Prevalence of circumcision

From Wikipedia, the free encyclopedia

The prevalence of circumcision (or circumcision rate) refers to the proportion of males that are circumcised in a given population. It may also refer to the proportion of newborn males that are circumcised.

The World Health Organisation estimates that as of 2006, 30% to 34% of males aged 15 or older (or approximately 665 million men or boys) are circumcised worldwide.[1] Estimates of the proportion of all males that are circumcised worldwide include one sixth,[2] one third,[3] and between 30 and 40%.[4] Canada, the United Kingdom and Australia have seen a decline in male circumcision,[5] while there are indications of increasing demand in Southern Africa.[6]

The following list states the proportion of males circumcised by country.

Contents

[edit] Africa

Studies indicate that about 62% of African males are circumcised overall. However, these rates differ by region, ethnic and religious groups.[7] 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]."[8]

Circumcision prevalence in Africa
Country Rate (Williams, B.G. et al[8]) Rate (WHO [5])
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

[edit] 80% or more

Algeria,[5] Morocco,[5] Mauritania,[5] Tunisia,[5] Libya,[5] Egypt,[5] Mali,[5] Senegal,[5] Gambia,[5] Guinea-Bissau,[5] Guinea,[5] Liberia,[5] Sierra Leone,[5] Ghana,[5] Togo,[5] Benin,[5] Burkina Faso,[5] Niger,[5] Nigeria,[5] Chad,[5] Cameroon,[5] Equatorial Guinea,[5] Gabon,[5] Republic of the Congo,[5] Democratic Republic of the Congo,[5] Eritrea,[5] Ethiopia,[5] Djibouti,[5] Somalia,[5] Kenya,[5] Angola,[5] Mauritius,[5] Madagascar.[5]

[edit] Between 20 and 80%

Côte d'Ivoire (Ivory Coast),[5] Central African Republic,[5] Sudan,[5] Uganda,[5] Tanzania,[5] Mozambique,[5] South Africa,[5] Lesotho.[5]

[edit] Less than 20%

Rwanda,[5] Burundi,[5] Zambia,[5] Zimbabwe,[5] Malawi,[5] Botswana,[5] Namibia,[5] Swaziland,[5] Canary,Is. (Spain).[5]


[edit] Americas

[edit] Between 20 and 80%

Canada,[5] United States.[5]

[edit] United States

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

Data from a national survey conducted from 1999 to 2002 found that the overall prevalence of male circumcision in the United States was 79%.[9] 91% of men born in the 1970s, and 83% of boys born in the 1980s were circumcised.[9] 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.[10]

A recent study, 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.[11]

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.[12] 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.[12] 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.[13]

There are various explanations for why the infant circumcision rate in the United States are different from comparable countries. Many parents’ decisions about circumcision are preconceived, and this may contribute to the high rate of elective circumcision. [14]

Medicaid funding for infant circumcision used to be universal in the United States; however, sixteen states no longer pay for the procedure under Medicaid.[citation needed] 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.[15]

Schoen states that the "80% to 85% US circumcision rate observed in practice contrasts with the 55% to 65% rate reported in statistics collected from birth centers across the nation". The explanation he offers is that "the published results of national statistical surveys represent only coded diagnoses obtained from birth centers; the reported figures do not include males who are circumcised at a later date for religious, medical, or personal reasons or who received newborn circumcision that was not coded."[16]

[edit] Canada

The Canadian Paediatric Society cites an estimate of 48% for the prevalence of male circumcision in Canada in 1970.[17] Statistics compiled by Wirth for the period 1970-1980 show large variations between provinces and "a fairly rapid decrease in the rate, except in the Yukon and Saskatchewan".[18]

In 1994/95, the newborn circumcision rate in Ontario was 299.1 per thousand or 29.9%.[19]

In 1999, the American Academy of Pediatrics reported that “in Canada, ~48% of males are circumcised”.[20] However, this figure has been questioned because the only citation provided for it is an Australian paper dating from 1970.[21]

Articles published in 2003 report Canadian neonatal male circumcision rates of "10 to 30%"[15] and "less than 17%".[22] According to the Halifax Daily News, the infant circumcision rate in 2003 was "just 1.1 per cent" in Nova Scotia and nil in Newfoundland.[23]

