Barriers to offering vasectomy at publicly funded family planning organizations

Male patient with provider

Credit: CC BY 2.0, by Army Medicine

Although vasectomy is a highly effective contraceptive option, only seven percent of publicly funded family planning organizations offer the procedure, which can cost up to $3,500. A recent study co-authored by Daniel Grossman, MD interviewed administrators at publicly funded family planning organizations in Texas to identify barriers to offering vasectomy.

Of the 54 organizations interviewed, only 20 percent offered vasectomy on site. The majority (65 percent) referred men to out-of-network providers and did not cover the cost. The main factors constraining organizations’ ability to offer or effectively refer men for vasectomy were:

  1. Shortage of trained providers: Most organizations believed only urologists could perform vasectomy but had none in their network. As a result, they referred patients to private urologists, whose cost and location posed barriers to low-income men.
  2. Poor reimbursement rate: Even organizations with Title X funding available to reimburse urologists struggled to contract with them because the reimbursement rate was so low compared to private-pay.
  3. Organizational culture: Many organizations, due to their own biases, reported rarely even counseling men on vasectomy. Some perceived vasectomy as low-priority compared to men’s other healthcare needs. Others presumed patients’ cultural norms precluded interest in vasectomy—especially among Latinos—despite evidence suggesting otherwise.

To address these key barriers, the authors recommend:

  • Train more family medicine clinicians to perform vasectomy.
  • Expand eligibility for publicly funded family planning services to include low-income men and/or raise the reimbursement rate.
  • Do more culturally tailored educational outreach to both men and their partners.