Circumcision rates for American newborns continue to decline

A new national analysis shows that fewer newborn boys are being circumcised in U.S. hospitals. The trend spans 2012 through 2022 and affects many patient groups.

Researchers reviewed more than 1.5 million U.S. hospitalizations of male neonates (newborns aged 0 to 28 days) between 2012 and 2022. They found that the prevalence of hospitalizations involving neonatal male circumcision declined significantly during this period, dropping from 54.1 percent to 49.3 percent.

White newborns saw a drop from 65.3 percent in 2012 to 60 percent in 2022. The study also noted reductions among Asian, Pacific Islander and Native American infants, with stability among Black and Hispanic infants.

Babies from the highest income ZIP codes and those with private insurance had the highest rates overall. They also showed the largest reductions over the decade.

Measuring hospital circumcision rates

The team examined inpatient procedures during the first month of life, often called the neonatal period. They focused on circumcision, which is the surgical removal of the foreskin.

The researchers used the Kids’ Inpatient Database, the largest all-payer pediatric inpatient dataset in the United States. It is released periodically and draws from millions of hospital discharges.

This approach captures hospital-based care during birth hospitalizations. It does not include procedures performed outside the hospital.

Circumcision rates drop

“Based on our findings, we believe that multiple factors may contribute to the decline in the number of neonates circumcised,” said Dr. Aaron Tobian, professor of pathology at the Johns Hopkins University School of Medicine.

Some parents are skeptical of medical recommendations. Others weigh cultural or family traditions differently than in past decades.

Public insurance decisions can matter as well. One study of California’s 1982 policy change found a 25- to 31-percentage-point decrease in circumcision rates among Medicaid-financed births after coverage ended.

“Despite overwhelming evidence that neonatal male circumcisions provide health benefits, increasing public skepticism in the United States toward medical recommendations may be driving more parents to choose not to have their sons get circumcised,” said Dr. Tobian.

Medical groups back informed choice

Global agencies tied early guidance to infection prevention. In 2007, the World Health Organization and UNAIDS experts recommended that male circumcision be recognized as an additional intervention to lower the risk of heterosexually acquired HIV in men.

“Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks,” stated the American Academy of Pediatrics (AAP) in a 2012 policy statement. Pediatric leaders in the United States took a measured position. 

“This document is intended to assist health care providers in the United States who share information with men and parents of male infants during decision-making about male circumcision,” noted a 2018 CDC guidance for clinicians. Federal health officials emphasized informed counseling. 

Circumcision health effects

Studies link the procedure to lower rates of certain infections. Evidence points to fewer urinary tract infection cases in infancy among circumcised boys.

The literature also shows lower acquisition of HPV and genital herpes in some settings. These effects vary by population and behavior.

Public health guidance frames circumcision as one tool among many. Safer-sex practices and testing remain essential for adults.

Weighing benefits, risks, and culture

Parents face a decision that mixes health data with values. The AAP supports access to circumcision while leaving the choice to families.

Clinicians can outline benefits and risks in plain terms. They can also address pain control, timing, and aftercare. Insurance coverage can affect options, especially for Medicaid insured births. State policies differ and may change over time.

Families who decline the procedure can still take practical steps for hygiene and care. Families who choose it can plan for comfort and healing.

Gaps in circumcision reporting

These numbers reflect inpatient procedures recorded in hospital data. They do not capture outpatient surgeries.

Coding practices and where births occur can influence counts. The Kids’ Inpatient Database is strong for national snapshots but not designed to explain motives.

Race and ethnicity labels are drawn from hospital records. They may not perfectly reflect identity.

Income was measured by ZIP code, which can blur household level differences. Insurance type serves as a proxy for financial coverage.

Circumcision rates continue steady decline

Circumcision of newborn boys in U.S. hospitals became less common from 2012 to 2022. The reasons likely span trust, culture, and coverage.

Health organizations continue to describe medical benefits while underscoring choice. Parents remain the decision makers for their newborns.

Researchers will watch whether trends shift again as policies and demographics change. Clear communication will help families weigh their options.

The study is published in the journal JAMA Pediatrics.

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