Changes

America is predominantly an English-speaking nation. As in other English-speaking nations, non-therapeutic [[circumcision]] of boys was popularized in the late nineteenth century. Due to the rates of infant circumcision that formery formerly approached 90 percent, the vast majority of [[Circumcised doctors| male doctors were neonatally circumcised]] and have no real knowledge of a normal body part.Such doctors frequently give poor advice to parents on the care of the [[intact]] [[penis]].<ref name="goldman2005">{{REFjournal |last=Goldman |first=Ronald |init=R |author-link=Ronald Goldman |etal=no |title=Circumcision policy: a psychosocial perspective |trans-title= |language= |journal=Paediatrics & Child Health (Ottawa) |location= |date=2005-11 |volume=9 |issue=9 |pages=630-3 |url=https://academic.oup.com/pch/article/9/9/630/2648566?login=true |quote= |pubmedID=19675851 |pubmedCID=2724127 |DOI=10.1093/pch/9.9.630 |accessdate=2020-03-16}}</ref> They are also much more likely to injure [[intact]] boys during office visits by premature [[Forced foreskin retraction| forcible foreskin retraction]] (PFFR).<ref>{{REFjournal |last=Narvaez |first=Darcia |init=D |author-link= |last2=Geisheker |first2=John V. |init2=JV |author2-link=John V. Geisheker |url=https://www.psychologytoday.com/us/blog/moral-landscapes/201110/what-is-the-greatest-danger-uncircumcised-boy |title=What Is the Greatest Danger for an Uncircumcised Boy? |journal=Psychology Today |date=2011-10-23 |volume= |issue= |pages= |accessdate=2021-10-31}}</ref>

The United States is unique in having a medical [[circumcision industry ]] that aggressively promotes the practice of medically-unnecessary, non-therapeutic , harmful infant [[circumcision]]. The decline of the unnecessary practice has been slowed by continual encouragement and promotion of circumcision by the medical [[circumcision industry]]. However, the practice of non-therapeutic [[circumcision ]] of boys is now in decline.

Despite the financially self-serving promotional efforts of the [[circumcision industry]], the incidence of non-therapeutic [[circumcision ]] of infant boys was reported to have continued its slow decline to 52.1 percent in 2016.<ref name="jacobson2021">{{REFjournal

Jews have lived in America since before the Revolutionary War. They have always practiced [[Jewish circumcision| ritual circumcision]], ([[Brit Milah]]), of boys on the eighth day of life in accordance with the [[Abrahamic covenant]], however this was only for a very small percentage of the population.<ref name="self2016">{{REFjournal |url=https://journals.troy.edu/index.php/test/article/view/386/302 |title=The Rise of Circumcision in Victorian America |first=Eleanor |last=Self |author-link=Eleanor Self |journal=The Alexandrian |volume=5 |issue=1 |date=2016 |accessdate=2022-09-02 |format=PDF}}</ref>

One may be certain that the eighteenth century [https://www.nationalgeographic.org/article/founding-fathers/ Founding Fathers of the United States] of America were men with [[intact]] [[Foreskin| foreskinsforeskin]] s as were the [[foreskinned]] men who fought the American Civil War (1861-1865).

The late nineteenth century was characterized by various prominent medical doctors advancing all sorts of absurd reasons for the performance of non-therapeutic circumcision, including the prevention of venereal disease.<ref name="self2016" />

The first recorded non-religious circumcision of a boy in the United States occurred in 1870 when [[Lewis Albert Sayre]], a prominent New York City doctor, [[circumcised ]] a boy of five years of age for paralysis.<ref name="gollaher1994">{{REFjournal |last=Gollaher |first=David L. |init=DL |author-link= |title=From ritual to science: the medical transformation of circumcision in America |journal=Journal of Social History |date=GollaherDL 1994-09 |volume=28 |issue=1 |pages=5-36 |url=http://www.cirp.org/library/history/gollaher/ |accessdate=2021-10-26}}</ref> [[Lewis Albert Sayre|Sayre]] then continued to advocate circumcision for numerous reasons until his death in 1900. According to [[Lewis Albert Sayre|Sayre]], circumcision was recommended for paralysis, epilepsy, hernia, lunacy, curvature of the spine, and clubfoot.

