By Elizabeth Simpson
The nation's largest pediatric organization released an updated policy today, saying the benefits of circumcision for newborn males clearly outweigh the risks, and, for the first time, recommending that insurance pay for the procedure.
The American Academy of Pediatrics stopped short of advising it for all newborn boys, saying the decision needs to be left to parents within the context of their religious, cultural and personal preferences.
Since the policy was last updated in 1999, a growing body of studies has shown circumcision lowers the risk of getting HIV, genital herpes, human papillomavirus and syphilis. Removing the foreskin of the penis also lowers the risk of penile cancer over a lifetime and urinary tract infections in the first year of life. Males who have been circumcised also are less likely to transmit sexual diseases.
Dr. Wally Carlo, who served on the American Academy of Pediatrics task force that reviewed the policy, said the scientific evidence is included in the updated policy, which doctors should review with parents.
The review was prompted by studies and statistics that show a decline in circumcision rates.
'The rates of circumcision have gone down in the last 20 years, and it's not clear why,' Carlo said. 'In a number of states, Medicaid has stopped paying for circumcision.'
In 2010, 55 percent of newborn boys had the procedure, a drop from 58 percent in 2001, according to statistics from the federal Centers for Disease Control and Prevention. That compares to 68 percent in 1995.
In Virginia, circumcision is covered by Medicaid, the joint federal-state health insurance for low-income families. Recent surveys by the media and various health organizations have shown circumcision is not covered by Medicaid in 18 states, and that some states have dropped the coverage within the past few years.
Some health experts have questioned whether that has led some parents to forgo the procedure.
In other cases, parents decide against it because they believe it causes unnecessary pain and is more of a cosmetic consideration than a medical one.
An organization called Intact America opposes circumcision and 'other forms of medically unnecessary genital alteration, whether carried out for cultural conformity or profit, in medical or non-medical settings.'
A statement from executive director Georganne Chapin took issue with the academy's updated policy, saying Intact America 'deplores the focus on selective evidence supporting medical benefits of removing normal foreskins from baby boys.'
The statement said the task force failed to consider 'the large body of evidence from the developed world that shows no medical benefits for the practice, and has given short shrift, if not dismissed out of hand, the serious ethical problems inherent in doctors removing healthy body parts from children who cannot consent.'
The procedure is typically performed by a pediatrician or obstetrician before a baby goes home from the hospital. Circumcisions done for religious reasons are usually performed by people trained in the procedure.
Dr. Jyoti Upadhyay, a pediatric urologist with Children's Hospital of The King's Daughters, said that if the procedure is done when babies are older, the cases are referred to pediatric urologists. The cost is greater at that point, and insurance is likely to decline to cover the procedure unless there's a medical reason.
But she said she has noticed an increase in parents being referred to urologists with older babies because it wasn't done before discharge, in some cases because of insurance issues.
She said she agrees with the updated American Academy of Pediatrics policy and hopes it will lead to more insurance coverage.
She said it helps pediatricians to consider what's best for a child during his entire lifetime rather than just his first 18 years.
A study by Johns Hopkins University researchers released this month found that if circumcision rates remain in the 50 percent range instead of the higher rates of years past, the lifetime health-care costs for all of the babies born in one year would rise by about $211 million.
That study, published in the Archives of Pediatric and Adolescent Medicine, found that nearly 80 percent of the additional projected costs would be linked to HIV infection.
The pediatrics academy said the procedure is safest and offers the most benefits if performed during the newborn period, and it should be performed by trained and competent providers, using sterile techniques and effective pain management.
Health providers should inform parents-to-be before or early in pregnancy to give them time to consider the information.
'The health benefits outweigh the risks, but parents still should be given a choice,' Carlo said. 'That's what this is about, giving parents a choice.'
Elizabeth Simpson, 757-446-2635, firstname.lastname@example.org