PROJECT SUMMARY/ABSTRACT Circumcision is one of the most common surgical procedures performed in the United States. Periprocedural risk is lowest, costs are lowest, and health benefits (e.g., decreased risk of urinary tract and sexually transmitted infections) are greatest when circumcision is performed as a neonatal circumcision (NC) under local anesthesia, rather than as an operative circumcision (OC) under general anesthesia later in life. However, young boys for whom an infant circumcision was desired commonly present for elective OC after the neonatal period. Previous research indicates that boys of lower socioeconomic status have more difficulty accessing NC such that the increased risks and decreased health benefits of OC disproportionally affect boys of lower socioeconomic status. Recent data show that changes in Medicaid coverage of NC disproportionately affect Black/African American boys compared with boys of other racial/ethnic backgrounds. Available data indicate that both healthcare operational and insurance coverage factors contribute to the disparity in access to NC. Chicago-Area clinician interviews have identified multiple operational barriers to NC, including clinical logistical challenges and lack of standardized processes that compound substantial variation in NC reimbursement that dis-incentivizes some birth hospitals from uniformly offering NC. The proposed study aims to address the operational barriers to providing NC to desirous families. The World Health Organization’s evidence-based Standards and Procedures for high-quality, high-volume NC programs will be used as a framework (developed for low- and middle-income countries) and adapted for utilization in multiple clinical settings in the United States (US). The goals of this proposal are to (1) leverage the WHO Standards and Procedures to develop and implement safe, efficient, and contextually-adapted NC programs at 3 hospitals that promote equity of NC; (2) evaluate each NC program’s impact on patient outcomes; and (3) provide a cost analysis of the NC program to support dissemination. A multidisciplinary team (pediatrics, obstetrics, pediatric urology, health services research, health economics, and global health) has been assembled to execute the study. Findings from this study will provide US birthing hospitals with examples of safe, efficient, and contextually adaptable NC programs, based on the evidence-based WHO Standards and Procedures. These examples will include cost analyses from both hospital and patient perspectives to facilitate dissemination. Ultimately, by implementing NC programs that overcome both structural and health system barriers, equity in NC should improve.