, but let's just go with 3%), that would get us to roughly 36%. Beyond that, add any other religious rites, maybe that's 1% who would happen outside the hospital for religious reasons (making that up). That's 37%. Then, add the percentage that you think are circ'd after discharge from the hospital, but NOT for religious reasons; plus babies born at home/not in a hospital who later seek circ. I find it hard to believe that percentage is higher than 10% of all baby boys born in the US, but even if it's as high as 13%, that only gets us to 50%. So I think 50% is proabably a reasonable estimate.

2. HOWEVER -- and this is a big one -- the decline from 56% to 33% shown by the CDC's own (apples-to-apples) statistics is a huge decline, and shouldn't be pushed aside as not important/accurate/relevant. Although I do think the true, total circ rate is higher than 33%, the drop from 56% to 33% means that a huge number of babies were spared RIC in the hospital, either because their insurance no longer pays for it (yippee!) or they are delaying the procedure/decision until later (again, yippee -- that gives one of us intactivists an opportunity to delay it further or sway their thinking in the meantime; allows for breastfeeding to be established; and *perhaps* increases the changes that, if a circ is done, pain control will be used).

Bottom line, at the very least, the timing and venue of infant circ are changing, and although this presents different challenges for the intactivist movement (now we have to worry about every doctor in the US and not just every hospital...), it also provides more opportunities for the one-on-one conversations that we all know *do* sometimes work.

At the very best, we have been very, very successful in helping circ rates drop precipitously, despite a lot of pro-circ propoaganda/"research" findings released during the same time horizon. I think this is partially related to the lack of Medicaid coverage for circ in some states with relatively large Medicaid populations and relatively high birth rates (e.g., lots of babies born who did not have coverage for circ, so therefore the parent(s) did not do it out-of-pocket). That's an area for continued focus and effort -- if Medicaid doesn't cover circ, it won't matter where it happens, the doctor will not be paid to do the procedure. I guarantee it: if they're not paid to do it, 99.9% of them won't do circs. Period.

Off of my chatty soapbox now  Have a great day, everyone.


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## purplerose (Dec 27, 2010)

It's so very hard to believe the rate is so low, from what I see. I live in the Southeast, and it's very rare to come across anyone who does not circumcise. The only place I've met anyone who doesn't is in a local crunchy homeschool/unschool group. I have never met anyone outside that group who leaves the penis natural.


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## mi.birthdoula (Jun 12, 2008)

Quote:


> Originally Posted by *MsFortune*
> 
> I'm from the midwest and I think they are ALL circed there. It's not really considered an "issue" there.
> 
> From MI here and not ALL the boys are circ'd. I have a good number of friends with intact sons as well


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## newsolarmomma2 (Jan 6, 2011)

I think 32% is accurate, as OPs have said already.

I am THRILLED that so many people are choosing not to mutilate their sons! I don't care if EVERYONE did it, I still would NOT subject my son to it, but it's so much easier when it's not popular.


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## tammylsmith (Jul 11, 2008)

I wanted to add that, to me, what"s more important than the exact number is the trend it represents, and that number of circ'd baby boys is dropping fast!


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## brant31 (Jan 11, 2009)

I was at the CDC presentation in Vienna, Austria last July when the 32% figure was first made public. It was in a presentation about the rate of complications from circumcision, not actually the circumcision rate, and the data were compiled by a private firm for the CDC. I think the CDC's goal was to lowball the US circumcision rate, so the combination of a low rate coupled with the CDC's ridiculously low estimate of complications would result in a very small number they could report for complications... something like 1,000 per year, when we know the real number is anywhere from 20 to 50 times that, based on one million infant circumcisions a year in the US.

Just this week the US Department of Health and Human Services (HHS), through its Agency for Health Research and Quality (AHRQ), published data for the 33 states that participate in the State Inpatient Databases. Among the data collected is circumcisions performed in-hospital before discharge. This means that any trend to perform infant circumcisions after the initial maternity stay, as seems to be the strong trend in several Western states, would not be included.

