Arizona rightly ended funds for circumcisions

Arizona, whose most popular alternate license plate says, It Shouldn't Hurt to Be a Child, has validated that statement by deciding to no longer pay for routine infant circumcisions for newborn boys under Medicaid.

It means as many as 12,600 more Arizona newborns per year likely won't suffer genital mutilation at birth because there will be no Medicaid funding to subsidize the intrusive, medically unnecessary surgery.

Arizona becomes the seventh state, along with California, Oregon, Washington, Nevada, North Dakota and Mississippi, to end such taxpayer-supported circumcisions. North Dakota stopped Medicaid coverage in 1991.

When government departments were instructed to offer up ways to cut their budgets, the  Arizona Health Care Cost Containment System staff determined they could save money by not cutting foreskins. While their prime motive was balancing the budget, their actions were a de facto endorsement of infant human rights and body integrity. They confirmed what has been known for decades about circumcision: The impairing procedure permanently removes what nature put there for a purpose and offers spurious health benefits.

There are all kinds of reports now that say it isn't medically necessary, said Sen. Ruth Solomon, D-Tucson, during the recent legislative session as lawmakers sought ways to balance the $6.1 billion budget for the year beginning July 1. With no medical society in the world recommending circumcision, it becomes an issue of medical ethics to stop the discredited procedure that survives in America largely out of cultural tradition and conformity with the tacit support of doctors who know better. Repeated studies by the American Academy of Pediatrics, since 1971, and other research confirm that medical risks, pediatric trauma and permanent structure loss outweigh any slight benefits.

Other states, also facing tough challenges to balance budgets, are eyeing eliminating medical reimbursements for circumcision. A growing number of private insurance companies have similarly dropped coverage. They have determined it is a form of elective cosmetic surgery — elective for parents, but clearly without consent of a helpless baby boy whose foreskin is amputated.

Medicaid paid an average of $132 per circumcision in Arizona last year, or $1.6 million — two-thirds of it in federal dollars and one-third, or about $554,400, from state funds. A national study, completed last year, noted that where states pay more than $60 per circumcision, the rate of such surgeries is twice as high as when they are under $50 (38 percent to 20.2 percent), thus suggesting a financial incentive for doctors to perform what they otherwise wouldn't press parents to perform.

With growing public awareness that the foreskin plays multiple roles for protection, sensitivity, lubrication and the mechanics of sex, the rate of circumcision in America has dropped from almost 90 percent in the 1970s to under 60 percent today, and only about 35 percent in America's western states.

Public awareness has stemmed from a host of books debunking circumcision, countless Internet Web sites and clearer informed-consent forms for expectant parents. Add to that lawsuits from botched circumcisions, deaths attributed to complications from circumcisions, and the work of activists and such outspoken anti-circumcision voices as Howard Stern, Dr. Dean Edell and the late Dr. Benjamin Spock. Currently about 25.9 percent of all circumcisions of newborns performed nationally are in low-income families covered by Medicaid. At least $35 million in public funds could be saved and more than 310,000 baby boys per year could grow up whole and intact as more than 80 percent of males do worldwide. Dr. George Denniston, a Seattle physician who founded  Doctors Opposed to Circumcision, recalls when he once did circumcisions, I clearly violated, all in one instant, the Golden Rule (I certainly would not have wanted that done to me); the major tenet of medical practice, First, do no harm; and all seven Principles of the American Medical Association's Code of Ethics.

Forty-seven human rights and genital integrity organizations and centers last year sent petitions to Congress to end Medicaid reimbursements. They further question the double standard of the federal government, which banned female circumcision in 1996, but fails to provide equal protection under the law for males in the area of genital mutilation. Some 1.2 million American baby boys are circumcised annually — an estimated $270 million business. Little wonder, many doctors perpetuate the process despite its lack of support by professional groups. They capitalize on uninformed and misinformed parents who typically think circumcisions are correcting nature or somehow go with birth.

In a Tribune article in December 1978, Dr. Robert Ganelin, then chairman of pediatrics at Maricopa County Hospital, assailed routine circumcisions, which had reached 88 percent of all males born at Desert Samaritan Hospital in Mesa. I have a great concern for the dollar cost and the time involved — too much money is being spent for circumcisions that generally are not necessary, he said. Also, our personnel at county, in taking the time to perform circumcisions, are being taken away from medical calls that many be more important. The kids scream through the entire procedure because it's very painful, he added.

Now 24 years later, Arizona, which often ranks abysmally low in measurements of the health, safety and welfare of its children, has taken a key step forward in respecting the rights of our newest citizens. Fewer newborns will face the assault of the Gomco clamp — the rudest welcome to a baby's world. May parents, regardless of income or insurance, recognize the inherent right of all human beings to an intact body, especially in Arizona, where it shouldn't hurt to be a child.

Tribune writer Lawn Griffiths has worked for more than 25 years for newborn rights.

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