Circumcision and Non-circumcision in Australia

Male circumcision was popularized in Australia during the early twentieth century just as was done in other English-speaking nations. Consequently, a majority of adult Australian males, who were born prior to 1980, are circumcised.

In 1967, J.E. Wright published a paper which was highly critical of the then current practice of non-therapeutic circumcision of infant males.¹ This was followed in 1970 by I.O.W. Leitch, who published a landmark article that showed male neonatal circumcision is not necessary and is harmful in some ways.²

The following year, in 1971, medical authorities decided that non-therapeutic male neonatal circumcision was not necessary,³ and in 1983, medical authorities decided that non-therapeutic male neonatal circumcision should be discouraged.⁴

The incidence of circumcision of boys then started to decline. Wallerstein,⁶ relying on Wirth, provided the following table:

Table 3 Estimated Neonatal Circumcision Rate in Australia by State, 1973-74 to 1979-80(%)*

                            YEARS                PERCENTAGE
                  1973-1974       1979-1980      DECREASE
Total                 49              39            10
New South Wales       52              42            10
Victoria              39              28            11
Queensland            62              51            11
South Australia       47              41             6
Western Australia     51              38            13
Tasmania              68              43            25

Adapted from Wirth, J.L.: Current circumcision practices in Australia. Med. J. Aust., 1:179, 1982.

Wirth reported a further decline in neonatal circumcision from 50 percent to 24 percent during the period 1974-1983.⁷

In 1996, the Australasian Association of Paediatric Surgeons, said:

The Australasian Association of Paediatric Surgeons does not support the routine circumcision of male neonates, infants or children in Australia. It is considered to be inappropriate and unnecessary as a routine to remove the prepuce, based on the current evidence available.⁸

The incidence of non-therapeutic male neonatal circumcision, therefore, has declined sharply over the years. Richters et al. carried out a telephone survey of Australian males, aged 16 through 59 years of age in 2001-2, as part of the Australian Study of Health Relationships.⁹ That survey produced the following findings:

Richters et al. (2006) report that 69 percent of Australian-born men in the 2001-2 survey were circumcised.⁹ Of all the men surveyed, 58.7 percent reported being circumcised.⁸ In 2001-2, among Christians 61.39 percent were circumcised, and among Muslims, 74.31 percent were circumcised.⁹

The incidence of non-therapeutic neonatal circumcision started to decline in 1971 and non-circumcision became the norm in Australia about 1980.^5,6 This has produced a sharp dichotomy between older and younger age groups. The older age group is about 65 percent circumcised and the younger group is about 70 percent non-circumcised.⁹ (Some older Australian circumcised males may feel some anxiety regarding their missing body part and lobby for restoration of the practice of medically-unnecessary non-therapeutic circumcision.)

The incidence of circumcision in Australia continued to decline and in 1996 the Australian College of Pediatrics estimated that only about 10 percent of newborn boys currently were being circumcised.¹⁰ Spilsbury et al. report that in Western Australia, the incidence of routine [i.e., non-therapeutic] circumcision had declined from 9.8 percent in 1994 to 7.8 percent in 1999.¹¹ In Western Australia, boys circumcised between the age of six months and 15 years were most likely to be aboriginal or Torres Strait Islanders.¹⁰

Post-neonatal allegedly-therapeutic circumcision appears to be over-performed in Australia. Spilsbury et al. report that the number of such circumcisions is seven times the expected rate of phimosis.¹² Hill suggests that this is due to outmoded and inaccurate data in textbooks regarding development of preputial retractability in children and adolescent males that causes improper confusion of developmentally non-retractile foreskin with pathological phimosis.¹³

The Medicare statistics of the Department of Health provide information on the number of claims for male circumcision. O'Donnell has studied these claims. In 2004, the incidence of male neonatal circumcision in Australia was stable at about 12.7 percent, which means that genital integrity was preserved for 87.3 percent of boys born in that year.¹⁴ O'Donnell reports sharp divisions by state. Tasmania was the lowest at 3.9 percent, while Queenland was the highest at 19.5 percent for the year ended February 2004.¹⁴ The absolute number of claims paid for males less than six months of age for the year ended February 2004 was 16,311.¹⁴

As the incidence of circumcision has gone down, infant and child mortality steadily has gone down,¹⁵ while the life expectancy of Australians steadily has increased,¹⁶ according to the Australian Institute for Health and Welfare.

Australian States operate public hospitals. By the end of 2007, most public hospitals had stopped providing free non-therapeutic circumcisions, however, Medicare still offered a subsidy.

It appears that certain medical doctors in South Australia, New South Wales, and Queensland are promoting the circumcision of male children for personal financial gain and this is keeping the rate inappropriately high in those states. In spite of their efforts, the overall incidence of circumcised males in Australia is expected to decline gradually as older circumcised males pass away and newborn non-circumcised males enter the population and Australia continues to march inexorably toward increased genital integrity for its males.

The Royal Australasian College of Physicians estimated in 2010 that 10 to 20 percent of newborn Australian boys are still being circumcised.¹⁷

In January 2013, Circumcision Information Australia collected data on the incidence of infant circumcision in Australia from 2009 through 2012. The data show a renewed decline of the popularity of circumcision in Australia in Queensland and New South Wales, which produced an overall decline in the percentage of Australian boys being circumcised. The decline is attributed to a smaller percentage of circumcised fathers in the current generation of fathers. 9.3 percent of Australian infant boys were circumcised in fiscal year 2012.¹⁸

2013 Statistics

It can safely be said that the infant circumcision rate in Australia in 2013 was lower than at any time in the previous one hundred years. And this, despite the proportion of all male infants subjected to religiously motivated circumcision being at an all-time high.

Medicare claims for circumcision at less than 6 months of age, 2013 Rate*
-------------------------------------------------------------------------
New South Wales 14.5%
South Australia 14.5%
Queensland 11.2%
Australian Capital Territory 7.8%
Victoria 7.6%
Western Australia 7.3%
Tasmania 1.8%
Northern Territory 1.7%
-----
Australia 10.8%
* Number of claims as a percentage of male births

NSW and South Australia are neck and neck for the state with the highest rate, but the rate in NSW has been declining steadily for a number of years whilst the rate in South Australia has been fairly stable, so it is likely that South Australia will become the state with the highest rate in 2014.

The proportion of the Australian population that is foreign-born is higher than that of any other industrialised nation. The immigration in recent years of large numbers of people from countries where circumcision is a religious or cultural norm has given rise to speculation that births to parents of immigrants are making the infant circumcision rate (defined for this purpose as the number of Medicare claims in respect of boys aged less than 6 months divided by the number of male births) higher than it would be without immigration and, by corollary, that the infant circumcision rate among boys born to Australian-born parents might be lower than the overall infant circumcision rate shown in the table above.

While, naturally, the rate among boys born to parents born in countries where circumcision is prevalent is probably higher than the overall rate, one must take into account boys born to parents born in countries where circumcision is not the norm (notably, China and India) to evaluate the overall effect of immigration on the infant circumcision rate. Having analysed this in considerable depth, my conclusion is that the overall effect of births to foreign-born parents is still to reduce the infant circumcision rate, as it has undoubtedly done throughout the last one hundred years (at until recently, when the effect has become less certain). Much depends, of course, upon the assumptions one makes about the proportion of male births to Muslim parents, to non-Muslim parents from the Middle East and North Africa, and to Filipino and Korean parents, that result in a Medicare claim for circumcision at less than 6 months of age.

Note:

See also  Circumcision in Australia.

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