The AHRQ figures for 2009 show an overall national infant circumcision rate of 57%, unchanged from 2008. They range from a low of 13% in Nevada and 15% in Washington state to highs of 85% in Michigan, 84% in Kentucky, 83% in Nebraska and 82% in Iowa & Wisconsin. Matt Hess has updated the statistics page at MGMbill.org to reflect the latest federal numbers. Roll your mouse pointer over each state to see its most recent information about newborn male circumcision, including whether that state's Medicaid program continues to automatically pay for the procedure on healthy boys. AHRQ shows that the male infant circumcision rate rose slightly in 9 states from 2008 to 2009, declined slightly in 12 states, and remained the same in 11 states.

Given that 57% appears to be the figure that HHS has determined to be the in-hospital circumcision rate, and it's a fact that more and more families are having their sons circumcised later by their Pediatrician or Family Practitioner, it's safe to assume the national rate is still considerably higher than 57% -- perhaps as high as 2/3. Nevertheless, it is not incorrect to say that the CDC presented figures to the public showing US circumcision rates had fallen from 56% in 2006 to 33% in 2009. Whether it was in error or they were measuring something else entirely, those are the figures they published and the New York Times reported.


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## brant31 (Jan 11, 2009)

Quote:


> Originally Posted by *tammylsmith*
> 
> I wanted to add that, to me, what"s more important than the exact number is the trend it represents, and that number of circ'd baby boys is dropping fast!


I wish that were actually the case, but the AHRQ figures from HHS show that the US infant circumcision rate has shown no statistically significant change in the last 10 years. The last movement downward was just after the 1999 AAP statement affirming that there was no compelling medical indication for circumcision of newborns.

On a personal note, I want to let all the moms and dads here know that I regret not having been able to participate much in the last 6 months or so. I'm around, though! Been taking care of some urgent medical needs (successfully) and lurking when I can. My research and volunteering on this topic continues unabated. I should have some new figures and stories from the Rome conference this summer. As usual, feel free to PM me anytime!


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## tammylsmith (Jul 11, 2008)

Oh wow  that is so disappointing. I'm glad you are doing everything you can brant. What is it going to take? It seems like there is so much information out there, and minds are being changed. How do we reach a tipping point on this?


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## brant31 (Jan 11, 2009)

Quote:


> Originally Posted by *tammylsmith*
> 
> Oh wow  that is so disappointing. I'm glad you are doing everything you can brant. What is it going to take? It seems like there is so much information out there, and minds are being changed. How do we reach a tipping point on this?


Great question! First off, everybody who supports body integrity should be actively contacting their state officials about ensuring that Medicaid does not pay for automatic (on-demand) circumcision of healthy male newborns. This was a problem before the current economic crisis, when Medicaid was paying for about 25% of all circumcisions performed in this country. Now, with so many on public assistance, it's well over 30%, even with a couple more states having recently dropped coverage. South Carolina was the newest, on Feb 1.

I don't want to confuse this reply with something better suited for the Activism forum, so I'll distinguish it: over there it's more about the specifics of how to go about joining a movement or campaign. For the moment, I'm just calling attention to the fact that nearly a third of all unnecessary infant circumcisions in the US are being paid for with our tax dollars, which is a de facto endorsement of RIC (routine infant circumcision) by our own government. Given the headlines lately about states looking for every last penny at this time of budget crisis, it's unconscionable that any state spends even a nickel on RIC.

Moreover, there is evidence that private insurers are taking their cue from Medicaid. In those states where public circumcision funding has ceased, HMOs and insurance companies are more likely to drop the coverage. It becomes a domino effect.

