Research Update - Circumcision in America: Tradition, Medicine, and Changing Trends
A new study found that neonatal male circumcision (NMC) rates in the US declined nationally from 54.1% in 2012 to 49.3% in 2022
Research Update
A new study published in JAMA Pediatrics in September 2025, titled “Trends in Circumcision Among Newborn Males in the US” by Ping Yang, Xianming Zhu, Eshan U. Patel, Thomas C. Quinn, Mary K. Grabowski, and Aaron A. R. Tobian, examined over 1.5 million neonatal hospitalizations annually between 2012 and 2022. The analysis, using the Kids’ Inpatient Database, found that neonatal male circumcision (NMC) rates declined nationally from 54.1% in 2012 to 49.3% in 2022. Declines were most pronounced among White newborns and in higher-income families, while rates among Black and Hispanic newborns remained largely stable. Regional differences persisted, with the Midwest maintaining the highest prevalence (68.5% in 2022) and the West the lowest (19.7%). The authors noted that this decline occurred despite endorsements from the World Health Organization (2007), the American Academy of Pediatrics (2012), and the CDC (2018), all of which concluded that the health benefits of circumcision outweigh the risks. The findings suggest that cultural shifts, demographic changes, skepticism toward medical authority, and financial barriers such as lack of Medicaid coverage in many states may be driving the downward trend.
Broader Context (400–600 words)
Circumcision has long carried both medical and cultural significance. Medically, it is associated with reduced risks of urinary tract infections in infancy, penile inflammation, certain sexually transmitted infections, and, indirectly, lower rates of HIV transmission in high-prevalence areas. These benefits formed the basis for recommendations by leading health bodies, including the AAP and CDC. Yet, unlike vaccines, circumcision is considered elective, and professional guidelines emphasize that the final decision rests with parents.
Beyond medicine, circumcision is deeply tied to religious identity. For Jews, circumcision—performed on the eighth day of life as the brit milah—is a covenantal ritual tracing back thousands of years. In Islam, circumcision is also widely practiced, though the timing and rituals vary across cultures. These religious traditions have ensured that circumcision remains one of the most common surgical procedures worldwide, independent of medical rationale.
In the United States, however, the practice has also been driven by 20th-century medical norms. For decades, circumcision was almost universal in certain regions, promoted as part of good hygiene and preventive medicine. Today, this consensus has eroded. Opponents, often self-described as “intactivists,” argue that routine circumcision violates a child’s bodily autonomy and exposes newborns to unnecessary pain and surgical risks. They also point out that most of the cited health benefits can be achieved by non-surgical means, such as safe sexual practices. This movement has gained traction in the broader climate of parental skepticism toward medical authority, similar to debates over vaccines or birth interventions.
Professional societies walk a careful line. The American Academy of Pediatrics, in its 2012 policy statement, concluded that the health benefits outweigh the risks but stopped short of recommending universal circumcision. Instead, it stressed parental choice, balanced counseling, and access to the procedure when desired. The American College of Obstetricians and Gynecologists echoes this nuanced position, recognizing the benefits but framing circumcision as an elective, not essential, intervention.
Recent declines in U.S. circumcision rates reflect this shifting landscape. Cultural diversification plays a role: Hispanic populations, who traditionally have lower circumcision rates, represent a growing share of U.S. births. Financial factors are also powerful—when states withdraw Medicaid coverage, circumcision rates fall. At the same time, wealthier families, once more likely to circumcise, are now leading the trend away from the practice, perhaps reflecting broader cultural debates about medicalization of childhood.
The ethical question remains: is circumcision a medical intervention, a cultural ritual, or both? For many families, the decision blends tradition, faith, health considerations, and social norms. For clinicians, the task is to provide accurate, balanced counseling that respects parental autonomy while clarifying the evidence.
Reflection
Circumcision sits at the intersection of medicine, religion, and personal freedom. Its declining prevalence in the U.S. may be less about science and more about changing identities, values, and trust in medicine. Should physicians see this as a loss of preventive opportunity, or as an affirmation of parental autonomy?