Do Men Face Barriers to Birth Control?

Vasectomies are a safe, non-invasive, and often reversible, male sterilization procedure; yet the US has low vasectomy rates.

doctor holding plastic sperm

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The recent Supreme Court decision to overturn Roe v. Wade is a massive restriction of access to reproductive health care. Given this, it is crucial to promote accessibility to the health care and birth control options we do have available for both men and women, such as vasectomies.

Vasectomies are a safe, non-invasive, and often reversible, male sterilization procedure. It’s a minor surgery that prevents sperm from entering semen, typically conducted under local anesthesia and requiring only a day or two of recovery. Compared to tubal ligation – the female sterilization equivalent – male sterilization produces fewer complications and is easier to reverse.

Yet, the United States has the lowest vasectomy rates among wealthy nations. Tubal ligation is twice as common. Medical misinformation, limited insurance coverage, and individual provider restrictions disempower men from taking control of their own reproductive care. These barriers, in addition to social stigma, culminate to place the burden of birth control on female partners.

In a qualitative study conducted in San Francisco, male participants discussed their concerns about vasectomies. The men involved had partners who had undergone tubal ligation and were asked why they had not opted for a vasectomy. Participants of all races cited misconceptions about vasectomy side effects including losing masculinity or “manhood,” genital disfiguration, and impotence. Black and Latino participants noted a lack of social support and fear of stigma if they opted for the procedure. They also cited a negative connotation with the word “sterilization,” associating it with the practice of forced sterilization.

Even if one does opt for a vasectomy, there are additional barriers to actually getting one.

Two common barriers are insurance coverage and procedure cost. Depending on private insurance coverage, vasectomies can cost up to $1,000 out of pocket. This price is especially steep when compared to the cost of tubal ligations, which are free under the Affordable Care Act (ACA), as are all other forms of female birth control. Male sterilization is not covered under the law. State-specific Medicaid coverage is similar; only eight states fully cover vasectomies.

This financial disparity incentivizes men to remain passive and leave female partners in charge of birth control. This leads more couples to rely on female birth control because it’s more affordable, even if it poses greater risk to the patient.

Lastly, some health care providers also act as barriers to vasectomy. Although vasectomies are legal if the patient is 18,  urologists often turn patients away if they are under 35 or do not already have children. Providers also often fail to educate men on birth control options at routine appointments, leading to further misinformation.

All these factors dissuade men from carrying their share of responsibility in family planning. While policy solutions such as expanding Medicaid coverage for vasectomies would likely increase availability, the multi-faceted nature of this problem requires both lawmakers and health care providers to solve this problem. We need a collaborative effort to promote family planning in the face of national reproductive health restrictions.

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