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Madison AM, Powers D, Maslowsky J, Goyal V. Association Between Publicly Funded Contraceptive Services and the Abortion Rate in Texas, 2010-2015. Obstet Gynecol 2023; 141:361-370. [PMID: 36649327 PMCID: PMC9858333 DOI: 10.1097/aog.0000000000005057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/20/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate how the availability of contraceptive services was associated with a change in the abortion rate before and after Texas' legislative changes to the family planning budget in 2011 and abortion access in 2013. METHODS In this cross-sectional study, we obtained 2010 and 2015 data on contraceptive provision (number of publicly funded clinics and number of contraceptive clients served per 1,000 reproductive-aged women) from the Guttmacher Institute and county-level abortion data from the Texas Department of State Health Services. We categorized counties as having an abortion rate that increased or declined less than the national rate between 2010 and 2015 ( low-decline counties ) compared with those having an abortion rate that declined equal to or greater than the national rate between 2010 and 2015 ( high-decline counties ). We evaluated differences in contraceptive provision between high-decline and low-decline counties and evaluated county characteristics (racial and ethnic composition, unemployment, poverty, uninsured, education, distance to an abortion clinic, deliveries covered by Medicaid, and Catholic hospital marketplace dominance) as potential confounders. RESULTS Of 157 counties that had at least one contraceptive clinic in either 2010 or 2015, 49 were low-decline counties and 108 were high-decline counties. Although the total number of publicly funded family planning clinics increased by 10.8%, there was a 4.7% decrease in the total number of contraceptive clients served statewide. Compared with low-decline counties, high-decline counties had a higher median number of contraceptive clients served per 1,000 women aged 18-44 years (31.9 vs 60.7, P <.05) in 2015. Between 2010 and 2015, the abortion rate decreased 19.7% for each 1.0% increase in contraceptive clients served. CONCLUSION Texas counties with higher abortion-rate declines had more publicly funded contraceptive clinics and served more contraceptive clients than counties with lower declines, which may indicate the importance of greater access to publicly funded contraceptive services.
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Affiliation(s)
- Anita M Madison
- Department of Obstetrics and Gynecology, Louisiana State University Health Science Center, Baton Rouge, Louisiana; the Population Research Center, University of Texas at Austin, Austin, Texas; and the School of Public Health, University of Illinois Chicago, Chicago, Illinois
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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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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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White AL, Davis RE, Billings DL, Mann ES. Men's Vasectomy Knowledge, Attitudes, and Information-Seeking Behaviors in the Southern United States: Results From an Exploratory Survey. Am J Mens Health 2021; 14:1557988320949368. [PMID: 32812507 PMCID: PMC7444157 DOI: 10.1177/1557988320949368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Vasectomy is one of the few options men have to manage their reproductive capacity and take on a more equitable role in pregnancy prevention. While the method is underused throughout the United States, the southern states have a lower prevalence rate compared to the rest of the country. Existing survey research does not assess what men know or think about the procedure as a means of understanding why this is the case. We created and conducted an exploratory survey to assess men’s knowledge, attitudes, and information-seeking behaviors about vasectomy in the Southern United States. We used targeted Facebook advertising to recruit men ages 25–70 years living in 7 southern states to complete an online survey (n = 397). Using regression analyses, we identify that participants who had a vasectomy knew more about the procedure than participants who had not. Participants who had not had a vasectomy had less positive attitudes about the procedure across all six attitude subscales compared to participants with vasectomies. We highlight potential avenues for future research to understand why this may be the case. Finally, the majority of participants knew someone who had had a vasectomy. This suggests that men disclose having a vasectomy to others. The interpersonal dynamics around vasectomy decision-making and disclosure remain unknown and a viable area for future research. Findings from this exploratory survey may be used by public health officials interested in implementing campaigns to increase knowledge about vasectomy and reduce stigma, which may encourage more positive attitudes about the procedure.
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Affiliation(s)
- Ashley L White
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Rachel E Davis
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Deborah L Billings
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Institute for Families in Society, University of South Carolina, Columbia, SC, USA.,Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Emily S Mann
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Women's and Gender Studies Program, University of South Carolina, Columbia, SC, USA
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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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Ayele AD, Beyene FY, Wudineh KG, Kassa BG, Goshu YA, Mihretie GN. Intention to use vasectomy and its associated factors among married men in Debre Tabor Town, North West Ethiopia, 2019. PLoS One 2020; 15:e0238293. [PMID: 32881873 PMCID: PMC7470275 DOI: 10.1371/journal.pone.0238293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 08/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vasectomy is one of the most effective and permanent male contraceptive methods, and involves cutting and ligating the vas deferens to make the semen free of sperm during ejaculation. Although it is effective, simple, and safe, it is not well known and practiced in the majority of our community. This study assessed the intention to use vasectomy and its associated factors among married men in Debre Tabor Town, North West Ethiopia, 2019. METHODS A community- based cross-sectional study was conducted among 402 married men from March 05 to April 15, 2019. A simple random sampling technique was employed to select the study participants. Data was collected by face to face interview using a structured and pre-tested questionnaire. Questions concerned socio-demographic and reproductive variables and views on vasectomy. The association between variables was analyzed using a bivariable and multivariable logistic regression model. RESULT A total of 402 participants were included with a response rate of 98.75%. The mean participant age was 37.12(SD ± 6.553) years with the age range of 20-56 years. The prevalence of intention to use vasectomy was 19.6% with 95%CI (15.6%-23.4%). Multivariable logistic regression showed that age from 30-39 years (AOR = 3.2(95% CI: 1.19-8.86)), having more than three living children (AOR = 2.5(95% CI: 1.41-4.68)), good knowledge (AOR = 3.4(95%CI: 1.88-6.40)) and positive attitude (AOR = 4.8(95% CI: 2.61-8.80)) of married men were significantly associated with intention to use vasectomy. CONCLUSION AND RECOMMENDATION Intention to use vasectomy was comparable with findings in four regions of Ethiopia (Amhara, Oromia, SNNP, and Tigray). Age, the number of living children, knowledge, and attitude were significantly associated with the intention to use vasectomy. Improving the level of knowledge and attitude towards vasectomy is an essential strategy to scale up the intention of men to use vasectomy.
