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Prevalence of circumcision

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This is an old revision of this page, as edited by 115.187.226.20 (talk) at 14:52, 20 September 2016 (→Australia: statement around immigration being the cause of higher circumcision is not supported by the reference, in fact it seems unlikely that migration is the key driver when over 50% of the older population is impacted). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Male circumcision prevalence (not rate) by country according to the World Health Organization's 2007 review of the global trends and determinants of prevalence, safety, and acceptability of circumcision[1]
  >80% prevalence
  20-80% prevalence
  <20% prevalence
  Not available

The prevalence of circumcision refers to the percentage of males in a given population who have been circumcised. It does not refer to the current rate of newborn males who undergo neonatal circumcision, which may influence future prevalence. In 2007, the World Health Organization (WHO) estimated that globally one-third of males aged 15 years and over are circumcised, with almost 70% of those being Muslims.[2][3]

Male circumcision is nearly universal in the Muslim world and in Israel due to the religious requirements of the majority of Muslims and Jews; however, some non-Muslim groups living within Islamic countries, such as Armenians and Assyrians, do not practice it.[4] It is prevalent in some Islamic countries in southeast Asia such as Indonesia and Malaysia; however, the WHO states that there is "little non-religious circumcision in Asia, with the exceptions of the Republic of Korea and the Philippines".[2] In parts of Africa it is often practiced as part of tribal or religious customs. The prevalence of circumcision is also high in the United States, although there has reportedly been a decrease in routine neonatal circumcision in recent years.

In contrast, it is relatively rare in most of Europe, parts of southern Africa, and most of Asia and Oceania.[2] The prevalence of circumcision is universally low in Latin America, constituting South America, Central America, the Caribbean and Mexico.[5]

Australia, Canada, Ireland, New Zealand and the United Kingdom are examples of countries that have seen a significant decline in male circumcision in recent decades, while there have been indications of increasing demand in southern Africa, partly for preventative reasons due to the HIV epidemic there.[6]

Africa

Studies indicate that about 62% of African males are circumcised. However, the rate varies widely between different regions, and among ethnic and religious groups, with Muslim North Africans practicing it for religious reasons, central Africans as part of tribal rituals or local custom,(with some practicing female circumcision as well) and some traditionally non-circumcising populations in the South recently adopting the practice due to measures by the World Health Organization to prevent AIDS.[7] Williams, B.G. et al. commented that: "Most of the currently available data on the prevalence of [male circumcision] are several decades old, while several of the recent studies were carried out as adjuncts to demographic and health surveys and were not designed to determine the prevalence of [male circumcision]."[8]

Prevalence of circumcision in Africa
Country Rate (Williams, B.G. et al.)[8] Rate (WHO)[9]
Angola 66 >80
Central African Republic 67 20–80
Chad 64 >80
Republic of the Congo 70 >80
Democratic Republic of the Congo 70 >80
Gabon 93 >80
Burundi 2 <20
Djibouti 94 >80
Eritrea 95 >80
Ethiopia 76 >80
Kenya 84 >80
Rwanda 10 <20
Somalia 93 >80
Sudan 47 20–80
Tanzania 70 20–80
Uganda 25 20–80
Botswana 25 <20
Lesotho 0 20–80
Malawi 17 <20
Mozambique 56 20–80
Namibia 15 <20
South Africa 35 20–80
Swaziland 50 <20
Zambia 12 <20
Zimbabwe 10 <20
Benin 84 >80
Burkina Faso 89 >80
Cameroon 93 >80
Equatorial Guinea 86 >80
Gambia 90 >80
Ghana 95 >80
Guinea 83 >80
Guinea-Bissau 91 >80
Côte d'Ivoire (Ivory Coast) 93 20–80
Liberia 70 >80
Mali 95 >80
Mauritania 78 >80
Niger 92 >80
Nigeria 81 >80
Senegal 89 >80
Sierra Leone 90 >80
Togo 93 >80

Less than 20%

Botswana, Burundi, Malawi, Mauritius, Namibia, Rwanda, Swaziland, Zambia, Zimbabwe.[9]

Between 20 and 80%

Central African Republic, Lesotho, Mozambique, South Africa, Sudan, Tanzania, Uganda.[9]

More than 80%

Angola, Algeria, Benin, Burkina Faso, Cameroon, Chad, Congo (Democratic Republic), Congo (Republic), Côte d'Ivoire (Ivory Coast), Djibouti, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gambia, Ghana, Guinea-Bissau, Gabon, Guinea, Kenya, Liberia, Libya, Madagascar, Mali, Mauritania, Morocco, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Tunisia, Togo.[9]

