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Hoover AT, Shattuck D, Andes KL. Vasectomy provider decision-making balancing autonomy and non-maleficence: qualitative interviews with providers. Gates Open Res 2023; 7:132. [PMID: 38352125 PMCID: PMC10861492 DOI: 10.12688/gatesopenres.15036.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 02/16/2024] Open
Abstract
Background Male sterilization, or vasectomy, is 99.9% effective at preventing pregnancy with less than a 2% risk of complications. Despite the high efficacy, low risk, low cost, and gender equity benefits of vasectomy, just 2% of women reported that they and their partners relied on vasectomy as their contraceptive method globally in 2019. Health care providers can be both a facilitator and a barrier in men's health generally, and may be in vasectomy provision as well. This study sought to describe the decision-making rationales of experienced vasectomy providers when evaluating patient candidacy in complex cases. Methods Fifteen vasectomy providers belonging to the global Vasectomy Network google group from seven countries participated in online interviews using a semi-structured in-depth interview guide. Providers were asked about their vasectomy training, their reasons for vasectomy provision, challenging cases they have faced, and approaches used to manage challenging cases. Vignettes were used to further elicit decision-making rationale. Thematic analysis was conducted using MAXQDA20. Results Provider decision-making was predicated on ensuring patients were well-informed, able to consent, and certain about their choice to have a vasectomy. Once those foundational conditions were met, providers filtered patient characteristics through their training, laws and policies, sociocultural norms, experience, and peer influence to produce a cost-benefit breakdown. Based on the cost-benefit analysis, providers determined whether to weigh autonomy or non-maleficence more heavily when determining vasectomy patient candidacy. Conclusions Despite clinical best practices that promote prioritizing patient autonomy over non-maleficence, some providers continued to weigh non-maleficence over autonomy in vasectomy patient candidacy evaluations. Non-maleficence was particularly prioritized in cases providers deemed to be at higher risk of regret. The findings of this study suggest vasectomy provider training should emphasize evidence-based best practices in shared decision-making and patient-centered care to facilitate vasectomy provision that honors patient autonomy and rights.
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Affiliation(s)
- Alison T. Hoover
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, 30322, USA
| | - Dominick Shattuck
- Center for Communication, and Department of Health Behavior and Society at the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, 21205, USA
| | - Karen L. Andes
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island, 02903, USA
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Drobner J, Fu MZ, Kaldany A, Velez-Leitner D. Historical Review of the Vasectomy: Antiquated Beliefs, Novel Techniques, and Contemporary Challenges. Urology 2023; 182:1-4. [PMID: 37783399 DOI: 10.1016/j.urology.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Jake Drobner
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
| | - Melinda Z Fu
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alain Kaldany
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Mock KO, Moyer A, Lobel M. Explaining sex discrepancies in sterilization rates in the United States: An evidence-informed commentary. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:116-121. [PMID: 37594046 DOI: 10.1363/psrh.12243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
CONTEXT With abortion no longer deemed a constitutional right in the United States (US), the importance of effective contraceptive methods cannot be overstated. Both male sterilization (vasectomy) and female sterilization (tubal ligation) have the lowest failure rates of available means of contraception. Despite the less invasive and reversible nature of vasectomy compared to tubal ligation procedures and even though some healthcare professionals dissuade certain women, especially those who are white and/or economically advantaged, from undergoing a sterilization procedure, female sterilization is approximately three times more prevalent than male sterilization in the US. PURPOSE We suggest that the discrepancy in sterilization rates is attributable to the burdens of pregnancy and birth experienced by women, beliefs that pregnancy prevention is a woman's responsibility, a dearth of sex education that results in lack of knowledge and poor understanding of contraception, perceptions of masculinity in which contraception is viewed as feminizing, and the increase in long-term singlehood that shapes the desire of individuals to avoid unwanted pregnancy that may result in single parenting. IMPLICATIONS Recent reports suggest that court rulings restricting abortion access and looming threats to contraceptive legality and accessibility may be prompting a national increase in male sterilization.
