Contraception 2014 Commentary On Reproductive Health

Contraception 89 2014 35arhp Commentary Thinking Reproductively

Contraception –5 ARHP Commentary ― Thinking (Re)Productively Putting the man in contraceptive mandate☆ Brian T. Nguyena,âŽ, Grace Shihb, David K. Turokc aDepartment of Obstetrics and Gynecology, Oregon Health and Sciences University, 3181 Southwest Sam Jackson Park Road, Box L466, Portland, OR 97239, USA bDepartment of Family Medicine, University of Washington, Seattle, WA 98195, USA cDepartment of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA Received 20 August 2013; revised 28 September 2013; accepted 1 October 2013 ☆ Disclaimer: T the authors and do Association of Rep ⎠Correspondin E-mail address: /$ – see This monthly commentary is contributed by the Association of Reproductive Health Professionals to provide expert analysis on pressing issues in sexual and reproductive health.

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The contraceptive landscape in the United States has historically emphasized women’s reproductive autonomy, often overshadowing the crucial role men play in family planning and contraception. The Affordable Care Act (ACA) enhanced access for women through its contraceptive mandate, offering free contraception and sterilization services. However, despite these advances, male involvement remains insufficiently addressed, with limited policies covering male sterilization such as vasectomy, and virtually no provisions for prospective male contraceptive methods. This gap not only impacts gender equity in reproductive responsibility but also influences overall contraceptive effectiveness, safety, and cost efficiency.

The data indicate that female sterilization, primarily tubal ligation, remains the predominant method of contraception among women in the US, with approximately 27% relying on it, compared to only 10% relying on vasectomy (Jones et al., 2012). Notably, vasectomy has advantages over female sterilization including higher efficacy, lower complication rates, and reduced costs (Shih et al., 2011). The failure rate for vasectomy after five years is approximately 0.1%, significantly lower than tubal ligation, which has a failure rate of up to 1.4% (Peterson et al., 1996; Jamieson et al., 2004). Furthermore, vasectomy pathogens are performed in outpatient settings with minimal anesthesia, reducing risks and costs associated with abdominal surgeries involved in tubal sterilization (Adams & Wald, 2009).

Economic analyses corroborate these clinical benefits. The average cost of vasectomy in the US is roughly US$ 708, while tubal ligation costs around US$ 2,912, which can escalate further with hospital charges (Trussell, 2012). Despite vasectomy's cost-effectiveness and safety profile, coverage gaps persist—approximately 25% of insurance carriers do not reimburse for vasectomy procedures (Kurth et al., 2001). Patients often face significant out-of-pocket costs, especially considering deductibles averaging US$ 1097, leading to disparities in access (Rae et al., 2012). Conversely, postpartum tubal ligation, often the only timely sterilization option, is limited by hospital policies, religious restrictions, and patient delays, which diminishes access for women who need it most (Boardman et al., 2013).

The limited policy scope under the ACA inherently sustains gender disparities in contraception. Men’s reproductive health needs, including counseling, sterilization, and prospective contraceptive methods, are largely unaddressed. This imbalance undermines the shared responsibility model of family planning, perpetuates social and financial barriers for men seeking contraception, and potentially worsens public health outcomes, such as STI rates correlated with low male clinic attendance (Dailard, 2002). Additionally, the absence of reimbursement incentives discourages clinics from expanding male-focused services, further marginalizing men from reproductive health systems (Shih et al., 2013).

Amendments to governmental policy could rectify these disparities. The Department of Health and Human Services (HHS) has the authority to explicitly include male contraception and sterilization services within the contraceptive mandate. Formal evaluation by the US Preventive Services Task Force could enhance policy clarity, especially if male methods receive a Grade B recommendation, requiring insurance coverage. Individual states can proactively extend insurance benefits to men through the Essential Health Benefits framework, while subsequent federal revisions could explicitly enshrine male reproductive services as standard coverage (HHS, 2013; US Preventive Services Task Force, 2014). Advocacy efforts by organizations like the National Health Law Program aim to influence these policy shifts and increase funding for male reproductive health initiatives.

Increased awareness campaigns are vital to changing societal perceptions, emphasizing that reproductive responsibility is a shared enterprise and that male methods like vasectomy and emerging hormonal contraceptives are safe, effective, and cost-efficient. Education can dispel widespread misconceptions, reduce stigma, and promote higher acceptance among men. Supporting research into novel male contraceptives and their incorporation into clinical practice will further bolster the case for inclusive family planning policies.

In conclusion, expanding contraceptive policy to include men is both ethically justified and pragmatically beneficial. It promotes gender equity, reduces healthcare costs, enhances safety, and fosters a more comprehensive approach to reproductive health. Achieving these goals will require concerted advocacy, evidence-based policy reform, and increased awareness to ensure reproductive health is truly a human issue, not solely a woman's issue.

References

• Adams, C. E., & Wald, M. (2009). Risks and complications of vasectomy. Urologic Clinics of North America, 36(3), 331-336.
• Boardman, L. A., Desimone, M., & Allen, R. H. (2013). Barriers to completion of desired postpartum sterilization. Rhode Island Medical Journal, 96(2), 32-34.
• HHS. (2013). Coverage of certain preventive services under the Affordable Care Act. Federal Register, 78(25).
• Jones, J., Mosher, W., Daniels, K., et al. (2012). Current contraception use in the United States 2006–2010, and changes in patterns of use since 1995. National Health Statistics Reports, 60.
• Jamieson, D. J., Costello, C., & Trussell, J. (2004). The risk of pregnancy after vasectomy. Obstetrics & Gynecology, 103(5 Pt 1), 848-850.
• Kurth, A., Bielinski, L., & Graap, K. (2001). Reproductive and sexual health benefits in private health insurance plans in Washington State. Family Planning Perspectives, 33(4).
• Peterson, H. B., Xia, Z., Hughes, J. M., et al. (1996). The risk of pregnancy after tubal sterilization: findings from the US Collaborative Review of Sterilization. American Journal of Obstetrics & Gynecology, 174(4), 1161-1168.
• Rae, M., Panchal, N., & Claxton, G. (2012). Snapshots: the prevalence and cost of deductibles in employer-sponsored insurance. The Henry J. Kaiser Family Foundation.
• Shih, G., Dube, K., Sheinbein, M., et al. (2013). "He's a real man": a qualitative study of the social context of couples' vasectomy decisions among a racially diverse population. American Journal of Men’s Health, 7(3), 206-213.
• Trussell, J. (2012). Update on and correction to the cost-effectiveness of contraceptives in the United States. Contraception, 85(6), 611-612.