Since 2010, both the World Health Organization and Joint United Nations Programme on HIV/AIDS have been promoting a higher rate of circumcision prevalence as a prevention against HIV transmission and some STIs in areas with high HIV transmission and low circumcision rates.[1][2][3][4] According to Hay & Levin, 2012, around 50% of all circumcisions worldwide are performed for reasons of preventive healthcare, while the other 50% are predominately performed for religious or cultural reasons.[5]
In 2016, the global prevalence of circumcision was estimated to be around 38%, with notable increases of circumcision prevalence seen in the United States, the Middle East, and Africa; major medical organizations have promoted a higher rate of circumcision in Africa as a preventive against the spread of HIV/AIDS.[14][16] In 2020, the World Health Organization reiterated that it is an efficacious prophylactic intervention if carried out by medical professionals under safe conditions in areas of high HIV/AIDS prevalence.[17][18]
Between 2008 and 2010, the prevalence of circumcision in the United States was estimated to be around 80%. Similarly, Wolters Kluwer estimated that close to 80% of United States males in 2021 were circumcised.[19][9] Large portions of Africa have adopted the practice as a preventive measure against the spread of HIV. It has overwhelming prevalence in the Muslim world and in Israel due to the religious beliefs of most Muslims and Jews; however, some non-Muslim groups living within Muslim-majority countries, such as Armenians and Assyrians, do not practice it.[20] 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".[11] In parts of Africa it is often practiced as part of tribal customs from Christians, Muslims and Animists. 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.[21] 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.[22]
Studies suggest that about 62% of African males are circumcised.[23] 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 ethnic rituals or local custom, and some traditionally non-circumcising populations in the South recently adopting the practice due to measures by the World Health Organization to prevent AIDS.[24] 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."[25]
It is estimated that 48.7% of males are circumcised in South Africa.[13] One national study reported that 54.2% of black Africans were circumcised, with 32.1% of those traditionally circumcised and 13.4% circumcised for medical reasons.[28]
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, Nicaragua, Panama, Paraguay, Peru, Suriname, Saint Lucia, The Bahamas, Trinidad and Tobago, Uruguay, Venezuela.[26]
The overall prevalence of circumcision is reported to be 6.9%.[31] The reported rate is 13% in Rio de Janeiro, indicating possible differences between urban and rural rates.[32]
In 2006 the prevalence of circumcision in Mexico was estimated to be 10% to 31%.[33] A recent (2020) HIV study conducted in Mexico City found a participant circumcision rate of 23% (255/1118).[34]
Circumcision in Canada followed the pattern of other English speaking countries, with the practice being adopted during the 1900s on hygienic grounds, 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.[37][38] The Canadian Paediatric Society estimated that, in 1970, 48 percent of males were circumcised.[39] 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.[40] The rate continued to drop, with the newborn circumcision rate in Ontario in 1994–95 dropping to 29.9%.[41]
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%.[36] Rates varied markedly across the country, from close to zero in Newfoundland and Labrador to 44.3% in Alberta and 43.7% in Ontario. In 2015, the Canadian Paediatric Society used those statistics in determining the national circumcision rate it currently quotes.[36][42]
A more recent survey conducted in 2011 on expecting couples in Saskatchewan (average age 30.3) found the circumcision rate of the male participants to be 61%.[43]
Table: Percentage of mothers reporting having their baby circumcised, by region (2006/07) [36]
As of 2014, an estimated 80.5% of American men aged 14-59 are circumcised.[14][44] Morris et al. found a present rate of 77% in 2010, when accounting for underreporting. 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 (of any race) were circumcised, according to Mayo Clinic Proceedings.[14]Wolters Kluwer estimated that closer to 80% of males as of April 2023 were circumcised.[45]
