Prevalence of circumcision

The prevalence of circumcision is the percentage of males in a given population who have been circumcised. The rates vary widely by country, from virtually 0% in Honduras and Japan, to 6.6% in Spain, to 20.7% in the United Kingdom,[1] to 45% in South Africa, to 75% in the United States,[2][3][4] to over 90% in Israel and many Muslim-majority countries.[2][5][6] In 2010, the World Health Organization (WHO) estimated 30% of adult males worldwide (aged 15+) are circumcised, with about two-thirds of those being Muslims.[2]

Map of countries based on circumcision prevalence, based on a 2007 World Health Organization report
  >80% prevalence
  20-80% prevalence
  <20% prevalence
  N/A

Male circumcision is nearly universal in the Muslim world and in Israel due to the religious beliefs of the majority of Muslims and Jews; however, some non-Muslim groups living within Muslim-majority countries, such as Armenians and Assyrians, do not practice it.[7] It is prevalent in some Muslim-majority countries in southeast Asia such as Indonesia and Malaysia; however, the WHO states that there is "little non-religious circumcision in Asia, with the exceptions of the Republic of Korea and the Philippines".[2] In parts of Africa it is often practiced as part of tribal or religious customs. The prevalence of circumcision used to be high in the United States, although there has been a major decrease in routine neonatal circumcision in recent years.[8]

In contrast, rates are much lower in most of Europe, parts of southern Africa, most of Asia, Oceania and Latin America, constituting South America, Central America, the Caribbean and Mexico.[9]

Australia, Canada, Ireland, New Zealand and the United Kingdom are examples of countries that have seen a decline in male circumcision in recent decades, while there have been indications of increasing demand in southern Africa, partly for preventive reasons due to the HIV epidemic there.[10]

Africa

Studies suggest that about 62% of African males are circumcised. However, the rate varies widely between different regions, and among ethnic and religious groups, with Muslim North Africans practising it for religious reasons, central Africans as part of tribal rituals or local custom, (with some practising female genital mutilation as well) and some traditionally non-circumcising populations in the South recently adopting the practice due to measures by the World Health Organisation to prevent AIDS.[11] Williams, B.G. et al. commented 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."[12]

Extended content
Prevalence of circumcision in Africa
Country WHO

(2006)[13]

 Williams et al

(2006)[12]

 Morris et al

(2016)[6][14]

 Angola>8066 57.5
 Central African Republic20–8067 63
 Chad>8064 73.5
 Republic of the Congo>8070 70
 Democratic Republic of the Congo>8070 97.2
 Gabon>8093 99.2
 Burundi<202 61.7
 Djibouti>8094 96.5
 Eritrea>8095 97.2
 Ethiopia>8076 92.2
 Kenya>8084 91.2
 Rwanda<2010 13.3
 Somalia>8093 93.5
 Sudan20–8047 39.4
 Tanzania20–8070 72
 Uganda20–8025 26.7
 Botswana<2025 15.1
 Lesotho20–800 52
 Malawi<2017 21.6
 Mozambique20–8056 47.4
 Namibia<2015 25.5
 South Africa20–8035 44.7
 Swaziland<2050 8.2
 Zambia<2012 21.6
 Zimbabwe<2010 9.2
 Benin>8084 92.9
 Burkina Faso>8089 88.3
 Cameroon>8093 94
 Equatorial Guinea>8086 87
 Gambia>8090 94.5
 Ghana>8095 91.6
 Guinea>8083 84.2
 Guinea-Bissau>8091 93.3
 Côte d'Ivoire20–8093 96.7
 Liberia>8070 97.7
 Mali>8095 86
 Mauritania>8078 99.2
 Niger>8092 95.5
 Nigeria>8081 98.9
 Senegal>8089 93.5
 Sierra Leone>8090 96.1
 Togo>8093 95.2

Less than 20%

Botswana, Rwanda, Swaziland, Zimbabwe.[6][14]

Between 20% and 80%

Angola, Burundi, Central African Republic, Chad, Congo (Rep), Lesotho, Malawi, Mozambique, Namibia, South Africa, Sudan, Tanzania, Uganda, Zambia.[6][14]

South Africa

It is estimated that 44.7% of males are circumcised in South Africa.[6] One national study reported that 48.2% of black Africans were circumcised, with 32.1% of those traditionally circumcised and 13.4% circumcised for medical reasons.[15]

More than 80%

Benin, Burkina Faso, Cameroon, Congo (Dem Rep), Cote d’Ivoire, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Togo.[6][14]

Americas

Less than 20%

Less than 20% of the population are circumcised in 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, Saint Lucia, The Bahamas, Trinidad and Tobago, Uruguay, Venezuela.[13]

