Prevalence of circumcision

Map published by the United Nations (WHO/UNAIDS) showing 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 (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. Estimates of the proportion of males that are circumcised worldwide vary from ¹⁄₆^[3] to ¹⁄₃.^[4] The World Health Organization has estimated that 664,500,000 males aged 15 and over are circumcised (30% global prevalence), with almost 70% of these being Muslim.^[5]

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. It is relatively rare in Europe, parts of Southern Africa, and most of Asia and Oceania.^[5] In Latin America, prevalence is universally low.^[6] The WHO states that "there is generally little non-religious circumcision in Asia, with the exceptions of the Republic of Korea and the Philippines".^[5] Estimates for individual countries include Spain,^[7] Colombia^[7] and Denmark^[8] less than 2%, Finland 0.006%^[9] and 7%,^[10] Brazil^[7] 7%, Taiwan^[11] 9%, Thailand^[7] 13%, and Australia 58.7%.^[12]

Canada, New Zealand, Australia and the United Kingdom have generally seen a decline in male circumcision while there are indications of increasing demand in Southern Africa.^[13] The Centers For Disease Control and Prevention (CDC) reports that circumcision rates were stable in the United States between 1979 and 1999.^[14]

Africa

Studies indicate that about 62% of African males are circumcised overall. However, these rates differ by region, ethnic and religious groups.^[15] 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]."^[16]

Circumcision prevalence in Africa

Country	Rate (Williams, B.G. et al.[16])	Rate (WHO [17])
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%

Rwanda,^[17] Burundi,^[17] Zambia,^[17] Zimbabwe,^[17] Malawi,^[17] Botswana,^[17] Namibia,^[17] Swaziland,^[17] Canary,Is. (Spain).^[17]

Between 20 and 80%

^[17] Central African Republic,^[17] Sudan,^[17] Uganda,^[17] Tanzania,^[17] Mozambique,^[17] South Africa,^[17] Lesotho.^[17]

80% or more

Algeria,^[17] Morocco,^[17] Mauritania,^[17] Tunisia,^[17] Libya,^[17] Egypt,^[17] Mali,^[17] Senegal,^[17] Gambia,^[17] Guinea-Bissau,^[17] Guinea,^[17] Liberia,^[17] Sierra Leone,^[17] Ghana,^[17] Togo,^[17] Benin,^[17] Burkina Faso,^[17] Niger,^[17] Nigeria,^[17] Chad,^[17] Cameroon,^[17] Equatorial Guinea,^[17] Gabon,^[17] Republic of the Congo,^[17] Democratic Republic of the Congo,^[17] Eritrea,^[17] Ethiopia,^[17] Djibouti,^[17] Somalia,^[17] Kenya,^[17] Angola,^[17] Mauritius,^[17] Madagascar.^[17] Côte d'Ivoire (Ivory Coast).^[17]

Americas

Less than 20%

Mexico,^[17] Belize,^[17] Costa Rica,^[17] El Salvador,^[17] Guatemala,^[17] Honduras,^[17] Nicaragua,^[17] Panama,^[17] Cuba,^[17] Jamaica,^[17] Haiti,^[17] Dominican Republic,^[17] Puerto Rico,^[17] Argentina,^[17] Bolivia,^[17] Brazil,^[17] Chile,^[17] Colombia,^[17] Ecuador,^[17] French Guiana,^[17] Guyana,^[17] Paraguay,^[17] Peru,^[17]Trinidad and Tobago,^[17] Uruguay,^[17] Venezuela.^[17]

The overall prevalence of circumcision is reported to be 6.9% in Colombia, and 7.4% in Brazil (13% in Rio de Janeiro).^[7]

The prevalence of circumcision in Mexico is estimated to be 10% to 31%.^[18]

Between 20 and 80%

Canada,^[17] United States.^[17]

United States

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

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.^[19]

Data from a national survey conducted from 1999 to 2002 found that the overall prevalence of male circumcision in the United States was 79%.^[20] 91% of men born in the 1970s, and 83% of boys born in the 1980s were circumcised.^[20] 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.^[21]

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.^[22]

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.^[23] 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.^[23] 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.^[24] 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.^[25]

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.^[26]

Medicaid funding for infant circumcision used to be available in every state, but starting with California in 1982, some states have eliminated Medicaid coverage of routine (non-therapeutic) circumcision.^[27][28] 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.^[29] 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.^[30] In 2006, Hawaii and Vermont introduced resolutions questioning the public funding of male circumcision.^{[citation needed]}

Edgar 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."^[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]

Canada

A survey of Canadian maternity practices conducted in 2006/2007 by the national public health agency found a newborn circumcision rate of 31.9%.^[33] 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[33]

In 1999, the American Academy of Pediatrics reported that “in Canada, ~48% of males are circumcised”.^[34] However, this figure was questioned because the only citation provided for it was an Australian paper dating from 1970.^[35] The Canadian Paediatric Society cites an estimate of 48% for the prevalence of male circumcision in Canada in 1970.^[36]