Medicaid funding for infant circumcision used to be available in every state, but starting with California in 1982, 13 states (Arizona, California, Idaho, Louisiana, Maine, Minnesota, Mississippi, Montana, Nevada, North Dakota, Oregon, Utah, and Washington) had eliminated Medicaid coverage of routine circumcision by 2024, with several states reversing their decisions and reinstating coverage for the procedure.[46][47][48][49][50][51] 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.[52] 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.[53]
The 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.[14] Methodologically flawed calculations throughout the 2000s and 2010s showed the rate decreasing off of these statistics, but this data is believed to be misleading due to an increasing trend of performing neonatal circumcisions outside of hospitals, a trend not reflected in hospital discharge data.[45][54][55]
Circumcision was the second-most common procedure performed on patients under one year of age, after routine inoculations and prophylactic vaccinations.[56] 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.[57] Brown & Brown (1987) reported the most correlated factor is whether the father is circumcised.[58]
Armenia, Bhutan, Burma, China, Cambodia, Hong Kong,[59] India, Japan, Laos, Mongolia, Nepal, North Korea, Papua New Guinea, Singapore, Sri Lanka, Taiwan, Thailand, Vietnam.[26]
A sample of children aged <12 found a circumcision rate of 3.4% (1982).[59] A survey on men who regularly visit female sex workers from 2012 found a circumcision rate of 28%.[61]
Circumcision is largely a modern-day phenomenon in South Korea. While during the twentieth century, the rate of circumcision increased to around 80%, virtually no circumcision was performed prior to 1945, as it was against Korea's long and strong tradition of preserving the body as a gift from parents.[63][better source needed] A 2001 study of 20-year-old South Korean men found that 78% were circumcised.[64] 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.[8] In 2012, it is 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, were against indiscriminate circumcision and 97% were for).[63] 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.".[63]
Afghanistan, Azerbaijan, Bangladesh,[13] Bahrain, Brunei, Iran, Iraq, Israel,[65] Pakistan,[13] Jordan, Kuwait, Kyrgyzstan, Oman, Palestine, the Philippines,[31] Qatar, Saudi Arabia, Syria, Tajikistan, Turkey, Turkmenistan, Uzbekistan, the United Arab Emirates and Yemen.[26]
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 and 13.[66][67]
An exact number for the circumcision rate in Germany is not available. A 2016 study in Population Health Metrics quotes a survey stating 6.7% for men aged 30 to 61.[70] Public health insurances in Germany paid for 32 thousand circumcisions on boys in 2020.[71]
In this context, a peer-reviewed study found that circumcisions of minors increased slightly throughout the study period between 2013 and 2018. The corresponding population-related number rose from 7.5 circumcisions per 1,000 minors in 2013 to 8 in 2018.[72] A peer-reviewed study in 2021 found that circumcisions were more frequent in the first 5 years of life and above 15 years of age, whereas preputium-preserving procedures were preferred in the age groups between 5 and 14 years of age.[73] Its also claims a decrease in the number of circumcisions in recent years, stating that "[t]he hnumber of circumcisions and preputium-preserving operations decreased in absolute and relative numbers" and that "[t]he increasing trend towards neonatal circumcision observed in the United States is absent in Germany". Neonatal in this context refers to circumcisions shortly after birth.
Another peer-reviewed study in 2023 also reports that among than 38,000 German homosexual men without migration background 19.7% were circumcised.[74]
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, while 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.[69] 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[update] an estimated 3.8% of male children in the UK were being circumcised for medical reasons by the age of 15.[75] 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%.
