Prevalence of circumcision

The prevalence of circumcision is the percentage of males in a given population who have been circumcised. Worldwide circumcision rates are significantly rising, with the procedure most commonly being performed as a prophylactic health intervention, religious obligation, or cultural practice.[1] Since 2010, both the World Health Organization and Joint United Nations Programme on HIV/AIDS have been promoting a higher rate of international circumcision prevalence as a prophylaxis against STD transmission and other pathological conditions, stating: "There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men."[2]

Map of countries based on circumcision prevalence, based on a 2007 World Health Organization report
  Widespread, near-universal: >80% prevalence
  Widespread, common: 20–80% prevalence
  Uncommon: <20% prevalence
  N/A

According to Bolnick, Koyle & Yosha (2012), worldwide circumcision rates are projected to significantly rise in the coming decades:[1]

Current medical advice and public health projects now underway seem to point to a worldwide increase in circumcision rates in the first half of the twenty-first century.[1]

Overview

Present

Rates vary widely, from over 90% in Israel and many Muslim-majority countries, 86.3% in South Korea, to 80% in the United States, to 58% in Australia, to 45% in South Africa, to 20.7% in the United Kingdom, to under 1% in Japan and Honduras.[3][4][5][6][7][8][9][10][11] In 2016, the global prevalence of circumcision was estimated to be around 38%, with notable increases of circumcision prevalence seen in the United States, the Middle East; and Africa; major medical organizations have promoted a higher rate of circumcision in Africa as a preventive against the spread of HIV/AIDS. In 2020, the World Health Organization reiterated that it is an efficacious prophylactic intervention in if carried out by medical professionals under safe conditions in areas of high HIV/AIDS prevalence.[12][10][13][14][15][16][17]

Even though mainstream Christian denominations do not require male circumcision,[18] male circumcision is commonly practiced in many predominantly Christian countries and among many Christian communities.[19][20][21][22] Circumcision is nearly universal among the members of the Coptic, Ethiopian, and Eritrean Orthodox Churches.[23] The prevalence of circumcision in the United States is approximately 80%[5] due to support from the country's medical community as a prophylactic health intervention against disease.[16] The continent of Africa, similarly, has widely adopted the practice as a preventive measure against the spread of HIV. While it has overwhelming prevalence in the Muslim world and in Israel due to the religious beliefs of most Muslims and Jews; however, some non-Muslim groups living within Muslim-majority countries, such as Armenians and Assyrians, do not practice it.[24] It is prevalent in some Muslim-majority countries in southeast Asia such as Indonesia and Malaysia; however, the WHO states that there is "little non-religious circumcision in Asia, with the exceptions of the Republic of Korea and the Philippines".[7] In parts of Africa it is often practiced as part of tribal customs from Christians, Muslims and Animists. In contrast, rates are much lower in most of Europe, parts of southern Africa, most of Asia, Oceania and Latin America, constituting South America, Central America, the Caribbean and Mexico.[25]

Australia, Canada, Ireland, New Zealand and the United Kingdom are examples of countries that have seen a decline in male circumcision in recent decades, while there have been indications of increasing demand in southern Africa, partly for preventive reasons due to the HIV epidemic there.[13]

Future

Bolnick, Koyle & Yosha, 2012 has projected that international circumcision prevalence will significantly rise in the coming decades, stating:[1]

Current medical advice and public health projects now underway seem to point to a worldwide increase in circumcision rates in the first half of the twenty-first century.

Attributing this increase predominately to:[1]

  • Increasingly positive statements by major medical organizations surrounding its usage in developed nations.
  • Population growth in nations that have high circumcision incidence.
  • Population stagnation or decreases in countries that predominately do not circumcise.
  • Public health projects by international medical organizations, including by the World Health Organization, which have widely encouraged it as part of a comprehensive means of HIV/AIDS prevention.

