To Cut or Not to Cut?

Chris Macgowan was one of a dozen first-time dads enrolled in a class for expectant fathers. Topics ranged from breast-feeding to car-seat safety to daycare options, but there was one subject that brought the freewheeling conversation to a virtual standstill: circumcision.

Legs were crossed and the room grew quiet; Macgowan quickly realized he was the only soon-to-be dad who did not plan to circumcise his son. Even the class leader seemed to favor the procedure, in which the foreskin is trimmed from the penis of an infant boy, usually on the second day after birth. “It seemed like in Minnesota circumcision was just the expected thing to do,” says Macgowan, a software engineer who lives in St. Paul. “I remember feeling very alone.”

It wasn’t his imagination. While the rate of nonreligious neonatal circumcision has gone down nationwide, with recent estimates as low as 56 percent, the procedure remains enormously popular—critics say puzzlingly so—in the Upper Midwest. While only a third of infant boys are circumcised in the western United States, a little boy born in the Midwest still has about a seven in ten chance of leaving the hospital without his foreskin.

In the rest of the world, this ratio is almost reversed. It was Macgowan’s experience living (and visiting the occasional locker room) in Germany that first made him question whether circumcision was necessary. By the time he and his wife, Jennifer Hays, were expecting their first boy seven years ago, the circumcision rate in the United States had been trending down (from a high of between 85 and 90 percent in 1965) and public opinion seemed to be tipping against it. In 1999, the American Academy of Pediatrics issued a statement saying the potential medical benefits of neonatal circumcision weren’t sufficient to recommend the practice. The American Medical Association followed suit soon after, declaring neonatal circumcision a “nontherapeutic” procedure.

Then, last winter, the results of a National Institutes of Health study in Africa suggested that circumcision may reduce a man’s risk of contracting AIDS from heterosexual sex by more than half. The clinical trials of nearly 8,000 men in Kenya and Uganda were discontinued when health officials decided it would be unethical not to offer the procedure to all the men in the study. The NIH findings sparked a flurry of letters to The Lancet, the British medical journal that first published the data, and in New York City inspired discussion about offering circumcision to men at high risk of contracting AIDS. The findings also reignited the anxieties of new parents, who are burning up online message boards with heated arguments for or against the procedure. As the editors of the online parenting magazine babble.com noted, “broaching the topic of circumcision has become a sure-fire way to start a shouting match.”

The shouting may be somewhat muted in Minnesota, says Laurie Frattalone, a birth and family educator with Fairview Children’s Clinic in Minneapolis. “Parents might be afraid to reveal what they’re planning to do because it’s politically hot right now.”