[[M. J. Moses]] (1871) advocated [[circumcision ]] to prevent [[masturbation]].<ref name="moses1871">{{Moses1871}}</ref>

[[H. H. Kane]] (1879) 'discovers' that [[circumcision ]] cures nocturnal emissions and abdominal neuralgia.<ref>{{Kane1879}}</ref>

Seventh-day Adventist [[John Harvey Kellogg]], {{MD}}, of Battle Creek, Michigan, was an important 19th century promoter of male circumcision. Although masturbation is never mentioned in the Bible, Dr. Kellogg believed that [[masturbation]] was immoral, sinful, and caused one to dream "impure dreams", which he believed was harmful to the mental faculties, resulting in mental disorders, such as feeblemindness.<ref name="kellogg1888">{{Kellogg1888}}</ref> He believed that the urge to masturbate could be prevented by eating bland foods, for which purpose, he and his brother invented corn flakes.<ref name="self2016" />

[[Elizabeth Blackwell]], {{MD}}, ({{LifeData|1821|1910}}), was born in England, but attended medical school in the United States. She was the first woman to become a medical doctor in the United States. Blackwell thought [[masturbation ]] was immoral but that [[circumcision ]] was not the way to correct it. She wrote against it in her 1894 book:

|lastinit=BlackwellE

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[[Peter Charles Remondino]], {{MD}},<ref name="gollaher1994" /> was a San Diego, California physician, who was born in Turin (''Torino'') in 1846, but migrated with his family to the United States at the age of eight. There is some reason to believe that he was of Sephardic Jewish descent and had been [[circumcised ]] while still in Turin, however this is uncertain.

Remondino is famous for his 346 page book, ''The History of Circumcision''(1891).<ref name="remondino1891">{{REFbook

[[H. L. Rosenberry]], {{MD}}, (1894) published a paper "proving" that circumcision cures urinary and rectal incontinence.<ref name="self2016" /> <ref name="rosenberry1894">{{Rosenberry1894}}</ref>

Dr. [[E. J. Spratling]] (1895) provided information for other doctors.<ref name="self2016" /><ref>{{REFjournal |last=Spratling |init=EJ |title=Masturbation in the Adult |journal=Medical Record |volume=24 |issue= |pages=442-443 |url=https://www.proquest.com/openview/9a247c3410d34390e418dc970faa3b87/1?pq-origsite=gscholar&cbl=40146 |quote= |date=1895 |accessdate=2022-08-30}}</ref> By the end of the nineteenth century, America had at least one prominent physician and surgeon on the east coast promoting circumcision and another prominent physician and surgeon on the west coast promoting circumcision. There was no real medical science with which to dispute and discredit their false claims. Non-therapeutic [[circumcision ]] of males was now well-established in the United States.

Brimhall (1902) reported an [[amputation ]] of a [[penis ]] after circumcision.<ref name="brimhall1902">{{REFjournal

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}}</ref> Wolbarst's paper appeared shortly before the start of World War I. It is thought that Wolbarst's false claims inspired some military commanders to require men under their command to be [[circumcised ]] so as to reduce venereal disease (VD).

J. Brennermann (1921) reported that [[Meatal stenosis| meatal disease ]] occurs only in [[circumcised ]] boys who lack the protection of the [[foreskin]].<ref name="brennermann2021>{{REFjournal

[[Abraham L. Wolbarst|Wolbarst]] (1926) made his claim for the first time that male circumcision prevents [[penile cancer]].<ref name="wolbarst1926!>{{REFjournal

[[Abraham L. Wolbarst|Wolbarst]] (1932) put forward his claim again that [[circumcision]] would prevent [[penile cancer]] in the British journal, ''The Lancet''.<ref name="Wolbarst 1932">{{REFjournal |last=Wolbarst |init=AL |author-link=Abraham L. Wolbarst |title=Circumcision and penile cancer |journal=Lancet |volume=1 |issue=5655 |date=1932-01-16 |pages=150-153Wolbarst1932}}</ref> In those long ago days, the true causes of cancer were unknown so it was impossible to disprove Wolbarst's falsehoods.