Africa

Studies suggest that about 62% of African males are circumcised.[26] However, the rate varies widely between different regions, and among ethnic and religious groups, with Muslim North Africans practising it for religious reasons, central Africans as part of ethnic rituals or local custom, (with some practising female genital mutilation as well) and some traditionally non-circumcising populations in the South recently adopting the practice due to measures by the World Health Organisation to prevent AIDS.[27] Williams, B.G. et al. commented that: "Most of the currently available data on the prevalence of [male circumcision] are several decades old, while several of the recent studies were carried out as adjuncts to demographic and health surveys and were not designed to determine the prevalence of male circumcision."[28]

Prevalence of circumcision in Africa
Country WHO

(2006)[29]

 Williams et al

(2006)[28]

 Morris et al

(2016)[9][30]

 Angola>8066 57.5
 Central African Republic20–8067 63
 Chad>8064 73.5
 Republic of the Congo>8070 70
 Democratic Republic of the Congo>8070 97.2
 Gabon>8093 99.2
 Burundi<202 61.7
 Djibouti>8094 96.5
 Eritrea>8095 97.2
 Ethiopia>8076 92.2
 Kenya>8084 91.2
 Rwanda<2010 13.3
 Somalia>8093 93.5
 Sudan20–8047 39.4
 Tanzania20–8070 72
 Uganda20–8025 26.7
 Botswana<2025 15.1
 Lesotho20–800 52
 Malawi<2017 21.6
 Mozambique20–8056 47.4
 Namibia<2015 25.5
 South Africa20–8035 44.7
 Eswatini<2050 8.2
 Zambia<2012 21.6
 Zimbabwe<2010 9.2
 Benin>8084 92.9
 Burkina Faso>8089 88.3
 Cameroon>8093 94
 Equatorial Guinea>8086 87
 Gambia>8090 94.5
 Ghana>8095 91.6
 Guinea>8083 84.2
 Guinea-Bissau>8091 93.3
 Côte d'Ivoire20–8093 96.7
 Liberia>8070 97.7
 Mali>8095 86
 Mauritania>8078 99.2
 Niger>8092 95.5
 Nigeria>8081 98.9
 Senegal>8089 93.5
 Sierra Leone>8090 96.1
 Togo>8093 95.2

Less than 20%

Botswana, Rwanda, Eswatini, Zimbabwe.[9][30]

Between 20% and 80%

Angola, Burundi, Central African Republic, Chad, Congo (Rep), Lesotho, Malawi, Mozambique, Namibia, South Africa, Sudan, Tanzania, Uganda, Zambia.[9][30]

South Africa

It is estimated that 48.7% of males are circumcised in South Africa.[9] One national study reported that 54.2% of black Africans were circumcised, with 32.1% of those traditionally circumcised and 13.4% circumcised for medical reasons.[31]

More than 80%

Benin, Burkina Faso, Cameroon, Congo (Dem Rep), Cote d’Ivoire, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Togo.[9][30]

Americas

Less than 20%

Less than 20% of the population are circumcised in Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, El Salvador, Ecuador, French Guiana, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Saint Lucia, The Bahamas, Trinidad and Tobago, Uruguay, Venezuela.[29]

The overall prevalence of circumcision is reported to be 6.9% in Colombia, and 7.4% in Brazil (13% in Rio de Janeiro), with most of those being done due to medical issues later in life.[32]

The prevalence of circumcision in Mexico is estimated to be 10% to 31%.[33]

Canada
Rate of neonatal circumcision by province according to data from the Maternity Experiences Survey (MES) in 2006–2007.[34]

Circumcision in Canada followed the pattern of other English speaking countries, with the practice being adopted during the 1900s, to prevent masturbation and other perceived issues of the time, but with the rate of circumcision declining in the latter part of the 20th century, particularly after a new policy position was released in 1975.[35] The Canadian Paediatric Society estimated that, in 1970, 48 percent of males were circumcised.[36] However, studies conducted in 1977–1978 revealed a wide variation in the incidence of circumcision between different provinces and territories. For example, Yukon reported a rate of 74.8 percent, while Newfoundland reported an incidence of 1.9 to 2.4 percent.[37] The rate continued to drop, with the newborn circumcision rate in Ontario in 1994–95 dropping to 29.9%.[38]

A survey of Canadian maternity practices conducted in 2006/2007, and published in 2009 by the national public health agency, found a newborn circumcision rate of 31.9%.[34] Rates varied markedly across the country, from close to zero in Newfoundland and Labrador to 44.3% in Alberta. In 2015, the Canadian Paediatric Society used those statistics in determining the national circumcision rate it currently quotes.[34][39]

