The American Academy of Pediatrics says the health benefits of newborn male circumcision outweigh the risks. The new position is the first the group has taken since it last reviewed the issue in the late 1990s.
In a statement released Aug. 27, the group also qualified its position, saying “the benefits are not great enough to recommend universal circumcision” and the final decision should be left to parents to make in the context of religious, ethical and cultural beliefs.
Audrey Rhee, who specializes in pediatric urology at Cleveland Clinic, said the academy’s ruling was surprising given its previous, more neutral stance.
“It’s pretty brave of the AAP to come out at this point and say they are recommending that children get circumcised,” she said.
In most medical circles, the decision is left up to the parent as to whether to have a child circumcised, Rhee said, but the debate she has with her colleagues revolves more around the payer, like Medicaid.
“Several states have withdrawn the financial support to have families have circumcisions performed,” Rhee said. “By not offering it they are in many ways making that decision for the parent. … I think that the parents should always have that option.”
The benefits of circumcision include a lower risk of urinary tract infection during a baby’s first year, a lower risk of penile cancer over its lifetime and a lower risk of acquiring sexually transmitted diseases such as HIV, said Jonathan Fanaroff, co-medical director of the neonatal intensive care unit at University Hospitals in Cleveland.
The academy’s statement comes two months after Germany tried to legally outlaw circumcision for religious reasons but allow it for medical purposes.
The Berlin Senate ruled Sept. 5 that doctors could legally perform circumcisions for religious reasons in the region, becoming the first German city-state to protect the practice while the national government works on new circumcision laws.
Fanaroff, a congregant at Park Synagogue in Cleveland Heights and Pepper Pike, said the controversy surrounding the procedure revolves around two things.
“One, there’s a very small risk of a very serious complication such as an amputation, along with the risks of bleeding or infection,” he said. “Then there are a number of people out there who question whether this needs to be done when they’re an infant or whether they should wait until the male is an adult and can choose for themselves.”
When performed by the right person, Fanaroff said the procedure is considered “very safe.”
The debate is not a new one, said Rabby Sruly Koval, a mohel who lives in University Heights.
“It’s been outlawed many times in our history,” Koval said. “It’s always been targeted by anti-Semites. The earliest reference to this is when the Greeks occupied Jerusalem.”
Before circumcisions were performed for medical reasons, they were a religious procedure.
“Circumcision is referred to as the ‘covenant of Abraham,’” Koval said. “There’s something about this ritual which is very connected with history. God told Abraham, ‘This is what I’d like you to do with your family.’”
The procedure is as much about spiritual benefits as it is about medical ones, Koval said.
“Before there was any discovery of medical benefits, it was something we did as part of Jewish continuity,” he said. “It’s almost a 4,000-year-old ritual. … It’s a fine balance between medicine and tradition. I’m in touch with all the other mohels in town, as well as with many doctors, and I’m in constant conversations with pediatricians. We’re always trying to make sure that we’re safe and we’re updated without compromising the tradition with the history of it.”
Even while the circumcision debate rages, Koval said United States citizens should be thankful “that we live in a country that protects our religious rights and allows us the freedom to make religious decisions without outlying our observances and our traditions.”