South Africa

A national study from 2014 found an overall prevalence of 42.8% for self-reported male circumcision. 48.2% of black Africans were circumcised, with 32.1% of those traditionally circumcised and 13.4% circumcised for medical reasons.[10]

Americas

Less than 20%

Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, El Salvador, Ecuador, French Guiana, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Trinidad and Tobago, Uruguay, Venezuela.[9]

The overall prevalence of circumcision is reported to be 6.9% in Colombia, and 7.4% in Brazil (13% in Rio de Janeiro), with most of those being done due to medical issues later in life.[11]

The prevalence of circumcision in Mexico is estimated to be 10% to 31%.[12]

Between 20 and 80%

Canada, [9] United States.[9]

Canada

Rate of neonatal circumcision by province according to data from the Maternity Experiences Survey (MES) in 2006-2007.[13]

Circumcision in Canada followed the pattern that existed in other English speaking countries, picking up the practice during the 1900s to prevent masturbation and other perceived issues of the time, and then had its rate of circumcision decline due to new policy statements passed and due to coverage for the procedure being dropped, with a pattern of declining incidence of circumcision occurring from 1970 to 1979 after a new policy statement was released In 1975.[14] The Canadian Paediatric Society offered an estimate of 48 percent for the prevalence of male circumcision in Canada in 1970 prior to this fall in prevalence.[15] However, when conducting new studies to determine is prevalence in 1977-1978 There was a wide variation in the incidence of circumcision between different provinces and territories. For Example, Yukon reported a rate of 74.8 percent in while Newfoundland reported an incidence of 1.9 to 2.4 percent in 1977-78.[16] The rate continued to drop, with the newborn circumcision rate in Ontario In 1994-95 dropping to 29.9%.[17]

A survey of Canadian maternity practices conducted in 2006/2007 and published in 2009 by the national public health agency found a newborn circumcision rate of 31.9%.[13] Rates varied markedly across the country, from close to zero in Newfoundland and Labrador to 44.3% in Alberta. In 2015, the Canadian Paediatric Society used those statistics in determining their national circumcision rate, with that being the once which is currently used.[13][18]

Percentage of mothers reporting having their male baby circumcised, by province and territory, Canada, 2006/2007
Newfoundland and Labrador *
Prince Edward Island 39.2
Nova Scotia 6.8
New Brunswick 18.0
Quebec 12.3
Ontario 43.7
Manitoba 31.6
Saskatchewan 35.6
Alberta 44.3
British Columbia 30.2
Yukon *
Northwest Territories 9.7
Nunavut *
Canada 31.9
* Numerator too small for rate calculation
Source:  Canadian Maternity Experiences Survey[13]

United States

Rate of neonatal circumcision in the United States by region in 2009. Based on data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project.[19]

Statistics from different sources give widely varying estimates of infant circumcision rates in the United States.

In 2011, circumcision was one of the most common procedures performed during hospital stays in the U.S. There were approximately 1.1 million hospitalizations with a circumcision, a rate of 36 stays per 10,000 population. This was a decrease of 16% from 1997, when there was a rate of 43 stays per 10,000 population. It was the second-most common procedure performed on patients under one year of age.[20]

In 2005, about 56 percent of male newborns were circumcised prior to release from the hospital according to statistics from the Agency for Healthcare Research and Quality.[21]

Data from a national survey conducted from 1999 to 2002 found that the overall prevalence of male circumcision in the United States was 79%.[22] 91% of boys born in the 1970s, and 83% of boys born in the 1980s were circumcised.[22] An earlier survey, conducted in 1992, found a circumcision prevalence of 77% in US-born men, born from 1932–1974, including 81% of non-Hispanic White men, 65% of Black men, and 54% of Hispanic men, vs. 42% of non U.S. born men who were circumcised.[23]

A study published in 2005, which used data from the Nationwide Inpatient Sample (a sample of 5–7 million of the nation's total inpatient stays, and representing a 20% sample taken from 8 states in 1988 and 28 in 2000), stated that neonatal circumcisions rose from 48.3% of males in 1988 to 61.1% in 1997.[24]

The Centers For Disease Control and Prevention (CDC) reports that circumcision rates were stable in the United States between 1979 and 1999.[25]

Figures from the 2003 Nationwide Hospital Discharge Survey state that circumcision rates declined from 64.7% in 1980 to 59.0% in 1990, rose to 64.1% in 1995, and fell again to 55.9% in 2003.[26] On page 52, it is shown that the western region of the United States has seen the most significant change, declining from 61.8% in 1980 to 31.4% in 2003.[26] Part of the decline in the western region has been attributed by some experts to an increasing percentage of births to immigrants from Latin America, who have been shown to be less likely to circumcise than other parents in the U.S.[27]

