Barriers to Offering Vasectomy at Publicly Funded Family Planning Organizations in Texas

Abstract

Few publicly funded family planning clinics in the United States offer vasectomy, but little is known about the reasons this method is not more widely available at these sources of care. Between February 2012 and February 2015, three waves of in-depth interviews were conducted with program administrators at 54 family planning organizations in Texas. Participants described their organization’s vasectomy service model and factors that influenced how frequently vasectomy was provided. Interview transcripts were coded and analyzed using a theme-based approach. Service models and barriers to providing vasectomy were compared by organization type (e.g., women’s health center, public health clinic) and receipt of Title X funding. Two thirds of organizations did not offer vasectomy on-site or pay for referrals with family planning funding; nine organizations frequently provided vasectomy. Organizations did not widely offer vasectomy because they could not find providers that would accept the low reimbursement for the procedure or because they lacked funding for men’s reproductive health care. Respondents often did not perceive men’s reproductive health care as a service priority and commented that men, especially Latinos, had limited interest in vasectomy. Although organizations of all types reported barriers, women’s health centers and Title X-funded organizations more frequently offered vasectomy by conducting tailored outreach to men and vasectomy providers. A combination of factors operating at the health systems and provider level influence the availability of vasectomy at publicly funded family planning organizations in Texas. Multilevel approaches that address key barriers to vasectomy provision would help organizations offer comprehensive contraceptive services.

Men’s Vasectomy Knowledge, Attitudes, and Information-Seeking Behaviors in the Southern United States: Results From an Exploratory Survey

“…Despite these differences, race/ethnicity was not a predictor for any of the attitude subscales. Our findings suggest that it may not be attitudes about vasectomy that are preventing non-White men from having a vasectomy but rather other factors such as generally low rates of counseling about vasectomy (Borrero et al, 2010) or resource constraints in offering vasectomy services (White et al, 2017). Further research into vasectomy disparities based on race/ethnicity are needed.…”

Fertility Intentions and Perspectives on Contraceptive Involvement Among Low‐Income Men Aged 25 to 55

“…When men attend health‐related visits, either for themselves or with their partner for contraceptive or prenatal appointments, providers should take these opportunities to counsel and educate them. Counseling about vasectomy, in particular, is uncommon, and this likely prevents men from considering it as an option when they are certain that they do not want more children. Community health worker and peer educator models used in low‐resource settings may provide an acceptable approach and could address gender norms about male involvement in contraception .…”

Assessing the Acceptability of Vasectomy as a Family Planning Option: A Qualitative Study with Men in the Kingdom of Eswatini

“…The lack of knowledge and awareness of vasectomy could be attributed to the poor promotion of vasectomy as a men's FP option. The literature suggests that health providers often have poor knowledge about vasectomy or have attitudes towards and cultural biases against it, which affect what they say and do when they interact with clients [18,24]. It is imperative that providers are trained in client-oriented service provision for underutilized methods, such as vasectomy, to increase access and knowledge [2].…”

“…This, however, does not underscore the need for the involvement of men in RH, but highlights the gap in the implementation of strategies. The literature shows that because of a lack of training, health care professionals are more likely to give priority to other services at the cost of a vasectomy because of their attitudes towards and cultural biases against vasectomy [24]. In order to incorporate vasectomy, in the SRH program, there is a need to collect scientific empirical evidence on how men perceive vasectomy.…”