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Affiliation(s)
- K Olivia Mock
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Anne Moyer
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
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Gómez-Torres P, Lucha-López AC, Martínez-Pérez GZ, Sheridan T, Vera Cruz G. Acceptability and Determinants of using Male Hormonal Contraceptives: A Systematic Review from a Gender Perspective. PSYCHOLOGY & SEXUALITY 2023. [DOI: 10.1080/19419899.2023.2191606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Piedad Gómez-Torres
- Department of Physiatrics and Nursing, University of Zaragoza, Zaragoza, Spain
- Research Group Sector III Heathcare (GIIS081), Institute of Research of Aragón, Zaragoza, Spain
| | - Ana C. Lucha-López
- Department of Physiatrics and Nursing, University of Zaragoza, Zaragoza, Spain
- Research Group Sector III Heathcare (GIIS081), Institute of Research of Aragón, Zaragoza, Spain
- Unidad de Investigación en Fisioterapia (UIF), University of Zaragoza, Zaragoza, Spain
| | | | - Taylor Sheridan
- Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | - Germano Vera Cruz
- Department of Psychology, University of Picardie Jules Verne, Amiens, France
- Centre de Recherche en Psychologie: Cognition, Psychisme et Organisations UR 7273 CRP-CPO, University of Picardie Jules Verne, Amiens, France
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White K, Martínez Órdenes M, Turok DK, Gipson JD, Borrero S. Vasectomy Knowledge and Interest Among U.S. Men Who Do Not Intend to Have More Children. Am J Mens Health 2022; 16:15579883221098574. [PMID: 35562856 PMCID: PMC9112422 DOI: 10.1177/15579883221098574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Vasectomy is used less often than female sterilization, and many men who do not want more children may lack accurate information about vasectomy. Between May and June 2018, we used a nationally representative online panel to survey U.S. men between 25 and 55 years of age who did not want more children about their vasectomy knowledge. We also asked about interest in undergoing the procedure if it were free or low cost and explored whether a paragraph addressing common misperceptions was associated with interest. We assessed characteristics associated with high vasectomy knowledge (≥3 accurate responses to four questions about vasectomy's effect on sexual functioning and method efficacy) and vasectomy interest, using chi-square tests and multivariable-adjusted Poisson regression. Of 620 men surveyed, 564 had complete data on the outcomes and covariates of interest. Overall, 51% of respondents demonstrated high vasectomy knowledge. Men who knew someone who had a vasectomy were more likely to have high knowledge (prevalence ratio [PR]: 1.50; 95% CI [1.22, 1.85]). One-third of the sample (35%) said they would consider getting a vasectomy. Men with high (vs. moderate/low) knowledge were more likely (PR: 1.36; 95% CI [1.04, 1.77]) to consider getting a vasectomy. Race/ethnicity, income level, and receiving the informational paragraph were not associated with vasectomy interest. Greater vasectomy knowledge affects men's interest in the procedure. Given that many U.S. men lack accurate knowledge, efforts are needed to address misinformation and increase awareness about vasectomy to ensure men have the information they need to meet or contribute to reproductive goals.
