Neonatal male circumcision rates decline in the United States despite health benefits

Scientific evidence supporting the health benefits of male circumcision - surgical removal of the foreskin from the penis - dates back hundreds of years to observations made by physicians of their circumcised patients. More recently, research has continued to confirm that the procedure reduces penile inflammation, urinary tract infections, and acquisition of HIV and other sexually transmitted infections, such as genital herpes and HPV (known to cause oral, cervical and penile cancers). 

In response to the evidence, the World Health Organization (2007), the American Academy of Pediatrics (2012) and the U.S. Centers for Disease Control and Prevention (2018) have all recommended that male babies be circumcised for lifelong health benefits. 

However, a new study by researchers at Johns Hopkins Medicine and the Johns Hopkins Bloomberg School of Public Health reveals that neonatal male circumcision (NMC) rates in the United States declined nearly 5% in the 10 years following the American Academy of Pediatrics statement in favor of the practice. 

The findings are reported today in a research letter in JAMA Pediatrics. 

We reviewed over 1.5 million U.S. hospitalizations of male neonates, ages 0 to 28 days, during the period 2012 to 2022, and found that the overall prevalence of hospitalizations where a neonatal male circumcision was performed decreased significantly, from 54.1% to 49.3%. Decreases were observed across most patient and hospital subgroups, including whites - a group with traditionally high circumcision rates - where circumcisions dropped 5.3% over the decade studied." 

Aaron Tobian, M.D., Ph.D., study co-senior author, professor of pathology, Johns Hopkins University School of Medicine

While the number of white male babies receiving circumcisions declined (65.3% in 2012 and 60.0% in 2022), the study showed NMC prevalence among Black (64.9% to 66.1%) and Hispanic (21.2% to 21.0%) neonates remained stable during that same period. There were decreases for Asian or Pacific Islanders (39.7% to 37.5%) and Native Americans (44.2% to 40.9%). 

Neonates from the highest-income ZIP codes in the United States and those whose families had private insurance had the highest NMC rates overall but experienced the largest reductions (59.4% to 51.1% and 64.2% to 56.3%, respectively) during the 10-year study period. 

"Based on our findings, we believe that multiple factors may contribute to the decline in the number of neonates circumcised," says Tobian. 

Among the factors listed by the researchers is parental distrust of medical advice. 

"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," explains Tobian. 

Another factor may be cultural influences, says Tobian. "Hispanics - the ethnic group that historically reports the lowest circumcision prevalence - also is the largest growing population in the United States; therefore, the overall circumcision rate is skewed downward," he says. 

"Finally, by 2011, one year before our study period began, 17 states had ended Medicaid coverage for routine neonatal male circumcisions," says Tobian. "This likely created barriers to such services for families at low-income levels during the decade we analyzed." 

The Johns Hopkins Medicine/Johns Hopkins Bloomberg School of Public Health study used 2012 to 2022 data from the Kids' Inpatient Database, a nationally representative dataset of U.S. pediatric hospitalizations produced every three years by the federal Agency for Healthcare Research and Quality. 

Along with Tobian, the members of the research team from the Johns Hopkins University School of Medicine are study lead author Ping Yang, M.H.S.; co-senior study author Mary Grabowski, Ph.D.; and Thomas Quinn, M.D. Team members from the Johns Hopkins Bloomberg School of Public Health are Eshan Patel, Ph.D., and Xianming Zhu, M.H.S. 

The study was supported in part by grant R01DK131926 from the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health. 

Tobian reports receiving other grants from the National Institutes of Health and the U.S. Department of Defense during the conduct of the JAMA Pediatrics study. None of the other authors had any conflict-of-interest disclosures to report.