Decision-Making Regarding Newborn Circumcision: A Qualitative Analysis

Objectives Circumcision of newborn males is left to parental preference, as medical necessity has not been demonstrated. For medical providers seeking to help parents make decisions and provide informed consent, there is little information regarding how parents gather and process information about circumcision. This study aimed to characterize the comprehensive range of parental attitudes, gaps in knowledge, and decision-making regarding circumcision. Methods Qualitative data was obtained from semi-structured open-ended interviews conducted during the postpartum hospitalization. Interviews were recorded, transcribed, and coded by multiple independent reviewers. A grounded theory approach was used to identify emergent themes regarding attitudes towards, sources of information about, and decision-making surrounding circumcision. Results Ten mothers were interviewed, of whom six planned to circumcise and four did not. Major themes emerged: the importance of cultural norms, limited yet influential discussions, and the lack of, but desire for, more knowledge. Discussions with medical providers were often limited, though when physician conversation was more extensive, provider input was highly influential. Parents lacked evidence-based knowledge of the risks and benefits of the procedure. They uniformly desire more information and counseling from their medical providers. Conclusions for Practice This study affirms the importance of sociocultural factors and identified a discrepancy between parents' desire for empiric information and the counsel offered by providers, identifying a need for improved parent counseling. The qualitative themes that emerged from this work enabled the development of a comprehensive conceptual model that can be further tested to develop a decision aid for circumcision of the newborn.