"There's a good case to be made that circumcisions can protect our children," said study author Arleen A. Leibowitz, a professor of public policy at the University of California, Los Angeles. "If you can alleviate the cost of the procedure, then people are more likely to adopt it."
Circumcision rates have been dropping since the 1980s amid controversy about whether the procedure is necessary or desirable. More states, meanwhile, have stopped paying for the procedure through Medicaid, including 10 in this decade alone. If all states covered circumcision, the percentage of male babies who get the procedure would rise from 56 percent to 62 percent, Leibowitz estimated.
Critics say circumcision is brutal and robs males of sexual sensation, but many in the medical community point to research that suggests circumcision reduces the risk of sexually transmitted diseases such as AIDS and the virus that can cause cervical cancer.
Currently, 16 states don't cover circumcision through their Medicaid programs, according to the new study. The procedure for an infant can cost $250 to $300, Leibowitz said.
Circumcision rates among Latinos are especially low, even if the government pays for the procedure, Leibowitz said. She added that rates are about equal among whites and blacks.
The study authors looked at a national sample of 417,282 newborn boys from 2004. The researchers examined the statistics with an eye toward whether the states where the boys were born covered circumcision.
The findings were published in the January issue of the American Journal of Public Health.
According to Leibowitz, the states that don't cover the procedure are: Arizona, California, Florida, Idaho, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Nevada, North Carolina, North Dakota, Oregon, Utah and Washington.
The researchers adjusted the numbers to account for factors such as the number of days that infants spent in the hospital. According to Leibowitz, it's difficult to fit in a circumcision if the baby is just there for a day.
Even with the adjustments, circumcision rates were significantly lower in states that didn't pay for the procedure through Medicaid, she said, adding that "not covering it under Medicaid sends a signal to recipients that this not a valuable procedure."
Robert C. Bailey, a professor of epidemiology at the University of Illinois at Chicago, said the poor are robbed of a chance to make a choice about circumcision because of the lack of funding.
"It's another way in which our health system is increasing inequality across the population," he said. "People who can't afford good health care are essentially being discriminated against by this policy."
SOURCES: Arleen A. Leibowitz, Ph.D., professor, public policy, University of California, Los Angeles; Robert C. Bailey, Ph.D., professor, epidemiology, University of Illinois at Chicago; January 2009, American Journal of Public Health.