After a comprehensive review of the available research evidence, the American Academy of Pediatrics issued a new policy statement about male circumcision. The AAP states there is now enough research evidence to support the health benefits of male circumcision. In light of the public health benefits the AAP urges the procedure should be covered by insurance. Currently, the procedure is not covered by Medicaid, and private carriers are following this lead. The AAP adds that local anesthesia should be used during the procedure.
However, as part of the new policy, the AAP does not recommend that all male infants be circumcised. The AAP says this is a decision based on the family’s cultural, religious, ethical and health considerations.
The research evidence regarding the transmission of HIV is most salient to regions in the world where HIV/AIDS infection rates are most high, such as Africa. In July 2012, the Global Advocacy for HIV Prevention stated the leading tool for HIV prevention is voluntary male circumcision, particularly in sub-Saharan African countries, where the HIV relative transmission rate is halved. This finding does not generalize to Western countries.
Cultural patterns regarding male circumcision have shifted dramatically in the United States. The rate of male circumcision has dropped from 90% in the 1970’s to 33% today. Rates are lower in European countries, at about 20% in the United Kingdom and as low as 1% in Scandinavia. Germany has outlawed male circumcision except for strict medical reasons, but this is being opposed by citizens whose cultural and religious beliefs require the practice. Austria, Switzerland and Denmark are considering outlawing the practice. There are large and vocal advocacy groups in the U.S. and Canada who strongly oppose the procedure as violent, painful and unethical.
However, there are many ethnic groups, such as Jewish and Muslim families, who perform male circumcision for both religious and cultural reasons.
It is confusing for a brand-new parent to sort through this mix of cultural, health, and ethical issues. The new AAP policy brings us the new evidence supporting the procedure as public health protection in certain affected areas of the world, so it should be covered by health insurance for those who wish to avail themselves of this health protection. However, the AAP feels that its member doctors should not pressure individual families in their decision-making.
For some, it seems like a simple question with a simple answer. The foreskin is innervated with nerves and causes pain, so it should not be done.
But for others, it is not a simple question. Many parents go through a complex decision-making process, influenced by familial, cultural and ethical issues.
How do you feel about this issue?