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 年龄在25岁到34岁到80%的男性，年龄在30岁左右的S和40岁出头的S。尽管有 美国男性生育意愿差异不大黑人、拉丁裔和低收入男性更有可能 参与意外怀孕，这可能会助长弱势群体的贫困循环。 输精管结扎术(即男性永久避孕)是对以下人群最有效的男性避孕方法 不想要更多的孩子。有色人种男性和低收入男性依赖输精管结扎术的可能性远远低于 白人男性和收入较高的人，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，输精管结扎术的使用率也低于女性绝育术。 但在白人和收入较高的人群中，使用绝育更像是女性绝育。 这些长期使用避孕药具的不均衡模式可能与种族/民族和基于收入的情况有关 关于输精管结扎术及其对性功能的(缺乏)影响的知识获取方面的差异。然而，即使是 有了准确和有意义的信息，输精管结扎术使用的差异可能会由于获得机会的不平等而持续存在 照顾，特别是在医疗服务不足的男性中。几乎没有什么努力来全面地 评估导致美国男性差异的个人需求和医疗保健供给侧因素 对输精管结扎术的依赖，这阻碍了实现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--确保所有男性，无论种族/民族和收入，都能够 关于避孕的知情、价值一致的决定。此外，我们还将评估 可能塑造男性获得负担得起和及时的服务的医疗保健生态系统。《公约》的具体目标 研究目的是：1)建立面向患者的网络辅助决策系统，支持高质量的输精管结扎决策；2) 评估辅助决策对输精管结扎决策的质量和对 750名男性在线寻找输精管结扎或产前检查信息的随机对照试验 美国的护理或计划生育访问；以及3)确定获得所需输精管结扎术的可修改障碍 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策略 几个月，并进行深入采访。这项创新的研究提供了一种新的方法来直接解决 通过生产可扩展的工具，在输精管结扎知识和获取方面的种族/民族和基于收入的差异 旨在加强男性知情的避孕决策和护理导航。这项研究还将 使我们能够确定其他可能的战略，促进及时、公平地获得所需的输精管结扎术 在选择终止妊娠的时候，在避孕工作中提供服务和促进性别平等 意外怀孕的人数急剧减少。

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.