[edit] Less than 20%

Mexico,[5] Belize,[5] Costa Rica,[5] El Salvador,[5] Guatemala,[5] Honduras,[5] Nicaragua,[5] Panama,[5] Cuba,[5] Jamaica,[5] Haiti,[5] Dominican Republic,[5] Puerto Rico,[5] Argentina,[5] Bolivia,[5] Brazil,[5] Chile,[5] Colombia,[5] Ecuador,[5] French Guiana,[5] Guyana,[5] Paraguay,[5] Peru,[5]Trinidad and Tobago,[5] Venezuela.[5]

The overall prevalence of circumcision is reported to be 6.9% in Colombia, and 7.4% in Brazil.[24]

The prevalence of circumcision in Mexico is estimated to be 10% to 31%.[25]

[edit] Asia

[edit] 80% or more

Israel,[5][26] South Korea,[5] Bangladesh,[5] Pakistan,[5] Afghanistan,[5] Azerbaijan,[5] Bahrain,[5] Brunei,[5] Tajikistan,[5] Kyrgyzstan,[5] Uzbekistan,[5] Turkmenistan,[5] Iran,[5] Iraq,[5] Kuwait,[5] Turkey,[5] Syria,[5] Lebanon,[5] Jordan,[5] Saudi Arabia,[5] Yemen,[5] Oman,[5] United Arab Emirates,[5] Qatar,[5] Malaysia,[5] Philippines.[24]

The overall prevalence of circumcision in the Philippines is reported to be 92.5%. [24] Most circumcision in the Philippines are performed at the age of 11 to 13.[citation needed]

According to Dr. Inon Schenker of the Jerusalem AIDS Project, "about 100 percent of men have been circumcised" in Israel.[26]

According to the World Health Organisation, 80% or more of males in South Korea are circumcised.[5] A 2001 study of 20-year old South Korean men found that 78% were circumcised. [27] The authors comment "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."

[edit] Between 20 and 80%

Kazakstan.[5]

[edit] Less than 20%

Russia,[5] Mongolia,[5] China,[5] Taiwan,[5] North Korea,[5] India,[5] Sri Lanka,[5] Nepal,[5] Bhutan,[5] Burma,[5] Thailand,[5] Laos,[5] Vietnam,[5] Cambodia,[5] Japan,[5] Papua New Guinea.[5]

The overall prevalence of circumcision in Thailand is reportedly 13.3%.[24]

[edit] Europe

[edit] Between 20 and 80%

Slovenia,[5] Bosnia,[5] Serbia,[5] Montenegro,[5] Albania,[5] Macedonia.[5]

[edit] Less than 20%

The following countries have a circumcision rate of less than 20%: Iceland,[5] United Kingdom,[5][28] Ireland,[5] Sweden,[5] Norway,[5] Finland,[5] Denmark,[5] Estonia,[5] Latvia,[5] Lithuania,[5] Portugal,[5] Spain,[5] France,[5] Switzerland,[5] Italy,[5] Netherlands,[5] Belgium,[5] Slovakia,[5] Germany,[5] Poland,[5] Czech Republic,[5] Hungary,[5] Greece,[5] Bulgaria,[5] Romania,[5] Moldova,[5] Ukraine,[5] Austria,[5] Belarus,[5] Russia,[5] Cyprus,[5] Georgia.[5]

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. It also found that, apart from black Caribbeans, men born overseas were more likely to be circumcised. [28] 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.[29]. 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.[30] Similarly, Wallerstein estimated in 1980 that the Finnish rate of adult circumcision for health reasons is six per 100,000.[31] Schoen et al., however, reported in 2006 that data from 1996-1998 indicate a circumcision rate of about 7.1%;[32] Houle reported the same figure in 2007.[33] 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",[34] amounting to 710 nationwide cases in 2002.[35]

The overall prevalence of circumcision in Spain is reported to be 1.8%.[24]

In 1986, only 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.[36]

[edit] Not known

Luxemburg,[5] Croatia,[5] Andorra[5]

[edit] Map unclear

Monaco, San Marino, Vatican City, Liechtenstein, Malta

[edit] Oceania

[edit] 100%

Guam, Northern Mariana Islands, and Niue.