Percentage of mothers reporting having their male baby circumcised, by province and territory (2006/07)[34]
Province/Territory Percentage
Alberta 44.3
British Columbia 30.2
Canada 31.9
Manitoba 31.6
New Brunswick 18.0
Newfoundland and Labrador *
Northwest Territories 9.7
Nova Scotia 6.8
Nunavut *
Ontario 43.7
Prince Edward Island 39.2
Quebec 12.3
Saskatchewan 35.6
Yukon *
* Numerator too small for rate calculation

United States

As of 2014, an estimated 80.5% of American men are circumcised, and the prevalence of the procedure is considered to be near-universal in the country.[10][40] In reaction to a 2012 statement by the American Academy of Pediatrics (AAP) and a 2014 statement by the Centers of Disease Control and Prevention (CDC), public acceptance of the practice and its prevalence are believed to have increased.[16] The CDC has calculated the present rate of circumcision in the United States to be 81%; Morris et al. found a somewhat lower present incidence of 77% in 2010. During the 2000s, the prevalence of circumcision in men aged 14–59 differed by race: 91 percent of non-Hispanic white men, 76 percent of black men, and 44 percent of Hispanic men were circumcised, according to data in Mayo Clinic Proceedings.[10]

Medicaid funding for infant circumcision used to be available in every state, but starting with California in 1982, 18 states (Arizona, California, Colorado, Florida, Idaho, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Nevada, North Carolina, North Dakota, Oregon, South Carolina, Utah, and Washington) had eliminated Medicaid coverage of routine circumcision by July 2011.[41] One study in the Midwest of the U.S. found that this had no effect on the newborn circumcision rate but it did affect the demand for circumcision at a later time.[42] Another study, published in early 2009, found a difference in the neonatal male circumcision rate of 24% between states with and without Medicaid coverage. The study was controlled for other factors such as the percentage of Hispanic patients.[43] Other studies have shown that the rise of immigrants from East Asia, Southeast Asian, South Asia and Hispanic South American countries are a large factor in why the rates continue to drop in the US.[44]

The Centers For Disease Control and Prevention (CDC) uses two data sources to track circumcision rates. The first is the National Health and Nutrition Examination Survey (NHANES), which records circumcisions performed at any time at any location. The second is the National Hospital Discharge Survey (NHDS), which does not record circumcisions performed outside the hospital setting or those performed at any age following discharge from the birth hospitalization.[45] Methodologically flawed calculations throughout the 2000s and 2010s showed the rate as significantly plummeting, but these statistics are almost universally believed to be artificially low by researchers due to an increasing trend of performing neonatal circumcisions outside of hospitals, a trend not reflected in the data.[46]

Circumcision was the second-most common procedure performed on patients under one year of age, after routine inoculations and prophylactic vaccinations.[47] There are various explanations for why the infant circumcision rate in the United States is different from comparable countries. Many parents’ decisions about circumcision are preconceived, which may contribute to the high rate of elective circumcision.[48] Brown & Brown (1987) reported the most correlated factor is whether the father is circumcised.[49]

Asia

Less than 20%

Armenia, Bhutan, Burma, China, Cambodia, Hong Kong,[50] India, Japan, Laos, Mongolia, Nepal, North Korea, Papua New Guinea, Singapore, Sri Lanka, Taiwan, Thailand, Vietnam.[29]

The overall prevalence of circumcision in Cambodia is reported to be 3.5%.[32]

The overall prevalence of circumcision in China is reported to be 14%.[9]

Between 20% and 80%

Indonesia, Kazakhstan, Malaysia, and South Korea.[51]

