The United States was one of six countries AVSC selected as part of a global study on the way clients and their partners choose vasectomy as their method of contraception. Results from the study, which was completed last fall, will assist in the design of materials and approaches to promote the wider use of vasectomy worldwide.

The study is part of AVSC's Men as Partners program to increase men's use of, and support of their partners' use of, family planning methods for the prevention of both pregnancy and sexually transmitted infections. The other five countries included in the study were Bangladesh, Kenya, Mexico, Rwanda, and Sri Lanka.

Interviews with Men and Their Partners
For the U.S. study, the research team conducted in-depth interviews with 31 men from the Philadelphia area who chose vasectomy and 30 of their partners.

In addition, separate focus groups were conducted with two groups in the United States that have not traditionally chosen vasectomy--African American and Latino men--to learn about their perceptions of vasectomy and to identify barriers to its use.

Most of the men who had obtained vasectomies and their partners said they decided to have no more children because they were happy with the number of children they already had. However, more than two-thirds of the respondents were concerned about the financial burden of additional children.

"If I feel in my heart that I can't give any more kids what I would give the two that I have... then I wouldn't even want to bring them on this earth," said one man.

Frequently, respondents said that they did not feel that they could give additional children the time, attention, and quality parenting they were able to give their other children.

Many respondents--both men and women--felt too old to have more children. For women, this was sometimes related to their feeling that they were too old for the physical toll of childbearing. Some couples told stories of difficult or dangerous past pregnancies and were concerned that further pregnancies would be detrimental to the woman's health.

Choosing Vasectomy
The two words most frequently used by the respondents were "permanent" and "effective." Both men and women said they decided it was the "man's turn" to use a method since women had taken most of the responsibility for pregnancy prevention up to that point.

"It's my turn to step up to the plate and be a man and do it for the team," said one man.

All the couples had discussed the merits of vasectomy over other methods.

"Because I smoke and I'm 39, the pill was out of the question. I got pregnant on the diaphragm. I wouldn't consider an IUD. I never liked the idea of that [because] I knew people who had cramping and who got pregnant. And the implants I really don't know enough about. I just wanted a permanent solution," said one woman.

About half of the couples considered tubal occlusion but decided against it because vasectomy was an easier procedure. "Why should I go through general anesthesia and have a major medical procedure when he can go to the [doctor's] office?"

Almost all of the couples made the decision that they wanted the vasectomy during or immediately after a pregnancy; a few couples experienced an unintended pregnancy before choosing to have the vasectomy.

Selecting a Service Setting
Of the 31 men in the study, about half had the procedure done by a doctor in private practice. The other half went to a Title X family planning clinic in either an urban or suburban setting. Most of the men chose the clinic or doctor's office where they had the procedure performed because they already knew about it or because it was the only option available to them. Cost considerations frequently determined their choice of provider.

One man said that the private doctor is "just more intimate and you feel a little more special with an appointment. A clinic is not as warm."

The men were asked their overall feelings about having a vasectomy. None reported having any regrets or reservations. A few men said they had had several days of minor discomfort, but otherwise all comments were positive.

"I would recommend it to anybody, and, if I had to, I would have it done again," said one man.

Misconceptions
Many of the men in the African American and the Latino groups were aware of vasectomy and knew someone who had had a vasectomy. However, most of the men in both groups reported that they had never considered and would never consider vasectomy as an option.

Many of them had numerous misconceptions about vasectomy. The African American men were opposed to it because they considered it irreversible, but they believed that tubal occlusion is reversible. While most of the Latino men were opposed to vasectomy, many thought the procedure was reversible.

At the end of each group discussion, the moderators provided factual information about vasectomy and asked if there was now any interest in the procedure; only the African American men expressed a change in attitude toward vasectomy, with some saying that they might consider it as an option in the future.

Recommendations
The researchers found that prenatal and postpartum programs, well-baby clinics, gynecologist's, pediatrician's, and family physician's offices are important locations for providing information about vasectomy.

They recommended that counseling and promotional materials on vasectomy focus on the "positive" aspects of vasectomy and address men's fears, women's concerns, and cultural issues surrounding vasectomy. Clinics and private physicians need to make their vasectomy services known by placing articles in local newspapers.