The circumcision decision: Parents want info, not directives, from docs

July 21, 2014 Volume 21 Issue 4
  • Most parents (81%) feel their baby’s healthcare provider is the best source of information about circumcision.
  • The majority of parents (87%) say the best time to get information about circumcision is before the baby is born.
  • Only 23% of parents say the provider should recommend what decision to make about circumcision.

Over half of male infants born in the United States are circumcised, with substantial variation by region and by race/ethnicity. Parents cite a variety of reasons for or against circumcision, and many feel anxious about making the right choice. In March 2014, the C.S. Mott Children’s Hospital National Poll on Children’s Health asked a national sample of parents about the role of healthcare providers in helping them make decisions about circumcision.

Preferred Source of Information

In terms of who would be the best healthcare provider to assist in making a decision about circumcision, 81% of parents say the baby’s healthcare provider (pediatrician or family physician), while 19% say the mother’s obstetric provider (obstetrician, midwife, childbirth educator). The healthcare provider is rated by 78% of parents as a very trustworthy source of information about circumcision. In comparison, 64% of parents give the American Academy of Pediatrics a very trustworthy rating, 47% for the US Centers for Disease Control, and 14% for parenting books. Only 5% of parents rate internet searches as very trustworthy, and only 9% strongly agree that they would be able to tell the difference between true and false information from an internet search about circumcision.

The majority of parents (87%) feel that the best time to get information about circumcision is before the baby is born; 11% say the best time is at the hospital once the baby is born, and 2% at the baby’s first check-up.

Role of Healthcare Providers

Most parents feel the healthcare provider should answer their questions and provide scientific information about circumcision; fewer parents believe the healthcare provider should recommend a specific decision (Figure).  One in five parents strongly agree that circumcision is a family decision, and healthcare providers should stay out of it. Once a decision is made, 75% of parents say the healthcare provider should accept the parents’ decision without argument.

Implications

Circumcision rates in the U.S. have declined over the past decades, and it is not assumed that all newborn males will be circumcised. In making a decision about circumcision, parents may consider cultural or religious traditions, status of other males in the family, risks of the procedure, and future health benefits. Both pro- and anti-circumcision advocates feel strongly about their views, which can create anxiety for new or expectant parents who are trying to find objective information on which to base a decision. In this situation, healthcare providers can be an important source of help.

Findings from this poll highlight a mismatch between parent preferences and typical healthcare patterns. The majority of parents want information about circumcision before their child is born, and 4 out of 5 parents feel their child’s healthcare provider would be best at assisting them with circumcision decisions. However, many parents do not schedule a prenatal visit with a pediatrician or family doctor, and thus miss the opportunity receive information from a trusted source at a critical time in their decision making about circumcision.  

Another key finding from this poll is that parents want healthcare providers to be involved in considerations about circumcision – but in a consultant role, not telling them what to do or second-guessing their decision. This may require providers to take a slightly different approach to conversations about circumcision, allowing parents to guide the discussion, rather than giving an expert opinion on the “right” course of action.   

There is a bounty of circumcision information on the Internet, yet few parents feel Internet searches are very trustworthy sources of information, and less than 10% believe they can distinguish true vs false information in an Internet search about circumcision.  Therefore, a critical role for healthcare providers is to assist parents in identifying sources of information that are accurate and balanced.

National organizations, such as the American Academy of Pediatrics (AAP), can serve to guide parents in making healthcare decisions for their children. With regard to circumcision, the current AAP policy, updated in 2012, indicates that the health benefits outweigh the risks, but not enough to recommend that all male infants be circumcised. Parents in this poll rate the AAP as the second most-trusted source; however, they may still want the healthcare provider to explain the rationale behind the AAP’s policy.

With regard to circumcision, this poll shows that parents don’t want directives or advocacy from their healthcare providers, but rather a neutral source of accurate information and support for the family’s decision, whatever it may be.

Data Source

This report presents findings from a nationally representative household survey conducted exclusively by GfK Custom Research, LLC (GfK), for C.S. Mott Children’s Hospital via a method used in many published studies. The survey was administered in March 2014 to a randomly selected, stratified group of adults age 18 and older from GfK’s web-enabled KnowledgePanel® that closely resembles the U.S. population. Responses from parents and adults expecting or planning to have a child within the next two years (n=1,516) were used for this report. The sample was subsequently weighted to reflect population figures from the Census Bureau. The survey completion rate was 53% among the parent panel members contacted to participate. The margin of error is ± 1 to 4 percentage points.

C.S. Mott Children’s Hospital National Poll on Children’s Health
Director: Matthew M. Davis, MD, MAPP
Associate Director: Sarah J. Clark, MPH
Manager & Editor: Dianne C. Singer, MPH
Data Analyst: Acham Gebremariam, MS
Web Editor: Anna Daly Kauffman, BA

Findings from the C.S. Mott Children's Hospital National Poll on Children's Health do not represent the opinions of the investigators or the opinions of the University of Michigan. The University of Michigan reserves all rights over this material.
 

QUESTIONS WERE ANSWERED BY PARENTS AND ADULTS EXPECTING OR PLANNING TO HAVE A CHILD WITHIN THE NEXT TWO YEARS.

In the US, some male babies are circumcised, and some are not. In making a decision about whether to circumcise their baby, parents may get information about circumcision from many different sources.

Imagine that you are about to become the parent of a baby boy, and you need to make a decision about circumcision.

Q1. Which of the following would be the best health care provider to assist you in making a decision about circumcision? 

  1. Obstetrician
  2. Midwife
  3. Pediatrician
  4. Family doctor
  5. Nurse at birthing hospital
  6. Teacher of childbirth class

Q2. When would be the best time for you to get more information about circumcision?

  1. Before child is born
  2. At the hospital, once the child is born
  3. At the baby's first check-up

Q3. What should health care provider do to help you in your decision about circumcision?

Definitely should do Possibly should do Should NOT do
1 2 3
  1. Provide scientific information about circumcision
  2. Answer your questions
  3. Describe experience with other patients
  4. Provide information about cost or insurance coverage
  5. Suggest other information sources
  6. Recommend what decision you should make
  7. Accept your decision without argument

Q4. How trustworthy are the following sources of information about circumcision?

Very trustworthy Somewhat trustworthy Not trustworthy
1 2 3
  1. Health care provider
  2. U.S. Centers for Disease Control (CDC.gov)
  3. American Academy of Pediatrics (AAP)
  4. Internet search
  5. Parenting books
  6. Family members

Q5. How much do you agree with the following statements?

Strongly agree Agree Disagree Strongly disagree
1 2 3 4
  1. In searching the internet, I would be able to tell the difference between true and false information about circumcision.
  2. Most circumcision information on the internet is biased.

Participants were also asked demographic questions on gender, race/ethnicity, annual household income, education and insurance status.

C.S. Mott Children’s Hospital National Poll on Children’s Health
Director: Matthew M. Davis, MD, MAPP
Associate Director: Sarah J. Clark, MPH
Manager & Editor: Dianne C. Singer, MPH
Data Analyst: Acham Gebremariam, MS
Web Editor: Anna Daly Kauffman, BA

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Parents' views on role of healthcare providers regarding circumcision

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