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Affiliation(s)
- Kari White
- Steve Hicks School of Social Work and Department of Sociology, The University of Texas at Austin, Austin, TX, USA
| | - Macarena Martínez Órdenes
- Department of Health Care Organization & Policy, The University of Alabama at Birmingham, Birmingham, AL, USA.,Universidad San Sebastián, Santiago, Chile
| | - David K Turok
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT, USA
| | - Jessica D Gipson
- Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sonya Borrero
- Center for Innovative Research on Gender Health Equity (CONVERGE), Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Lang JJ, Giffen Z, Hong S, Demeter J, El-Zawahry A, Sindhwani P, Ekwenna O. Assessing Vasectomy-Related Information on YouTube: An Analysis of the Quality, Understandability, and Actionability of Information. Am J Mens Health 2022; 16:15579883221094716. [PMID: 35491867 PMCID: PMC9066630 DOI: 10.1177/15579883221094716] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aims to critically appraise the quality of vasectomy-related health information currently available on YouTube to better address patient information needs moving forward. A YouTube search was performed using the keyword “vasectomy.” The first 100 videos were assessed, with irrelevant and duplicate videos excluded. Two independent reviewers evaluated the remaining videos using the DISCERN instrument for evaluating the quality of information and the Patient Education Materials Assessment Tool for Audiovisual materials (PEMAT-A/V) for assessing the understandability and actionability of materials. Source characteristics and markers of bias and misinformation were also collected. Seventy-eight videos were included in the study, with a mean duration of 6.6 minutes and mean of 216,672 views. The median DISCERN score was poor at 28 (IQR 22–33) out of a possible 80 with mean PEMAT-AV Understandability and Actionability scores of 67.6% (±16.7%) and 33.8% (±36.2%), respectively. A medical doctor was present in 61 (78.2%) of the videos, of which 53 (86.9%) were urologists and 38 (62.2%) promoted their personal practice or institution. False statements regarding vasectomy were made in 14 (17.9%) videos. Notably, no significant difference was noted in quality, understandability, or actionability of videos created by those with personal promotion to those without. The quality of information regarding vasectomy on YouTube is poor and reaches a wide audience. Continued appraisal and creation of YouTube videos that contain quality, understandable and actionable information by urologists is necessary to ensure patients are well-informed.
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Affiliation(s)
- Jacob J. Lang
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Zane Giffen
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Department of Urology and Transplantation, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Stephen Hong
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Jonathan Demeter
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Department of Urology and Transplantation, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Ahmed El-Zawahry
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Department of Urology and Transplantation, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Puneet Sindhwani
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Department of Urology and Transplantation, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Puneet Sindhwani, Department of Urology and Transplantation, College of Medicine and Life Sciences, The University of Toledo, 3000 Arlington Avenue, Mailstop 1091, Toledo, OH 43614, USA.
| | - Obi Ekwenna
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Department of Urology and Transplantation, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
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Storck KE, Gawron LM, Sanders JN, Wiaderny N, Turok DK. “I just had to pay the money and be supportive”: A qualitative exploration of the male-partner role in contraceptive decision-making in Salt Lake City, Utah family planning clinics. Contraception 2022; 113:78-83. [DOI: 10.1016/j.contraception.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
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Guo XM, Lore M, Madrigal J, Kiley J, Zumpf K, Adam M, Patel A. Vasectomy interest and awareness among patients and their partners in prenatal clinics in the United States. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:e67-e74. [PMID: 34272208 DOI: 10.1136/bmjsrh-2021-201062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Although vasectomy is safer, more effective and less expensive than tubal ligation, rates of permanent contraception are consistently higher in women than in men. We sought to explore vasectomy interest and awareness in patients and their partners during prenatal visits, a time when contraceptive counselling is typically performed. METHODS Anonymous surveys were distributed between January and July 2019 to a cross-sectional, convenience sample of pregnant women and their partners, if available, presenting for outpatient prenatal care at two hospitals (one public, one private) serving different patient populations in Chicago, Illinois, USA. Survey questions gauged participant awareness and interest in vasectomies. RESULTS Surveys were completed by 436 individuals (78% female, 24% male). Seventy percent of respondents indicated interest in vasectomy after achieving optimal family size, but most respondents had never discussed it with their healthcare provider. Factors associated with vasectomy interest included being partnered, having a lower household income, and knowing someone who has had a vasectomy. Almost 50% of respondents would be interested in obtaining information about vasectomies from their obstetrician or prenatal care provider. CONCLUSIONS Many patients and their male partners in the prenatal clinic setting were interested in vasectomy as a method for permanent contraception, but most respondents had never received counselling. Since comprehensive prenatal care includes contraceptive planning, obstetric providers are uniquely positioned to educate individuals on vasectomy.
