Studying the “Snip”: A Multi-Methods Exploration of Vasectomy in the Southern United States

Introduction: To date, women have primarily born the physical, emotional, and financial burden of contraceptive use. Men, on the other hand, have remained largely absent from conversations about pregnancy prevention and reproduction, in part because of the lingering assumption that men are uninterested in contraception. Vasectomy, one of only three available male-centered contraceptive options, represents a rare opportunity for men to control their reproduction and take on a more equitable role in pregnancy prevention. Even though vasectomy is 99.9% effective at preventing pregnancy, the method remains underused in the United States, particularly in the southern states where prevalence lags behind other parts of the country. Limited research has explored why this is the case. The purpose of this study is to explore influences on vasectomy use – including individual knowledge and attitudes, interpersonal relationships, structural barriers to access, and prevailing gender norms – in the southern United States. Methods: Three aims guided this research. Aim 1 was to conduct a systematic review and thematic metasynthesis of global qualitative research about men’s experiences having a vasectomy over the past 20 years (n=13). Aim 2 was to create and conduct an online survey of men’s vasectomy knowledge, attitudes, and information seeking behaviors. Targeted Facebook advertising was used to recruit men aged 25-70 living in one of seven states (Alabama, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee) (n=397). Survey data were analyzed using linear and logistic vi regression models in SPSS. Men who provided contact information at the end of the survey were eligible to be selected for Aim 3, a series of individual telephone interviews. Individual, intensive telephone interviews were conducted with men who had a vasectomy (n=21) and men who did not have a vasectomy (n=27). Transcripts and memos from the interviews were analyzed using a constructivist approach to grounded theory to develop an understanding of men’s vasectomy decision making. Results: The metasynthesis of published literature revealed that men describe having a vasectomy as an autonomous decision, but this decision is heavily influenced by female partners and norms about masculinity. Regression models found that knowledge and attitudes about vasectomy were statistically significantly higher among men who had the procedure. Interview data moved beyond the importance of men’s attitudes to focus on the ways interpersonal relations with partners and peers shape men’s understandings. Decisions about whether or not to use vasectomy were also influenced by structural and societal factors, including insurance coverage, reproductive healthcare availability, the economy and personal finances, and what it meant to be a “good man.” Findings from across the three aims were synthesized to produce 1) a map of men’s reproductive decision making and 2) a substantive conceptual framework for understanding vasectomy use. Conclusions: Overall, this research provides empirical evidence about how men think about, consider, and experience vasectomy as not only an individual act but as one that is influenced by a range of social actors, practices, and norms. Reproductive health interventions aimed at increasing the visibility of vasectomy as a contraceptive option must consider how interpersonal and structural factors may impact individual decisions