Articles published in 2003 reported Canadian neonatal male circumcision rates of "10 to 30%"^[29] and "less than 17%".^[37] 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.^[38] In 1994/95, the newborn circumcision rate in Ontario was 299.1 per thousand or 29.9%.^[39] A 2006 article placed the (2003) rate at 13.9%.^[40]

Asia

Less than 20%

Russia,^[17] Mongolia,^[17] China,^[17] Taiwan,^[17] North Korea,^[17] India,^[17] Sri Lanka,^[17] Nepal,^[17] Bhutan,^[17] Burma,^[17] Thailand,^[17] Laos,^[17] Vietnam,^[17] Cambodia,^[17] Japan,^[17] Papua New Guinea.^[17]

The overall prevalence of circumcision in Thailand is reportedly 13.3%.^[7] The Irish government estimates that fewer than one percent of males are circumcised in China and Japan.^[41]

Between 20 and 80%

Kazakhstan.^[17]

80% or more

Israel,^[17][42] South Korea,^[17] Bangladesh,^[17] Pakistan,^[17] Afghanistan,^[17] Azerbaijan,^[17] Bahrain,^[17] Brunei,^[17] Tajikistan,^[17] Kyrgyzstan,^[17] Uzbekistan,^[17] Turkmenistan,^[17] Iran,^[17] Iraq,^[17] Kuwait,^[17] Syria,^[17] Lebanon,^[17] Jordan,^[17] Saudi Arabia,^[17] Yemen,^[17] Oman,^[17] United Arab Emirates,^[17] Qatar,^[17] Malaysia,^[17] Turkey,^[17] Philippines.^[7] Indonesia,^[17]

The overall prevalence of circumcision (tuli) in the Philippines is reported to be 92.5%.^[7] 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.^[42]

According to the World Health Organisation, 80% or more of males in South Korea are circumcised.^[17] A 2001 study of 20-year old South Korean men found that 78% were circumcised.^[43] 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."

Europe

Less than 20%

The following countries have a circumcision rate of less than 20%: Iceland,^[17] United Kingdom,^[17][44] Ireland, Sweden, Norway, Finland, Denmark, Estonia, Latvia, Lithuania, Portugal, Spain, France, Switzerland, Italy, Netherlands, Belgium, Slovakia, Germany^[45], Poland, Czech Republic, Hungary, Greece, Bulgaria, Romania, Moldova, Ukraine, Austria, Belarus, Cyprus, Georgia.^[17]

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.^[44] 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.^[46] 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.^[47] Similarly, Wallerstein estimated in 1980 that the Finnish rate of adult circumcision for health reasons is six per 100,000.^[48] Schoen et al., however, reported in 2006 that data from 1996–1998 indicate a circumcision rate of about 7.1%;^[49] Houle reported the same figure in 2007.^[50] 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",^[51] amounting to 710 nationwide cases in 2002.^[52]

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.^[45]

In France, according to a telephone survey (TNS Sofres Institute, 2008), 14% of men are circumcised.^[53]

The overall prevalence of circumcision in Spain is reported to be 1.8%.^[7]

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.^[54]

Between 20 and 80%

Bosnia,^[17] Serbia,^[17] Montenegro,^[17] Albania,^[17] Macedonia.^[17]

Not known

Luxembourg,^[17] Croatia,^[17] Andorra^[17]

Map unclear

Monaco, San Marino, Vatican City, Liechtenstein, Malta

Oceania

Less than 20%

According to the World Health Organisation, fewer than 20% of males are circumcised in New Zealand.^[17] 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.^[58]

Between 20 and 80%

Australia.^[17][59]

A survey of Australian men, conducted in 2001–2002, reported that 58.7% were circumcised.^[59]

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%).^[60] In New South Wales, rates have risen from 13% in 1999 to 18% in 2009.^[61] 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.^[62] Non-therapeutic infant circumcision is no longer provided in public hospitals in New South Wales, Tasmania, Western Australia, Victoria, and South Australia.^[63][64]

Pacific Island

References

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62. ^ White, Alex (2010-08-28). "Once routine, banned in 2007, now it's back". Herald Sun. http://www.heraldsun.com.au/ipad/once-routine-banned-in-2007-now-its-back/story-fn6bfmgc-1226123498756. 
63. ^ "Victoria to scrap public hospital circumcision". Melbourne: The Age. 2007-08-12. http://www.theage.com.au/news/national/victoria-to-scrap-public-hospital-circumcision/2007/08/12/1186857323447.html. Retrieved 2007-08-12. 
64. ^ Pengelley, Jill (2007-11-12). "Cosmetic circumcision banned". The Advertiser. http://www.news.com.au/adelaidenow/story/0,22606,22741626-2682,00.html. Retrieved 2007-11-12. 

External links

• Drain, PK, Halperin, DT, Hughes, JP, Klausner, JD, Bailey, RC. (November 2006). "Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries". BMC Infect Dis 6 (1): 172. doi:10.1186/1471-2334-6-172. PMC 1764746. PMID 17137513. http://www.biomedcentral.com/1471-2334/6/172.