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Affiliation(s)
- Xiaoyue Mona Guo
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marybeth Lore
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jessica Madrigal
- Department of Obstetrics and Gynecology, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Jessica Kiley
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katelyn Zumpf
- Biostatistics Collaboration Center, Northwestern University, Chicago, Illinois, USA
| | - Megan Adam
- Department of Obstetrics and Gynecology, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Ashlesha Patel
- Department of Obstetrics and Gynecology, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
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9
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White AL, Mann ES, Billings DL, Shah P. A qualitative exploration of men's perceptions of the terms "male sterilization" versus "vasectomy" in the southern United States. Contraception 2021; 104:524-530. [PMID: 34245720 DOI: 10.1016/j.contraception.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Clinical literature and contraception information guides use the terms "male sterilization" and "vasectomy" interchangeably. We investigate the meanings men attach to "sterilization" and how those meanings compare to perceptions of "vasectomy." STUDY DESIGN Cisgender, heterosexual men, ages 25 to 67, living across seven U.S. southern states participated in individual telephone interviews from May to December 2019. Interviews explored men's experiences with contraception, including their perception of the term "sterilization." We audio-recorded and transcribed the interviews and conducted thematic analyses using an inductive approach. RESULTS While most participants described "vasectomy" as a relatively benign procedure, they described "sterilization" as "sinister," "bleak," and "barbaric." Participants' discussions of sterilization invoked associations with eugenicist practices and specific historical examples of forced sterilization. While some participants recognized that vasectomy is a means of achieving sterilization, most viewed the term "sterilization" as incongruous with the modern medical procedure of "vasectomy," precisely because sterilization has been used as a form of reproductive oppression. CONCLUSION Our findings suggest that men have strong affective responses to the term "sterilization." Participants' knowledge of historical eugenicist practices has implications for the acceptability of vasectomy as a permanent contraceptive option in our contemporary context. IMPLICATIONS The phrase "male sterilization" can be associated with eugenics and coercive reproductive practices. Using the term for reproductive counselling, education, or research purposes may have implications for the acceptability of vasectomy as a permanent contraceptive option.
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Affiliation(s)
- Ashley L White
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
| | - Emily S Mann
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Women's and Gender Studies Program, University of South Carolina, Columbia, SC, United States
| | - Deborah L Billings
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Institute for Families in Society, University of South Carolina, Columbia, SC, United States; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Payal Shah
- Department of Educational Studies, College of Education, University of South Carolina, Columbia, SC, United States
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Nicholas L, Newman CE, Botfield JR, Terry G, Bateson D, Aggleton P. Men and masculinities in qualitative research on vasectomy: perpetuation or progress? HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2021; 30:127-142. [PMID: 34018906 DOI: 10.1080/14461242.2020.1789486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/23/2020] [Indexed: 06/12/2023]
Abstract
Although vasectomy is a safe and highly effective method of contraception, uptake is variable globally, with scope for increased engagement in high income nations. Very little qualitative research has been published in recent years to explore men's perspectives on vasectomy, which represents a key opportunity to better understand and strengthen men's contribution to reproductive and contraception equality. This paper takes a scoping review approach to identify key findings from the small but important body of qualitative literature. Recent masculinities research argues that, despite some expansion in ways of being masculine, an underpinning ethos of masculinist dominance remains. Extant research on men's attitudes to vasectomy supports this ambivalent picture, indicating that while there are extending repertoires of masculinity for men to draw on in making sense of vasectomy, many remain underpinned by masculinist narratives. There remains scope for education and health promotion ensuring vasectomy is viewed as a suitable and safe option by more men of reproductive age. Increased uptake of vasectomy may also help shift the longstanding social expectation that women take primary responsibility for contraceptive practices, challenging gender discourses on contraception.