[edit] Between 20 and 80%

Australia.[5][37]

A survey of Australian men, conducted in 2001-2002, reported that 58.7% were circumcised.[37]

According to the Sydney Morning Herald, the infant circumcision rate in Australia was 12.9% as of 2003. 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%).[38] Non-therapeutic infant circumcision is no longer provided in public hospitals in New South Wales, Tasmania, and Western Australia, with a similar ban taking effect in Victoria in September 2007.[39] South Australia followed suit two months later.[40]

Pacific Island

[edit] Less than 20%

According to the World Health Organisation, fewer than 20% of males are circumcised in New Zealand.[5] In a study of men born in 1972-1973 in Dunedin, 40.2% were circumcised.[41] In a study of men born in 1977 in Christchurch, 26.1% were circumcised.[42] A 1991 survey conducted in Waikato found that 7% of male infants were circumcised.[43]

[edit] References

  1. ^ Male circumcision - global trends and determinants of prevalence, safety and acceptability by World Health Organization, UNAIDS, UNICEF, UNFPA ,ANRS and World Bank
  2. ^ Williams N, Kapila L. Complications of circumcision. Brit J Surg. 1993;80:1231-6. (full text)
  3. ^ Crawford DA. Circumcision: a consideration of some of the controversy. J Child Health Care. 2002 December;6(4):259-70. PMID 12503896
  4. ^ Kravetz, R E (2007). "Circumcision kit". Am J Gastroenterol 102 (4): 714–715. doi:10.1111/j.1572-0241.2007.01081.x. “In fact, it is estimated that the worldwide circumcision rate is between 30% and 40%.” 
  5. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at au av aw ax ay az ba bb bc bd be bf bg bh bi bj bk bl bm bn bo bp bq br bs bt bu bv bw bx by bz ca cb cc cd ce cf cg ch ci cj ck cl cm cn co cp cq cr cs ct cu cv cw cx cy cz da db dc dd de df dg dh di dj dk dl dm dn do dp dq dr ds dt du dv dw dx dy dz ea eb ec ed ee ef eg eh ei ej ek el em en eo ep eq er es et eu ev ew ex ey ez fa fb fc fd fe ff fg fh fi Information package on male circumcision and HIV prevention: insert 2 2. World Health Organisation.
  6. ^ "Demand for male circumcision rises in a bid to prevent HIV" (2006). Bulletin of the World Health Organization 84 (7): 505–588. “As a result, there are already indications of increasing demand for male circumcision in traditionally non-circumcising societies in southern Africa.” 
  7. ^ Questions and answers: NIAID-sponsored adult male circumcision trials in Kenya and Uganda. National Institute of Allergy and Infectious Diseases (December 2006).
  8. ^ a b Williams, B G; et al (2006). "The potential impact of male circumcision on HIV in sub-Saharan Africa". PLos Med 3 (7): e262. doi:10.1371/journal.pmed.0030262. 
  9. ^ a b Xu, F, L Markowitz, M Sternberg, and S Aral (2006). "Prevalence of circumcision in men in the United States: data from the National Health and Nutrition Examination Survey (NHANES), 1999-2002". . XVI International AIDS Conference Retrieved on 2006-09-21.
  10. ^ Laumann, EO; et al (1997). "Circumcision in the United States". JAMA 277 (13): 1052–1057. doi:10.1001/jama.277.13.1052. 
  11. ^ Nelson, CP.; R. Dunn, J. Wan, JT. Wei (March 2005). "The increasing incidence of newborn circumcision: data from the nationwide inpatient sample" (Abstract). Journal of Urology 173 (3): 978–981. doi:10.1097/01.ju.0000145758.80937.7d. ISSN 0022-5347 PMID 15711354. 
  12. ^ a b Kozak, LJ; KA Lees, and CJ DeFrances (2006). "National Hospital Discharge Survey: 2003 annual summary with detailed diagnosis and procedure data." (PDF). Vital Health Statistics 13 (160). 
  13. ^ Trends in circumcisions among newborns. Health E-Stats. National Center for Health Statistics (January 11, 2007). Retrieved on 2007-01-30. “However, the most notable change occurred in the West where newborn male circumcisions dropped from 62 percent in 1980 to 37 percent in 1999. This latest available figure for the West represents over a two-fold difference when compared with circumcision estimates for the Midwest. Part of this decline, appears to reflect the increasing percentage of boys born to immigrant Hispanics, who have been shown in several other studies to be significantly less likely to receive circumcisions than other infant males.”
