United Kingdom: Incidence of Male Circumcision

The incidence of male circumcision in the United Kingdom has varied sharply over the decades of the twentieth century. The National Health Service does not offer free non-therapeutic circumcision, so non-therapeutic circumcision of the newborn is almost unknown. When non-therapeutic circumcision of the newborn does occur, it is most likely to be in furtherance of the religious views of the parents.

There are sharp variations by age group in the percentage of males who are circumcised. Younger males are less likely to be circumcised.

Rickwood et al. report that the male circumcision rate was about 35 percent in the 1930s. 7 The rate had declined to about 1/5 of boys being circumcised in the 1940s, or about 90,000 annually. 1 Gairdner reported a sharp division by social class with the upper classes being circumcised much more frequently. 1 The National Health Service (NHS) started operations in 1948 and did not provide non-therapeutic neonatal circumcisions. Following the publication of Gairdner's influential report on the lack of necessity of neonatal circumcision in 1949 1 , the incidence of male non-therapeutic (routine) circumcision declined sharply. The BMJ reported that the incidence of non-therapeutic circumcision was 6 percent in 1975. 2 Rickwood reported in 1989 that about 30,000 circumcisions a year were carried out in England and 70 percent were on boys under 15 years of age. 3 Gordon and Collin suggested in 1993 that 5.6 percent of boys in England would be circumcised by age 17. 4

Johnson et al. surveyed 7990 British men (1990) and found that 21.9 percent of all men in the survey were circumcised. 5 There was a sharp division by age group. The oldest are the most likely to be circumcised while the youngest group is the least likely to be circumcised.

Age group % Number Birth Year 16-24 12.5 1874 1966-1974 25-34 15.9 2111 1956-1975 35-44 26.4 1956 1946-1955 45-59 32.3 2049 1931-19455

Religion % Number None 18.4 4120 Church of England 24.7 2011 Roman Catholic 18.6 678 Other Christian 22.1 863 Non-Christian 55.8 3125

Ethnic group % Number White 20.9 7551 Black 34.1 150 Asian 35.3 165 Other 51.5 1075

Johnsoncompared racial groups and found that whites were the least likely to be circumcised.

At the present time (2000) non-therapeutic (routine) neonatal circumcisions are rare in England. A few are performed for religious reasons. They are not covered by the NHS. Post-neonatal circumcisions are performed usually due to mis-diagnosis of phimosis. 7 Rickwood reports that the incidence of post-neonatal circumcisions has declined sharply in the late 1990s. About 12,200 circumcisions were performed in Britain in a recent year (1998?). 7 This would suggest that 3.8 percent of British boys born today would be circumcised by their 15th birthday, if current trends continue. 7 However, in the Liverpool and Sefton districts only 1.5 percent of boys born today would be circumcised by their 15th birthday, if current trends continue. 7

The British Medical Association (BMA) take the ethical position that doctors have a right to conscientiously object to the performance of non-therapeutic male circumcisions of children on moral, ethical, or legal grounds. 6 The BMA consider male circumcision to be an invasive, radical procedure, and state that unless conservative treatments are tried first, a therapeutic circumcision would be unethical. 6 The BMA and the British Association of Paediatric Surgeons (BAPS) insist that the written consent of both parents should be obtained for non-therapeutic circumcision. 6,8,9 This ethical guidance may act to reduce the incidence of circumcision of male children.

The 2000 British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) found that 15.8 percent of British males aged 16 to 44 reported being circumcised. The incidence of circumcision was highest in the men aged 40-44 at 19.6 percent [born 1956-60] and lowest in the group aged 16-19 [born 1981-84] at 11.7 percent. 10 Men of ethnic minorities (except black Caribbeans) were signficantly more likely to circumcised than those described as "white". 10 Jews were 98.7 percent circumcised and Sikhs, Hindus, and Buddists were only 9.8 percent circumcised. 10 The most recent survey, therefore, appears to show a continuing decline in the incidence of circumcised males in Britain when compared with previous data.

NATSAL 2000 Age Percent Circumcised Birth Year 16-44 15.8% 1956-1984 40-44 19.6% 1956-1960 16-19 11.7% 1981-1984