South Korea

Circumcision is largely a modern-day phenomenon in South Korea. While during the twentieth century the rate of circumcision increased to around 80%, virtually no circumcision was performed prior to 1945, as it was against Korea's long and strong tradition of preserving the body as a gift from parents.[51] A 2001 study of 20-year-old South Korean men found that 78% were circumcised.[52] At the time, the authors commented that "South Korea has possibly the largest absolute number of teenage or adult circumcisions anywhere in the world. Because circumcision started through contact with the American military during the Korean War, South Korea has an unusual history of circumcision." According to a 2002 study, 86.3% of South Korean males aged 14–29 were circumcised.[4] In 2012, it's the case of 75.8% of the same age group. Only after 1999 has some information against circumcision become available (at the time of the 2012 study, only 3% of Korean internet sites, using the most popular Korean search engine Naver, were against indiscriminate circumcision and 97% were for).[51] The authors of the study speculate "that the very existence of information about the history of Korean circumcision, its contrary nature relative to a longstanding tradition, its introduction by the US military, etc., has been extremely influential on the decision-making process regarding circumcision."[51]

More than 80%

Afghanistan, Azerbaijan, Bangladesh,[9] Bahrain, Brunei, Iran, Iraq, Israel,[53] Pakistan,[9] Jordan, Kuwait, Kyrgyzstan, Lebanon, Oman, Palestine, the Philippines,[32] Qatar, Saudi Arabia, Syria, Tajikistan, Turkey, Turkmenistan, Uzbekistan, United Arab Emirates and Yemen.[29]

The overall prevalence of circumcision (tuli) in the Philippines is reported to be 92.5%. Most circumcisions in the Philippines are performed between the ages of 11 to 13.[54][55]

Europe

Less than 20%

Armenia, Austria, Belarus, Belgium, Bulgaria, Croatia, Czech Republic, Cyprus, Denmark, Estonia, Finland, France, Georgia, Germany,[56] Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Malta, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Russia, Slovakia, Slovenia, Spain, Serbia, Sweden, Switzerland, Ukraine,[29] and the United Kingdom.[57]

A national survey on sexual attitudes in 2000 found that 15.8% of men or boys in the United Kingdom (ages 16–44) were circumcised by their parents' choosing, while 11.7% of 16- to 19-year-olds, and 19.6% of 40- to 44-year-olds said they had been circumcised. Apart from black Caribbeans, men born overseas were more likely to be circumcised.[57] Rickwood et al. reported that the proportion of English boys circumcised for medical reasons had fallen from 35% in the early 1930s to 6.5% by the mid-1980s. As of 2000 an estimated 3.8% of male children in the UK were being circumcised for medical reasons by the age of 15.[58] The researchers stated that too many boys, especially under the age of 5, were still being circumcised because of a misdiagnosis of phimosis. They called for a target to reduce the percentage to 2%.

In Finland, the overall prevalence of circumcision is 2–4%, according to a recent publication by the Finnish Health Ministry.[59]

In Germany, the German Health Interview and Examination Survey for Children and Adolescents found in 2007 that 10.9% of boys aged 0–17 had been circumcised.[56]

In France, according to a telephone survey (TNS Sofres Institute, 2008), 14% of men are circumcised.[60]

The overall prevalence of circumcision in Spain is reported to be 6.6%.[9]

In 1986, 511 out of approximately 478,000 Danish boys aged 0–14 years were circumcised. This corresponds to a cumulative national circumcision rate of around 1.6% by the age of 15 years.[61]

In Slovenia, a 1999-2001 national probability sample of the general population aged 18–49 years found that overall, 4.5% of Slovenian male citizens reported being circumcised. Prevalence strongly varied across religious groups, with 92.4% of Muslims being circumcised, 1.7% of Roman Catholics, 0% of other religious affiliations (Evangelic, Serbian Orthodox, other), and 7.1% of those with no religious affiliation.[62]

Between 20% and 80%
Circumcision rate by region in Albania for males aged 15-49, 2017-2018.

Albania, Kosovo, North Macedonia, and Bosnia and Herzegovina.[29]

In Albania during the years 2008–09 the percentage of men age 15–49 who reported having been circumcised was 47.7%.[63] In the years 2017–18 the circumcision rate in Albania had declined to 36.8%.In Bosnia-Herzegovina the circumision rate is 58.7% by 2018.[64]

Over 80%

Azerbaijan and Turkey, 98.6%.[9]

Unknown

Andorra, Croatia and Luxembourg are listed as unknown on the WHO prevalence map. Liechtenstein, Malta, Monaco, San Marino and Vatican City are unclear from the map.[29]