The overall prevalence of circumcision is reported to be 6.9% in Colombia, and 7.4% in Brazil (13% in Rio de Janeiro), with most of those being done due to medical issues later in life.[16]

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

Between 20% and 80%


Canada
Rate of neonatal circumcision by province according to data from the Maternity Experiences Survey (MES) in 2006-2007.[18]

Circumcision in Canada followed the pattern of other English speaking countries, with the practice being adopted during the 1900s, to prevent masturbation and other perceived issues of the time, but with the rate of circumcision declining in the latter part of the 20th century, particularly after a new policy position was released in 1975.[19] The Canadian Paediatric Society estimated that, in 1970, 48 percent of males were circumcised.[20] However, studies conducted in 1977-1978 revealed a wide variation in the incidence of circumcision between different provinces and territories. For example, Yukon reported a rate of 74.8 percent, while Newfoundland reported an incidence of 1.9 to 2.4 percent.[21] The rate continued to drop, with the newborn circumcision rate in Ontario in 1994-95 dropping to 29.9%.[22]

A survey of Canadian maternity practices conducted in 2006/2007, and published in 2009 by the national public health agency, found a newborn circumcision rate of 31.9%.[18] Rates varied markedly across the country, from close to zero in Newfoundland and Labrador to 44.3% in Alberta. In 2015, the Canadian Paediatric Society used those statistics in determining the national circumcision rate it currently quotes.[18][23]

Percentage of mothers reporting having their male baby circumcised, by province and territory, Canada, 2006/2007
Newfoundland and Labrador*
Prince Edward Island39.2
Nova Scotia6.8
New Brunswick18.0
Quebec12.3
Ontario43.7
Manitoba31.6
Saskatchewan35.6
Alberta44.3
British Columbia30.2
Yukon*
Northwest Territories9.7
Nunavut*
Canada31.9
* Numerator too small for rate calculation
Source:  Canadian Maternity Experiences Survey[18]

United States

During the 2000s, the prevalence of circumcision in men aged 14–59 differed by race: 91 percent of non-Hispanic white men, 76 percent of black men, and 44 percent of Hispanic men were circumcised, according to data in Mayo Clinic Proceedings.[24]

The new generation of American boys is less likely to be circumcised, however. A HCUP statistical brief reported in February 2012 that circumcisions had dropped from around 60% in 2000 to 54.5% in 2009.[25] The CDC's Division of Health Care Statistics (Owings et al.) reported an estimate in August 2013 that "[a]cross the 32-year period from 1979 through 2010, the national rate of newborn circumcision declined 10% overall, from 64.5% to 58.3%."[26] A July 2013 study in the Sexually Transmitted Diseases journal by Introcaso et al. posed a different question, namely how many boys and men aged 14 to 59 in the 2005–2010 period (that is, who were newborns between 1946 and 1996) were circumcised, concluding that 80.5% of them were. Because Introcaso et al. included men aged 32–59 but excluded boys aged 0–13, this suggests that circumcision of newborns was much more widespread in 1946 before it dropped to 64.5% in 1979.[27]

Rate of neonatal circumcision in the United States by region in 2009. Based on data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project.[25]

Medicaid funding for infant circumcision used to be available in every state, but starting with California in 1982, 18 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.[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] Other studies have shown that the rise of immigrants from East Asia, Southeast Asian, South Asia and Hispanic South American countries are a large factor in why the rates continue to drop in the US.[31]

The Centers For Disease Control and Prevention (CDC) uses two data sources to track circumcision rates. The first is the National Health and Nutrition Examination Survey (NHANES), which records circumcisions performed at any time at any location. The second is the National Hospital Discharge Survey (NHDS), which does not record circumcisions performed outside the hospital setting or those performed at any age following discharge from the birth hospitalization.[32]

Circumcision was the second-most common procedure performed on patients under one year of age.[33] 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, which may contribute to the high rate of elective circumcision.[34] Brown & Brown (1987) reported the most correlated factor is whether the father is circumcised.[35]

Asia

Less than 20%

Bhutan, Burma, China,[36] Cambodia, India, Japan, Laos, Mongolia, Nepal, North Korea, Papua New Guinea, Singapore, Sri Lanka, Taiwan, Thailand, Vietnam.[13]

The overall prevalence of circumcision in Cambodia is reported to be 3.5%.[16]

The overall prevalence of circumcision in China is reported to be 14%.[6]

Between 20% and 80%

Indonesia, Kazakhstan, Malaysia, and South Korea.[37]

