Knowledge and practice patterns regarding vasectomy among Family PACT providers

Vasectomy is the most effective and only long-acting form of contraception for men in the United States. Although vasectomy has low failure rates, is safe and is cost effective, it only accounts for 6% of contraceptive use. The goal of our study is to examine provider and system level barriers to male sterilization including provider knowledge and attitudes towards vasectomy and perceived barriers to vasectomy services. We distributed 1,467 surveys to all Family PACT health care sites that served at least one male adult contraceptive patient in 2007/08 and achieved a response rate of 61% (895). Family PACT is a California program that provides comprehensive family planning for eligible males and females, including sterilization. Most providers considered vasectomy services to be safe (93%) and effective (94%). However, only 48% reported regularly providing counseling on vasectomy among patients seeking permanent contraception. Significant reasons reported for not regularly counseling on vasectomy, included that clients aren't interested in vasectomy (45%), they prefer female sterilization (32%), and clients are exclusively female (31%). Respondents also reported perceived barriers to vasectomy services including poor reimbursement (58%), lack of vasectomists (54%), and poor infrastructure/staffing (42%). Routine inclusion of vasectomy counseling for female clients with long-term male partners in addition to male clients seeking permanent contraception may be one way to increase utilization of this safe and highly-efficacious contraceptive method. Increased reimbursement and vasectomy training opportunities may also improve utilization.