Oceania

Australia

Circumcision reached its peak in Australia in the 1950s with a rate of more than 80%, but has steadily fallen to an estimated 26% in 2012. The rate of circumcision has dropped rapidly over the years. It is estimated that roughly 80 percent of males 35 and under are uncircumcised. Circumcision rates have declined drastically in recent years as young fathers are starting to have children of their own and leaving them uncircumcised.[65]

The Australian Longitudinal Study of Health and Relationships is a computer assisted telephone interview of males aged 16–64 that uses a nationally representative population sample.[66] In 2005 the interview found that the prevalence of circumcision in Australia was roughly 58%. Circumcision status was more common with males over 30 than males under 30, and more common with males who were born in Australia. 66% of males born in Australia were circumcised and less than 1/3 of males under 30 were circumcised.[3] There has been a decline in the rate of infant circumcision in Australia.[7][67] The Royal Australasian College of Physicians (RACP) estimated in 2010 that 10 to 20 percent of newborn boys are being circumcised,[68] but the prevalence of male circumcision is much higher due to the presence of older circumcised males remaining in the population.[69] Medicare Australia records show the number of males younger than six months that underwent circumcision dropped from 19,663 in 2007/08 to 6309 (4%) in 2016/17.[70]

New Zealand

According to the World Health Organisation, fewer than 20% of males are circumcised in New Zealand in 2007.[7] In New Zealand routine circumcision for which there is no medical indication is uncommon and no longer publicly funded within the public hospital system.[71] In a study of men born in 1972–1973 in Dunedin, 40.2% were circumcised.[72] In a study of men born in 1977 in Christchurch, 26.1% were circumcised.[73] A 1991 survey conducted in Waikato found that 7% of male infants were circumcised.[74]

Pacific Islands

Circumcision for cultural reasons is routine in Pacific Island countries.[71]