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Affiliation(s)
- Lucy Nicholas
- Genders and Sexualities / Sociology, Western Sydney University, Sydney, Australia
| | | | - Jessica R Botfield
- Centre for Social Research in Health, UNSW Sydney, Australia
- Family Planning NSW, Ashfield, Australia
| | - Gareth Terry
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Deborah Bateson
- Centre for Social Research in Health, UNSW Sydney, Australia
- Family Planning NSW, Ashfield, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Australia
- Centre for Gender and Global Health, UCL, London, UK
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11
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Campbell AD, Turok DK, White K. Fertility Intentions and Perspectives on Contraceptive Involvement Among Low-Income Men Aged 25 to 55. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:125-133. [PMID: 31449728 PMCID: PMC6779495 DOI: 10.1363/psrh.12115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 01/03/2019] [Accepted: 01/18/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Unintended pregnancy is disproportionately reported by low-income individuals in the United States, and studies of men's roles in preventing pregnancy have largely focused on adolescents and young adults. Less is known about the pregnancy-related attitudes and behaviors among men older than 24, who are involved in the majority of pregnancies ending in a birth. METHODS Between December 2015 and August 2016, in-depth interviews were conducted with 26 low-income men in Alabama who were aged 25-55, were sexually active and did not want more children. Interviews explored men's reasons for not wanting more children, their contraceptive knowledge and attitudes, and their involvement in contraceptive decision making. Transcripts were examined using content analysis to identify themes related to men's perspectives about preventing pregnancy and using contraceptives. RESULTS Participants' motivations to prevent a pregnancy centered primarily on their age and financial circumstances. Most men had limited contraceptive knowledge and perceived their risk of causing a pregnancy to be low, regardless of method use. Few men engaged in decisions about contraceptive use, despite their beliefs that men and women had a shared responsibility to prevent pregnancy. Although some men were interested in vasectomy, a few were hesitant about undergoing the procedure because they might want to have children later if their life circumstances changed, and others worried that vasectomy might affect sexual performance. CONCLUSIONS Some low-income adult men were uncertain about their pregnancy desires, and many lacked contraceptive knowledge that would help them avoid unwanted pregnancy. Research is needed to identify the types of programs that could effectively promote men's constructive engagement in preventing pregnancies over their reproductive life course.
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Affiliation(s)
- Anthony D Campbell
- Assistant Professor, Department of Sociology, Anthropology, and Social Work, Auburn University, Auburn, AL
| | - David K Turok
- Associate Professor, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City
| | - Kari White
- Associate Professor, Department of Health Care Organization and Policy, University of Alabama at Birmingham
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Filoche SK, Snook S, Lawton BA. Exploring access to vasectomy services: a case study of funding in Counties Manukau. J Prim Health Care 2018. [PMID: 29530192 DOI: 10.1071/hc16033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Although vasectomy rates in New Zealand have been reported as among the highest worldwide, there is limited information about who is receiving these services and how they are being accessed. This information is needed to develop equitable access to vasectomy services. AIM To describe the ethnicity and socioeconomic status of men accessing District Health Board-funded and self-funded vasectomies in Counties Manukau. METHODS A retrospective cohort analysis of provider data linked to ethnicity and area deprivation as an indicator of socioeconomic status. RESULTS Of 332 vasectomies, 66% were for New Zealand European men. Socioeconomic status was not associated with the number of procedures for New Zealand European men, but of the Māori and Pacific men who underwent vasectomies, most lived in the greatest areas of deprivation; 58% (18/31) and 50% (12/24), respectively. When vasectomies were funded, the number of procedures doubled for men from areas of high deprivation. The number of procedures was low for men of other ethnicities. DISCUSSION Our findings indicate differential access to vasectomies by ethnicity and socioeconomic status. Funding vasectomies may provide community benefits in terms of improving equity in access and alleviating a financial burden for many families living in areas of high deprivation.