Down here, I've been working with Baby Mario's lawyer on drafting something we're tentatively calling Mario's Law. In effect, it does not block circumcisions but does require sensible safeguards, including:

1) a waiting period of at least 7 days for the baby to stabilize and gain strength

2) treatment of circumcision as a surgery under JCAHO rules. This means full anesthesia with waiting; "time-out" by doctors and nurses to check records before starting; actual surgical marking of the site to be cut; a valid written diagnosis of the problem the surgery will treat (given to parents and made part of the hospital record); and full surgical follow-up care including pathology report of the tissue removed (including details as to size and disease), evaluation for success against standard criteria and cross-check with diagnosis.

3) a specific recognition of the infant as patient for circumcision, not the parents

4) proper informed proxy consent, including description of complications up to and including death, with full disclosure that the procedure is completely unnecessary and not generally performed on newborns in most of the developed world.

plus much more. It's all pretty reasonable, doesn't interfere with a family's social or faith decisions, yet conforms to 21st century surgical standards. The JCAHO part is key, because fully 80% of hospitals in the US don't classify circumcision as surgery; it's merely a "procedure", like removing a hangnail or splinter, and thus has virtually no standards of care. Mario's Law also highlights that circumcision is outside of the practice area of OB/Gyns, and requires explanation of the urgency that might require an OB to be enlisted to do one.

For over 60 years the US has been working hard to remove obstacles to circumcision, including payment. It's time the surgery was seen for the costly, complicated, unnecessary intervention it is.

In sum:

blog about it

talk to family and friends

participate - even just one post - in every online discussion you can find

bring up your opposition to your doctors (they need to know)

help out the Medicaid project

write to private insurers and HMOs

It was once said that the foreskin's greatest enemy was the English language. (Well, at least in the developed world it seemed to be primarily a problem of/in English-speaking countries). By corollary, we can say that the internet is circumcision's greatest enemy by the power it has to enlighten so many people and get them to think & discuss.


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## Lineymom (Mar 14, 2009)

So what is the best route for ending Medicaid coverage in my state? Is there an online form letter or something that would tell me which politician to write?


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## CatholicBFMama (Aug 6, 2007)

You know what pisses me off, is that Medicaid will pay to slice off part of a baby boy's penis, but my insurance company wouldn't pay a penny of my (not nurse) midwife-attended, freestanding birth center birth. Grrrrr........









Really?!?


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## CatholicBFMama (Aug 6, 2007)

Circumcision is definitely the norm here in West Texas, as is fully medicalized birth. (One of our local hospitals has a 60% c-section rate!!!







) I'm seen as something of a freak, given that none of my children have been born in a hospital, I cloth-diaper, breastfeed for at least 12 months, and DIDN'T CIRCUMCISE MY SON! Wow, what is wrong with me?!

I live in the wrong area of the country for being as crunchy as I am, that's what's wrong....


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## Night_Nurse (Nov 23, 2007)

Quote:


> Originally Posted by *CatholicBFMama*
> 
> Circumcision is definitely the norm here in West Texas...


Yes, I believe it's the norm in W. TX just as it's the "norm" all over Texas. I hear/read all over the web that TX circ rates are pretty low, maybe 50%. But I live in N. TX (and worked in OB for over 10 years) and the vast majority of U.S. boys are circumcised. I'd guess probably 70%+. People will say TX has a lower rate due to the Hispanic and immigrant population, but I haven't really seen that. Correct me if I'm wrong, but the majority in west TX is Hispanic, yes? Yet you still say the majority circ there. I will say that most of my patients I cared for who were actually Mexico residents, maybe 60 - 70% of them, kept their boys intact. But we still had plenty who would circ (not sure if they wanted their boys to be "Americanized" or maybe they just didn't understand what they were agreeing to).

I don't even believe for one minute that the nationwide circ/intact rate is 50/50. Last summer, I decided to call various maternity and newborn floors throughout the nation. All over TX I heard the circ rate high and is definitely the majority. I decided to call hospitals in the progressive east coast, specifically states which supposedly have very low rates (30% or so). In Portland, OR, I was told by a head nurse that "most" boys are still circed but she didn't have exact numbers. I called a major hospital in Seattle, WA and the OB manager said it was "about 50/50". So if the numbers are still at least half or more in the progressive states, I'm sure they are much higher throughout. I'd love it if some others would call their local hospitals and get some circ stats to share.

