Published October 05, 2011
State governments looking to save a little money should not reduce funding for circumcisions, according to researchers at Johns Hopkins University. Currently, 18 states do not provide Medicaid funding for infant circumcision, and San Francisco has attempted to ban the procedure.
In an editorial to appear Wednesday (Oct. 5) in the Journal of the American Medical Association (JAMA), Hopkins doctors Ronald Gray and Aaron Tobian said the increasing efforts to defund or outright ban infant male circumcision are unfounded, harmful and "ethically questionable."
More than 500 published studies in the past decade have reaffirmed the benefits of circumcision in preventing sexually transmitted disease (STD) in both men and their partners, as well as preventing urinary tract infections, as relayed in the editorial. Studies in Africa have shown that circumcision can decrease HIV infection by up to 60 percent.
Decreasing funding for Medicaid, the researchers said, would hurt the most vulnerable: certain minority groups and the poor who rely on Medicaid and who suffer from higher STD rates compared with the general population. In Washington, D.C., 7.1 percent of African-American males are HIV-positive, and heterosexual sex is the most common mode of transmission among them, Tobian said. "Male circumcision decreases dramatically when not covered by insurance," Tobian added.
Tobian compares circumcision to childhood vaccination: There's an extremely low risk of infection from the procedure (less than 0.5 percent); and there's an abundance of lifelong health benefits for the individual as well as population at large. [Circumcision: Fact, Fiction and Hype]
"If a vaccine was available that reduced HIV risk by 60 percent, genital herpes risk by 30 percent and HR-HPV [cervical cancer virus] risk by 35 percent, the medical community would rally behind the immunization, and it would be promoted as a game-changing public health intervention," Tobian told LiveScience.
Instead, in 2011, Colorado and South Carolina, joined 16 other states in denying Medicaid coverage of circumcision. In July, the San Francisco initiative to ban male circumcision was removed from the city's November ballot because of a legal technicality. Just this weekend, Calif. Gov. Jerry Brown signed into law a bill that prevents local governments from banning male circumcision in the state.
Many who oppose the practice of infant male circumcision say that it violates the child's rights to decide for himself or that it reduces sensitivity during sex. But Tobian said that parents make health decisions for children all the time. Waiting until the child turns 18 places him at risk for STDs.
"Based on the medical evidence, banning infant male circumcision would deprive parents of the right to act on behalf of their children's health," the researchers wrote in the editorial.
As for sex, studies conducted in the last five years in Africa, Europe and North America of men circumcised as adults have revealed either no difference in sensitivity or an increase in sexual pleasure for both men and their partners.
Some compare infant male circumcision with female genital mutilation, which entails partial or total removal of the external female genitalia or injury to the genital organs for nonmedical reasons. Most health authorities dismiss the comparison, however, on grounds that male circumcision has no lasting negative impact, barring a rare neonatal infection, and is not performed as a means of subjugation.
Nevertheless, worldwide, infant male circumcision is rare, with the United States being the last bastion of the practice for non-religious reasons. Over 60 percent of newborns were circumcised in 2000, according to the Centers for Disease Control and Prevention (CDC), although current rates might have dropped to about 56 percent, according to the federal Agency for Healthcare Research and Quality.
Rates recently have plummeted in Canada and Australia, where infant circumcision is now rare. And aside from the Muslims and Jews who perform circumcisions as part of a religious tradition, the procedure has become nearly non-existent since the 1960s in all of Latin America, Europe and Asia; and Sweden and Finland restrict most circumcisions.
Tobian and Gray could not offer an explanation for the global trend nor speculate in its impact on public health, other than to say that parents should have the right to choose whether their child should be circumcised.