The sign that David Atkinson held over his head — "CIRCUMCISION IS SEXUAL MUTILATION" — was perhaps less striking than his uniform: a white cowboy hat, white bandana, white shirt, and, on the crotch of his white pants, a large splotch of blood-red paint.

“My goal," the 31-year-old Atkinson said, “is to spread awareness so people will never be able to say they’ve never heard someone complain that part of his penis was taken from him.”

He spent part of his childhood living in Mapleton and returned to Utah in July for a monthlong series of protests against infant circumcision, organized by the group Bloodstained Men and Their Friends.

The demonstrations along the Wasatch Front weren’t huge; groups of about a half-dozen to 20 activists joined the Bloodstained Men, who donned white, blood-marred outfits like Atkinson’s to lead street-corner protests in five Utah cities.

But the protesters represent a growing cohort of parents who are opting not to circumcise their infant sons.

(Photo courtesy of James Loewen) Anti-circumcision advocates hold a demonstration in Salt Lake City on July 31, 2019.

The Centers for Disease Control and Prevention shows U.S. rates of infant circumcision declining in recent decades, with the lowest rates in Western states. As of 2010, state data showed 38.8% of newborn males in Utah were circumcised.

More recent data is unavailable because previous numbers were based on hospital billing records, which now do not reflect circumcisions because so few insurers cover the procedure, said Tom Hudachko, spokesman for the Utah Department of Health. Utah is one of 18 states where Medicaid also does not cover newborn circumcision.

The American Academy of Pediatrics since 2012 has held that the benefits of circumcision outweigh the risks — though the benefits are not so overwhelming that the academy recommends universal circumcision. The CDC points to evidence that circumcision is associated with some reduced risk of urinary tract infections, penile cancer, and sexually transmitted infections, most notably HIV.

But the dropping rate of circumcision brings the United States more in line with most other developed countries, where infant circumcision is far less common and public health positions are more ambivalent. In Canada, where the major pediatric association has objected to routine circumcision, fewer than a third of all men and boys are circumcised. Elective circumcision is banned in public hospitals in Australia, where fewer than 20% of newborn boys were being circumcised as of 2010. In many other European countries, as well as most of Asia and South America, fewer than 10% of males are circumcised.

In Denmark, where one poll showed more than 80% support for a ban on circumcision, legal prohibitions have been brought to Parliament for consideration. In Germany, lawmakers codified the right to circumcise infant boys only after a regional court deemed religious circumcision a criminal offense in a ruling that outraged Jewish and Muslim communities. In Iceland, where lawmakers have considered a ban on nonmedical circumcisions, health officials have documented 21 instances of the procedure since 2006.

But there is little appetite for a legal ban in the United States, acknowledged Steve Scott, a longtime Utah activist against circumcision, who joined Bloodstained Men in a Salt Lake City protest July 31.

Instead, Scott said, protesters hope to persuade parents to rethink circumcision and take their concerns to their doctors.

“These operations are not just removing a tag of skin,” Scott said. “It’s a radical, radical excision. It’s not a little snip, snip. It’s an enormous amount of tissue, even though in a baby it’s very small.”

Scott said one argument in particular has been compelling to a lot of Utah parents who have opted not to circumcise their children: An infant has no opportunity to consent to the removal of his foreskin.

Because of Mormon emphasis on “premortal existence,” he said — the belief that people’s souls exist before their lives begins on earth — Utah parents may be more likely to hesitate before seeking to permanently alter a child’s body.

“Mormons believe children are not property of the parents; parents are stewards,” Scott said. “The patient is not the parent [when they say], ‘I want you to cut off normal, healthy parts of my child's genitals.’”

(Photo courtesy of James Loewen) Anti-circumcision advocates hold a demonstration in Orem on July 13, 2019.

Scott said he also joined the protest to offer validation to any person who feels conflicted about his own circumcision, “whether he can consciously recall his circumcision or not.”

“It’s not an accepted thing for an American man to complain," Scott said, “especially about his genitals.”

That’s one of the factors guiding the uniforms that Bloodstained Men and Their Friends selected for the protests.

“We wear white outfits with bloodstains on [the] crotch, symbolizing the damage that was done to us without our consent, and we wear cowboy hats as a symbol of the American man,” said Harry Guiremand, spokesman for the group.

The Salt Lake Tribune reached out to four pediatric clinics and a pediatric urologist in Utah for comment; they declined to comment or did not return calls.