Factors associated with family planning and vasectomy discussions: results from a health provider survey.

UNDERUTILIZATION OF VASECTOMY IN THE US Male sterilization through vasectomy is far less expensive, less invasive and safer than female sterilization through tubal ligation. Despite vasectomy's advantages, tubal ligation is utilized approximately three times as often, contributing to an overall underutilization of vasectomy in the US. The underutilization of vasectomy may be related to patient concerns and misconceptions about vasectomy as well as poor access to family planning services and male underutilization of health care in general. Hopton demonstrated the low priority male patients assign to family planning in a patient survey (N=3,482) in which family planning was ranked 26th in a list of 36 health care services. Racial and ethnic minorities and the uninsured are less likely to utilize vasectomy than other groups. Bensyl et al. found that men undergoing vasectomy tend to be a "homogenous group" who are married/cohabitating (91%), nonHispanic whites (87%), who have at least a high school education (81%), and finance the procedure with private insurance (81%). In an attempt to reach populations with the least access to vasectomy, the Rhode Island Department of Health initiated a No Cost Vasectomy Program (NCVP) in 1999 to provide vasectomies at no cost to uninsured men and men whose insurance does not cover vasectomy. As of 2007, approximately 100 men received vasectomies through the program, of whom one third were Hispanic; no African Americans utilized the program. Increased vasectomy uptake in the population may depend on the ability and willingness of providers to reorient men towards the positive aspects of vasectomy and help patients overcome their fears and misconceptions about the procedure. Uptake may also depend on providers' ability to link patients to resources such as the NCVP. An important first step in understanding vasectomy underutilization is to ask health care providers whether they are addressing family planning and sterilization options with their patients in the first place. Do these discussions target female and male patients equally? Are there specific provider-related factors associated with whether or not these discussions are taking place? Are health care providers aware of local resources available for uninsured or underinsured men?