Down But Not Out: Vasectomy Is Faring Poorly Almost Everywhere-We Can Do Better To Make It A True Method Option

Abstract

Introduction: Demand for vasectomy-1 of 2 contraceptive methods for men-has been low, with deep-seated myths, misconceptions, and provider bias against it widespread. Programmatic attention and donor funding have been limited and sporadic.

Methods: We analyzed vasectomy use in 84 low- and middle-income countries (LMICs) plus the 11 high-income countries with vasectomy prevalence above 1%. These 95 countries comprise 90% of the world's population. Data come from United Nations survey compilations, population estimates, and gender inequality rankings. We also reviewed recent articles on vasectomy and analyses of chronic challenges to vasectomy service provision.

Results: Vasectomy use is 61% lower now than 2 decades ago. Of 922 million women using contraception worldwide, 17 million rely on vasectomy-27 million fewer than in 2001. In contrast, 219 million women use tubectomy-8 million more than in 2001. Of 84 LMICs, 7 report vasectomy prevalence above 2%. In 56 LMICs, no more than 1 in 1,000 women relies on vasectomy. Female-to-male disparities in permanent method use widened globally, from 5:1 to 13:1, and are much higher in some regions and countries (e.g., 76:1 in India). Countries with the highest vasectomy prevalence are among those with the highest gender equality and vice versa.

Conclusion: Vasectomy use is surprisingly low globally and declining. Use remains negligible in almost all LMICs, reflecting low demand and program priority. For vasectomy to become an accessible, rights-based option, program efforts need to be holistic, ensuring an enabling environment while coordinating demand- and service-focused efforts. Vasectomy champions at all levels should be supported on a sustained basis. On the demand side, harnessing mass and social media to increase accurate knowledge and normalize vasectomy as a method and service will be particularly valuable. Evidence from Bolivia suggests relatively few trained providers and procedures could result in a country's attaining 1% vasectomy prevalence.

FIGURE 1

Trends in Global Use of Vasectomy and Tubectomy, 1982–2019 Data Sources: For 1982, 1991, and 2001, EngenderHealth 2002. For 2009, EngenderHealth 2014. For 2015 and 2019, UNDESA 2015, and UNDESA 2019.

FIGURE 2

Poster From Vasectomy Demand Creation Campaign in Ghana Source: The ACQUIRE Project/EngenderHealth via Knowledge SUCCESS (reproduced with permission).

FIGURE 3

Poster From Vasectomy Demand Creation Campaign in Honduras Source: The ACQUIRE Project/EngenderHealth via Knowledge SUCCESS (reproduced with permission).

FIGURE 4

Poster From Vasectomy Demand Creation Campaign in India Source: The RESPOND Project/EngenderHealth (reproduced with permission).

FIGURE 5

Increase in Vasectomies Following Media Events Promoting Vasectomy in São Paolo, Brazil Adapted from Kincaid et al., Impact of a Mass Media Vasectomy Promotion Campaign in Brazil, (JHU/SPH/CCP & PRO-PATER) with permission.

FIGURE 6

Holistic Supply-Enabling Environment-Demand Model for Family Planning Abbreviation: SRH, sexual and reproductive health. Source: EngenderHealth.