NEW YORK (ABP) — The foundational symbol of God's ancient covenant with his people is getting a lot less common in the United States, but medical and theological debates still rage about the propriety of circumcision.
Recent legal battles over whether parents can mandate circumcision for their children and new medical findings regarding the relative merits and risks of the practice have given parents reason to pause.
The debate, although originating in the religious realm, now deals mainly with social mores and the latest scientific consensus.
At the height of circumcision's popularity in the mid-20th century, 90 percent of American males were circumcised. But the rate in the United States has declined steadily since the 1970s, according to the National Hospital Discharge Survey and other health organizations. In 2005, roughly 80 percent of all U.S. males were circumcised.
That percentage is likely to decrease in the future, as recent annual statistics show only 56 percent of male babies born in America are being circumcised.
Some Baptists who once understood the procedure to be an American standard rooted in biblical tradition now are taking a second look at it.
Catherine and Jerry Bell did just that when they decided not to circumcise their son Nicolas, now 4. She had remained undecided about the procedure prior to her delivery, but at the hospital, when she happened to hear some recently cut babies crying, she opted out.
“My reasoning was, I just didn't see the point,” said Bell, who attends First Baptist Church in Paragould, Ark. “I know there's a very small risk of things going wrong, but why do it if you don't have to?”
She's not alone. According to Jennifer Lusk, a registered nurse in the pediatric urology department at Houston's Texas Children's Hospital, ever-increasing numbers of expectant mothers are questioning the practice.
“It used to be that people would come in and say, ‘We want this done!' Now it's like, ‘We've done a lot of reading, the older kids are circumcised and my husband is circumcised, but … I'm not sure if we have to do this,'” Lusk said. “More people are figuring out that they don't have to. They're starting to ask questions about it.”
In some areas, it's a slow change. Bell said Nicolas is a minority in their small city — as far as she knows, he is the only uncircumcised boy in the two preschools he's attended. And family members, she said, “laid it on thick” when they heard the Bells decided not to have their son snipped.
Many of her friends are curious about her decision to forego the operation, she said, adding that ignorance is the main factor in the public's reticence to accept it as “normal.”
“People think it's unusual because of a lot of misinformation and misunderstanding about why it's even done,” she said. “People just do it because it's what everybody else does.”
Everybody in the United States, that is. Only 30 percent of males worldwide are circumcised, according to the World Health Organization. The procedure is most prevalent in Muslim countries, Israel, the United States, the Philippines and South Korea. Various tribes in Africa also use the practice, sometimes as a counterpart to female circumcision.
Though not mentioned in the Quran, the practice is discussed in the secondary collection of Islamic holy writings known as the Hadith, and Muslim scholars still debate whether it is mandatory or merely recommended.
And while most Christians associate circumcision with Abraham's Genesis-based covenant with God, it was prevalent in the ancient world well before then, according to Jim Nogalski, a professor of Old Testament at Baylor University.
“Circumcision in the Middle East was a fairly common practice,” he said. “There are varying versions of where it came from and who did it first.”
Among the earliest Christians, circumcision became a topic of heated debate. The Apostle Paul and a faction of the ancient church known as the Judaizers debated the relevance of the procedure in light of the New Covenant. Some thought that in order to be Christian, a man had to be Jewish, which meant being circumcised, Nogalski said. Others thought no one should be circumcised against his will.
A third group, described mostly in the books of Luke and Acts, believed Jews, but not Gentiles, who became Christians should be circumcised. A fourth group, most notably in Ephesians, believed a proper reading of Scripture showed literal circumcision no longer was expected for anyone, Nogalski said.
Like their ancient counterparts, modern Jews attach significant symbolism to the circumcision ceremony, called a brit milah or bris. For Jews worldwide, it is one of the fundamental ways to identify with their faith.
Circumcision celebrates the vitality of the Jewish tradition and expresses hope and confidence in the future of the faith, said Rabbi Mark Cooper of New Jersey.
“The ceremony is a covenant ceremony, and it serves the purpose of formally welcoming the child into the people of Israel with God,” said Cooper, who is a fifth-generation mohel, a Jewish leader trained to conduct the rite of circumcision.
The ceremony also serves the purpose of celebrating parenthood and committing to raise the child in the Jewish faith, said Cooper, who performs several circumcisions a month.
But while matters of faith and tradition dictate circumcision for Jewish males, social norms and the medical community largely have dictated its prevalence for non-Jewish Americans.
Experts in sexually transmitted infections called for universal circumcision as early as 1914, but the practice among Anglo-Saxon Protestants in the United States gained momentum in the 1930s from obstetricians and gynecologists who touted the medical advantages of the operation.
Most medical books around that time began to prescribe circumcision to relieve a wide variety of conditions, and many thought circumcision led to improved personal hygiene.
What's more, in the 1950s, American insurance and welfare programs began paying for the procedure, which removed any financial burden from having it done, noted Robert Darby, an Australian medical historian who maintains the site www.historyofcircumcision.com.
In 1997, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists reclassified neonatal circumcision from a “routine” to an “elective” procedure. Since then, 16 states have stopped including circumcisions in Medicaid plans, with more considering the option.
Texas Children's Hospital offers the procedure as an option for parents, unless there are conflicting medical issues that require it. Typically, children under 10 pounds and one month old undergo an injection of local anesthetic and are given a sugar-soaked pacifier to suck on. Others receive general anesthesia.
As a new mother, Bell couldn't bear to think of her son undergoing the cut, and she may be ahead of her time.
“It's weird for me now to see boys who are circumcised,” she said. “Why cut on something you don't need to cut on?”