Addressing factors related to disparities in vasectomy

在美国，不想要更多孩子的男性比例从43%上升到40%。 在30多岁和40出头的男性中，25至34岁的人占80%。尽管有 美国男性的生育意愿几乎没有差异，黑人，拉丁裔和低收入男性更有可能 妇女参与意外怀孕，这可能会加剧弱势群体的贫困循环。 输精管切除术（即，男性永久避孕）是最有效的男性避孕方法， 不想要更多的孩子。有色人种和低收入男性远不太可能依赖输精管切除术， 白色男性和那些收入较高的人，而这些使用上的差异已经持续了几十年。 在少数民族和低收入人群中，输精管切除术的使用频率也低于女性绝育术 在白人社区，使用避孕药具的情况与女性绝育手术的情况更相似，但在白人和收入较高的人中，使用避孕药具的情况与女性绝育手术的情况更相似。 永久避孕药使用的这些不平衡模式可能与种族/民族和收入有关 获得输精管切除术知识的差异及其对性功能的影响（缺乏）。但即使 在准确和有意义的信息，输精管结扎术的使用差异可能会持续由于不平等的机会， 特别是在医疗条件差的男性中很少有人努力全面地 评估导致美国男性性别差异的个人需求和医疗保健供应方面的因素， 依赖输精管切除术，这阻碍了生殖健康公平的进展。拟议的研究旨在 解决输精管结扎术使用差异的关键个人层面决定因素-男性的知识和决策 关于方法的冲突-确保所有男人，无论种族/民族和收入如何，都能够 知情的、价值观一致的避孕决策。此外，我们将评估其他方面的 卫生保健生态系统可能会影响男子获得负担得起的及时服务。该委员会的具体目标 研究是：1）建立一个面向患者的基于网络的决策辅助工具，以支持高质量的输精管切除术决策; 2） 评估决策辅助工具对输精管切除术决策质量的影响， 随机对照试验，750名男性在线寻求有关输精管切除术或产前护理的信息 在美国的护理或计划生育访视; 3）确定获得所需输精管切除术的可修改障碍 以及通过前瞻性评估男性在2岁和6岁时获得护理的经历来解决这些问题的战略 几个月，进行深入访谈。这项创新的研究提供了一种新的方法，直接解决 通过制作一个可扩展的工具，在输精管切除术的知识和获取方面存在种族/民族和收入差异 旨在加强男子的知情避孕决策和护理导航。本研究还将 使我们能够确定其他潜在的战略，可以促进及时，公平地获得所需的输精管结扎术 在选择终止妊娠时， 意外怀孕的情况急剧减少。

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.