Circumcision In Decline: Why Fewer U.S. Parents Are Heeding Recommendation By Doctors

Rates For Male Newborns Drop Below 50% Despite Medical Support

BALTIMORE — Circumcision among newborn boys in the United States has steadily declined over the past decade, even as leading health organizations have voiced support for the procedure.

A new analysis from researchers at Johns Hopkins University of more than 1.5 million annual hospital records shows the share of newborn boys circumcised during their first month of life fell from 54.1% in 2012 to 49.3% in 2022.

This decline came after the World Health Organization (2007), the American Academy of Pediatrics (2012), and the Centers for Disease Control and Prevention (2018) each issued statements supporting access to newborn circumcision. These groups highlighted research linking the procedure with lower risks of urinary tract infections, penile inflammation, and transmission of sexually transmitted infections including HIV.

White Families Account for the Largest Circumcision Decline

Trends varied sharply across racial and ethnic groups. For White newborns, circumcision prevalence was 61.0% in 2012, rose to a peak of 65.3% in 2019, and then declined to 60.0% in 2022.

By contrast, Black families maintained the highest rates at about 66% throughout the study period, while Hispanic families consistently had the lowest at around 21%.

Regional differences were just as pronounced. Hospitals in the Midwest recorded the highest prevalence at 68.5% in 2022, while Western hospitals reported only 19.7%. Among White families in the West, circumcision dropped from 34.3% in 2012 to 26.2% in 2022.

Wealth and Insurance Status Shape Decisions

Household income and insurance coverage also influenced circumcision choices. Parents in the wealthiest zip codes started with higher rates (59.4% in 2012) but saw some of the steepest declines, falling to 51.1% by 2022.

Insurance patterns told a similar story. Families with private coverage had the highest baseline prevalence, 64.2% in 2012, yet their rate fell sharply to 56.3% in 2022. Medicaid-covered families showed smaller shifts, with circumcision declining from 44.5% to 42.3% over the same period.

Policy changes may have contributed. By 2011, 17 states had ended Medicaid coverage for routine newborn circumcision, creating financial hurdles for some families. Still, researchers noted that cost alone cannot explain the overall decline, since reductions were also seen among privately insured families.

Cultural Factors and Changing Attitudes Towards Circumcision

The authors note that several factors may contribute to why parents are choosing circumcision less often despite medical endorsements. The American Academy of Pediatrics affirms that the health benefits outweigh the risks but stresses that the decision should remain with parents, stopping short of a recommendation for all newborns.

They highlight increased skepticism toward medical recommendations in the United States and the continual growth of the Hispanic population and births, given that Hispanic families have consistently low circumcision rates.

The study, published in JAMA Pediatrics, also found that rates among Black newborns stayed stable across regions, while White newborns showed the largest decreases. The authors did not investigate reasons for these racial differences, only documenting their persistence.

Medical Guidance Meets Parental Autonomy

The researchers relied on the Kids’ Inpatient Database, a nationally representative sample of pediatric hospitalizations. They examined circumcision procedures performed within 28 days of birth, identified through billing codes. This design captures most newborn circumcisions, though not those performed in outpatient clinics or later in infancy.

Limitations include possible underreporting due to coding sensitivity, lack of state-level identifiers, and the fact that the database counts hospital discharges rather than unique infants. Still, the study represents the most comprehensive national picture available.

Between 2012 and 2022, medical organizations offered some of their clearest endorsements of circumcision’s health benefits. Yet parents moved in the opposite direction, choosing the procedure less often. The gap between institutional recommendations and family decisions underscores how health behaviors reflect more than clinical guidance alone.

As the authors concluded, circumcision trends reflect a mix of demographic change, cultural views, and shifting trust in healthcare, factors that shape decisions even when medical benefits are emphasized.

Disclaimer: This article is for general information only and should not be taken as medical advice. Parents should consult healthcare professionals when making decisions about circumcision or other procedures.