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AUDIE CORNISH, Host:

In recent months, this show has been exploring the impact of parents backing off of vaccinations for their babies. Well, there's another piece of conventional child-rearing wisdom that people are resisting, this time about circumcision.

New research made headlines this past week, about a steep drop in circumcisions of baby boys. Circumcision rates in hospitals fell from 56 percent in 2006, to less than a third of boys born last year, according to a federal researcher.

Now, doctors caution that those numbers aren't definitive. For instance, they don't include circumcisions done in religious settings.

But Dr. Douglas Diekema, a pediatrics bioethicist at the University of Washington, says there's no doubt about the overall trend.

DOUGLAS DIEKEMA: I think all of us agree there probably is a decrease in the number of circumcisions over time, and that's probably the result of a number of factors - one of which is that about 10 years ago, the American Academy of Pediatrics came out with a policy statement that was fairly neutral on whether circumcisions should be recommended for newborns or not. And that probably changed the way pediatricians were talking to their families.

Along with that recommendation, a decrease in Medicaid funding. And that means a lot of families...

CORNISH: So Medicaid essentially stopped covering this after that neutral comment from the academy?

DIEKEMA: That's correct, in many states. And of course, insurance coverage often follows Medicaid. You know, it's also worth pointing out that our population is becoming increasingly Hispanic, and that's a population that traditionally, has not circumcised their babies.

CORNISH: People who oppose circumcisions are known as intactivists.

(SOUNDBITE OF LAUGHTER)

CORNISH: And they're also known to be very vocal in their opposition to the procedure. Tell us what their arguments are.

DIEKEMA: Their arguments are largely emotional. I mean, just the fact that they insist on referring to this as genital mutilation tells you that they're refusing to recognize whether there may be any medical benefit to the procedure.

Their use of that term is intentional. I think they're trying to make a point that if it's wrong on girls, it's wrong on boys. But there are some significant differences with boys - the most important of which is that there are, in fact, some proven medical benefits to circumcision.

There is a fairly substantial, important reduction in the risk of contracting many sexually transmitted infections. In newborns, there is a decreased likelihood of getting a urinary tract infection, which for a newborn baby can be a fairly significant illness. It's much different than when an adult gets a urinary tract infection.

And of course, the one most people are now familiar with is that at least three very well-done, randomized control trials in Africa show that in Africa, there's a substantial decrease in the transmission of HIV.

CORNISH: And transmission from female to male partners, I believe, in those studies.

DIEKEMA: That's correct.

CORNISH: So Dr. Diekema, as a doctor, how do you approach patients about the issue of circumcision, especially if they raise a question about it?

DIEKEMA: I think the most important issue for physicians, when they talk to parents about circumcision, is that they be honest about the risks and the benefits. But the other thing they should probably know is that the risks of circumcision are considerably lower in the newborn population than they are if that child is older.

CORNISH: Dr. Douglas Diekema is a pediatric bioethicist at the University of Washington. He joined me today from our member station KUOW in Seattle.

Dr. Diekema, thank you so much.

DIEKEMA: You're welcome.

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