Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths

Article excerpt

Baby boys can and do succumb as a result of having their foreskin removed. Circumcision-related mortality rates are not known with certainty; this study estimates the scale of this problem. This study finds that approximately 117 neonatal circumcision-related deaths (9.01/100,000) occur annually in the United States, about 1.3% of male neonatal deaths from all causes. Because infant circumcision is elective, all of these deaths are avoidable. This study also identifies reasons why accurate data on these deaths are not available, some of the obstacles to preventing these deaths, and some solutions to overcome them.

Keywords: male, infant, death, mortality, neonatal, circumcision, penis, foreskin, United States

"The life of man is., nasty, brutish, and short."

-Thomas Hobbes

Circumcision is a surgical procedure performed upon newborn baby boys in the United States once every seven seconds,1 three thousand times a day, over a million times a year. The practice is so deeply rooted in American childbirth and medical culture that the public is largely unaware of two facts: first, that infant circumcision is not medically necessary in almost all instances, and second, that it carries serious medical risks, including the risk of death. For some parents, circumcising their son will mean losing their baby boy to what they have been told is a harmless procedure.

Medical associations fail to warn parents of the very real risk of death from circumcision. Neither the American Academy of Pediatrics (AAP, 1999), nor the American College of Obstetricians and Gynecologists (ACOG, 2001), nor the American Medical Association (AMA, 1999) mentions death as a possible outcome of the surgery in their policy statements on circumcision. The American Academy of Family Physicians (AAFP, 2002) statement says death is possible, but (according to this study's findings) significantly underreports the risk as 1/500,000.

Parenting and baby books are equally culpable in failing to mention death as a possible, if rare, outcome of circumcision. A survey of ten popular infant-care books found that none warn that circumcision could result in a baby's death.2 Most websites and literature on circumcision also minimize or ignore the risk of death, and no contemporary study has attempted to learn the magnitude of this problem. Perhaps this is due to the peculiar place occupied by circumcision in American medicine- an elective, almost incidental, procedure carried out on babies, behind closed doors, and mostly by residents and obstetricians rather than by the baby's own doctor (Stang & Snellman, 1998).

This study reviews the few sources that have reported on deaths occurring as a result of circumcision and attempts to provide a rough estimate for neonatal (first 28 days after birth) circumcision-related mortality in the United States. Since infant circumcision is elective, this study will consider all circumcision sequelae, not just the procedure itself. Its goal is to promote discussion, encourage solutions, and- most importantly- save children's lives.

Background

About 1 .3 million boys are circumcised each year in the United States (HCUP, 2007); however, the number of boys who died from those surgeries has not been reported or estimated in any credible way. Some reasons include record-keeping practices, indifference, and- no doubt- concerns about liability.

Death certificates typically do not list circumcision as the immediate or leading cause of death and rarely list circumcision as an underlying cause. Incomplete and inaccurate death certificates for children are a common phenomenon (Cunniff , Carmack, Kirby, & Fiser, 1995). Thus, many circumcision-related deaths are more often reported as surgical mishap, infection, hemorrhage, cardiac arrest, stroke, reaction to anesthesia, or even parental neglect.

In recent years, U.S. infant deaths have been infrequently reported in the media (Rachter, 1982; The State, 1992; Miami Herald, 1993; Lum & Sorelle, 1995; NewsNet5, 1998; Proctor, 2002; Cohen, 2005; Verges, 2009). …