By Jennifer Mayerle

MINNEAPOLIS (WCCO) — It is one of the first decisions parents make when they have a baby boy: whether to have him circumcised.

Nationwide, numbers have trended down by about 10 percent over the past 30 years, but the Midwest still has the highest rate at nearly 70 percent.

READ MORE: Prescription Drug Disposal Set Up For Nat'l Drug Take Back Day

Families opened up to WCCO-TV about how they made the decision, and found out why this topic continues to be debated.

The Keepman family is a busy bunch, with three girls under age 5.

“Crazy, busy, but fun, rewarding,” Bethany Keepman said.

Bethany and Jared Keepman will soon add a fourth to their growing family. This time it’s a boy.

“It’s exciting and it’s a little frightening. We’ve got girls down. We know exactly what to do with them,” Jared Keepman said.

The first decision the couple had to make: whether to circumcise their son.

“I never really thought otherwise, just kind of assumed,” Jared Keepman said.

“All the males on both sides of the family are circumcised,” Bethany Keepman added.

Still, the couple researched the topic. They talked with their doctor and other families to look at the benefits and possible drawbacks.

“I first assumed we would circumcise for medical reasons and the health benefits, but then the more we talked about it and talked to my doctor, we realized it’s almost more of a social, cultural issue in this area,” Bethany Keepman said.

States in the Midwest have the highest circumcision rates in the country. Currently about two out of three boys in the region are circumcised.

“Typically it’s done in newborns,” Dr. Sheldon Berkowitz, medical director of Children’s Hospitals and Clinics of Minnesota, said.

READ MORE: St. Paul Police: Suspect Killed 55-Year-Old Man In Stolen Car

Berkowitz believes the decision comes down to three things.

“In both the Jewish religion and the Muslim religion, it’s done as a commandment. You may be doing it for social reasons — dad is circumcised, older brother is circumcised. And then there are also medical reasons why you would want to be doing it,” Berkowitz said.

Recommendations from the American Academy of Pediatrics have changed over the years, which Berkowitz said has fueled the debate and caused the number of families choosing the procedure to fluctuate.

“At this time, it’s felt to be medically indicated. It is worthwhile to go ahead and do circumcision for health reasons. It can decrease chances for infections — both bladder and kidney infections — and sexually transmitted infections later in life,” Berkowitz said.

He believes the decision should be left to each family, and he knows some people feel strongly about the topic.

“I’m horrified why this still goes on today,” Kandace O’Neill said. “My husband was concerned about the normal things: cleanliness and being made fun of.”

She was adamantly against the procedure, and tries to educate people about their choices.

“I believe this is a human rights issue. I don’t believe we should be doing cosmetic surgery on infants and children that can’t say no,” O’Neill said.

The Keepmans weighed the options. Crosby was born on Nov. 8, and was circumcised a few days later.

“We would regret not doing it,” Bethany Keepman said.

“The research that we did helped us better understand why we were going to do what we were going to do and helped us solidify that decision,” Jared Keepman said.

Medicaid stopped covering circumcision in Minnesota in 2005 because, at that time, the American Academy of Pediatrics found the procedure was not medically necessary. Berkowitz said that could factor into the declining numbers.

MORE NEWS: Aromatherapy Spray From India Blamed For Illness That Sickened Minnesotan

The procedure costs between $300 to $600, but, it could run as high at $1,500 depending on where it’s done. Some hospitals charge a facility and equipment fee.

Jennifer Mayerle