Mass circumcision ceremonies held twice a year in South Africa, known as "Ulwaluko" and intended to mark a boy's passage into manhood, have resulted in 43 deaths and dozens of mutilations, prompting renewed alarm from officials. The rite, which sees initiates isolated from their families for three weeks and traditionally performed by experienced surgeons, is increasingly being carried out at unregulated, illegal initiation schools where unqualified operators use crude implements such as old spears, scissors and razor blades, sometimes without anaesthetic.

A government-commissioned report recorded 322 deaths of boys between 2021 and 2024, alongside thousands of hospitalisations and amputations, with 2024 alone seeing 93 deaths and 11 penis amputations across the winter and summer rituals; gangrene, sepsis and dehydration are the leading causes of death, though some boys have reportedly been stabbed, drowned or beaten. Criminal gangs running illegal schools have also been accused of kidnapping boys as young as 12 and extorting parents for their safe return. In response, South Africa's Customary Initiation Act now requires registration and proper training for traditional surgeons, and police have shut down 42 illegal schools, made 40 arrests and rescued 180 boys, though the centuries-old tradition remains deeply significant, as men who skip it are barred from tribal meetings, social participation and marriage.