The topic is controversial. Yet Michelle Iturrate says it was an easy decision for her. The Boulder woman did not choose to circumcise her two sons.

“There was just no good reason,” she says. “The foreskin is there for protection, just like an eyelid.”

Still, the choice stirred concern with her parents, who said it was a family tradition and were concerned her sons wouldn’t fit in with other kids. But even that wasn’t a good reason, Iturrate says.

“As a mom, my biological instinct is to protect my kids, and I naturally wouldn’t do anything to harm them purposely, so why would I circumcise?” Iturrate says. “My husband and I had a lot of angst just over the heel prick in the hospital, so imagine that very same day, taking them and cutting their foreskins.”

And the truth is, her sons may not be all that different anymore. The number of circumcisions in the United States is slowly on the decline. In 1999, the National Hospital Discharge Survey, conducted by the National Center for Health Statistics, reported about 63 percent of boys were circumcised. That number dropped to 57 percent in 2008.

Data from the Charge Data Master, as printed in the Journal of the American Medical Association, show rates continued to drop to 55 percent last year.

However, these numbers don’t reflect home births or children who are circumcised after leaving the hospital, such as Jewish boys who are undergo the procedure at a ceremony eight days after birth. Some statistics indicate about 95 percent of Jewish boys are circumcised.

This controversial topic — about whether or not to surgically remove the foreskin of the penis — has heated up in recent months, with ballot attempts to ban circumcision in California and Massachusetts, and the procedure is being dropped from Medicaid coverage in 18 states, including Colorado on July 1. The change was part of a series of budget cuts, essentially asserting that circumcision has no medical justification.

And this is leading to changes. A study at UCLA found that circumcision rates dropped in states without Medicaid coverage. The study estimates that if all 50 states dropped the coverage, rates would plunge to about 39 percent.

Still, circumcision is the most common medical procedure on children in the United States, and it has deep societal, historical and religious roots.

The Centers for Disease Control says it’s still developing its recommendations on the topic, including whether circumcision should be recommended as a means of reducing HIV infection. Some studies have suggested it may reduce transmission of STDs.

Last month, the Boulder Jewish Community Center was host to a panel about the choice to circumcise, and showed a 70-minute documentary called “Cut: Slicing through the myths of circumcision.” The screening was part of a national tour, promoting a critical look at circumcision from a religious, scientific and ethical perspective.

Morah Yehudis Fishman, at Boulder’s Aish Kodesh Open Orthodox Jewish congregation, sat on the discussion panel afterward. She says “by an interesting stroke of fate,” she also taught the filmmaker, Eliyahu Ungar-Sargon, 30 years ago when he was in elementary school.

From her perspective, there is no question about whether or not to circumcise: The act is central to her religion.

“The Orlah, the foreskin, represents a barrier between a Jew and his connections both to Torah, to his fellow human beings and to G-d,” Fishman wrote, in a recent essay, after she says she didn’t feel like she was able to express her thoughts “in the given time frame” at the panel. “Removing the foreskin reveals the inner levels of the soul and therefore opens the channels to a holy relationship with all three.”

Fishman says she believes a primary purpose of a Jew’s existence is to close the gap between the spiritual and material realms, and the Brit Milah, or “covenant of circumcision” ceremony, “imprints the divine ineffable Name on the reproductive male organ responsible for the continuity of life in this world.” To her, circumcision is a holy act that has brought positive values to the world.

But religious freedom ends where another person’s human rights begin, says Gillian Longley, of Boulder, an area neonatal nurse who refuses to assist in circumcision. She says her decision to not circumcise her two sons, and her activism in the topic, came from seeing parents agree to “have part of their son’s penis cut off” without having substantive information on the risks, long-term affects and pain involved.

It’s not just a “little snip,” says Longley, who recently completed her master’s degree, in which her thesis research was on informed consent for neonatal circumcision. The foreskin is 15 square inches of skin on an adult male, with a double layer of skin, and has the densest concentration of light-touch nerves than any other part of the penis, she says. She says removing it affects sexual function and puts a child at risks for unnecessary complications. She adds that the American Academy of Pediatrics does not recommended routine circumcision.

Not to mention the ethics involved with making this choice for a non-consenting child, she says.

Beyond religious reasons, Longley says the procedure came to American in the sexually repressive Victorian era as a way to prevent boys from masturbating — “before a modern-medical understanding of disease — and human rights.”

“Now, we just have this habit of continuing and self-perpetuating it through defense mechanisms that you don’t want to believe you’ve been harmed or that you harmed your child,” Longley says. “These are ways to justify it because it’s too ugly to look at, if you look at it in an honest sense.”

Miriam Pollack is a Jewish woman in Boulder who has been active in the movement to end neonatal circumcision for about 20 years. She thinks it is also a woman’s issue.

“When a culture, be it American or Jewish, tells a newly birthed mother that she must and is expected to hand over her brand new baby to have his male organs altered and cut, she is also implicitly being told her instincts to protect that baby have to be subservient to this rite, and in doing so, it is a way of creating a male dominant society and family,” Pollack says.

She says increasingly more Jews are struggling with the topic — even holding Brit Milah-influenced ceremonies without the cutting.

Tara Faith Brockman, of Lyons, is a Jewish mom who decided not to circumcise her son, despite family and religious norms. Instead, she says, when her son was 31/2 months old, she organized a special ceremony for him. The rabbi, in St. Louis, played the guitar and did blessings, Brockman and her husband washed her son’s feet and gave him his Hebrew name and family members brought items to bless, put in a medicine bag and give to the child when he’s older.

Brockman says it was a difficult decision, yet an instinctual one. She says it wasn’t easy to go against the grain, but she believed her son had been born with the body he was meant to have. Plus, as an acupuncturist, she says her understanding of Eastern medicine suggested the act would create trauma for his body.

Maybe the act of circumcision is actually a metaphor for opening your heart to God, Brockman says.

“I feel like my understanding and connection with God — my God wouldn’t really ask me to do this. It’s a belief that I feel is very old,” she says. “I feel like this is really my son’s choice. If it’s something he wants to do in the future, I’ll be by his side.”

Contact Staff Writer Aimee Heckel at 303-473-1359 or heckela@dailycamera.com.