Introduction

In the United States of America today, approximately 65% of newborn males are circumcised, and approximately 77% of the male population overall have been circumcised[4].

This article discusses the variations in US circumcision rates over time. Unfortunately, reliable figures have not been maintained until relatively recently (1979), and so earlier rates are estimated using publically available data.

Recent rates (1979-1999)

In the United States, circumcision rates have remained essentially unchanged over the period 1979-1999. Regionally, however, some trends are apparent. There has been a significant decline in the West, partly due to an increase in the Hispanic population[3]. The effect of this on the national figures, however, has been offset by increases in the South and Midwest.

Table 1: Neonatal circumcision rates in the USA^*

Year	National	Northeast	Midwest	South	West
1979	64.3	66.2	74.3	55.8	63.9
1981	66.0	66.5	77.5	58.4	57.2
1983	64.6	69.2	74.9	58.1	52.7
1985	62.1	65.2	70.5	56.0	49.0
1987	61.7	68.6	73.1	54.7	42.4
1989	62.8	63.2	74.0	57.9	41.0
1991	65.6	62.4	78.2	63.6	40.4
1993	63.5	65.2	75.6	61.4	35.5
1995	67.8	68.3	79.8	66.1	42.6
1997	66.1	68.3	81.6	64.5	38.0
1999	65.3	65.4	81.4	64.1	36.7

^* Adapted from CDC/NCHS data[1,2].

The following graph shows the national circumcision rate (in black), as well as regional rates during this period.

Figure 1: Neonatal circumcision rates in the USA

Dan Bollinger, Executive Director of the International Coalition for Genital Integrity, provides alternative statistics[8]. While these may not be as reliable as the CDC data, they are broadly similar.

Table 2: Neonatal circumcision rates in the USA (Alternative source)^*

Year	% Circumcised
1990	63.9
1991	62.9
1992	64.2
1993	61.5
1994	61.4
1995	60.3
1996	66.2
1997	57.8
1998	57.2
1999	58.8
2000	58.5
2001	55.1
2002	61.4

^* From Bollinger[8].

Individual locations

A number of studies have reported neonatal circumcision rates at various US sites. Some of these are recorded in the following table.

Table 3: Neonatal circumcision rates (various locations)

Study	Year(s)	Location	No. of boys	% circumcised
Wiswell[10]	1989	US Army	136,086	73.6
Schoen[11]	1996	Northern California	28,812	64.9
Quayle-community[12]	2003	Missouri	4,992	81
Quayle-tertiary[12]	2003	Missouri	9,859	82
WIlkes-whites[13]	1980-1986	New York State	?	70
WIlkes-hispanics[13]	1980-1986	New York State	?	25
O'Brien-Jul85[14]	July 1985	Atlanta, Georgia	?	89.3
O'Brien-Sep85[15]	September 1985	Atlanta, Georgia	?	87.5
O'Brien-Sep86[15]	September 1986	Atlanta, Georgia	?	84.3

Accuracy of data

Wiswell[9] suggests that the CDC figures may underestimate the true circumcision rate. His second criticism would apply to Bollinger's data.

Unfortunately, the NCHS only collects voluntary data from participating hospitals. Fewer than 5% of hospitals in the United States have their records reviewed by the HCHS. Moreover, many of these institutions do not document neonatal circumcision as a specific procedure on the medical record. For such centers, despite having performed circumcisions on the majority of newborns males, the NCHS would assess a CFR of 0%. The NCHS data reveal an apparent decline in the national CFR from approximately 68% to 62% during the mid-1980s.

A study in Atlanta found that circumcision was noted in medical records for only 84.3% of circumcised boys.

Some internet resources (eg., [5,8]) use predicted rates from Wallerstein[7], sometimes via other authors (eg., Bigelow). The book in which these predictions was published was printed in 1980; any later data is obviously unreliable.

Historical rates

No reliable sources are available for historical circumcision rates. Much of the available data consists of surveys of adults. These figures are not directly comparable to neonatal rates, as many circumcisions are performed later in life.

Laumann et al.[4] reported on a large-scale survey of adult men. The following data was taken from their graph.