See also

References
  1. Yosha, Assaf; Bolnick, David; Koyle, Martin (2012). Surgical Guide to Circumcision. Springer Publishing. p. 256. ISBN 9781447128588. It seems likely that in the near future revised recommendations, taking a more positive attitude to circumcision, are likely in many English-speaking countries. What of the future? Current medical advice and public health projects now underway seem to point to a worldwide increase in circumcision rates in the first half of the twenty-first century.
  2. Manual for early infant male circumcision under local anaesthesia. Geneva: World Health Organization. 2010. There are significant benefits in performing male circumcision in early infancy, and programmes that promote early infant male circumcision are likely to have lower morbidity rates and lower costs than programmes targeting adolescent boys and men.
  3. Ferris JA, Richters J, Pitts MK, Shelley JM, Simpson JM, Ryall R, Smith AM (April 2010). "Circumcision in Australia: further evidence on its effects on sexual health and wellbeing". Australian and New Zealand Journal of Public Health. 34 (2): 160–4. doi:10.1111/j.1753-6405.2010.00501.x. PMID 23331360.
  4. Pang MG, Kim DS (January 2002). "Extraordinarily high rates of male circumcision in South Korea: history and underlying causes". BJU International. 89 (1): 48–54. doi:10.1046/j.1464-410x.2002.02545.x. PMID 11849160.
  5. Introcaso, Camille E.; Xu, Fujie; Kilmarx, Peter H.; Zaidi, Akbar; Markowitz, Lauri E. (July 2013). "Prevalence of Circumcision Among Men and Boys Aged 14 to 59 Years in the United States, National Health and Nutrition Examination Surveys 2005–2010". Sexually Transmitted Diseases. 40 (7): 521–525. doi:10.1097/01.OLQ.0000430797.56499.0d. PMID 23965763. S2CID 31883301.
  6. Homfray, Virginia; Tanton, Clare; Mitchell, Kirstin R.; Miller, Robert F.; Field, Nigel; Macdowall, Wendy; Wellings, Kaye; Sonnenberg, Pam; Johnson, Anne M.; Mercer, Catherine H. (July 2015). "Examining the association between male circumcision and sexual function". AIDS. 29 (11): 1411–1416. doi:10.1097/QAD.0000000000000745. PMC 4502984. PMID 26091302. The prevalence of male circumcision in Britain was 20.7% [95% confidence interval (CI): 19.3–21.8].
  7. "Male circumcision: Global trends and determinants of prevalence, safety and acceptability" (PDF). World Health Organization. 2007. p. 8. Retrieved 4 March 2009.
  8. "Neonatal and child male circumcision: a global review" (PDF). World Health Organization. 2010. p. 8. Retrieved 12 April 2015.
  9. Morris BJ, Wamai RG, Henebeng EB, Tobian AA, Klausner JD, Banerjee J, Hankins CA (1 March 2016). "Estimation of country-specific and global prevalence of male circumcision". Population Health Metrics. 14 (1): 4. doi:10.1186/s12963-016-0073-5. PMC 4772313. PMID 26933388.
  10. Morris, Brian J.; Bailis, Stefan A.; Wiswell, Thomas E. (1 May 2014). "Circumcision Rates in the United States: Rising or Falling? What Effect Might the New Affirmative Pediatric Policy Statement Have?". Mayo Clinic Proceedings. 89 (5): 677–686. doi:10.1016/j.mayocp.2014.01.001. ISSN 0025-6196. PMID 24702735.
  11. Hart-Cooper, G. D.; Tao, G.; Stock, J. A.; Hoover, K. W. (20 October 2014). "Circumcision of Privately Insured Males Aged 0 to 18 Years in the United States". Pediatrics. 134 (5): 950–956. doi:10.1542/peds.2014-1007. PMID 25332502. S2CID 14839564.
  12. "Preventing HIV through safe voluntary medical male circumcision for adolescent boys and men in generalized HIV epidemics: recommendations and key considerations". www.who.int. Retrieved 3 October 2021.
  13. Wise, Jacqui (2006). "Demand for male circumcision rises in a bid to prevent HIV". Bulletin of the World Health Organization. 84 (7): 509–511. PMC 2627386. PMID 16878217. As a result, there are already indications of increasing demand for male circumcision in traditionally non-circumcising societies in Southern Africa.
  14. "Preventing HIV through safe voluntary medical male circumcision for adolescent boys and men in generalized HIV epidemics: recommendations and key considerations". www.who.int. Retrieved 9 October 2021.
  15. Morris, Brian J; Wamai, Richard G; Henebeng, Esther B; Tobian, Aaron AR; Klausner, Jeffrey D; Banerjee, Joya; Hankins, Catherine A (1 March 2016). "Estimation of country-specific and global prevalence of male circumcision". Population Health Metrics. 14: 4. doi:10.1186/s12963-016-0073-5. ISSN 1478-7954. PMC 4772313. PMID 26933388.
  16. "CDC Encourages Circumcision, Even for Adult Men". Healthline. 3 December 2014. Retrieved 3 October 2021. The CDC’s move contributes to a shift in the American scientific community toward stronger support for circumcision... Circumcision rates seem to have ticked upward since the AAP changed its stance.
  17. "Circumcision Rates in Sub-Saharan Africa Spike After Partnership with Local Religious Leaders". WCM Newsroom. Retrieved 3 October 2021.
