Study: Declining circumcision rates could lead to increase in health care costs, disease

Published: Thursday, Aug. 23 2012 9:00 p.m. MDT

Nurse Angie Hagen tends to a new born baby boy in the nursery at Denver Health medical facility in Denver on Thursday, June 23, 2011. Colorado will end coverage for routine circumcisions under Medicaid next month, adding to what's become a national debate over the once widely-accepted procedure. The change will take effect July 1. Lawmakers agreed to end funding as part of a package of cuts to balance the budget.

Ed Andrieski, Associated Press

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SALT LAKE CITY — Circumcision rates have been declining during the past 10 years in Utah and the country, and researchers are now saying the trend could result in higher health care costs because of potential medical complications.

The American Academy of Pediatrics, which holds the leading opinion on the matter, has also announced an upcoming change to its decades-old stance on circumcision. An official statement explaining its new position is expected Monday.

The organization has been neutral on the procedure since 1999, saying that while there are some health benefits to the procedure, they don't outweigh the risks and circumcision is considered a cosmetic procedure.

Utah Medicaid stopped covering the procedure in 2003, as a cost-saving measure decided by lawmakers. Unless it is deemed medically necessary, it is not covered. But officials in Utah are now considering potential changes to current benefits as the number of parents choosing to circumcise their children continues to drop.

Approximately 39 percent of infant boys in Utah were circumcised in 2010, according to the latest data available from the Utah Department of Health. That's down from nearly 70 percent of newborn boys in 2000, with the largest decline happening the year Medicaid dropped coverage of the procedure.

Davis County circumcises the largest number of newborn males, at 54.2 percent in 2010, while southwestern Utah performs the procedure on slightly more than 20 percent of babies.

Nationwide, 80 percent of males were circumcised in the 1970s and 1980s, but the number dropped significantly in 1999, to 62 percent, according to the U.S. Centers for Disease Control and Prevention. In 2010, the rate continued to decline, hovering around 55 percent.

Dr. Mark Witt, a pediatrician with Intermountain Healthcare's Holladay Pediatrics clinic, said that while most pediatricians refer patients to the AAP recommendation, the decision is entirely up to the parents of a newborn boy.

"There is a dilemma in that parents know the American Academy of Pediatrics says it is more a cosmetic procedure and I think that causes some anxiety, and rightfully so," he said. "In talking to parents, they feel a little on the fence. They're making a choice for their one- to two-day-old little boy who doesn't have a say in it."

The procedure is generally performed at a hospital, one or two days after birth, or up to about two weeks at a pediatrician's office. After that time period, a urologist at a hospital typically takes over.

For many families, the procedure results from tradition or a desire for sons to be like their fathers, who were also circumcised out of tradition, religious or otherwise.

Acknowledging it is a personal decision for families to make on their own, Marlise Smurthwaite said she studied the pros and cons of both circumcising and not circumcising her newborn sons. Her stepson, she said, had not been circumcised, and "I was in a situation where my sons would either be the same as their father or their brother, so I went back and forth."

Biblically, and according to Judaism, circumcision is a sign of a covenant relationship between God and Abraham, a symbol of cleanliness and a reminder of the generations to come. It is considered religious law for those of the Jewish and Islamic faiths, and barring any sickness, happens on the eighth day after birth, when humans typically form blood-clotting properties.

"It is not just a medical act, it is a connection with our God, symbolizing our devotion to him, and it serves as a reminder of the importance of being moral," said Rabbi Gadi Levy, who lives in Colorado and travels throughout the country as a fully trained mohel, performing circumcisions.

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