Determinants and Policy Implications of Male Circumcision in the United States

Department of Public Policy, UCLA School of Public Affairs, Box 951656, Los Angeles, CA 90095-1656, USA.
American Journal of Public Health (Impact Factor: 4.55). 12/2008; 99(1):138-45. DOI: 10.2105/AJPH.2008.134403
Source: PubMed


We sought to determine whether lack of state Medicaid coverage for infant male circumcision correlates with lower circumcision rates.
We used data from the Nationwide Inpatient Sample on 417 282 male newborns to calculate hospital-level circumcision rates. We used weighted multiple regression to correlate hospital circumcision rates with hospital-level predictors and state Medicaid coverage of circumcision.
The mean neonatal 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). Hospitals serving greater proportions of Hispanic patients had lower circumcision rates; this was not true of hospitals serving more African Americans. Medicaid coverage had a smaller effect on circumcision rates when a hospital had a greater percentage of Hispanic births.
Lack of Medicaid coverage for neonatal male circumcision correlated with lower rates of circumcision. Because uncircumcised males face greater risk of HIV and other sexually transmitted infections, lack of Medicaid coverage for circumcision may translate into future health disparities for children born to poor families covered by Medicaid.

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    • "Since over 40% of all US births are funded by Medicaid [6], these polices have the potential for far-reaching effects. Medicaid defunding of neonatal circumcision will likely result in significantly lower rates of circumcision in the United States [7]. A reduction in rates of neonatal circumcision in states "
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    ABSTRACT: Objective: To project the increased incidence of HIV and subsequent costs resulting from the expected decreased rate of circumcision due to Medicaid defunding in one southeastern state. Methods: Using 2009 South Carolina (SC) Medicaid birth cohort (n = 29, 316), we calculated expected heterosexually acquired HIV cases at current circumcision rates. To calculate age/race/gender specific HIV incidence rates, we used 2009 South Carolina Department of Health and Environmental Control reported gender and race specific HIV cases, CDC reported age distribution of HIV cases, and 2009 S.C. population data. Accounting for current circumcision rates, we calculated the change in incidence of heterosexually acquired HIV assuming circumcision provides 60% protection against HIV transmission to males and 46% protection against male to female transmission. Published lifetime cost of HIV was used to calculate the cost of additional HIV cases. Results: Assuming Medicaid circumcision rates decrease from current nationally reported levels to zero secondary to defunding, we project an additional 55 male cases of HIV and 47 female cases of HIV among this birth cohort. The total cost discounted to time of infection of these additional HIV cases is $20,924,400 for male cases and $17,711,400 for female cases. The cost to circumcise males in this birth cohort at currently reported rates is $4,856,000. Conclusions: For every year of decreased circumcision rates due to Medicaid defunding, we project over 100 additional HIV cases and $30,000,000 in net medical costs.
    Infectious Diseases in Obstetrics and Gynecology 10/2012; 2012:540295. DOI:10.1155/2012/540295
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    • "Few African governments have expressed interest in offering free circumcision, with health ministries often deterred by costs (despite proven costeffectiveness ) and concerns over disinhibition. In the US, a significant minority of state Medicaid programs do not currently fund routine male circumcision, with the consequence that infant circumcision rates are significantly lower in those states (Leibowitz et al. 2009). In both developed and developing world settings, according to a participant at the Future Direction of Male Circumcision in HIV Prevention meeting, there has been resistance among HIV prevention providers, who are more often trained in community behavior work than in surgical techniques and therefore sometimes distrust new medical technologies. "
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    ABSTRACT: Now that male circumcision has been shown to have a protective effect for men against HIV infection when engaging in vaginal intercourse with HIV-infected women, the research focus needs to shift towards the operational studies that can pave the way for effective implementation of circumcision programs. Behavioral research is needed to find out how people perceive the procedure and the barriers to and facilitators of uptake. It should also assess the risk of an increase in unsafe sex after circumcision. Social research must examine cultural perceptions of the practice, in Africa and beyond, including how likely uncircumcised communities are to access surgery and what messages are needed to persuade them. Advocates of male circumcision would benefit from research on how to influence health policy-makers, how best to communicate the benefits to the public, and how to design effective delivery models.
    AIDS and Behavior 03/2009; 14(5):1203-6. DOI:10.1007/s10461-009-9523-4 · 3.49 Impact Factor
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    ABSTRACT: Circumcision is one of the most common surgical procedures performed on males in the United States. Ethical considerations of the procedure have been considered for many years and, recently, research on the topic has shed more light on the debate. The purpose of this study was to review the history and emergence, current demographics, and practices of male circumcision, specifically, nonreligious, nonmedically indicated routine neonatal circumcision. A review of the current literature was conducted using PubMed and current practices from guidelines of major professional societies. Physicians should consider the various ethical concerns and provide the patient's guardians with unbiased counsel. There is a lack of evidence both in favor of and against recommending routine neonatal circumcisions in the United States. The question remains whether we should continue unwarranted male circumcisions, especially when the major tenet of medical ethics is "do no harm."
    Journal of the National Medical Association 09/2012; 104(9-10):455-8. · 0.96 Impact Factor
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