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Periodic Survey 74 Circumcision Counseling

 

PERIODIC SURVEY OF FELLOWS

American Academy of Pediatrics

Division of Health Services Research

EXECUTIVE SUMMARY

 

 

This survey topic was initiated by the AAP Task Force on Circumcision to track changes in pediatricians’ attitudes and behavior regarding counseling on circumcision of healthy, stable, male newborns with no medical complications.  The questions on this survey were replicated from a previous Periodic Survey (PS#37, 1997) and responses are compared across years.  The findings will be used to inform the Task Force in its deliberations on the revision of the AAP policy statement on circumcision.  
 
PS#74 was mailed to a random sample of 1,620 non-retired U.S. members of the Academy.  An original mailing and 6 follow-up mailings to nonrespondents were conducted from February to July 2009.  After seven mailings we received a total of 927 completed questionnaires for a response rate of 57%.  Analysis was limited to post-residency pediatricians who provide patient care (584 or 75% of all post-resident respondents in 2009 and 734 pediatricians or 80% of all post-residents in 1997).
 
 

Counseling Practices:

 
Pediatricians’ discussion of circumcision with parents of male newborns has decreased since 1997.  The proportion of pediatricians who make no recommendation regarding circumcision has increased over the years, while the proportion who make a recommendation that healthy male newborns be circumcised has decreased.
 
Fewer pediatricians in 2009 compared to 1997 say they discuss the pros/cons of circumcision with all or most parents of healthy male newborns (67% vs. 74%, p<.01).
 
In 2009, the proportion of pediatricians who make no recommendation regarding circumcision to the majority of parents increased from that reported in 1997 (62% vs. 51%, p<.001).
 
Fewer pediatricians in 2009 compared to 1997 recommend to all/most parents of healthy male newborns that circumcision be performed (18% vs. 24%, p<.05).
 
A similar proportion in both survey years (47%, 52%) say they make a recommendation regarding circumcision to all/most parents dependent on their discussion with the parents (not statistically significant).
 
Fewer than 10% of pediatricians in both survey years recommend to all/most parents of male newborns that circumcision not be performed (7%, 9%).
 
Only 5% of pediatricians in both survey years say the majority of parents are uncertain about circumcision and seek their recommendation.
 
 

 

Attitudes Toward Medical Evidence Surrounding Circumcision

  

Attitudes toward the medical evidence for or against circumcision have remained the same across survey years.
 

Most pediatricians in both survey years think the medical indications for circumcision are inconclusive (57% in 2009 and 56% in 1997).  

About one-third of pediatricians in both years (30% in 2009, 34% in 1997) say the potential medical benefits of circumcision outweigh the disadvantages and risks, while about 1 out of 10 pediatricians in both years (12%, 11%) say the disadvantages and risks outweigh the potential medical benefits.