Monday, September 26, 2011

32% of U.S. Baby Boys Circumcised in 2009: A Response to Critics Questioning the CDC Reported Rate

By Danelle Frisbie © 2011



If you're a seasoned reader of Saving Our Sons, you know that last summer (2010) the CDC presented statistics in Vienna at the International AIDS Conference showing the rate of newborn male genital cutting in the United States dropped from 56.2% in 2006 to 32.5% in 2009.

If you run in intactivist circles, you also know that there is a small handful of those who strongly oppose genital cutting, but question the reality of this CDC presented statistic. It is an issue that has surfaced somewhat regularly, and we believe one worth addressing here.

The CDC presented statistic was delivered in an address by Charbel El Bcheraoui, an epidemic intelligence officer in the division of HIV/AIDS with the CDC. When presenting to a largely non-U.S. population, CDC representatives had no trouble standing behind this 32.5% genital cutting rate and suggested we may do ourselves good to increase cutting. At the time, (in conjunction with a few other biased, pro-cutting agencies), they were making attempts to push MGM on adult African men as a "protective measure against HIV" (a proposed "vaccine" of sorts for HIV that we know is bogus).

When media back home in the U.S. picked up on the presented rate (thanks in part to Intact America intactivists at the conference who photographed the presentation slides, and the New York Times publishing a story on the research) it was used by human rights advocates to exemplify that genital cutting is drastically dropping in the U.S. (which it is) and that the old "locker room argument" is out the window. This spin on the stat in the last year seems to have pushed (a pro-cutting) CDC into indifference or passive pro-cutting silence on the most comprehensive statistics and research findings, while using old data (~50% cutting) on their website and invalid methods of securing this stat in recent publications, as current.

If there is any validity to the old statistics (having been presented for almost a decade now), we can know the rate is less than 56% because this figure comes from 2005-2006, and as education on the subject has increased (not only among parents, but among doctors, midwives, doulas, CBEs, lactation consultants, and college professors as well) more boys go home intact. To propose that genital cutting has remained the same for the past 7 years is naive at best, deliberately fabricated to push MGM at worst.

The actual study - which was a meta-analysis (the largest study on newborn circumcision rates in the U.S. to ever be conducted) showed steady decline between 2006-2009. It included genital cutting (i.e. prepuce amputation surgery) that was done during the first 12 months postpartum (1st year of a baby's life) in a hospital or clinic, or when insurance was used, and was therefore recorded as a covered surgical procedure and/or short hospital stay. [Many parents today still do not realize that genital cutting is classified on hospital and insurance documentations as surgery.]

The vast majority of babies cut in the U.S. go under the knife during their first 10 days after birth (most within the first 48 hours). If a baby is not cut until later in their first year, insurance is almost always used because general anesthesia is also recommended -- post 10lbs or 6 months age. [We still seem to buy into the old myth that "newborn babies don't feel pain" and can therefore be cut apart without anesthesia.] Later genital cutting under anesthesia automatically requires insurance to get involved for a surgical procedure that must be documented in hospital or clinic records as such, and billed with anesthesiology. Often, these later procedures are done in the OR which is need for further hospital recording and insurance involvement because there must be "worthy cause" for anesthesia to be used, and an OR to be booked, for an otherwise healthy baby.

Not every hospital and clinic in the U.S. was surveyed - as with most comprehensive and analytical statistics, we take a measurement that represents a valid and reliable percentage of the population, and apply it to the whole. Again, this was the largest study of its kind to ever be conducted, and their results were significant and conclusive.

On a sociological scale then, the only babies who would not be included in this 32.5% stat are:

- those cut at home

- those cut outside a hospital or clinic that documents its surgical procedures and whose cutting is not covered by insurance

This would include Jewish parents opting for a Brit Milah at home. The current population of Jews in the U.S. is approximately 2%. (1, 2)  This means that even if every single Jewish adult had a son during the 2006 year, and every single one of these babies was cut, the rate of newborn circumcision would still only increase to 34.5%. We know this is certainly not the case - less than 50% of babies born are male, (nature tends to favor female offspring), and more Jewish parents today do not cut their sons, but instead elect for a Brit Shalom, or pass on the ceremony altogether. Some of the most outspoken intactivists today are Jewish men, women, rabbis, physicians, historians, etc. Obviously, the number of those cut within Judaism is not going to have a dramatic impact on the overall national rate. In nations today where all boys and men remain intact from birth except those born within Jewish families, the male genital cutting rate is still 1-2%.