Among participants of the HELIUS study, recruited between 2011 and 2015 (age 18–70), the circumcision rate for Dutch men without a migration background was 9%. The rate was > 95% for men of Moroccan, Turkish or Ghanaian background.[76] A small study from 2019 that recruited homosexual men suffering from various STDs found that 16% of the participants were circumcised.[77]
A study on hypospadias in 2016 recruited a control group (i.e. men without hypospadias) via the Swedish Population Registry; the reported circumcision rate of the controls was 11.8% with a mean age of 33.[79]
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.[80]
A recent survey (2017–2018) called Project SEXUS surveyed 62,675 Danes aged 15–89 years on sexual topics. The survey found the male circumcision rate to be 7%. Of the respondents 5% were circumcised for medical or other reasons, while 2% were circumcised for religious or traditional reasons.[81]
A 2017 survey of Polish university students (average age - 25) found a circumcision rate of 5%.[82] This figure is an estimate and fully representative only for students of the university where the survey took place. A 2016 study estimated a prevalence rate of 0.11% in total population.[13]
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.[83]
The circumcision rate was reported to be 8.5% in 2016.[13]
In Albania during the years 2008–09 the percentage of men age 15–49 who reported having been circumcised was 47.7%.[89] In the years 2017–18 the circumcision rate in Albania had declined to 36.8%.[90]
A study on genital sensitivity from 2013 recruited ~1400 adult men through leaflets randomly distributed at railway stations in Belgium. In this study 22.6% of the participants reported being circumcised.[85] The majority identified as being Caucasian with only a very small minority reporting being Asian, Arabic or African. In another more recent (2023) and similarly designed study on genital sensitivity 21.7% (152 out of 702) of participants reported being circumcised.[86]
According to data from the National Institute for Health and Disability Insurance (NIHDI or RIZIV), the number of circumcisions performed in Belgium amounted to 25,286 in the year of 2011. The vast majority of the procedures were performed on individuals aged < 16 years old. If this rate remains stable it is estimated that over time the circumcision rate for boys aged 16 will reach 31.71%.[91]
Circumcision reached its peak in Australia in the 1950s with a rate of more than 80%, but steadily fell to an estimated 15% in 2012.[92]
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.[93] 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.[7] There has been a decline in the rate of infant circumcision in Australia.[11][94] The Royal Australasian College of Physicians (RACP) estimated in 2010 that 10 to 20 percent of newborn boys were being circumcised,[95] but the prevalence of male circumcision is much higher due to the presence of older circumcised males remaining in the population.[96]Medicare Australia records show the number of males younger than six months that underwent circumcision dropped from 19,663 in 2007/08 to 6,309 (4%) in 2016/17[97] and further to 3,992 (2.48%) in 2023.[98]
According to the World Health Organization, fewer than 20% of males are circumcised in New Zealand in 2007.[11] In New Zealand routine circumcision for which there is no medical indication is uncommon and no longer publicly funded within the public hospital system.[99] In a study of men born in 1972–1973 in Dunedin, 40.2% were circumcised.[100] In a study of men born in 1977 in Christchurch, 26.1% were circumcised.[101] A 1991 survey conducted in Waikato found that 7% of male infants were circumcised.[102]
^Perry S, Hockenberry M, Cashion M, Rhodes Alden K, Olshansky E, Leonard Lowdermilk D (2022). "Nursing Care of the Newborn and Family". Maternal child nursing care (7th ed.). St. Louis: Elsevier Health Sciences. ISBN978-0-323-82587-0. The World Health Organization recognizes male circumcision as an important intervention in reducing the risk of heterosexually acquired HIV in men.
^Hart-Cooper GD, Tao G, Stock JA, Hoover KW (November 2014). "Circumcision of privately insured males aged 0 to 18 years in the United States". Pediatrics. 134 (5): 950–956. doi:10.1542/peds.2014-1007. PMID25332502. S2CID14839564.
^Baskin L (29 April 2021). Lockwood C, Wilcox D, Eckler K (eds.). "Patient education: Circumcision in baby boys (Beyond the Basics)". UpToDate. Archived from the original on 22 November 2022. Retrieved 22 November 2022. ...this is probably an underestimate of the true incidence of circumcised males, which is likely closer to 80 percent...
^Vardanyan AN (2013). "Reclaiming Circumcision: Armenian Stories". Genital Cutting: Protecting Children from Medical, Cultural, and Religious Infringements. pp. 307–315. doi:10.1007/978-94-007-6407-1_20. ISBN978-94-007-6406-4.
^Van Howe RS, Cold CJ, Lajous M, Lazcano-Ponce E, Mueller N (February 2006). "Human papillomavirus link to circumcision is misleading". Cancer Epidemiology, Biomarkers & Prevention. 15 (2): 405, author reply 405-405, author reply 406. doi:10.1158/1055-9965.EPI-05-0818. PMID16492939. 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.