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Affiliation(s)
- Sara K Filoche
- Women's Health Research Centre, Department of Obstetrics and Gynaecology, University of Otago-Wellington, NewZealand
| | - Simon Snook
- Wairarapa District Health Board, Masterton, NewZealand
| | - Beverley A Lawton
- Women's Health Research Centre, Department of Obstetrics and Gynaecology, University of Otago-Wellington, NewZealand
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Holliday CN, McCauley HL, Silverman JG, Ricci E, Decker MR, Tancredi DJ, Burke JG, Documét P, Borrero S, Miller E. Racial/Ethnic Differences in Women's Experiences of Reproductive Coercion, Intimate Partner Violence, and Unintended Pregnancy. J Womens Health (Larchmt) 2017; 26:828-835. [PMID: 28402692 PMCID: PMC5576208 DOI: 10.1089/jwh.2016.5996] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To explore racial/ethnic differences in reproductive coercion (RC), intimate partner violence (IPV), and unintended pregnancy (UIP). MATERIALS AND METHODS We analyzed cross-sectional, baseline data from an intervention that was conducted between August 2008 and March 2009 in five family planning clinics in the San Francisco, California area, to examine the association of race/ethnicity with RC, IPV, and UIP among female patients aged 16-29 (n = 1234). RESULTS RC was significantly associated with race/ethnicity, p < 0.001, [prevalence estimates: Black (37.1%), multiracial (29.2%), White (18.0%), Hispanic/Latina (24.0%), and Asian/Pacific Islander/other (API/other) (18.4%)]. Race/ethnicity was not associated with IPV. UIP was more prevalent among Black (50.3%) and multiracial (47.2%) women, with an overall range of 37.1%-50.3% among all racial/ethnic groups (p < 0.001). In adjusted analyses, factors associated with UIP were RC [adjusted odds ratio (AOR) = 1.59, 95% confidence interval (95% CI) = 1.26-2.01] and Black (AOR = 1.63, 95% CI = 1.02-2.60) and API/other (AOR = 1.41, 95% CI = 1.15-1.73) race/ethnicity, which remained significant in the presence of RC. Race-stratified models revealed that RC increased odds of UIP for White (AOR = 2.06, 95% CI = 1.45-2.93) and Black women (AOR = 1.72, 95% CI = 1.14-2.60). CONCLUSIONS Black and multiracial women seeking care in family planning clinics have a disproportionately high prevalence of RC and UIP. RC may partially explain differences in UIP prevalence, with the effect of race/ethnicity slightly attenuated in RC-adjusted models. However, the impact of RC on risk for UIP was similar for White and Black women. Findings from this study support the need to understand and prevent RC, particularly among women of color. Results are foundational in understanding disparities in RC and UIP that may have implications for refinement of clinical care.
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Affiliation(s)
- Charvonne N. Holliday
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Heather L. McCauley
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan
| | - Jay G. Silverman
- Division of Global Public Health, Department of Medicine, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, California
| | - Edmund Ricci
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel J. Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California
| | - Jessica G. Burke
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Patricia Documét
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Sonya Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Kısa S, Savaş E, Zeyneloğlu S, Dönmez S. Opinions and Attitudes About Vasectomy of Married Couples Living in Turkey. Am J Mens Health 2017; 11:531-541. [PMID: 26634860 PMCID: PMC5675235 DOI: 10.1177/1557988315620275] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study was conducted as a descriptive study, designed to determine the opinions and attitudes of married couples living in Turkey about vasectomy. The sample consisted of 350 women. Researchers used a questionnaire to collect data. Descriptive statistics and chi-square analysis were used. The results showed that 14% of women and 43.0% of men were of the opinion that undergoing a vasectomy procedure was a sin. Chi-square analysis determined statistically significant differences between the male and female groups ( p < .05). More than 88.0% of the men were not willing to have vasectomy and 35.4% thought that vasectomy had a negative effect on marriage and sexual health. In addition, 58.9% thought that vasectomy had a negative effect on men's health. Women were more likely than men to see vasectomy as merely a cultural taboo instead of a sin. Sociocultural factors, such as ideas that contraception is the woman's responsibility, that sterilized men lose status in society, or that sterilized men lose authority in the family, as well as misconceptions about vasectomy such as concerns about sexual functioning, psychological effects, and effects on physical strength, were determined to be the main barriers for vasectomy use in Turkish culture. The study recommends determining strategies for overcoming sociocultural barriers by raising awareness and increasing the utilization of vasectomy. Couple-specific family planning programs can make an important contribution toward improving awareness of the benefits of vasectomy.
