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Periodic Survey #37 Attitudes and Experiences Regarding Counseling on Circumcision

PERIODIC SURVEY OF FELLOWS
American Academy of Pediatrics
Division of Child Health Research

EXECUTIVE SUMMARY



This report presents findings from Periodic Survey #37 on pediatricians' practices and beliefs on circumcision of healthy newborn males, initiated by the Task Force on Circumcision. These data were collected to help inform the revision of the 1989 policy on circumcision. The survey was conducted from July to November 1997; after five mailings a total of 1,165 completed questionnaires were received for a response rate of 63.7%. These analyses are based on responses from the 734 post residency pediatricians who provide health supervision to newborns up to 2 months old (73% of all post residency respondents).

Current Counseling Practices Regarding Circumcision

Pediatricians were asked about the proportion of parents (all/almost all, most, some, few/none) with whom they discussed circumcision and gave advice regarding circumcision. The percents are based on the number of pediatricians who responded to each question independently.

  • Most pediatricians (74.1%) discuss the pros and cons of circumcision with all or most parents of healthy newborn male patients; another 20.7% say they do so with parents of some patients, while only 5.2% do not discuss the options.
  • Slightly more than half (52.3%) say they make a recommendation regarding circumcision for all or most patients dependent on discussion with the parents; 26.5% sometimes make a recommendation dependent on discussion with parents. For 21.2% of pediatricians, a recommendation is not dependent on such a discussion.


Regarding pediatricians' specific recommendation on circumcision:

  • One fourth of all pediatricians (24%) recommend to all or most parents that circumcision be performed; 12% recommend circumcision to some patients, while 64% recommend circumcision to only a few or no newborn male patients.
  • Nine percent of pediatricians recommend to all or most parents that circumcision not be performed; 14.6% so recommend to some parents, while 76.0% say they recommend against circumcision to few if any parents.
  • One half of pediatricians make no recommendation regarding circumcision to all or most of the parents of newborn male patients in their practice, and 16% make no recommendation to some parents. About one-third (34%) of pediatricians say they make no recommendation regarding circumcision to a few or no parents.

Pediatricians Who Recommend to:
(in percents)

All/Most
Patients
Some
Patients
Few/No
Patients
Recommend circumcision be performed 24.0 12.3 63.7 = 100%
Recommend circumcision not be performed 9.4 14.6 76.0 = 100%
Make no recommendation regarding circumcision 50.5 15.7 33.9 = 100%

  • The majority of pediatricians say most parents do not seek their recommendation regarding circumcision. Only 5.4% of pediatricians report all or most parents seek their recommendation regarding circumcision. More than half (56.8%)of pediatricians say only some parents are uncertain about circumcision and seek their recommendation, and 38.3% report few parents do so.


Current Clinical Practices Regarding Circumcision

Sixteen percent of pediatricians say they always perform the circumcision of their newborn male patients, 8.1% say they usually do so, and 5.6% only sometimes do so. Seven out of ten pediatricians (70.3%) do not perform circumcisions. Their reasons for not doing so are:

  • The mother's OB/GYN performs the circumcision (71.2%);
  • They prefer not to perform this procedure (31.8%);
  • Their hospital policy does not allow them to perform circumcisions (10.2%);
  • They refer circumcisions to another pediatrician (7.3%);
  • They were not trained in this procedure (6.6%).


Attitude Toward Circumcision

  • Most pediatricians (55.5%) think the medical indications for circumcision are inconclusive; 33.6% say the potential medical benefits outweigh the disadvantages and risks, while 10.9% say the disadvantages and risks outweigh the benefits.

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