Recent statistical evidence from the Center for Disease Control (CDC) (see figures below) indicates that in the United States (U.S.) newborn circumcisions among non-immigrant boys have increased over the past 2 decades. There are over 100 million circumcised U.S. boys and men, encompassing about 70% of the total male population in this country. Currently 65% of U.S. baby boys are being circumcised in the hospital as newborns, and at least another 5 – 10% of males will be circumcised later for foreskin problems and cultural reasons.
The CDC found that the total U.S. newborn circumcision rate rose very slightly (from 64% to 65%) over the two decade period, from 1979-1999, but the breakdown of these statistics is revealing. There have been increases in circumcision among blacks (from 56 to 64%) and in newborns from the Midwest (from 74 to 81%) and the South (from 56 to 61%), areas of the country with the fewest new immigrants. In specific communities very high circumcision rates are being reported: 84% in Atlanta, Georgia, 85% in Houston, Texas, and 92% in a Wisconsin community served by a pediatrician opposed to circumcision. In the Georgia survey the medical record face sheet reflected only 84% of the circumcisions actually done (O’brien, Southern Med J 1995); prevalence would have appeared to be only 70% using the face sheet diagnosis alone, as the CDC does suggesting that the CDC figures underestimate the true prevalence of newborn circumcision.
In view of these specific high and increasing circumcision rates why have the overall percentages not increased more? The answer lies on the West Coast, particularly in California, where the circumcision rate fell from 64% in 1979 to 37% in 1999. In 1979 the majority of births in California was among non-immigrant whites. By 1999 Hispanic infants constituted the largest group (46.5% of newborns); only 31.2% were non-immigrant whites and 6.2% were black; most of the rest were Asians. Hispanics and Asian immigrants rarely have their newborn boys circumcised. Since these 2 ethnic groups make up over 56% of California newborns, even if 100% of non-immigrant white and black infants were circumcised, the overall prevalence of circumcision in California would be under 40%, an explanation for the 37% Western circumcision rate reported by the CDC. In the East there is a similar though less marked effect, since there are proportionally fewer immigrants.
The rising non-immigrant circumcision rate in the U.S. probably represents growing public awareness of the compelling published medical evidence favoring circumcision. Since the 1980’s more than 15 separate studies have shown that uncircumcised male infants are about 10 times more likely to get serious kidney infections in the first year of life. Uncircumcised men are 22 times more likely to get devastating, invasive penile cancer. Over the past 15 years evidence, mainly from Africa, has shown that uncircumcised men are 2 – 5 times as likely to get human immunodeficiency virus (HIV) infection on exposure. Public response in Africa has resulted in a call for adult male circumcision. In the face of this increasing proof of the health benefits of circumcision, it seems likely that the newborn circumcision rate in the U.S. will continue to increase.