Brown (1937) reported restoration of the [[skin ]] of the [[penis ]] after a denudation complication of circumcision.<ref name="brown1837">{{REFjournal

The information on military circumcision in WWII is sketchy and anecdotal. It appears that many [[foreskinned]] American men were encouraged and, in some cases, forced to be [[circumcised]]. It seems that the American military's [[foreskin]]-phobia and circumcision policy persisted through the Korean War (1950-52) but was discontinued by a change in policy thereafter.

The "Sand Myth" circulated among English-speaking armies. According to the [http://www.circumstitions.com/sand.htm Sand Myth], [[foreskinned ]] men who fought in the Saharan desert had medical issues due to sand collecting under the [[foreskin]]. [[Intact]] Italian and German men who fought in the same desert had no such problems.<ref>{{REFjournal

'''Post-war era.''' In the post-war era after WWII, the popularity of non-therapeutic [[circumcision]] increased, driven by medical promotion by doctors seeking a nice [[Financial incentive| surgical fee]] as an alleged preventive of penile cancer and by the [[Adamant father syndrome| adamant request of circumcised men home from the war who became fathers]].

Non-therapeutic, medically-unnecessary [[circumcision ]] of boys had become a "routine" surgical operation that usually was performed automatically on newborn boys even without consent from anyone.

[[Eugene H. Hand]], {{MD}}, (1949) falsely claimed that circumcision would prevent cancer of the tongue and [[Circumcision and STDs| venereal disease]].<ref name="HandEH1949">{{REFjournal

The publication of a landmark article by [[Douglas Gairdner]] (1949) in the [[United Kingdom]] showing that infant circumcision is non-therapeutic, unnecessary, causes deaths, and which called for preservation of the [[foreskin]]<ref name="gairdner1949">{{GairdnerDM 1949}}</ref> was totally ignored by the [[circumcision industry ]] in the United States.

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California Medicaid (Medi-Cal) announced in 1968 that non-therapeutic circumcision would not be a covered benefit.<ref>{{REFweb |url=https://insuremekevin.com/california-health-plans-cover-new-born-circumcision/ |title=Medi-Cal won’t cover circumcision |last= |first= |accessdate=2021-10-05}}</ref> W. K. C. Morgan, a Canadian medical doctor, then on the faculty of the {{UNI|University of Maryland|UMD}} [https://www.medschool.umaryland.edu/ University of Maryland School of Medicine], in a highly critcal letter pubished by ''JAMA'' (1965), slammed the practice of non-therapeutic circumcision of boys as it had developed in the United States.<ref>{{REFjournal

Preston (1970) considered the matter of infant [[circumcision]]. He examined and debunked claims that male circumcision could prevent cancer of the [[cervix ]] in women, cancer of the [[penis ]] and cancer of the prostate in men. Preston concluded:

|archived= |quote= |pubmedID= |pubmedCID= |DOI= |accessdate=2021-10-05

The [[American Academy of Pediatrics]] (AAP) is not an "academy" at all. It is a [[medical trade association ]] that protects and advances the business and financial interests of its pediatrician "fellows". Influenced by Preston's paper, the AAP published a manual on the hospital care of newborn infants in 1971. The manual included the statement:

|pagespage=110 |location=Evanston, {{USSC|IL}} |publisher=American Academy of Pediatrics.

The statement falsely claimed facilitation of hygiene, prevention of [[phimosis]], and prevention of [[penile cancer]] as reasons that parents may elect non-therapeutic infant circumcision.<ref name="aap1975" />

The statement expressed no concern for the [[pain]] and [[trauma]] of circumcision, nor did it provide information on the functions and value of the [[foreskin]] nor did it recognize the child as a person with domestic and international rights to self-determination and [[physical integrity]]. The statement carefully avoided recommending [[circumcision]] and placed the responsibility for the certain [[amputation ]] injury on the parents rather than on the attending physician.<ref name="aap1975" />

<blockquote>There are no medical indications for [[Routine Infant Circumcision|routine circumcisions]], and the procedure cannot be considered an essential component of health care. If an infant is circumcised, the procedure must be delayed until the infant is at least 24 hours old and stable, without [[bleeding ]] tendency or any other illness. Circumcision must never be done at time of delivery.<ref>{{REFbook |last= |first=

|location=Evanston, {{USSC|IL}}

Infant circumcision traditionally had been carried out without any kind of anesthesia or analgesia because of the false belief that infants could not feel [[pain]]. Researchers started to investigate the [[Pain| pain of circumcision]] in the 1970s.