A 2008 study of male infants born in the US state of Maryland found that the circumcision rate was 75.3% based on hospital discharge data files, and 82.3% based on maternal post-partum survey data.[28]

Medicaid funding for infant circumcision used to be available in every state, but starting with California in 1982, eighteen states (Arizona, California, Colorado, Florida, Idaho, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Nevada, North Carolina, North Dakota, Oregon, South Carolina, Utah, and Washington) had eliminated Medicaid coverage of routine (non-therapeutic) circumcision by July 2011.[29] One study in the Midwest of the U.S. found that this had no effect on the newborn circumcision rate but it did affect the demand for circumcision at a later time.[30] Another study, published in early 2009, found a difference in the neonatal male circumcision rate of 24% between states with and without Medicaid coverage. The study was controlled for other factors such as the percentage of Hispanic patients.[31]

The CDC reported in 2011 that, following an earlier increase in neonatal circumcision rates, rates decreased in the period 1999 to 2010. Citing three different data sources, most recent rates were 56.9% in 2008 (NHDS) 56.3% in 2008 (NIS), and 54.7% in 2010 (CDM).[32]

The incidence of male non-therapeutic infant circumcision varies widely by region. The Western Region reported an incidence of 24.6% in 2009, while the North Central Region reported an incidence of 76.2%, while the overall incidence of circumcision in the United States stood at 54.5%, the lowest figure reported over the previous two decades.[19] The Northeast Region reported an incidence of 67% and the Southern Region reported 55.7%.[19]

There was also significant variation between rural and urban areas. Rural areas reported an incidence of circumcision of 66.9% while urban areas reported an incidence of 41.2%.[19]

There are various explanations for why the infant circumcision rate in the United States is different from comparable countries. Many parents’ decisions about circumcision are preconceived, and this may contribute to the high rate of elective circumcision.[33] Brown & Brown (1987) reported the most important factor is whether the father is circumcised.[34]

Asia

Less than 20%

Bhutan, Burma, Cambodia, China, Hong Kong (China),[35] India, Japan, Laos, Mongolia, Nepal, North Korea, Papua New Guinea, Sri Lanka, Taiwan, Thailand, Vietnam.[9]

The overall prevalence of circumcision in Cambodia is reported to be 3.5%.[11]

Between 20 and 80%

Kazakhstan, Indonesia, Malaysia,[9] South Korea.[36]

South Korea

Virtually no circumcision was performed before the year 1945 as it is against Korea's long and strong tradition of preserving the body as a gift from parents.[36] A 2001 study of 20-year-old South Korean men found that 78% were circumcised.[37] At the time, the authors commented that "South Korea has possibly the largest absolute number of teenage or adult circumcisions anywhere in the world. Because circumcision started through contact with the American military during the Korean War, South Korea has an unusual history of circumcision." According to a 2002 study, 86.3% of South Korean males aged 14–29 were circumcised.[38] In 2012, it's the case of 75.8% of the same age group. Only after 1999 has some information against circumcision become available (at the time of the 2012 study, only 3% of Korean internet sites, using the most popular Korean search engine Naver, are against indiscriminate circumcision and 97% are for).[36] The authors of the study speculate "that the very existence of information about the history of Korean circumcision, its contrary nature relative to a longstanding tradition, its introduction by the US military, etc., has been extremely influential on the decision-making process regarding circumcision."[36]

More than 80%

Afghanistan, Azerbaijan, Bahrain, Bangladesh, Brunei, Iran, Iraq, Israel,[39] Jordan, Kuwait, Kyrgyzstan, Lebanon, Oman, Pakistan, Palestine, Philippines,[11] Qatar, Saudi Arabia, Syria, Tajikistan, Turkmenistan, Uzbekistan, United Arab Emirates, Yemen.[9]

The overall prevalence of circumcision (tuli) in the Philippines is reported to be 92.5%. Most circumcision in the Philippines are performed at the age of 11 to 13.[40][41]

Europe

Less than 20%

Armenia, Austria, Belarus, Belgium, Bulgaria, Czech Republic, Cyprus, Denmark, Estonia, Finland, France, Georgia, Germany,[42] Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Russia, Slovakia, Spain, Sweden, Switzerland, Ukraine,[9] and the United Kingdom.[43]

A national survey on sexual attitudes in 2000 found that 15.8% of men or boys in the United Kingdom (ages 16–44) were circumcised. 11.7% of 16- to 19-year-olds, and 19.6% of 40- to 44-year-olds said they had been circumcised. Apart from black Caribbeans, men born overseas were more likely to be circumcised.[43] Rickwood et al. reported that the proportion of English boys circumcised for medical reasons had fallen from 35% in the early 1930s to 6.5% by the mid-1980s. An estimated 3.8% of male children in the UK in 2000 were being circumcised by the age of 15.[44] The researchers stated that too many boys, especially under the age of 5, were still being circumcised because of a misdiagnosis of phimosis. They called for a target to reduce the percentage to 2%.

