Infant circumcision in Australia: a preliminary estimate, 2000–10

Despite recent assertions that circumcision is ‘back in favour’ in Australia and approaching 20% of infants under 6 months, there is no evidence that the national incidence of circumcision is increasing. On the contrary, when claims for the circumcision rebate from Medicare are compared with male birth statistics it is clear that the circumcision rate is either static or falling in most states. In five of the eight states and territories the rate of circumcision is currently less than 10% of boys aged less than 6 months. Even in New South Wales, the state with an abnormally high incidence, there has been a steady decline since 2007. Nationally, the rate for males under 6 months in 2010 was 12.4%, down slightly from 13% in 2006. The most striking feature of the figures is the wide variation among the states – from a low of 1.5% in Tasmania to a high of 17.3% in New South Wales (Table 1). In between are the Australian Capital Territory and Western Australia on 6% and 6.8%, respectively, and South Australia and Queensland on 15.1% and 14%. Another feature of the figures are the sharp falls in Tasmania, from 9.3% in 2000 to 1.5% in 2010; the Northern Territory, from 7.6% to 2.7%; and Queensland, from 20.3% to 14%. The decline in Queensland during the second half of 2010 was so great that if it is sustained the rate may fall below 10% in 2011. These falls have been counterbalanced by smaller rises in NSW (from 14.3% to 17.3%) and Victoria (from 5.3% to 8%) over the same decade. These rises invite analysis, but are likely to be related to two factors: 1. The decision by state governments (NSW in 2006, Victoria and SA in 2007) to cease providing non-therapeutic circumcision as a service in their public hospitals, resulting in a shift in the provision of the service in hospitals (where no Medicare rebate is payable or recorded) to GPs and specialist clinics, where the procedure shows up in the Medicare statistics. 2. An increase in the number of circumcisions within communities of recent immigrants from countries where circumcision is prevalent, especially the Middle East and parts of Africa. The high birthrate in the Muslim community may also be relevant. The rise in circumcision incidence in Victoria and New South Wales may thus be more apparent than real and may not indicate an increasing demand for circumcision outside communities of recent immigrants. Overall, the data show that the infant circumcision rate is continuing its decline from the high point of the mid-1950s and is now close to its lowest level for nearly a century. Excluding New South Wales, the rate nationally in 2010 was about 10%. There is thus no basis in the facts for claiming that the incidence of circumcision is rising in Australia, and it is quite misleading to cite the high NSW figure as if it were typical of the nation. Even in NSW the rate seems to have stabilised: after reaching a recent peak of 18.5% in 2007 it has fallen steadily in each subsequent year. The abnormally high rate of circumcision in NSW may be related to the attitude of the local media and the laissez-faire policy of state medical and regulatory bodies. This is surprising, given that paediatric authorities have consistently discouraged circumcision since 1971, and in their most recent policy statement (October 2010) state: “After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand. ”1 That being the case one must wonder why the incidence of infant circumcision (almost never medically necessary) is as high as it is. Although the rate of circumcision as a proportion of male births is low, it still represents a large number of boys who have been deprived of their foreskins for no valid medical reason and without their consent. The many circumcisions on males under 6 months of age is of particular concern, given that the Australasian Association of Paediatric Surgeons has recommended that circumcision not be performed so soon. One must wonder why Medicare is providing a rebate for a medically unnecessary medical service, considering that its own guidelines state that rebates are not available for “medical services which are not clinically necessary” or “surgery solely for cosmetic reasons”.