Vasectomy provider decision-making balancing autonomy and non-maleficence: qualitative interviews with providers [version 1; peer review: 2 approved]

Background Male sterilization, or vasectomy, is 99.9% effective at preventing pregnancy with less than a 2% risk of complications. Despite the high efficacy, low risk, low cost, and gender equity benefits of vasectomy, just 2% of women reported that they and their partners relied on vasectomy as their contraceptive method globally in 2019. Health care providers can be both a facilitator and a barrier in men’s health generally, and may be in vasectomy provision as well. This study sought to describe the decision-making rationales of experienced vasectomy providers when evaluating patient candidacy in complex cases. Methods Fifteen vasectomy providers belonging to the global Vasectomy Network google group from seven countries participated in online interviews using a semi-structured in-depth interview guide. Providers were asked about their vasectomy training, their reasons for vasectomy provision, challenging cases they have faced, and approaches used to manage challenging cases. Vignettes were used to further elicit decision-making rationale. Thematic analysis was conducted using MAXQDA20. Results Provider decision-making was predicated on ensuring patients were well-informed, able to consent, and certain about their choice to have a vasectomy. Once those foundational conditions were met, providers filtered patient characteristics through their training, laws and policies, sociocultural norms, experience, and peer influence to produce a cost-benefit breakdown. Based on the cost-benefit analysis, providers determined whether to weigh autonomy or non-maleficence more heavily when determining vasectomy patient candidacy. Conclusions Despite clinical best practices that promote prioritizing patient autonomy over non-maleficence, some providers continued to weigh non-maleficence over autonomy in vasectomy patient candidacy evaluations. Non-maleficence was particularly prioritized in cases providers deemed to be at higher risk of regret. The findings of this study suggest vasectomy provider training should emphasize evidence-based best practices in shared decision-making and patient-centered care to facilitate vasectomy provision that honors patient autonomy and rights

Promoting vasectomy services in Ethiopia

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

Promoting vasectomy services in Rwanda

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

Men on the move and the wives left behind: the impact of migration on family planning in Nepal

Nepali migration is longstanding, and increased from 2.3% of the total population in 2001 to 7.2% in 2011. The estimated 1.92 million migrants are predominantly men. Consequently, 32% of married women have husbands working abroad. Social structures are complicated as many married women live with their in-laws who typically assume decision-making power, including access to health services. This study compares access to reproductive health services, fertility awareness, and decision-making power among a sample of married women aged 15–24 years (n = 1123) with migrant husbands (n = 485), and with resident husbands (n = 638). Predictably, women with migrant husbands had significantly lower contraceptive use than other married women (9.3% vs 30.3%, respectively), and expressed a higher intention to become pregnant in the next year. Despite their intentions, women with migrant husbands scored lower on a fertility awareness index, were less likely to discuss pregnancy planning with their spouse, and less likely to describe their relationships positively. Decision-making for both groups of married women was dominated by both husbands and in-laws in different ways. Yet, across multiple normative scales, fewer women with migrant husbands felt pressure to conform to existing social norms. Married women with migrant husbands reflect a subset of women, with unique fertility issues and desires. Interventions that increase knowledge of fertility among this subset of women, promote healthy preconception behaviours. Linking women for counselling opportunities throughout the pre and postnatal periods may help improve health outcomes for mothers and children

Promoting vasectomy services in Malawi

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

Promoting vasectomy services in the Philippines

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

Promoting vasectomy services in Uganda

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

Promoting vasectomy services in Kenya

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

How to create successful vasectomy programs

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming

Promouvoir les services de vasectomie au Burundi

Vasectomy is a safe and highly effective family planning method for men and couples who do not want any more children, but in low resource settings, few men seek out or have access to this method. Increasing the voluntary use of vasectomy is a cost-effective strategy for countries to reduce unmet need for family planning, decrease unintended pregnancies, and meet national family planning goals. By engaging men directly in family planning, vasectomy also holds promise for promoting positive gender norms and healthy relationships. | This brief is part of a set of resources from FHI 360/Evidence Project providing policymakers, advocates, program managers, and service providers with evidence-based recommendations for improving vasectomy programming