In Finland, the overall prevalence of circumcision is 2%, according to a recent publication by the Finnish Health Ministry.[45]

In Germany, the German Health Interview and Examination Survey for Children and Adolescents found that 10.9% of boys aged 0–17 had been circumcised.[42]

In France, according to a telephone survey (TNS Sofres Institute, 2008), 14% of men are circumcised.[46]

The overall prevalence of circumcision in Spain is reported to be 1.8%.[11]

In 1986, 511 out of approximately 478,000 Danish boys aged 0–14 years were circumcised. This corresponds to a cumulative national circumcision rate of around 1.6% by the age of 15 years.[47]

Between 20 and 80%

Albania, and Bosnia and Herzegovina.[9]

In Albania during the years 2008-09 the percentage of men age 15-49 who reported having been circumcised was 47.7% and that it was declining.[48]

Andorra, Croatia and Luxembourg are listed as unknown on the WHO prevalence map. Liechtenstein, Malta, Monaco, San Marino and Vatican City are unclear from the map.[9]

Oceania

Australia

The Australian Longitudinal Study of Health and Relationships is a computer assisted telephone interview of males aged 16–64 that uses a nationally representative population sample.[49] In 2005 the interview found that the prevalence of circumcision in Australia was roughly 58%. Circumcision status was more common with males over 30 than males under 30, and more common with males who were born in Australia. 66% of males born in Australia were circumcised and less than 1/3 of males under 30 were circumcised.[50] There has been a decline in the rate of infant circumcision in Australia.[2][51] The Royal Australasian College of Physicians (RACP) estimated in 2010 that 10 to 20 percent of newborn boys are being circumcised,[52] but the prevalence of male circumcision is much higher due to the presence of older circumcised males remaining in the population.[53]

New Zealand

According to the World Health Organisation, fewer than 20% of males are circumcised in New Zealand.[2] In New Zealand routine circumcision for which there is no medical indication is uncommon and no longer publicly funded within the public hospital system.[54] In a study of men born in 1972–1973 in Dunedin, 40.2% were circumcised.[55] In a study of men born in 1977 in Christchurch, 26.1% were circumcised.[56] A 1991 survey conducted in Waikato found that 7% of male infants were circumcised.[57] Circumcision for cultural reasons is routine in Pacific Island countries.[54]

References

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  48. ^ https://dhsprogram.com/pubs/pdf/FR230/FR230.pdf WHO page 236
  49. ^ Smith AMA, Pitts MK, Shelley JM, et al. The Australian longitudinal study of health and relationships. BMC Public Health. 2007;7:139. doi:10.1186/1471-2458-7-139.
  50. ^ Ferris JA1, Richters J, Pitts MK, Shelley JM, Simpson JM, Ryall R, Smith AM. (2010). "Circumcision in Australia: further evidence on its effects on sexual health and wellbeing". Aust N Z J Public Health. 34 (2): 160–164. doi:10.1111/j.1753-6405.2010.00501.x. PMID 23331360.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
  51. ^ Richters, J. Circumcision in Australia: prevalence and effects on sexual health. Int J STD AIDS. 2006;17(8):547–554. doi:10.1258/095646206778145730. PMID 16925903.
  52. ^ Royal Australasian College of Physicians. Circumcision of Male Infants; 2010.
  53. ^ The incidence of circumcision in Australia was very high until 1971 when it started a steep decline. Consequently, circumcised males tend to be older.
  54. ^ a b Afsari M, Beasley SW, Maoate K, Heckert K (March 2002). "Attitudes of Pacific parents to circumcision of boys". Pac Health Dialog. 9 (1): 29–33. PMID 12737414. Circumcision for cultural reasons is routine in Pacific Island countries.
  55. ^ Dickson, N; et al. (2005). "Herpes simplex virus type 2 status at age 26 is not related to early circumcision in a birth cohort". Sex Transm Dis. 32 (8): 517–9. doi:10.1097/01.olq.0000161296.58095.ab. PMID 16041257.
  56. ^ Fergusson, DM; et al. (2007). "Circumcision status and risk of sexually transmitted infection in young adult males: an analysis of a longitudinal birth cohort". Pediatrics. 118 (5): 1971–7. doi:10.1542/peds.2006-1175. PMID 17079568.
  57. ^ Lawrenson RA (1991). "Current practice of neonatal circumcision in the Waikato". N Z Med J. 104 (911): 184–5. PMID 1898442.
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