Prevalence of circumcision

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Map published by the United Nations (WHO/UNAIDS) showing estimated percentage of males who have been circumcised, at a country level. Data was provided by MEASURE DHS[1] and other sources.[2]

The prevalence of circumcision refers to the proportion of males in a given population who have been circumcised. It does not refer to the proportion of newborn males that are being circumcised today. Estimates of the proportion of males worldwide that are circumcised vary, but are generally approximately 13.[3] The World Health Organization (WHO) has estimated that globally 30% of males aged 15 and over are circumcised, with almost 70% of these being Muslim.[4]

Male circumcision is most prevalent in the Muslim world (near-universal), parts of Southeast Asia and of Africa, the United States, the Philippines, Israel, and South Korea. In contrast, it is relatively rare in Europe, parts of Southern Africa, and most of Asia and Oceania.[4] In Latin America, prevalence is universally low.[5] The WHO states that "there is generally little non-religious circumcision in Asia, with the exceptions of the Republic of Korea and the Philippines".[4] Estimates for individual countries include less than 2% in Spain,[6] Colombia[6] and Denmark;[7] between 0% and 7% in Finland;[8][9] 3% in Cambodia;[6] 7% in Brazil;[6] 9% in Taiwan;[10] and 13% in Australia.[11]

Canada, New Zealand, Australia and the United Kingdom are examples of countries which have seen a decline in male circumcision in recent decades, while there are indications of increasing demand in Southern Africa.[12] The Centers For Disease Control and Prevention (CDC) reported in 2011 that rates decreased in the United States in the period 1999 to 2010. Citing three different data sources, most recent rates for the U.S. were 56.9% in 2008 (NHDS), 56.3% in 2008 (NIS), and 54.7% in 2010 (CDM).[13]

Africa[edit]

Studies indicate that about 62% of African males are circumcised overall. However, these rates differ by region, ethnic and religious groups.[14] Williams, B.G. et al. comment 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]."[15]

Prevalence of circumcision in Africa
Country Rate (Williams, B.G. et al.)[15] Rate (WHO)[16]
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%[edit]

Botswana, Burundi, Canary Islands [Spain], Malawi, Mauritius, Namibia, Rwanda, Swaziland, Zambia, Zimbabwe.[16]

Between 20 and 80%[edit]

Central African Republic, Lesotho, Mozambique, South Africa, Sudan, Tanzania, Uganda.[16]

More than 80%[edit]

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.[16]

Americas[edit]

Less than 20%[edit]

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.[16]

The overall prevalence of circumcision is reported to be 6.9% in Colombia, and 7.4% in Brazil (13% in Rio de Janeiro).[6]

The prevalence of circumcision in Mexico is estimated to be 10% to 31%.[17]

Between 20 and 80%[edit]

Canada,[16] United States.[16]

Canada[edit]

Wirth showed a pattern of declining incidence of circumcision from 1970 to 1979. There was a wide variation in the incidence of circumcision between: Yukon Territory reported a rate of 74.8 percent in 1978-79 while Newfoundland reported an incidence of 1.9 to 2.4 percent in 1977-78.[18]

In 1994-95, the newborn circumcision rate in Ontario was 29.9%.[19] The Canadian Paediatric Society (1996) offered an estimate of 48 percent for the prevalence of male circumcision in Canada in 1970.[20] In 1999, the American Academy of Pediatrics reported that “in Canada, ~48% of males are circumcised”.[21] However, this figure was questioned because the only citation provided for it was an Australian paper dating from 1970.[22]

Articles published in 2003 reported Canadian neonatal male circumcision rates of "10 to 30%"[23] and "less than 17%".[24] According to the Halifax Daily News, the infant circumcision rate in 2003 was "1.1 per cent" in Nova Scotia and nil in Newfoundland.[25] A 2006 article placed the (2003) national rate at 13.9%.[26]

Individual Canadian provincial health insurance plans began to delist circumcision in the 1980s.[24] Manitoba Health Insurance Plan discontinued coverage of circumcision in 2005.[27] Circumcision is not covered by any provincial/territorial health insurance plan.[27]

A survey of Canadian maternity practices conducted in 2006/2007 by the national public health agency found a newborn circumcision rate of 31.9%.[28] Rates varied markedly across the country, from close to zero in Newfoundland and Labrador to 44.3% in Alberta.

