PT - JOURNAL ARTICLE AU - Roy Jacobstein AU - Scott Radloff AU - Farhad Khan AU - Kathryn Mimno AU - Manoj Pal AU - Jennifer Snell AU - Renae Stafford AU - Cheick Touré AU - Vandana Tripathi TI - Down But Not Out: Vasectomy Is Faring Poorly Almost Everywhere—We Can Do Better To Make It A True Method Option AID - 10.9745/GHSP-D-22-00369 DP - 2023 Feb 28 TA - Global Health: Science and Practice PG - e2200369 VI - 11 IP - 1 4099 - http://www.ghspjournal.org/content/11/1/e2200369.short 4100 - http://www.ghspjournal.org/content/11/1/e2200369.full SO - GLOB HEALTH SCI PRACT2023 Feb 28; 11 AB - Key FindingsVasectomy use has markedly declined globally, to only 39% of what it was in 2001, even as overall contraceptive use has risen in most countries. Almost all low- and middle-income countries (LMICs) report negligible to zero vasectomy prevalence. In 56 LMICs, no more than 1 in 1,000 women relies on vasectomy. Multiple demand-side and supply-side challenges hinder vasectomy’s becoming an available program method.Only 7 countries, including 3 LMICs, registered increases in vasectomy prevalence between recent surveys. Seven LMICs—Bhutan, Brazil, Colombia, Costa Rica, Iran, Mexico, and Nepal—have achieved substantial vasectomy prevalence (above 2%).Countries with the lowest gender inequality are among those with the highest vasectomy prevalence, and vice versa. Female-to-male disparities in permanent method use have widened further in the past 20 years.Key ImplicationsFor vasectomy to become a truly available, rights-based method option: Policymakers and donors should allot more time, attention, and priority to vasectomy; provide additive and sustained funding; and use metrics of success that focus on program inputs and progress toward longer-term goals, not immediate vasectomy uptake.Program managers should coordinate demand-side and supply-side interventions, promote constructive male engagement, identify and support vasectomy champions, and use a range of communication modalities to increase accurate knowledge of vasectomy.Introduction:Demand for vasectomy—1 of 2 contraceptive methods for men—has been low, with deep-seated myths, misconceptions, and provider bias against it widespread. Programmatic attention and donor funding have been limited and sporadic.Methods:We analyzed vasectomy use in 84 low- and middle-income countries (LMICs) plus the 11 high-income countries with vasectomy prevalence above 1%. These 95 countries comprise 90% of the world’s population. Data come from United Nations survey compilations, population estimates, and gender inequality rankings. We also reviewed recent articles on vasectomy and analyses of chronic challenges to vasectomy service provision.Results:Vasectomy use is 61% lower now than 2 decades ago. Of 922 million women using contraception worldwide, 17 million rely on vasectomy—27 million fewer than in 2001. In contrast, 219 million women use tubectomy—8 million more than in 2001. Of 84 LMICs, 7 report vasectomy prevalence above 2%. In 56 LMICs, no more than 1 in 1,000 women relies on vasectomy. Female-to-male disparities in permanent method use widened globally, from 5:1 to 13:1, and are much higher in some regions and countries (e.g., 76:1 in India). Countries with the highest vasectomy prevalence are among those with the highest gender equality and vice versa.Conclusion:Vasectomy use is surprisingly low globally and declining. Use remains negligible in almost all LMICs, reflecting low demand and program priority. For vasectomy to become an accessible, rights-based option, program efforts need to be holistic, ensuring an enabling environment while coordinating demand- and service-focused efforts. Vasectomy champions at all levels should be supported on a sustained basis. On the demand side, harnessing mass and social media to increase accurate knowledge and normalize vasectomy as a method and service will be particularly valuable. Evidence from Bolivia suggests relatively few trained providers and procedures could result in a country’s attaining 1% vasectomy prevalence.