Thailand Unprepared to Offer Newborn Circumcision for HIV Prevention

By Ball, H. | International Perspectives on Sexual and Reproductive Health, March 2014 | Go to article overview

Thailand Unprepared to Offer Newborn Circumcision for HIV Prevention


Ball, H., International Perspectives on Sexual and Reproductive Health


Male circumcision is a relatively safe procedure associated with a host of health benefits, including reductions in the risk of some STIs, genital ulcer disease, urinary tract infections and female-to-male HIV infection. Promotion of newborn circumcision is one long-term strategy for prevention of HIV transmission. However, a recent survey of Thailand's hospitals indicates that the country's health system, despite having the requisite medical infrastructure, may not be prepared to implement newborn circumcision as a public health intervention. (1) Among facilities thought to be able to provide newborn circumcision, just 31% of private and 2% of public hospitals had actually performed the procedure in the last year. Only a minority of responding health professionals considered newborn circumcision safe (39%) and agreed that their hospital should offer the procedure (29%), although half reported wanting to be trained to perform it.

Data come from a 2011 survey of all hospitals in Thailand that were capable of providing obstetric services and hence considered potentially able to perform circumcision. Each hospital was sent a questionnaire requesting information about the facility's characteristics and its provision of newborn circumcision in the previous year, specific topics included the type of staff who performed the procedure, the reasons for performing it and the surgical techniques used. A second questionnaire was to be completed by a doctor or nurse familiar with delivery and postpartum care; it asked about the difficulty of providing newborn circumcision, the safety of the procedure, desire for training in newborn circumcision and opinions on whether the procedure should be performed in the respondent's hospital and how it should be paid for.

Staff at just over half (55%) of hospitals responded to the survey. Of the 747 participating facilities, 85% were government hospitals and 15% were private hospitals, representing 68% of public and 27% of private facilities in the country. Only 6% of the hospitals (31% of private and 2% of public facilities) had provided newborn circumcision in 2010.

At the 46 facilities where newborn circumcision was available, the procedure was typically provided in response to parents' request (38 hospitals); less commonly, respondents reported that circumcision was performed for medical indications (12 hospitals) or on a physician's advice (five hospitals). At three-quarters of institutions, pediatric or general surgeons usually performed the procedure. …

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Thailand Unprepared to Offer Newborn Circumcision for HIV Prevention
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