}}</ref> Sidney S. Gellis, {{MD}} (1978) estimated that the number of deaths from infant circumcision exceeded the number of deaths from [[penile cancer]].<ref name="gellis1978">{{REFjournal

David Grimes, {{MD}}, (1978), recognized the increasing controversy regarding the practice of non-therapeutic infant [[circumcision]]. Grimes discussed several concerns including:

<blockquote> However, until the benefits of [[routine ]] circumcision of the neonate can be proved worth the risk and cost, medical resources probably should be allocated to measures of demonstrated value.<ref name="grimes1978" />

It was at about this time that several small organizations that opposed non-therapeutic circumcision of boys started to appear. They were the first [[intactivists]], although that word had not yet been coined. One such organization was the Remain Intact Organization of Larchwood, Iowa, which was lead by Rev. [[George Zangger| Russell George Zangger]]. From the 1970s to the 1990s Zangger sent out cards with New Testament quotations that said the outward sign of circumcision is of no value. [[Jeffrey R. Wood]] formed [[INTACT Educational Foundation| INTACT]] (Infants Need to Avoid Circumcision [[Trauma]]), founded in 1976 as a local resource serving Western Massachusetts, and "Dedicated to Preserving Freedom of Choice." The organization gained recognition and had members across the nation.

Boczko & Freed (1979) collected cases of [[penile cancer ]] in circucised [[circumcised]] men and by so doing, disproved the false belief propagated since 1932 by [[Abraham L. Wolbarst]] that circumcision was protective against penile cancer.<ref name="boczko1979">{{REFjournal

Robert Leon Baker, {{MD}} (1979) estimated 229 [[Death| deaths ]] per year in the United States from circumcision complications.<ref name="baker1979">{{REFjournal

[[Edward Wallerstein]] (1980) published his book, ''[[Circumcision, : An American Health Fallacy]]''.<ref name="wallerstein1980">{{WallersteinE 1980}}</ref>

The Bollinger (2017) reported the incidence of infant non-therapeutic circumcision peaked at about 85 percent of all infant boys in 1982.<refname="bollinger2017">{{REFweb

|author-link=Dan Bollinger

[[John A. Erickson]] (1982) started to work individually to advance [[genital integrity]]. Professor Lowell R. King (1982), who had been a member of the 1975 "ad hoc" task force on circumcision of the AAP, felt compelled to defend the reasoning of the task force.<ref name="king1982">{{REFjournal

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Anand & Hickey (1987) published a paper in the ''New England Journal of Medicine'' that conclusively proved that newborn infants are capable of feeling intense [[pain]]. After publication of this landmark paper, no doubt about the existence of pain sensation in infants remained. The article stated:

<i>Numerous lines of evidence suggest that even in the human [[fetus]], pain pathways as well as cortical and subcortical centers necessary for pain perception are well developed late in gestation, and the neurochemical systems now known to be associated with pain transmission and modulation are intact and functional. Physiologic responses to painful stimuli have been well documented in neonates of various gestational ages and are reflected in hormonal, metabolic, and cardiorespiratory changes similar to but greater than those observed in adult subjects. Other responses in newborn infants are suggestive of integrated emotional and behavioral responses to pain and are retained in memory long enough to modify subsequent behavior patterns.</i><ref name="anand1987">{{REFjournal

* failure to call for analgesia to ease the intense [[pain]] of the [[amputation]].

* attempting to shift responsibility for the performance of an injurious and harmful [[amputation ]] from the medical operator to the parents.

