by Isabel Beshar, Jody Y So, Kate A Shaw, Erica P Cahill, Jonathan Glazer Shaw
BMJ Sexual & Reproductive Health, 16 July 2024
Abstract
Objective: Male permanent contraception (PC), that is, vasectomy, is an effective way of preventing pregnancy. In the United States, vasectomy use has historically been concentrated among higher-educated/higher-income white men. In the last decade, use of long-acting reversible contraception (LARC) has increased dramatically. We sought to understand how socio-demographic patterns of male vasectomy use have changed in the context of rising LARC use.
Study design: We examined the nationally representative male public use files of the National Survey for Family Growth (NSFG) across five survey waves. Our outcome was primary contraceptive use at last sexual encounter within 12 months. Using four-way multinomial logistic regressions (male PC, female PC, LARC, lower-efficacy methods), we compared sociodemographic factors predictive of vasectomy use versus reported partner LARC use between 2006–2010 (early) and 2017–2019 (recent) waves.
Results: We included 15,964 participants. From 2006 to 2019, there were absolute declines in male vasectomy from 8.0% to 6.8%, while male-reported partner LARC use increased three-fold, from 3.4% to 11.0%. Among the highest economic strata, use of LARC converged with male vasectomy. In adjusted analyses, high income was significantly associated with male vasectomy use in the early wave (OR 4.6 (1.4, 14.8)), but no longer in the recent wave (OR 0.9 (0.2, 4.2)). Marital status remained a significant but declining predictor of male vasectomy use across survey waves. Instead, by 2019, number of children newly emerged as the strongest predictor of male vasectomy use.
Conclusion: Sociodemographic variables associated with vasectomy use are evolving, especially among high-income earners.