Ritual circumcision: no longer a problem for health services in the British Isles.

Area of Science:

• Pediatric Surgery
• Public Health Policy
• Surgical Morbidity

Background:

• Primary care trust (PCT) funding for ritual circumcision services was withdrawn, raising concerns about increased morbidity from community-based procedures.
• The study addresses the impact of this funding withdrawal on circumcision practices and outcomes.

Purpose of the Study:

• To document circumcision practices before and after PCT funding withdrawal.
• To determine the effect of funding withdrawal on circumcision-related morbidity.
• To survey pediatric surgical centers in the British Isles regarding ritual circumcision service provision.

Main Methods:

• Retrospective review of circumcision practice for one year prior to funding withdrawal.
• Prospective audit of practice for one year following funding withdrawal.
• Email survey of all British Isles pediatric surgical units on ritual circumcision service provision.

Main Results:

• Circumcision for medical reasons increased significantly after funding withdrawal (50% to 99%).
• Re-admission rates for hospital circumcisions remained similar, but community circumcision admissions rose (6 to 11 patients).
• Only one-third of British pediatric surgical centers offer ritual circumcision, with many facing funding issues or reconsidering service provision.

Conclusions:

• PCT funding withdrawal impacted procedural volume and resulted in cost savings despite increased postoperative complication admissions.
• Significant inequality in healthcare provision for ritual circumcision exists across the British Isles.
• Support and training are vital for medical and non-medical practitioners undertaking increased community circumcisions.