  18. S. Ellwood, Robert (2008). The Encyclopedia of World Religions. Infobase Publishing. p. 95. ISBN 9781438110387. It is obligatory among Jews, Muslims, and Coptic Christians. Catholic, Orthodox, and Protestant Christians do not require circumcision. Starting in the last half of the 19th century, however, circumcision also became common among Christians in Europe and especially in North America.
  19. Gruenbaum, Ellen (2015). The Female Circumcision Controversy: An Anthropological Perspective. University of Pennsylvania Press. p. 61. ISBN 9780812292510. Christian theology generally interprets male circumcision to be an Old Testament rule that is no longer an obligation ... though in many countries (especially the United States and Sub-Saharan Africa, but not so much in Europe) it is widely practiced among Christians
  20. Hunting, Katherine (2012). Essential Case Studies in Public Health: Putting Public Health Into Practice. Jones & Bartlett Publishers. p. 23-24. ISBN 9781449648756. Neonatal circumcision is the general practice among Jews, Christians, and many, but not all Muslims.
  21. R. Wylie, Kevan (2015). ABC of Sexual Health. John Wiley & Sons. p. 101. ISBN 9781118665695. Although it is mostly common and required in male newborns with Moslem or Jewish backgrounds, certain Christian-dominant countries such as the United States also practice it commonly.
  22. R. Peteet, John (2017). Spirituality and Religion Within the Culture of Medicine: From Evidence to Practice. Oxford University Press. p. 97-101. ISBN 9780190272432. male circumcision is still observed among Ethiopian and Coptic Christians, and circumcision rates are also high today in the Philippines and the US.
  23. N. Stearns, Peter (2008). The Oxford Encyclopedia of the Modern World. Oxford University Press. p. 179. ISBN 9780195176322. Uniformly practiced by Jews, Muslims, and the members of Coptic, Ethiopian, and Eritrean Orthodox Churches, male circumcision remains prevalent in many regions of the world, particularly Africa, South and East Asia, Oceania, and Anglosphere countries.
  24. Vardanyan, Astrik N (2013). "Reclaiming Circumcision: Armenian Stories". Genital Cutting: Protecting Children from Medical, Cultural, and Religious Infringements. pp. 307–315. doi:10.1007/978-94-007-6407-1_20. ISBN 978-94-007-6406-4.
  25. Drain PK, Halperin DT, Hughes JP, Klausner JD, Bailey RC (November 2006). "Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries". BMC Infectious Diseases. 6 (1): 172. doi:10.1186/1471-2334-6-172. PMC 1764746. PMID 17137513.
  26. Taiwo Lawal et al. (April 2017). "Circumcision and its effects in Africa". Translational Andrology and Urology. 6 (2): 149–157. doi:10.21037/tau.2016.12.02. PMC 5422680. PMID 28540221.{{cite journal}}: CS1 maint: uses authors parameter (link)
  27. "Questions and answers: NIAID-sponsored adult male circumcision trials in Kenya and Uganda". National Institute of Allergy and Infectious Diseases. December 2006. Archived from the original on 9 March 2010.
  28. Williams BG, Lloyd-Smith JO, Gouws E, Hankins C, Getz WM, Hargrove J, de Zoysa I, Dye C, Auvert B (July 2006). "The potential impact of male circumcision on HIV in Sub-Saharan Africa". PLOS Medicine. 3 (7): e262. doi:10.1371/journal.pmed.0030262. PMC 1489185. PMID 16822094.
  29. "Information package on male circumcision and HIV prevention: insert 2" (PDF). World Health Organisation. p. 2.
  30. Morris BJ, Wamai RG, Henebeng EB, Tobian AA, Klausner JD, Banerjee J, Hankins CA (4 April 2016). "Erratum to: Estimation of country-specific and global prevalence of male circumcision". Population Health Metrics. 14 (1): 11. doi:10.1186/s12963-016-0080-6. PMC 4820865. PMID 27051352.
  31. Peltzer K, Onoya D, Makonko E, Simbayi L (2014). "Prevalence and acceptability of male circumcision in South Africa". African Journal of Traditional, Complementary and Alternative Medicines. 11 (4): 126–30. doi:10.4314/ajtcam.v11i4.19. PMC 4202407. PMID 25392591.
  32. Castellsagué X, Peeling RW, Franceschi S, de Sanjosé S, Smith JS, Albero G, Díaz M, Herrero R, Muñoz N, Bosch FX (November 2005). "Chlamydia trachomatis infection in female partners of circumcised and uncircumcised adult men". American Journal of Epidemiology. 162 (9): 907–16. doi:10.1093/aje/kwi284. PMID 16177149.
  33. Van Howe RS, Cold CJ, Lajous M, Lazcano-Ponce E, Mueller N (February 2006). "Human papillomavirus link to circumcision is misleading". Cancer Epidemiology, Biomarkers & Prevention. 15 (2): 405, author reply 405–6. doi:10.1158/1055-9965.EPI-05-0818. PMID 16492939. Circumcision is not usually performed by public sector health care providers in Mexico and we estimate the prevalence to be 10% to 31%, depending on the population.
  34. "Data Tables — The Maternity Experiences Survey (MES) 2006–2007 Canadian Maternity Experiences Survey" (PDF). Public Health Agency of Canada. p. 267.
  35. "Circumcision Policy Statements". www.cirp.org.
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