The other population this CDC presented rate does not take into account includes boys born at home. Today the numbers of women who choose to birth at home is much less than the population of Jewish adults in our country. The National Vital Statistics Reports and CDC report that 0.59% of births in 2006 were at home (1/2 a percent!) and all of the births that took place outside the hospital were only 0.90% (still less than 1%). We do not have current 2009 statistics on the percentage of babies born at home (at least not that which has been published by the CDC / NVSR) but other research shows the rate of birth outside the hospital has stayed fairly steady - around 1% for the past 25 years. It is very unlikely that homebirth would statistically, significantly higher in 2009 (when genital cutting was found to have dropped). In addition, more often those who are opting to birth at home are well-informed women making choices based on health-conscious and well researched reasons. They are more likely to take an active role in protecting both themselves, their birth, and their baby. The rate of genital cutting tends to be lower among families birthing at home. But for argument's sake, let's say that the rate of home birth doubled between 2006 and 2009 -- up from 0.59% to 1.19% and that all of those women birthed boys... (again about 46% of live births are actually male) and all of those baby boys were cut. This would still only increase the 32.5% to 33.5%. Just as we find with Judaism, homebirth is not having a dramatic impact on the national average of MGM.

If we combined all the male babies born to Jewish parents (<1%), and all the male babies born at home (<0.29%), and assumed they were all circumcised in their first 12 months of life, this still only increases that 32.5% to 33.79%.

Others argue that there are babies who are (1) not cut in the hospital and (2) not covered by insurance and (3) not born to Jewish parents, but are still later cut in one way or another during their 1st year in life. It is very possible that there are infant boys who fall under all of these qualifiers, who also end up with parents that save up the money needed to have them cut in a private clinic, (or do so themselves at home with a box cutter and are never caught), in a time and place where surgical procedures are not recorded, and insurance is never taken. But the percentage of those who fit this category? Not very high... How many babies do YOU know who were cut in such a fashion? The vast majority (if they are going to do so) circumcise their newborn baby son within the first 10 days of life, and most of these prepuce amputation surgeries take place within a hospital or clinical setting. While we strive for the day when all non-medical genital cutting on minors, regardless of sex, will be against the law, and none of our tax dollars will fund MGM, the reality is that Medicaid continues to fund circumcision as well in the majority of states.

If the CDC comes at this issue from a pro-cutting stance while presenting information in the U.S., and then fudge their own research in order to respond to the "backlash of intactivism," that is one thing. But let's recognize the manipulation of stats and negligence of facts (re. intact health, proper prepuce care, destruction and risk of genital cutting, etc.) for what its worth.

The rate of genital cutting in 2011 is certainly even lower than it was two years ago in 2009. The percentage of families with older boys who were cut, and babies born this year who will remain intact, is soaring, thanks to grassroots efforts to get parents (both new and experienced) accurate and complete intact information. The recent rise of intact sons is also due in part to the media exposure of the San Francisco MGM Bill, stirring people nationwide who never thought about this issue before to look into it for the first time. As the saying goes, "The more you know..." And this rise in intact children is thanks in part to an increasing number of celebrities who are speaking out and raising awareness among a younger generation of new parents. Today more and more physicians, doulas, midwives, CBEs, lactation consultants, child development professors, and others working with expecting parents include intact information and care items in their intake folders, meetings, and classrooms.

MGM is decreasing.

Whether the actual national rate in 2011 is 28% or 32%, or even 10% higher at 42% - the majority of boys today remain intact, and the rate of genital cutting continues to plummet. What it actually was in 2009, we may never know. And it truly does not even matter. Where exactly that percentage lies today should not be the primary focus of our work. Rather, let's do what we need to do to ensure that next parent we meet has the information they need to make a fully informed decision, and that the next ONE single baby boy born within your circle of influence has parents who are well equipped to take their whole baby home.

In spirit of the season, Christina of Intact Iowa
shares this photo of her son in his "Cut Pumpkins. Not Babies." tshirt from Made By Momma.



References:

1) Ira M. Sheskin and Arnold Dashefsky, “Jewish Population of the United States, 2006,” in the American Jewish Year Book 2006, Volume 106.

2) David Singer and Lawrence Grossman, Editors. NY: American Jewish Committee, 2006.


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