  14. ^ Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision. 1999 AMA Interim Meeting: Summaries and Recommendations of Council on Scientific Affairs Reports 17. American Medical Association (December 1999). Retrieved on 2006-06-13.
  15. ^ a b Quayle, SS.; DE. Coplen, PF. Austin (October 2003). "The effect of health care coverage on circumcision rates among newborns". Journal of Urology 170 (4 Pt 2): 1533–1536. doi:10.1097/01.ju.0000091215.99513.0f. ISSN 0022-5347 PMID 14501653. 
  16. ^ Schoen, Edgar J. (July 2006). "Ignoring evidence of circumcision benefits". Pediatrics 118 (1): 385–387. doi:10.1542/peds.2005-2881. ISSN 0031-4005 PMID 16818586. 
  17. ^ "Neonatal Circumcision Revisited" (1996). Canadian Medical Association Journal 154 (6): 769–780. 
  18. ^ Wirth JL (1980). "Current Circumcision Practices: Canada". Pediatrics 66: 705–708.  (see table)
  19. ^ Goel, V. (ed.) (May 1996). Patterns of Health Care in Ontario, 2nd edition. Canadian Medical Association, 295. ISBN 0-9201-6979-1. 
  20. ^ "American Academy of Pediatrics: circumcision policy statement" (1999). Pediatrics 103 (3): 686–693. doi:10.1542/peds.103.3.686. PMID 10049981. 
  21. ^ Antonopoulos, John (2000). "Circumcision---The Debates Goes On". Pediatrics 105 (3): 684. 
  22. ^ Waldeck S (2003). "Using Male Circumcision to Understand Social Norms as Multipliers". University of Cincinnati Law Review 72: 455. 
  23. ^ MacDonald, Andrea (March 2006). N.S. circumcisions continue to drop. The Daily News (reprint: CIRP.org).
  24. ^ a b c d e Castellsagué, X; et al (2005). "Chlamydia trachomatis infection in female partners of circumcised and uncircumcised adult men". Am J Epidemiol 162 (9): 907–916. doi:10.1093/aje/kwi284. 
  25. ^ Lajous, M; et al (2006). "Human papillomavirus link to circumcision is misleading (author's reply)". Cancer Epidemiol Biomarkers Prev 15 (2): 405–6. doi:10.1158/1055-9965.EPI-05-0818. “Circumcision is not usually performed by public sector health care providers in Mexico and we estimate the prevalence to be 10% to 31%, depending on the population.” 
  26. ^ a b Israel teaches WHO about circumcision. ynet news (November 2006).
  27. ^ Ku, J H; et al (2003). "Circumcision practice patterns in South Korea: community based survey". Sex Transm Inf 79: 65–67. doi:10.1136/sti.79.1.65. 
  28. ^ a b Dave, SS; et al (2003). "Male circumcision in Britain: findings from a national probability sample survey". Sex Transm Infect 79: 499–500. doi:10.1136/sti.79.6.499. 
  29. ^ Rickwood, AMK; Kenny, SE; Donnell, SC (2000). "Towards evidence based circumcision of English boys: survey of trends in practice". BMJ 321: 792–793. doi:10.1136/bmj.321.7264.792. 
  30. ^ Denniston, G (Apr 1996). "Circumcision and the Code of Ethics". Humane Health Care International 12: 78–80. 
  31. ^ Wallerstein, E., Circumcision: an American Health Fallacy, New York, Springer, 1980.
  32. ^ Schoen, E J; Colby, C J; Trinh, T To (2006). "Cost analysis of neonatal circumcision in a large health maintenance organization". J Urol 175: 1111–1115. doi:10.1016/S0022-5347(05)00399-X. 
  33. ^ "Circumcision for all: the pro side" . Canadian Urological Association Journal 1: 398–400. 
  34. ^ Circumcision of boys: A study on international and Finnish practices 8. Ministry of Social Affairs and Health, Finland (12 February 2004).
  35. ^ Ibid., p. 39.
  36. ^ Frisch, M; et al (1995). "Falling incidence of penis cancer in an uncircumcised population (Denmark 1943-90)". BMJ 311: 1471. PMID 8520335. 
  37. ^ a b Richters, J; et al. (2006). "Circumcision in Australia: prevalence and effects on sexual health". Int J STD AIDS 17: 547–554. doi:10.1258/095646206778145730. 
  38. ^ Skatssoon, Judy (July 2004). Circumcision rates rise for some. Sydney Morning Herald (reprint: CIRP.org).
  39. ^ "Victoria to scrap public hospital circumcision", The Age, 2007-08-12. Retrieved on 2007-08-12. 
  40. ^ "Cosmetic circumcision banned", The Advertiser, 2007-11-12. Retrieved on 2007-11-12. 
  41. ^ 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): 517–519. doi:10.1097/01.olq.0000161296.58095.ab. PMID 16041257. 
  42. ^ 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): 1971–1977. doi:10.1542/peds.2006-1175. PMID 17079568. 
  43. ^ Lawrenson RA (1991). "Current practice of neonatal circumcision in the Waikato". N Z Med J 104 (911): 184–185. PMID 1898442. 

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