Do I think intact boys are more abundant now than 10 or 20 years ago? Sure. Does it help that some insurance companies won't pay for it? Yes! I'd still even bet 50 - 60% leave the hospital intact some states. But I just think that's because insurance doesn't pay for it and parents have to save up for it. Or, because parents are hearing our message about pain and "make sure you are there to witness pain relief used properly" and they just go to a pediatrician's office.

I think whoever came up with the 32% stat low-balled it to suit their needs. I fear intactivists will believe it really is 32% and not speak out against circ because they think nobody is circing anymore.

Just my two cents.


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## WaitingForKiddos (Nov 30, 2006)

I used to think that there was no way circ rates were so low. Recently the vast majority of new moms I've met have intact sons and within my circle of friends I'd say about 20-30% are circumcised.


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## Sarah (Nov 20, 2001)

Night Nurse- I had a big problem with the way these statistics were forced out into the public eye. I also have a lot of trouble believing them, and because they do not count outpatient circumcision- which currently does make up a large portion of circumcisions. But the fact remains, little is known about true circumcision statistics...at least not in one easy to understand database. Statistics on circumcision, the complications and the deaths should be compiled. There is no excuse for a situation like in the AAP policy on circumcision, that for the past 13 years has said, "The incidence of complications is unknown"

I have seen in the year since these Vienna stats were forced out to the public, that many people on parenting boards who are not activists, say, "I have heard the rate is well under 50% now so the locker room argument just doesn't hold true anymore." Because so much of circumcision was driven by peer pressure (of parents) to conform, this statistic has done a lot of good in opening the door for parents to question circumcision, when they used to feel obligated to do it and could not even consider the alternative. I see more parents than ever before on mainstream boards saying they will not circumcise....and the ones who say they will do it to conform, are being corrected that their son, if circumcised, may be in the minority.


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## sanity rules (Mar 1, 2008)

In my experience as an intactivist in 2011 America, 32% is (sadly) an unrealistically low number to quote.

Although it's not the only reason I say this about the rate not being so low, I often read blogs of expectant parents and cruise through sites with pregnancy related message boards. I do this sort of as a sociological overview of the views of the era on circumcision, and I'd have to say that among those American parents who do not come from a culture that already has intact males as a norm, most are still circumcising. (For instance, I read four blogs this afternoon, selected at random, and two couples mentioned their sons' circumcisions, with one other posting a picture of a first bath where the baby was undeniably cut...probably with a plastibell, IMHO THEE worst option for the procedure. My guess is, based on attitudes and location, the fourth couple probably circed as well.)

My best estimate is that nationwide we're very likely still around 65%-70% circumcised. I know some may disagree and say I'm way off and that's high, but....I seriously don't think it is.

HOWEVER, what I am also seeing is that we are scooting ever closer to the tipping point. In the 26 years I've been active to some extent in fighting circumcision, I've seen things change from a few lone voices in a hostile wilderness, to now where even those who circumcise their little boys at least have an awareness that there is another option in the matter. It's also an ever-rarer event for someone in America not to know someone first-hand who left their son intact, and that by itself is contributing to undermining circumcision as the automatic norm. So, while 32% isn't a statistic I can get behind (although I'd love to be proven wrong) I do have a huge amount of optimism about the future of intact-ness in 21st century America.

That's why I always say:

Keep up the good fight because we're winning!!!!!


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## CatholicBFMama (Aug 6, 2007)

Quote:


> Originally Posted by *sanity rules*
> 
> My best estimate is that nationwide we're very likely still around 65%-70% circumcised. I know some may disagree and say I'm way off and that's high, but....I seriously don't think it is.


That's probably a low number in my area. I don't know anyone else in my extended circle of friends and family that kept their son intact, sadly.


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