The American Academy of Pediatrics Monday morning jumped into the controversial topic of circumcision, issuing a highly anticipated new report that offers more support for the procedure without fully recommending it for all boys.
The pediatricians say new research has shown more definitively that circumcision can help prevent future STDs. But, whether or not an infant should undergo the procedure, they say, is best made by informed parents.
The new statement, published online Monday in Pediatrics, is sure to exacerbate tensions between two factions that have emerged since the AAP last issued a more neutral report on the procedure in 1999 (reaffirmed in 2005).
The statement authors seemed to be fully aware of the atmosphere, since their conclusions walk a line between outright endorsing the procedure and staying on the sidelines.
It cites (and includes in an accompanying review of) new evidence that demonstrates the health benefits of infant circumcision. Still, the statement does not go so far as to recommend it.
A review of recent studies “indicates that preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure. Benefits include significant reductions in the risk of urinary tract infection in the first year of life and, subsequently, in the risk of heterosexual acquisition of HIV and the transmission of other sexually transmitted infections,” the statement says.
It also calls for the procedure to be covered by insurance.
It goes on to add, however, that the medical benefits are not great enough to outweigh some other personal family beliefs.
Susan Blank, the pediatrician who chaired the task force that produced the statement said in an accompanying commentary that, “ultimately, this is a decision that parents will have to make.”
The new statement will likely bolster those who have or plan to circumcise their male children, including many who consider it a religious prerogative.
It may also hearten many in the medical community who view circumcision as an important protective procedure. Just last week, a report published by Johns Hopkins researchers in the Archives of Pediatrics & Adolescent Medicine say a decline in rates of circumcision in the United States could cost billions in avoidable health-care costs.
But it is sure to anger the growing ranks of activists, many of whom call themselves “intactivists,” who have become vocal in condemning circumcision, calling it a form of genital mutilation. Last year, an attempt to ban parents from circumcising their children in San Francisco received enough support to get on the ballot, but was withdrawn before it went to voters.
The divisive issue does not fit into any predetermined political framework. It often pits parents who might otherwise be on the same ideological team against one another.
Depending on the perspective, some say the decision to allow parents the choice to circumcise is a matter of religious freedom, others say it is a human rights issue, while still others say it is a personal family matter.
The cultural debate over circumcision became even more visible in recent months after a German regional court’s decision against a Muslim couple that ostensibly made it a crime to circumcise a child.
In Europe, circumcising boys tends to be less accepted, only about 10 percent of boys there undergo the procedure. In the United States, currently a bit more than half of boys are circumcised.
That’s a big drop from about 80 percent 20 years ago.
Experts say the drop is connected to cultural and religious shifts but may be even more attributable to finances. One of the points the Johns Hopkins researchers made in their report last week is that while the rates have fallen, so too has the likelihood of insurance covering the procedure.