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[28]

United States[edit]

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 for patients under one year of age.[29]

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.[30]

Data from a national survey conducted from 1999 to 2002 found that the overall prevalence of male circumcision in the United States was 79%.[31] 91% of boys born in the 1970s, and 83% of boys born in the 1980s were circumcised.[31] 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.[32]

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.[33]

The Centers For Disease Control and Prevention (CDC) reports that circumcision rates were stable in the United States between 1979 and 1999.[34]

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.[35] 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.[35] 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.[36] 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.[37]

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.[38] 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.[23] 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.[39]

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).[13]

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.[40] The Northeast Region reported an incidence of 67% and the Southern Region reported 55.7%.[40]

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%.[40]

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.[41] Brown & Brown (1987) reported the most important factor is whether the father is circumcised.[42]

Asia[edit]

Less than 20%[edit]

Bhutan, Burma, Cambodia, China, Hong Kong (China),[43] India, Japan, Laos, Mongolia, Nepal, North Korea, Papua New Guinea, Sri Lanka, Republic of China (Taiwan), Thailand, Vietnam.[16]

The overall prevalence of circumcision in Cambodia is reported to be 3.5%.[6]

Between 20 and 80%[edit]

Kazakhstan, Indonesia, Malaysia,[16] South Korea.[44]

South Korea[edit]

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.[44] A 2001 study of 20-year old South Korean men found that 78% were circumcised.[45] 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.[46] 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).[44] 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."[44]

At least one more recent study however has shown a decline in circumcision in South Korea, and even attempted to show that it was an access to new information on the subject that has caused the decline.[47]

More than 80%[edit]

Afghanistan, Azerbaijan, Bahrain, Bangladesh, Brunei, Iran, Iraq, Israel,[48] Jordan, Kuwait, Kyrgyzstan, Lebanon, Oman, Pakistan, Philippines,[6] Qatar, Saudi Arabia, Syria, Tajikistan, Turkey, Turkmenistan, Uzbekistan, United Arab Emirates, Yemen.[16]

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.[49][50]

According to the Jerusalem AIDS Project, "about 100 percent of men have been circumcised" in Israel.[48]

Europe[edit]

Less than 20%[edit]

Armenia, Austria, Belarus, Belgium, Bulgaria, Czech Republic, Cyprus, Denmark, Estonia, Finland, France, Georgia, Germany,[51] Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Russia, Serbia, Slovakia, Spain, Sweden, Switzerland, Ukraine,[16] and the United Kingdom.[52]

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 16–19 year olds, and 19.6% of 40–44 year olds said they had been circumcised. Apart from black Caribbeans, men born overseas were more likely to be circumcised.[52] 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.[53] 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%.

Denniston reported in 1996 that the neonatal circumcision rate in Finland is zero and that the rate of later circumcision is 1 in 16,667.[54] Similarly, Wallerstein estimated in 1980 that the Finnish rate of adult circumcision for health reasons is six per 100,000.[55] Schoen et al., however, reported in 2006 that data from 1996–1998 indicate a circumcision rate of about 7.1%;[56] Houle reported the same figure in 2007.[57] Finland's Ministry of Social Affairs and Health reported in 2004 that, "some 500-1000 circumcisions are performed as a therapeutic measure annually in Finnish hospitals",[58] amounting to 710 nationwide cases in 2002.[59]

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.[51]

In France, according to a telephone survey (TNS Sofres Institute, 2008), 14% of men are circumcised.[60]

The overall prevalence of circumcision in Spain is reported to be 1.8%.[6]

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.[61]

Between 20 and 80%[edit]

Albania, Bosnia, Kosovo, Macedonia, Montenegro.[16]

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.[16]

Oceania[edit]

Less than 20%[edit]

According to the World Health Organisation, fewer than 20% of males are circumcised in New Zealand.[16] In a study of men born in 1972–1973 in Dunedin, 40.2% were circumcised.[62] In a study of men born in 1977 in Christchurch, 26.1% were circumcised.[63] A 1991 survey conducted in Waikato found that 7% of male infants were circumcised.[64] Circumcision for cultural reasons is routine in Pacific Island countries.[65]

Australia[edit]

According to the Sydney Morning Herald, the infant circumcision rate in Australia was 12.9% as of 2003.[16][66] However, rates in the states varied, with highest rates in Queensland (19.3%), New South Wales (16.3%) and South Australia (14.3%), and the lowest in Tasmania (1.6%).[67] In New South Wales, rates have risen from 13% in 1999 to 18% in 2009.[68] In Victoria, according to the Herald Sun, the prevalence of 2010 circumcisions indicated that rates have risen but no information was provided about the rates prior to the rise.[69] Non-therapeutic infant circumcision is no longer provided in public hospitals in New South Wales, Tasmania, Western Australia, Victoria or South Australia.[70][71] The Royal Australasian College of Physicians (RACP) estimated in 2010 that 10 to 20 percent of newborn boys are being circumcised.[72]

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