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Affiliation(s)
- Sezer Kısa
- Oslo and Akershus University College of Applied Sciences, Kjeller, Norway
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15
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Higgins JA, Smith NK. The Sexual Acceptability of Contraception: Reviewing the Literature and Building a New Concept. JOURNAL OF SEX RESEARCH 2016; 53:417-56. [PMID: 26954608 PMCID: PMC4868075 DOI: 10.1080/00224499.2015.1134425] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
How contraceptives affect women's sexual well-being is critically understudied. Fortunately, a growing literature focuses on sexual aspects of contraception, especially hormonal contraception's associations with libido. However, a more holistic approach to contraceptive sexual acceptability is needed to capture the full range of women's sexual experiences. We conducted a narrative literature review of this topic, working with an original sample of 3,001 citations published from 2005 to 2015. In Part 1, we draw from a subset of this literature (264 citations) to build a new conceptual model of sexual acceptability. Aspects include macro factors (gender, social inequality, culture, and structure), relationship factors (dyadic influences and partner preferences), and individual factors (sexual functioning, sexual preferences, such as dis/inhibition, spontaneity, pleasure, the sexual aspects of side effects, such as bleeding, mood changes, sexual identity and sexual minority status, and pregnancy intentions). In Part 2, we review the empirical literature on the sexual acceptability of individual methods (103 citations), applying the model as much as possible. Results suggest contraceptives can affect women's sexuality in a wide variety of positive and negative ways that extend beyond sexual functioning alone. More attention to sexual acceptability could promote both women's sexual well-being and more widespread, user-friendly contraceptive practices.
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Hubert C, White K, Hopkins K, Grossman D, Potter JE. Perceived Interest in Vasectomy among Latina Women and their Partners in a Community with Limited Access to Female Sterilization. J Health Care Poor Underserved 2016; 27:762-77. [PMID: 27180707 PMCID: PMC4980830 DOI: 10.1353/hpu.2016.0083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The low prevalence of vasectomy among Latino men in the United States is often attributed to cultural characteristics despite limited evidence supporting this hypothesis. We assessed male partners' perceived willingness to undergo vasectomy through surveys with 470 Mexican-origin women who did not want more children in El Paso, Texas. Overall, 32% of women reported that their partner would be interested in getting a vasectomy. In multivariable analysis, completing high school (OR=2.03 [1.05, 3.95]), having some college education (OR=2.97 [1.36, 6.48]) or receiving US government assistance (OR=1.95 [1.1, 3.45]) was associated with partners' perceived interest. Additionally, we conducted two focus groups on men's knowledge and attitudes about vasectomy with partners of a subsample of these women. Despite some misperceptions, male partners were willing to get a vasectomy, but were concerned about cost and taking time off work to recover. Health education and affordable vasectomy services could increase vasectomy use among Mexican-origin men.
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Shaik S, Rajkumar RP. Post-vasectomy depression: a case report and literature review. Ment Illn 2014; 6:5494. [PMID: 25553234 PMCID: PMC4274458 DOI: 10.4081/mi.2014.5494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/02/2014] [Indexed: 11/22/2022] Open
Abstract
Vasectomy is a commonly performed and relatively safe procedure, with low reported rates of psychological morbidity, though there is some variability across studies. Depression following a vasectomy is relatively infrequent. A married man aged 30 developed a chronic depressive episode, lasting four years and resistant to an adequate trial of fluoxetine, following a vasectomy. His depression was heralded by a post-operative panic attack, and was accompanied by medically unexplained symptoms and the attribution of all his symptoms to the procedure – a belief that was shared by his family. Psychological complications of vasectomy have generally been studied under four heads: sexual dysfunction, effects on marital relationships, chronic post-operative pain, and other complications including anxiety and depression. These complications have generally been reported at higher rates in developing countries, and are linked to poor knowledge about the procedure and inadequate pre-operative counseling. The implications of the existing literature for the patient’s current complaints, and the mechanisms and risk factors involved, are discussed in the light of existing research. Suggestions for the prevention and treatment of post-vasectomy depression are also outlined.