^"Provider Bulletin"(PDF). Missouri Department of Social Services. 12 June 2014. Archived from the original(PDF) on 5 September 2015. Retrieved 21 October 2024.
^"Provider Bulletin"(PDF). Department of Health Care Policy and Financing Colorado. September 2017. Archived from the original(PDF) on 17 January 2021. Retrieved 21 October 2024.
^Quayle SS, Coplen DE, Austin PF (October 2003). "The effect of health care coverage on circumcision rates among newborns". The Journal of Urology. 170 (4 Pt 2): 1533–6, discussion 1536. doi:10.1097/01.ju.0000091215.99513.0f. PMID14501653.
^Leibowitz AA, Desmond K, Belin T (January 2009). "Determinants and policy implications of male circumcision in the United States". American Journal of Public Health. 99 (1): 138–145. doi:10.2105/AJPH.2008.134403. PMC2636604. PMID19008503. The mean mewborn male circumcision rate was 55.9%. When we controlled for other factors, hospitals in states in which Medicaid covers routine male circumcision had circumcision rates that were 24 percentage points higher than did hospitals in states without such coverage (P < .001).
^Fairbanks-Rossi L (1 July 2011). "Fretting over Foreskin". Inlander. Retrieved 22 June 2024. "The reason the stats are bogus," Dr. Seppa explains, "is that the numbers are based on what happens in hospitals … it's underestimated because people no longer circumcise at the hospital." Seppa estimates it would take "months of tallying" procedures at every private office and clinic in the community to get an accurate number.
^Wang Z, Lau JT, Gu J (October 2012). "Acceptability of circumcision among clients of female sex worker in Hong Kong". AIDS and Behavior. 16 (7): 1836–1845. doi:10.1007/s10461-011-0088-7. PMID22080385. S2CID23556728.
^Kamtsiuris P, Bergmann E, Rattay P, Schlaud M (2007). "[Use of medical services. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]" [Use of medical services. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz (in German). 50 (5–6): 836–850. doi:10.1007/s00103-007-0247-1. PMID17514470. S2CID29786579.
^Schmidt AJ, Ross MW, Berg RC, Altan P (January 2023). "Impact of Migration and Acculturation on Turkish Men Who Have Sex with Men in Germany: Results from the 2010 European MSM Internet Survey". Archives of Sexual Behavior. 52 (1): 283–290. doi:10.1007/s10508-022-02468-4. hdl:10037/28769. PMID36396921.
^Klavs I, Hamers FF (February 2008). "Male circumcision in Slovenia: results from a national probability sample survey". Sexually Transmitted Infections. 84 (1): 49–50. doi:10.1136/sti.2007.027524. PMID17881413. S2CID24535897.
^Maija K, Taskinen S. "Esinahan kirurgia"(PDF). Archived(PDF) from the original on 4 March 2016. Retrieved 20 October 2015.
^"12.10 Male Circumcision"(PDF). Albania Demographic and Health Survey 2008–09. March 2010. p. 203. Archived(PDF) from the original on 9 October 2022. Retrieved 10 December 2015.
^Richters J, Smith AM, de Visser RO, Grulich AE, Rissel CE (August 2006). "Circumcision in Australia: prevalence and effects on sexual health". International Journal of STD & AIDS. 17 (8): 547–554. doi:10.1258/095646206778145730. PMID16925903. S2CID24396989.
^The incidence of circumcision in Australia was very high until 1971 when it started a steep decline. Consequently, circumcised males tend to be older.
^ abAfsari M, Beasley SW, Maoate K, Heckert K (March 2002). "Attitudes of Pacific parents to circumcision of boys". Pacific Health Dialog. 9 (1): 29–33. PMID12737414. Circumcision for cultural reasons is routine in Pacific Island countries.
^Fergusson DM, Boden JM, Horwood LJ (November 2006). "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. PMID17079568. S2CID72751030.
^Lawrenson RA (May 1991). "Current practice of neonatal circumcision in the Waikato". The New Zealand Medical Journal. 104 (911): 184–185. PMID1898442.