Table 4: Historical circumcision rates^*

Year	% Circumcised
1932	30
1935	62.5
1938	55
1941	65
1944	72.5
1947	77
1950	80
1953	85
1956	85
1959	80
1962	85
1965	90
1968	80
1971	82.5
1974	77.5

^* Estimated from Laumann[5] (figure 1), samples at 3-year intervals. Note that this includes males circumcised at any age; the neonatal circumcision rate is necessarily lower.

In 1968, Stern & Lachenbruch reported on a 1959 examination of 330 men attending a Los Angeles Cancer Detection Center. They reported as follows:

Table 5: Historical circumcision rates, determined by examination^*

Year of birth	Total examined	Total circumcised	% circumcised
before 1889	22	12	54.5
1890-1899	66	29	43.9
1900-1909	65	30	46.2
1910-1919	94	47	52.2
1920-1929	70	43	61.4
1930-1939	11	8	72.7
1940-1949	2	2	100

Adapted from Stern & Lachenbruch[6].

These data may be combined to give an indication of change in circumcision rates over time (Stern & Lachenbruch's figure for 1940-1949 is discarded due to small sample size):

Table 6: Historical circumcision rates (various sources)

Year of birth	% circumcised
before 1889	54.5
1890-1899	43.9
1900-1909	46.2
1910-1919	52.2
1920-1929	61.4
1930-1939	72.7
1940-1949	71.5
1950-1959	82.5
1960-1969	85
1970-1979	80

As can be seen, circumcision rates peaked during the 1960-1969 period.

The following graph shows circumcision rates over time, from various sources.

Figure 2: Historical circumcision rates in the USA^*

^*Adapted from Laumann et al.[4], NOHARMM's estimates[5], and CDC/NCHS figures[1]. Intervening years estimated by interpolation when necessary.

References

1. Center for Disease Control. Percent of newborn males with circumcisions performed in short-stay hospitals by race [online]. 2002 [cited 2004 Sep 19]. Available from: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions_race.htm
2. Percent of newborn males with circumcisions performed in short-stay hospitals by region [online]. 2002 [cited 2004 Sep 19]. Available from: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions_region.htm
3. Trends in circumcisions among newborns [online]. 2002 [cited 2004 Sep 20]. Available from: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions.htm
4. Laumann, EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA 1997; 277(13): 1052-1057.
5. Estimated U.S. Incidence of Neonatal Circumcision Complications [online]. Feb 2004 [cited 2004 Sep 23]. Available at: http://www.noharmm.org/incidenceUS.htm
6. Stern E, Lachenbruch PA. Circumcision information in a cancer detection population. J Chron Dis. 1968; 21: 117-124
7. Wallerstein E. Circumcision: An American Health Fallacy. Springer Publ., New York, 1980
8. Bollinger D. Normal versus Circumcised: U.S. Neonatal Male Genital Ratio [online]. Feb 12 2004. [cited 2005 Feb 3]. Available from: http://www.cirp.org/library/statistics/bollinger2004/
9. Wiswell TE. Neonatal circumcision: a current appraisal. Focus & Opinion Pediat 1995; 1: 93-9
10. Wiswell TE, Geschke DW. Risks from circumcision during the first month of life compared with those for uncircumcised boys. Pediatrics 1989 Jun; 83(6): 1011-5
11. Schoen EJ, Colby CJ, Ray GT. Newborn circumcision decreases incidence and costs of urinary tract infections during the first year of life. Pediatrics 2000 Apr; 105(4 Pt 1): 789-93
12. Quayle SS, Coplen DE, Austin PF. The effect of health care coverage on circumcision rates among newborns. J Urol 2003 Oct; 170(4 Pt 2): 1533-6
13. Wilkes MS, Blum S. Current trends in routine newborn male circumcision in New York State. N Y State J Med. 1990 May;90(5):243-6.
14. O'Brien TR, Calle EE, Poole WK Incidence of neonatal circumcision in Atlanta, 1985-1986. South Med. 1995; 88:411-415

Additional references

The following materials have been identified as relevant to this topic, but have not yet been addressed in this article.

• Davenport C, Romberg R. 1984 hospital survey of circumcision rates in the United States. Birth. 1984 Winter;11(4):247-50.