The advocacy of [[circumcision ]] to prevent [[UTI ]] spurred a debate in the medical literature until the AAP published a new statement in 1999 that softened the claims.

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The [[Third International Symposium]] on Circumcision convened at the {{UNI|University of Maryland|UMD}}, College Park, Maryland{{USSC|MD}}, USA on 23-25 May 1994.

Professor [[George C. Denniston]], {{MD}}, {{MPH}}, organized [[Doctors Opposing Circumcision(D.O.C.)]] in 1995. Three registered nurses in Santa Fe, {{USSC|NM}}, who conscientiously objected to assisting with foreskin [[amputation]] operations, formed [[Nurses for the Rights of the Child]] in 1995.

[[John A. Erickson]] (1996) self-published ''Deeper into Circumcision: A Invitation to Awareness'' (196 pages).<ref name="erickson1996">{{REFbook |last=Erickson |first=John A. |init=JA |author-link=John A. Erickson |year=1996 |title=Deeper into Circumcision: An Invitation to Awareness |url=http://www.foreskin.org/je-dic.htm |publisher=Self-published (196 page pamphlet) |location=Biloxi, Mississippi}}</ref>

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|init4=GW |author4-link=George W. Kaplan

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Rhinehart (1999) was a practicing psychiatrist who described his patients later-life problems stemming from the psychic [[trauma]] of their neonatal [[circumcision]].<ref name="rhinehart1999">{{REFjournal

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[[Petrina Fadel]] founded [[Catholics Against Circumcision]]. Thomas et al. (2004) studied the incidence of [[HIV ]] in circumcision and intact men in a United States Navy population. A slightly higher incidence of [[HIV ]] infection was found in circumcised men (84.9%) as compared with intact men (81.8%). The authors concluded:

Although there may be other medical or cultural reasons for male circumcision, it is not associated with [[HIV ]] or STI prevention in this U.S. military population.<ref name="thomas2004">Thomas AG, Bakhireva LN, Brodine SK, Shaffer RA. [http://www.cirp.org/library/disease/HIV/thomas1/ Prevalence of male circumcision and its association with [[HIV ]] and sexually transmitted infections in a U.S. Navy population]. Abstract no. TuPeC4861. Presented at the XV International [[AIDS ]] Conference, Bangkok, Thailand, July 11-16, 2004.</ref>

|publisher=[[Doctors Opposing Circumcision(D.O.C.)]]

[[Doctors Opposing Circumcision (D.O.C.)]] issued a Genital Integrity Policy in June 2008.<ref name-"doc2008">{{REFdocument

|publisher=[[Doctors Opposing Circumcision(D.O.C.)]]

[[Robert S. Van Howe|Van Howe]] & Svoboda (2008) said of the American practice of medically-unnecessary, non-therapeutic infant circumcision:<blockquote>Once all factors are revealed, itis impossible to consider circumcision a minor issue,but rather circumcision comes to symbolize one of thegreatest ongoing systemic ethical violations for whichmodern medicine has been responsible.<ref name="vanhowe2008">{{REFjournal |last=Van Howe |first=Robert S. |init=RS |author-link=Robert S. Van Howe |last2=Svoboda |first2=J. Steven |init2=JS |author2-link=J. Steven Svoboda |etal=no |title=Neonatal pain relief and the Helsinki Declaration |journal=Journal of Law, Medicine, and Ethics |location= |date=2008-12 |volume=36 |issue=4 |article= |pages=803-23 |url=https://www.academia.edu/download/33981944/27_Van_Howe.pdf |pubmedID=19094008 |pubmedCID= |DOI=10.1111/j.1748-720X.2008.00339.x |accessdate=2021-10-31}}</ref></blockquote> The British journal, ''The Lancet'', published reports of two randomized controlled trials (RCTs) that were carried out in sub-Saharan Africa which purported to prove that male circumcision was protective against infection with [[HIV]]. The American Academy of Pediatrics consulted with the American College of Obstetricians and Gynecologists ([[ACOG]]) and the American College of Family Physicians ([[AAFP]]) (those being the medical trade associations that represent the specialties that perform most non-therapeutic infant circumcisions and make most of the money from the performance of the non-therapeutic [[amputation]]). The three associations determined to make common cause to produce a position statement that would promote male circumcision based on its alleged protection against [[HIV ]] infection. The AAP was to take the lead, but ACOG and AAFP provided representatives to the new [[AAP Circumcision Task Force 2012| AAP task force]], of which New York Jewess [[Susan Blank]], {{MD}}, {{MPH}}, was the chairwoman. This new task force did not publish a statement until 2012. The AAP declined to re-affirm the statement so it expired in August 2017. [[Dan Bollinger|Bollinger]] (2010) estimated approximately 117 neonatal circumcision-related deaths occur annually in the United States.<ref name="bollinger2010">{{BollingerD 2010}}</ref> [[Anthony Losquadro]] formed [[Intaction]], an [[intactivist]] organization in 2010. The Centers for Disease Control and Prevention ([[CDC]]) reported an incidence of newborn circumcision of 58.3 percent in 2010.<ref name="cdc2015">{{REFweb |url=https://www.cdc.gov/nchs/data/hestat/circumcision_2013/circumcision_2013.htm

