U.S. neonatal circumcision rates fall despite medical endorsements

For centuries, physicians have documented the medical benefits of male circumcision—the surgical removal of the foreskin. Modern research has reinforced those early observations, showing the procedure reduces penile inflammation, urinary tract infections, and the transmission of HIV and other sexually transmitted infections including herpes and HPV, which can lead to several types of cancer. The evidence has been weighty enough that three major health authorities—the World Health Organization in 2007, the American Academy of Pediatrics in 2012, and the U.S. Centers for Disease Control and Prevention in 2018—all issued recommendations in favor of neonatal circumcision for lifelong health protection.

Yet something unexpected has happened in the decade since the pediatricians weighed in. A new study from Johns Hopkins Medicine and the Johns Hopkins Bloomberg School of Public Health, published in JAMA Pediatrics, documents a steady decline in the procedure's uptake across the United States. Researchers analyzed hospitalizations of male newborns from 2012 to 2022—more than 1.5 million cases drawn from a nationally representative database of pediatric hospital stays. What they found was a significant drop: the share of newborn boys undergoing circumcision fell from 54.1 percent to 49.3 percent over the decade, a decline of nearly five percentage points despite the medical consensus supporting the practice.

The retreat was not uniform across all populations. Among white families, historically the group most likely to choose circumcision, the rate fell from 65.3 percent to 60 percent—a loss of more than five percentage points. For Asian or Pacific Islander newborns, the rate declined from 39.7 percent to 37.5 percent. Native American circumcision rates dropped from 44.2 percent to 40.9 percent. But the picture differed sharply for Black families and Hispanic families. Among Black newborns, circumcision rates actually ticked upward slightly, from 64.9 percent to 66.1 percent. For Hispanic newborns, the rate remained essentially flat, holding at around 21 percent throughout the period.

The most dramatic declines appeared among families with the most resources. Newborns from the wealthiest ZIP codes saw circumcision rates plummet from 59.4 percent to 51.1 percent. Among families with private insurance—typically a marker of higher income—the drop was even steeper, falling from 64.2 percent to 56.3 percent. This inversion is striking: the families most able to afford the procedure and most likely to have access to it are the ones choosing it least.

Aaron Tobian, a pathology professor at Johns Hopkins and one of the study's senior authors, identified several forces at work. One is a growing skepticism toward medical authority itself. "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," Tobian explained. Another factor is demographic. Hispanic Americans, the nation's fastest-growing ethnic group, have historically reported the lowest circumcision rates. As their share of the population grows, the national average shifts downward simply by composition.

A third factor is policy. By 2011, seventeen states had eliminated Medicaid coverage for routine neonatal circumcision. This created a financial barrier for low-income families during the entire decade the study examined, likely suppressing circumcision rates among those least able to absorb the cost out of pocket. The combination of these forces—eroding trust in medical institutions, cultural demographic change, and the withdrawal of public insurance coverage—appears to be reshaping a medical practice that major health organizations continue to endorse on clinical grounds. The result is a widening gap between what the evidence suggests is beneficial and what American parents are choosing to do.