Today, however, the practice has been virtually abandoned in Britain and New Zealand, and circumcision rates have been reduced markedly in Canada and Australia. In 1978 the American College of Obstetricians and Gynecologists endorsed the academy's position. Both of these groups reaffirmed this judgment in a 1983 report, Guidelines for Perinatal Care. These claims are not supported by epidemiological data. Moreover, smegma can be found under the clitoral foreskin of women, as well as under the foreskins of some other mammals of both sexes, and it apparently causes no harm.
Circumcision occasionally is a medical necessity and is so recognized worldwide.
As a surgical procedure, circumcision may result in hemorrhage, infection, surgical injury and even, although it happens very rarely, in death. The origin of the various forms of female circumcision is unknown. Still practiced in Africa, including parts of Egypt, Sudan, Somalia, and Kenya, the method and timing of the operation vary from group to group. According to a 1981 United Nations report, the practice is declining owing to opposition by African women. It rarely is performed today except for advanced cancer or extreme enlargement of the clitoris.