Despite vasectomy's well-recognized benefits including high contraceptive effectiveness, convenience, permanence, relative ease of provision, few side effects, and high levels of satisfaction, use of the method has plateaued globally (Figure)1–3 and continues to languish in most low- and middle-income countries, including having a 0.0% prevalence in Africa.4 This issue of GHSP includes a review by Shattuck et al. of program reports and research on vasectomy, in which the authors also advocate increased support for vasectomy.5 The review has some gaps, in part because of limitations of the review criteria. Nevertheless, we publish the article because we believe it is important to share such evidence as widely as possible, particularly since vasectomy is one of only two modern male contraceptive methods available (along with condoms). Moreover, we provide our own additional perspective here because we believe vasectomy merits more attention and advocacy—recognizing that fulfilling the potential for vasectomy will require long-term and substantial investment.
LOW DEMAND FROM MEN IS THE OVERRIDING ISSUE
Let's put front and center the fundamental underlying constraint to vasectomy uptake—low demand for the method among men in low- and middle-income countries. Among the many reasons for low demand:
First and foremost, men and women typically see contraception as women's responsibility, partly because women bear the brunt of …