By Jennifer Henderson

Neonatal male circumcision in the U.S. has declined over the past decade. From 2012 to 2022, the overall prevalence of hospitalizations with a circumcision decreased significantly from 54.1% to 49.3%. Circumcision has fielded criticism and ethical considerations despite potential health benefits.

Neonatal male circumcision in the U.S. has fallen over the past decade and now sits below 50%, a cross-sectional study indicated.

From 2012 to 2022, the prevalence of circumcision during hospitalization of male neonates age 0 to 28 days decreased significantly by nearly 5 percentage points, from 54.1% to 49.3%, reported Aaron Tobian, MD, PhD, of Johns Hopkins University School of Medicine in Baltimore, and colleagues.

There was a significant 5.3 percentage point decline among white neonates to 60%, while prevalence among Black and Hispanic neonates remained stable, at 66.1% and 21% in 2022, respectively, the researchers noted.

Neonates from the highest income zip codes and those with private insurance had the highest prevalence of circumcision, but the largest decline.

"These findings align with prior trends and reflect sociodemographic changes and evolving cultural, clinical, and policy landscapes," Tobian and colleagues wrote.

Indeed, circumcision has faced criticism and ethical concerns, such as that infants are not able to consent to the procedure. Meanwhile, potential health benefits have been cited as outweighing the risks of circumcision.

"Randomized trials have demonstrated that male circumcision reduces the risk of penile inflammation, urinary tract infections, HIV, genital herpes, and human papillomavirus (HPV) -- a virus that causes penile cancer," Tobian said in an email. "Additionally, circumcision has been shown to lower bacterial vaginosis, trichomoniasis, and HPV-related cervical cancer in the female partners of circumcised men."

Because of such data, the American Academy of Pediatrics [AAP] updated its policy in 2012 to support male circumcision. That policy revision was likely one factor, but more were probably at play in the shifting trend, Tobian and colleagues noted.

"Although the AAP affirms that [circumcision] benefits outweigh the risks and supports access to the procedure, it recommends leaving the decision to parents," they wrote. "There is also increased skepticism toward medical recommendations in the U.S."

"The continual Hispanic population growth and births, the ethnicity group with the lowest [circumcision] prevalence, may also contribute to overall decreases," they continued. "Additionally, 17 states had ended Medicaid coverage for routine [circumcision] by 2011, creating barriers for families with low income."

There were significant declines in circumcision prevalence across all census regions. The Midwest maintained the highest prevalence (68.5%) as of 2022, while the West had the lowest (19.7%).

Circumcision prevalence declined significantly among white neonates across all regions, while it remained stable among Black and Hispanic neonates across regions.

Tobian and colleagues used the Kids' Inpatient Database, a nationally representative dataset of U.S. pediatric hospitalizations, to look at inpatient circumcision procedures on males age 0 to 28 days. Overall, the study included more than 1.5 million hospitalizations during each year of the study period from 2012 through 2022.

Neonates with coagulopathies, penile anomalies, or prematurity were excluded from the study sample.

Limitations included that the database only captured inpatient circumcision using ICD codes, potentially leading to an underestimation of overall prevalence, and that it identified discharge records rather than individual patients, Tobian and colleagues noted. State identifiers also were lacking.