Social Norm Theory and Male Circumcision: Why Parents Circumcise

I agree with Michael Benatar and David Benatar (2003) that circumcision has powerful culture value. Indeed, empirical studies have shown that the parental decision to circumcise is based primarily on social, not medical, considerations. This commentary discusses how the cultural norm favoring circumcision influences parental decision making. The dynamics of this process make it unlikely that circumcision rates will decline dramatically, at least in the absence of legal intervention. Even if one withholds normative judgment about circumcision—labeling it neither good nor bad but simply something that is appropriately left to parental discretion—more time should be spent examining the actual reasons parents choose to circumcise. Too often the discussion is about only the medical pros and cons, even though the strength of the cultural norm frequently prevents parents from evenhandedly assessing the medical considerations.

Legal theorists have observed that norms often regulate behavior at least as effectively as the law. In part, norms are effective because of the costs that are associated with noncompliance. Individuals who deviate from the norm might suffer from self-imposed guilt (Cooter 1996) or experience shame and a loss of esteem among their peers (McAdams 1997), or simply fail to signal that they are of a good type (Posner 2000). These phenomena are apparent with circumcision. As American circumcision rates gradually increased during the early- and mid-twentieth century, circumcision was increasingly seen as something good parents do. Increasing circumcision rates had a feedback effect: as more and more infants were circumcised, the esteem-based and signaling incentives continued to grow because noncircumcision was seen as ever more deviant (Waldeck 2003). Today parents consistently describe the desire that a boy resemble his peers as one of the primary motivations for circumcision. Moreover, the empirical evidence suggests some basis for parental concerns about boys who look different. For instance, the largest study of American sexual practices found, among racial groups where circumcision was the norm, distinct differences in the sexual activities of circumcised and uncircumcised men. The researchers explained the data by suggesting that when circumcision is the common practice, a stigma is associated with the foreskin (Laumann et al. 1997).

Social norms also do more than create costs for behaviors that are perceived as deviant. Norms affect the way individuals understand information, so that from the outset the behavioral outcome is weighted in favor of the predominant social norm. Norms color every aspect of decision making, thereby encouraging an individual to either exaggerate or diminish the significance of other factors in the behavioral calculus (Waldeck 2003). For instance, Caucasian parents in the Midwest (where circumcision rates are upward of 80%) are likely to know only circumcised males, many of whom are healthy and probably most or all of whom consider themselves no worse off. Parents will also see that their peers continue to circumcise their sons, which provides another basis for discounting the disadvantages of the procedure and exaggerating its potential health benefits.

This hypothesis is supported by the work of researchers who have studied informed consent in the context of routine circumcision. Virtually all of these studies reveal that providing information about the advantages and disadvantages of the procedure does not lead to lower circumcision rates. In a study where physicians provided mothers with verbal counseling, researchers were able to assess parental reactions to information that suggested the disadvantages of circumcision outweighed its benefits. Parents were made visibly uncomfortable by the information, expressed resentment that the physician was challenging their previously established beliefs about circumcision, and tried to distance themselves from the physician who conveyed the information (Christensen-Szalanki et al. 1987). Parents demonstrated a clear desire to discount, or perhaps entirely ignore, the costs that would lead them to opt against circumcision.

Moreover, given prevalent gender stereotypes, parents might be able to conveniently ignore the pain of circumcision. Here norms of masculinity are relevant, and these norms might cause parents to...