South Korea

Circumcision is largely a modern-day phenomenon in South Korea. While the rate in the twentieth century has been nearing 80%, virtually no circumcision was performed just a century ago, as it was against Korea's long and strong tradition of preserving the body as a gift from parents.[37] A 2001 study of 20-year-old South Korean men found that 78% were circumcised.[38] 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.[39] 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).[37] 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."[37]

More than 80%

Afghanistan, Azerbaijan, Bangladesh,[40] Bahrain, Brunei, Iran, Iraq, Israel,[41] Pakistan,[6] Jordan, Kuwait, Kyrgyzstan, Lebanon, Oman, Palestine, the Philippines,[16] Qatar, Saudi Arabia, Syria, Tajikistan, Turkmenistan, Uzbekistan, United Arab Emirates and Yemen.[13]

The overall prevalence of circumcision (tuli) in the Philippines is reported to be 92.5%. Most circumcisions in the Philippines are performed between the ages of 11 to 13.[42][43]

Europe

Less than 20%

Armenia, Austria, Belarus, Belgium, Bulgaria, Croatia, Czech Republic, Cyprus, Denmark, Estonia, Finland, France, Georgia, Germany,[44] Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Malta, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Russia, Slovakia, Slovenia, Spain, Serbia, Sweden, Switzerland, Ukraine,[13] and the United Kingdom.[45]

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 by their parents' choosing. 11.7% of 16- to 19-year-olds, and 19.6% of 40- to 44-year-olds said they had been circumcised. Apart from black Caribbeans, men born overseas were more likely to be circumcised.[45] 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. As of 2000 an estimated 3.8% of male children in the UK were being circumcised for medical reasons 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%.

In Finland, the overall prevalence of circumcision is 2-4%, according to a recent publication by the Finnish Health Ministry.[47]

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.[44]

In France, according to a telephone survey (TNS Sofres Institute, 2008), 14% of men are circumcised.[48]

The overall prevalence of circumcision in Spain is reported to be 6.6%.[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.[49]

In Slovenia, a 1999-2001 national probability sample of the general population aged 18–49 years found that overall, 4.5% of Slovenian male citizens reported being circumcised. Prevalence strongly varied across religious groups, with 92.4% of Muslims being circumcised, 1.7% of Roman Catholics, 0% of other religious affiliations (Evangelic, Serbian Orthodox, other), and 7.1% of those with no religious affiliation.[50]

Between 20% and 80%
Circumcision rate by region in Albania for males aged 15-49, 2017-2018.

Albania, Kosovo, North Macedonia, and Bosnia and Herzegovina.[13]

In Albania during the years 2008-09 the percentage of men age 15-49 who reported having been circumcised was 47.7%.[51] In the years 2017-18 the circumcision rate in Albania had declined to 36.8% [52]

Over 80%

Turkey, 98.6%.[6]

Unknown

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.[13]

Oceania

Australia

Circumcision reached its peak in Australia in the 1950s with a rate of more than 80%, but has steadily fallen to an estimated 26% in 2012. The rate of circumcision has dropped rapidly over the years. It is estimated that roughly 80 percent of males 35 and under are intact. Circumcision rates have declined drastically in recent years as young fathers are starting to have children of their own and leaving them intact.[53]

The Australian Longitudinal Study of Health and Relationships is a computer assisted telephone interview of males aged 16–64 that uses a nationally representative population sample.[54] In 2005 the interview found that the prevalence of circumcision in Australia was roughly 58%. Circumcision status was more common with males over 30 than males under 30, and more common with males who were born in Australia. 66% of males born in Australia were circumcised and less than 1/3 of males under 30 were circumcised.[55] There has been a decline in the rate of infant circumcision in Australia.[2][56] The Royal Australasian College of Physicians (RACP) estimated in 2010 that 10 to 20 percent of newborn boys are being circumcised,[57] but the prevalence of male circumcision is much higher due to the presence of older circumcised males remaining in the population.[58] Medicare Australia records show the number of males younger than six months that underwent circumcision dropped from 19,663 in 2007/08 to 6309 (4%) in 2016/17.[59]

New Zealand

According to the World Health Organisation, fewer than 20% of males are circumcised in New Zealand in 2007.[2] In New Zealand routine circumcision for which there is no medical indication is uncommon and no longer publicly funded within the public hospital system.[60] In a study of men born in 1972–1973 in Dunedin, 40.2% were circumcised.[61] In a study of men born in 1977 in Christchurch, 26.1% were circumcised.[62] A 1991 survey conducted in Waikato found that 7% of male infants were circumcised.[63]

Pacific Islands

Circumcision for cultural reasons is routine in Pacific Island countries.[60]

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See also

References
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Bibliography
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