Boys born in the West are more likely to skip circumcision than they are to have the once common procedure.

It's a dramatic change over the past 32 years. Back in 1979, about two-thirds of boys out West got circumcised in the hospital soon after they were born. By 2010, only 40 percent were.

Overall, rates of circumcision performed in U.S. hospitals have dropped about a 10th over the past three decades. Fifty-eight percent of newborn boys got circumcised in the hospital in 2010, compared with around 65 percent in 1979. The rate has fluctuated, with the modern national low of 55 percent coming in 2007.

The national figures mask very different regional pictures. Rates in the Midwest are highest — at about two-thirds of boys. In the Northeast, the recent circumcision rate was just a tad lower, but has held pretty steady in the 60s, on a percentage basis, for most of the 30-year period. Rates have risen some in the South, but have declined from their 1998 peak.

The figures come from a report just released by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

"The overall modest rate of decline reflects that parents are more thoughtful about circumcision now than they were a decade or two ago when circumcision was a given," Dr. Thomas McInerny, president of the American Academy of Pediatrics, tells Shots in an email. "I don't think that anyone has surveyed parents by U.S. regions to determine why there are significant regional differences, so I can't tell you why this variation exists."

Insurance coverage for circumcision has fallen; that's one factor in the decline. In quite a few states, including Arizona, California, Oregon and Washington, Medicaid doesn't cover circumcision.

Parents have also been getting mixed messages about circumcision. The American Academy of Pediatrics said in the '70s that there was no medical indication for routine circumcision of the newborn. Then the AAP said in the late '80s that there might be some medical benefits. In an update in the late '90s, the group said there wasn't enough evidence of benefits to recommend routine circumcision.

In 2012, the pediatricians said "the medical benefits of circumcision outweigh the risks." Circumcision can reduce the risks of sexually transmitted disease.

Still, the group deferred to parents, saying the decision to circumcise is best made by them in consultation with their children's doctors. The group also acknowledged the importance of religious and personal beliefs in making a choice.

There is vocal opposition to circumcision from some quarters. "It's a brutal and unnecessary procedure to inflict on a baby that can't consent," Georganne Chapin, executive director of Intact America, said in an interview with Bloomberg News.

McInerny says he thinks the AAP's current policy statement "is supportive of the growing and very positive trend of family-centered care and shared decision-making between parents and physicians."

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