A History of the American Academy of Pediatrics anti-circumcision Policy, 1971-2006
In 1971, the (AAP) reported that there are no valid medical indications for circumcision in the neonatal period.2 After that the nationwide incidence of neonatal circumcision continued the slow decline that started in 1965, although Wallerstein (1985) reported spot samples of 77 to 98 percent.3
The AAP convened an "ad hoc Task Force" under the chair of Hugh C. Thompson, M.D., to review the issue of circumcision in 1975. The 1975 Task Force reaffirmed the 1971 AAP statement.9 The Canadian Paediatric Society (CPS) also took a position in 1975 that circumcision is medically unnecessary.
In 1989, the AAP issued a statement that claimed that circumcision had "potential benefits".4 The publication of this statement temporarily arrested the decline in circumcision. Nelson et al., who used a different source, the National Inpatient Survey (NIS), reported an increase in the incidence of circumcision in the 1988-2000 period.5 Based on the NIS, Nelson et al. reported a circumcision incidence of 48.3 percent in 1988-91, but the NHSD reported an incidence of 58.8 percent in 1989, 59.0 percent in 1990, and 61.1 percent in 1991. There would have been little or no increase if Nelson et al. had used data from the NHDS.
John R. Taylor and colleagues published a landmark article in 1996 that described original research into the anatomy and histology of the foreskin. The research showed that the foreskin is highly innervated tissue with the characteristics of a sensory organ designed to provide erogenous sensation.15
The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG), in a joint statement, reclassified neonatal circumcision from "routine" to "elective" in 1997.18 The change in policy was announced the year after the publication of Taylor's important article that describes in detail the injury inherent in every circumcision. This action removes any suggestion that circumcision is beneficial or that it is recommended by medical authorities. It may also be an attempt to shift legal liability for the injury that is inherent in every child circumcision from the doctor to the parents.
Persistent criticism of the obvious flaws of the supplemental 1989 Report of the Task Force on Circumcision has caused the AAP to distance itself from its own report. The AAP has removed its policy statement from its website. The AAP convened a new Task Force under the chair of Carole Marie Lannon, MD, in 1997 to develop a new evidence-based policy statement which was released in March 1999. After fully reviewing the medical evidence, the Task Force concluded that routine neonatal circumcision cannot be recommended because of lack of any proved benefit. It said that the benefits are "potential" (i.e. they are unproven).
In 1999, the AAP issued yet another statement that said the data on potential benefits were insufficient to recommend the practice of neonatal non-therapeutic circumcision.6 Shortly thereafter, the American Medical Association declared that neonatal circumcision is a non-therapeutic procedure.7 More parents began to opt for genital integrity and the percentage of boys circumcised once again began to decline.
A statement of reaffirmation for this policy was published on September 1, 2005, and
A statement of reaffirmation for this policy was published on May 1, 2006.
