Addressing factors related to disparities in vasectomy

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In the United States (US), the percentage of men who do not want more children increases from 43% among those between ages 25 to 34 years to 80% among men in their mid-30’s and early 40’s. Despite there being few differences in US men’s fertility intentions, Black, Latino and low-income men are more likely to be involved in unwanted pregnancies, which can contribute to the cycle of poverty among disadvantaged groups. Vasectomy (i.e., male permanent contraception) is the most effective male contraceptive method for those who do not want more children. Men of color and low-income men are far less likely to rely on vasectomy than White men and those with higher incomes, and these differences in use have persisted for decades. Vasectomy is also used less often than female sterilization in racial/ethnic minority and low-income communities, but use is more comparable to female sterilization among Whites and those with higher incomes. These uneven patterns of permanent contraception use may be related to racial/ethnic and income-based differences in access to knowledge about vasectomy and its (lack of) effect on sexual functioning. Yet, even with accurate and meaningful information, differences in vasectomy use may persist owing to unequal access to care, particularly among medically underserved men. There have been few efforts to comprehensively assess the individual demand- and healthcare supply-side factors that underlie differences in US men’s reliance on vasectomy, which hampers progress toward reproductive health equity. The proposed study seeks to address key individual-level determinants of disparities in vasectomy use - men’s knowledge and decisional conflict about the method - to ensure all men, regardless of race/ethnicity and income, are able to make informed, value-concordant decisions around contraception. Further, we will evaluate other facets of the healthcare ecosystem that may shape men’s access affordable and timely services. The specific aims of the study are to: 1) Build a patient-facing web-based decision aid to support high-quality vasectomy decisions; 2) Assess the impact of the decision aid on the quality of vasectomy decision making and interest in a randomized controlled trial with 750 men seeking information online about vasectomy or attending prenatal care or family planning visits in the US; and 3) Identify modifiable barriers to obtaining a desired vasectomy and strategies to address them by prospectively assessing men’s experiences accessing care at 2 and 6 months and conducting in-depth interviews. This innovative study offers a new approach to directly address racial/ethnic and income-based differences in vasectomy knowledge and access by producing a scalable tool designed to enhance men’s informed contraceptive decision making and care navigation. This study will also enable us to identify other potential strategies that can facilitate timely, equitable access to desired vasectomy services and advance gender equity in the work of preventing pregnancy at a time when options to terminate undesired pregnancies have narrowed drastically.