[[Doctors Opposing Circumcision (D.O.C.)]] (2013) provided evidence that the purpose of the 2012 AAP Circumcision Policy Statement was to get more money for doctors,<ref name="doc2013">{{REFdocument

|publisher=[[Doctors Opposing Circumcision(D.O.C.)]]

[[Robert S. Van Howe|Van Howe]] & [[J. Steven Svoboda|Svoboda]] (2013) criticized the 2012 AAP statement because it failed to include important points, in accurately inaccurately analyzed and interpret interpreted current medical literature, and made unsupported conclusions.<ref name="vanhowe2013">{{REFjournal

|pages=434-44141

[[Doctors Opposing Circumcision (D.O.C.)]] commissioned a [https://www,doctorsopposingcircumcision.org new website] in 2016.

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Navia et al. (2020) surveyed the incidence of non-therapeutic neonatal circumcision in four states. The incidence of circumcision in 2016 was found to have declined to 54.5 percent, which translates to an increase in [[genital integrity ]] and wholeness rate to 45.5 percent.<ref>{{REFjournal

|trans-title= |language= |last=Chapin

Jacobson ==Government financial support for non-therapeutic circumcision==The United States government provides [[financial incentive]] for medically-unnecessary, non-therapeutic [[circumcision]] by [[third-party payment]] through numerous government health insurance programs: * [https://www.medicaid.gov/ Medicaid] — About 45 percent of births are under Medicaid.* [https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/ Child Health Insurance Program (CHIP)] — Covers children whose family income is higher.* [https://www.ihs.gov/ Indian Health Service] — Covers the indigenous population.* [https://www.tricare.mil/ Tricare] — Covers military dependents.* [https://www.benefits.gov/benefit/4440 Federal Employees Health Benefits (FEHB) Program] — Covers federal employees and families. * [https://www.medicare.gov/ Medicare] − Covers persons who have reached 65 years of age. == Statistical data ===== Prevalence of circumcision ==='''Prevalence of circumcision''' is the percentage of all males of all ages in the population who have been [[circumcised]].[[Intact America]] carried out a survey in 2022 that claims that 73 percent of all American men were [[circumcised]],<ref>{{REFweb |url=https://www.intactamerica.org/newsroom-gender-equality/ |title=Intact Facts |last= |first= |init= |publisher=Intact America |date=2022 |accessdate=2023-03-29}}</ref> however no documentation has been provided so it is not clear in what region it was carried out or what age groups were surveyed. The prevalence of [[circumcision]] varies by age, region, race, and religion. On another webpage, Intact America claims 78 percent are circumcised so Intact America is uncertain of its claims. Peter Moore (2015) reported that 62 percent of all American males reported being [[circumcised]],<ref name="moore2015">{{REFweb |url=https://today.yougov.com/topics/lifestyle/articles-reports/2015/02/03/younger-americans-circumcision |title=Young Americans less supportive of circumcision at birth |last=Moore |first=Peter |date=2015-02-03 |accessdate=2022-02-07}}</ref> which increases the prevalence of [[intact]] [[foreskin]] to 38 percent of living American males of all ages. This percentage is expected to gradually but constantly decline, while the percentage of males who are [[intact]] due to the declining incidence of newborn boys receiving medically-unnecessary, non-therapeutic [[circumcision]] is expected to increase. The percentage of males with [[intact]] [[foreskin]] is lowest with senior citizens and highest in the youngest age groups. === Incidence of circumcision ==='''Incidence of circumcision''' is the percentage of newborn boys who currently are being [[circumcised]].