Studies done before 1988 clearly have shown that few parents were aware of the medical debate regarding circumcision, and most based their choice on concerns relating to hygiene and appearance.27,28 From 1983 to 1987 four separate trials tested formal educational intervenions aimed at discouraging circumcision.29-32 Only one showed a small reduction in the circumcision rate (72 versus 94 percent), but none showed any improvements in parents understanding of the medical issues involved despite the wide range of education levels. In one study the educational intervention was not only ineffective but also increased parental dissatisfaction with care. Only one study specifically addressed the timing of the decision,33 and found that 36 percent of women chose circumcision even before becoming pregnant. Since the AAP's 1989 statement emphasizing the informed consent process, no one has revisited the issue of how or when parents decide whether to have their sons circumcised.
Results Fifty-five surveys were completed. No parent refused to participate, but 3 surveys were returned uncompleted. Forty-two parents (76 percent) were seen at site A and belonged to an health maintenance organization through an employer or university; of these 23 (42 percent of total) received prenatal care from a private obstetrician or mures midwife, and 19 (35 percent of total) received prenatal care from a family physician. The remaining 13 participants (24 percent) were seen at site B, a community health center for patients without insurance or on public assistance; of these 10 had received prenatal care from a nurse midwife, and 3 listed other clinics. Respondents named 21 different physicians or nurse midwives as their providers, representing 7 different clinics. The most frequently reported provider had 7 patients, and the next most frequent 4 patients; thus the sample was not skewed by the practice of any single provider. Forty-four (80 percent) infants had been circumcised.
The Provider's Role in the Decision Regarding the character of the providers discussion, 38 of 46 respondents (83 percent) described a neutral process, with 6 (13 percent) having it recommended and 2 (4 percent) being advised against it. Not surprisingly, then, when asked whether the discussion had changed the parent's mind about circumcision, 38 (83 percent) said no. Of the 8 (17 percent who said yes, 5 (62 percent) chose circumcision, not a significant difference, 7 reported a neutral discussion, and only 1 reported a provider expressing an opinion (in that case favoring circumcision, and that infant was circumcised).
Of the 6 infants whose providers recommended circumcision, all were circumcised, whereas of the 2 infants whose providers recommended against circumcision, whereas of the 2 infants whose providers recommended against circumcision only 1 was not. Seven of these 8 parents reported making their decision before the provider's discussion; only one chose circumcision postpartum after having it recommended.
Reasons for avoiding circumcision are ranked in Table 2. No parents reported thinking the uncircumcised state was medically better: rather, most believed it was simply unnecessary. Parents did not report the father's status as important in the decision very often: however, of 8 infants with reportedly uncircumcised fathers, only 2 were circumcised.
Parents choosing against circumcision did not display strong beliefs that being uncircumcised was in any way better or healthier; they simply saw circumcision as unnecessary. An uncircumcised father appeared to be a strong predictor of the choice, although it is unclear how this fact affected the parents' decision-making process. Because these parents did not rate the father's status as important, having a similar appearance is probably not the issue. This finding also raises the issue of whether parents are being provided with information about the potential medical benefits of not being circumcised.
One who is called being Circumcised = With a Marriage Covenant One who is called being Uncircumcised = Without a Marriage CovenantOne who is called being a Servant = With a Marriage to an UnbelieverOne who is called being Free = With a Marriage to a Believer
To investigate the changing circumcision rate in South Korea in the last decade and to propose underlying causes for this change, in the context of the present fluctuating world-wide trends in circumcision. From 2009 to 2011, 3,296 South Korean males (or their parents) aged 0-64 years were asked about their circumcision status, their age at circumcision, and their information level regarding circumcision. We employed non-probability sampling considering the sensitive questions on the study theme. Currently the age-standardized circumcision rate for South Korean males aged 14-29 is found to be 75.8%. In an earlier study performed in 2002, the rate for the same age group was 86.3%. Of particular interest, males aged 14-16 show a circumcision rate of 56.4%, while the same age group 10 years ago displayed a much higher percentage, at 88.4%. In addition, the extraordinarily high circumcision rate of 95.2% found 10 years ago for the 17-19 age group is now reduced to 74.4%. Interestingly, of the circumcised males, the percentage circumcised in the last decade was only 25.2%; i.e., the majority of the currently circumcised males had undergone the operation prior to 2002, indicating that the actual change in the last decade is far greater. Consistent with this conjecture, the 2002 survey showed that the majority of circumcised males (75.7%) had undergone the operation in the decade prior to that point. Focusing on the flagship age group of 14-16, this drop suggests that, considering the population structure of Korean males, approximately one million fewer circumcision operations have been performed in the last decade relative to the case of non-decline. This decline is strongly correlated with the information available through internet, newspapers, lectures, books, and television: within the circumcised population, both the patients and their parents had less prior knowledge regarding circumcision, other than information obtained from person to person by oral communication 1e1e36bf2d