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Affiliation(s)
- Alemu Degu Ayele
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fentahun Yenealem Beyene
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | - Kihinetu Gelaye Wudineh
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Bekalu Getnet Kassa
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yitayal Ayalew Goshu
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gedefaye Nibret Mihretie
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Coleman-Minahan K, Hopkins K, White K. Availability of Confidential Services for Teens Declined After the 2011-2013 Changes to Publicly Funded Family Planning Programs in Texas. J Adolesc Health 2020; 66:719-724. [PMID: 31974014 PMCID: PMC7263963 DOI: 10.1016/j.jadohealth.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/05/2019] [Accepted: 12/04/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Texas is one of 24 states that does not explicitly allow minors to consent to contraception. We explore changes in the provision of confidential reproductive health services after the implementation of state policies that cut and reorganized public family planning funding, including Title X. METHODS We use data from 3 waves of in-depth interviews, conducted between February 2012 and February 2015, with program administrators at publicly funded family planning organizations in Texas about changes in service delivery. We conducted a thematic analysis of transcripts from 47 organizations with segments related to the provision of services to minor teens. RESULTS Overall, 34 of the 47 organizations received Title X funding before 2013, and 79% lost this funding during the study period. Respondents at these organizations frequently reported a decrease in teen clients, which they attributed to loss of confidential services previously guaranteed under Title X. As the number of Title X-funded sites decreased, availability of confidential services became inconsistent. Most organizations offered confidential testing for pregnancy and sexually transmitted infections, but availability of confidential contraceptive services varied across and within organizations and often depended on insurance coverage. Respondents also reported challenges clarifying parental consent requirements after the changes in Title X and state funding. CONCLUSIONS Loss of Title X funding decreased availability of quality family planning services for teens and burdened organizations. As the new Title X regulations are implemented, family planning organizations' experiences in Texas foreshadow what might occur nationally, particularly in states that do not allow minors to consent for contraception.
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Affiliation(s)
- Kate Coleman-Minahan
- College of Nursing, Anschutz Medical Campus, University of Colorado, Aurora, Colorado; University of Colorado Population Center (CUPC), University of Colorado Boulder, Boulder, Colorado.
| | - Kristine Hopkins
- Population Research Center, University of Texas at Austin, Austin, Texas
| | - Kari White
- Population Research Center, University of Texas at Austin, Austin, Texas; Department of Sociology, University of Texas at Austin, Austin, Texas; Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas
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Shongwe P, Ntuli B, Madiba S. Assessing the Acceptability of Vasectomy as a Family Planning Option: A Qualitative Study with Men in the Kingdom of Eswatini. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E5158. [PMID: 31861151 PMCID: PMC6950132 DOI: 10.3390/ijerph16245158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 11/25/2022]
Abstract
The uptake of vasectomy in many countries in sub-Saharan Africa is low. In Eswatini, a kingdom with strong patriarchal norms, the use of vasectomy is at 0.3%. This is despite great efforts to introduce vasectomy and involve men in reproductive health. This study explored the views of men about the acceptability of vasectomy and their willingness to adopt vasectomy as a family planning option. Focus group discussions were conducted with adult men recruited from health facilities located in rural, semi urban, and urban areas in two of the regions of Eswatini. A thematic approach was used to analyze the data. The acceptability of and intention to use vasectomy as a family planning option was very low. Cultural beliefs, societal norms, lack of knowledge about the procedure for vasectomy, and misconceptions influenced the acceptability of vasectomy greatly. The participants could not grasp the concept of a family planning method that is as permanent as vasectomy. However, the decisions to accept or reject vasectomy were influenced by their misconceptions and fears about vasectomy and were not based on facts. To address the need to involve men in reproductive health and improve the acceptability and adoption of vasectomy, planning should be conducted with them and informed by their understanding of their needs.
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Affiliation(s)
| | | | - Sphiwe Madiba
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0001, South Africa; (P.S.); (B.N.)
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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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