====Long-term declining trend====The incidence of non-therapeutic neonatal [[circumcision]] hit its peak at 85-90 percent in 1980. It has been slowly declining ever since. Peter Moore (2015) reported that the incidence of circumcision was 55 percent.<ref name="moore2015"/> Jacobsen et al. (2021) collected circumcision statistics used data from 2003 through 2016 from the KidsKid' s Inpatient Database from 2002 of the Agency for Healthcare Research and Quality to 2016compare [[intact]] with [[circumcised]] boys in the first 28 days of life. They The authors reported that a gradual declining trend in the incidence of neonatal non-therapeutic [[circumcision]] throughout the study period. The overall incidence of circumcision had decreased from 57.4 percent in 2003 to 52.1 percent in 2016 over the 13 year study period or 5.3 percentage points for an average decrease of 0.4 percentage point per year. The authors noted "neonatal circumcision rates decreased significantly over time." <ref name="jacobson2021" /> There was significant variation in the incidence of circumcision by region with 55 the Midwest reporting an incidence of 75 percent (three out of four) for the period, while boys in the West were most likely to preserve their [[foreskin]] as the West reported an incidence of only 25.9 percent or about 1 boy in 4 being [[circumcised]].<ref name="jacobson2021" /> One should also note that the [[American Academy of Pediatrics]] [[medical trade association]] vacated its fraudulent 2012 Circumcision Policy Statement by allowing it to expire in 2017 without being re-affirmed. ====Midwest====The Midwest has been called the 'circumcision capital of America' because of its higher rates of circumcision. Nevertheless, the popularity of circumcision is declining even in the Midwest. In the Midwest, the incidence of [[circumcision]] has declined to 75 percent, which translates to a [[genital integrity (intact) ]] rate of 45 increase to 25 percentor 1 in 4 boys having an [[intact]] foreskin. <ref name="jacobson2021" /> The previous report from 2010 was one boy in five being intact rate for the nation had been reported to be 41.7 percent ,<ref name="bollinger2017" /> and before that it was 1 in 201010 boys being [[intact]], so this represents in an improvement increase of 7250 percent (0.25/0.9 percent 10 X 100 = 250%) in the number rate of intact boys[[Intact| intactness]] for the Midwest. The still high incidence of circumcision for in the Midwest is counterbalanced by the low incidence in the entire United States had declined to 52West.1 percent  === Intact is the new norm === [[Intact America]] argues that public opinion regarding non-therapeutic [[circumcision]] of children is approaching or at a "tipping point" at which [[intact]] genitals would be preferred over the end [[circumcised]] variety.<ref>{{REFweb |url=https://intactamerica.org/public-opinion-on-circumcision/ |title=Public Opinion on Circumcision: Can Intactivists Hit A Tipping Point? |last=Anonymous |first= |init= |publisher=Intact America |date=2024-03-23 |accessdate=2024-04-09}}</ref>  The percentage of American boys being [[circumcised]] has been slowly declining for a long time, while the study period (2016), which indicates that 47.9 percent number of boys born in that year are with [[intact]] [[foreskin]] has correspondingly increased.<ref name="jacobson2021" />The percentage of [[intact]] newborn boys now exceeds the percentage of [[circumcised]] newborn boys. As the present trend continues, being [[intact]] is now the more usual, normal condition for infant boys in America. ==American [[genital integrity]] organizations== The United States of America now have numerous [[genital integrity]] ([[intactivist]]) organizations working to promote and encourage the protection of the [[physical integrity]] of American boys.