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Affiliation(s)
- Subahani Shaik
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research , Dhanvantari Nagar, Pondicherry, India
| | - Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research , Dhanvantari Nagar, Pondicherry, India
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White K, Potter JE. Reconsidering racial/ethnic differences in sterilization in the United States. Contraception 2014; 89:550-6. [PMID: 24439673 PMCID: PMC4035437 DOI: 10.1016/j.contraception.2013.11.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/20/2013] [Accepted: 11/24/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Cross-sectional studies have found that low-income and racial/ethnic minority women are more likely to use female sterilization and less likely to rely on a partner's vasectomy than women with higher incomes and whites. However, studies of pregnant and postpartum women report that racial/ethnic minorities, particularly low-income minority women, face greater barriers in obtaining a sterilization than do whites and those with higher incomes. In this paper, we address this apparent contradiction by examining the likelihood a woman gets a sterilization following each delivery, which removes from the comparison any difference in the number of births she has experienced. STUDY DESIGN Using the 2006-2010 National Survey of Family Growth, we fit multivariable-adjusted logistic and Cox regression models to estimate odds ratios and hazard ratios for getting a postpartum or interval sterilization, respectively, according to race/ethnicity and insurance status. RESULTS Women's chances of obtaining a sterilization varied by both race/ethnicity and insurance. Among women with Medicaid, whites were more likely to use female sterilization than African Americans and Latinas. Privately insured whites were more likely to rely on vasectomy than African Americans and Latinas, but among women with Medicaid-paid deliveries reliance on vasectomy was low for all racial/ethnic groups. CONCLUSIONS Low-income racial/ethnic minority women are less likely to undergo sterilization following delivery compared to low-income whites and privately insured women of similar parities. This could result from unique barriers to obtaining permanent contraception and could expose women to the risk of future unintended pregnancies. IMPLICATIONS Low-income minorities are less likely to undergo sterilization than low-income whites and privately insured minorities, which may result from barriers to obtaining permanent contraception, and exposes women to unintended pregnancies.
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Affiliation(s)
- Kari White
- Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Joseph E Potter
- Population Research Center, University of Texas at Austin, Austin, TX 78712, USA
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Shattuck D, Wesson J, Nsengiyumva T, Kagabo L, Bristow H, Zan T, Ngabo F. Who chooses vasectomy in Rwanda? Survey data from couples who chose vasectomy, 2010-2012. Contraception 2014; 89:564-71. [PMID: 24630244 DOI: 10.1016/j.contraception.2014.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 01/28/2014] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Vasectomy is safe and highly effective; however, it remains an underused method of family planning (FP) in Africa. In view of this, three Rwandan physicians were trained in no-scalpel vasectomy with thermal cautery and fascial interposition on the prostatic end as vasectomy trainers in 2010, and this initiative has resulted in over 2900 vasectomy clients from February 2010 to December 2012. STUDY DESIGN This cross-sectional descriptive study describes vasectomy clients (n=316) and their wives (n=300) from 15 randomly selected hospitals in Rwanda. RESULTS The vasectomy clients were mainly over age 40, had young children (age <3) and were married and cohabiting. Limited financial resources, satisfaction with existing family size and avoiding side effects from hormonal methods (wives') were key motivators for vasectomy uptake. High rates of previous FP use and high degree of interspousal communication are known correlates of higher FP use. CONCLUSIONS Future and current Rwandan FP programs and other interested parties will benefit from understanding which couples elect vasectomy, their motivations for doing so and their service utilization experiences. Better integration of vasectomy counseling and postvasectomy procedures will benefit the program. IMPLICATIONS Until this project, vasectomy projects in sub-Saharan Africa were viewed as unrealistic. This study confirms factors influencing vasectomy uptake identified in earlier research, but does so within a robust sample of vasectomy users and their wives and provides a strong understanding of who likely vasectomy users are in this context. Promotion of vasectomy services should be considered as an essential element of a healthy contraceptive method mix.
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Nguyen BT, Shih G, Turok DK. Putting the man in contraceptive mandate. Contraception 2013; 89:3-5. [PMID: 24210279 DOI: 10.1016/j.contraception.2013.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 09/28/2013] [Accepted: 10/01/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Brian T Nguyen
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, 3181 Southwest Sam Jackson Park Road, Box L466, Portland, OR 97239, USA.
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