Consultant, Cary, NC, USA.
The Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins University, Baltimore, MD, USA.
Glob Health Sci Pract. 2023 Feb 28;11(1). doi: 10.9745/GHSP-D-22-00369.
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.
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.
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.
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.
男性避孕方法之一的输精管切除术（vasectomy）需求一直较低，其背后存在根深蒂固的神话、误解和提供者的偏见。项目关注度和捐赠资金一直有限且零星。
我们分析了 84 个低收入和中等收入国家（LMICs）以及 11 个输精管切除术普及率高于 1%的高收入国家的输精管切除术使用情况。这 95 个国家占世界人口的 90%。数据来自联合国调查汇编、人口估计和性别不平等排名。我们还审查了最近关于输精管切除术的文章以及对输精管切除术服务提供的慢性挑战的分析。
现在输精管切除术的使用比 20 年前低了 61%。在全球使用避孕措施的 9.22 亿妇女中，有 1700 万人依赖输精管切除术，比 2001 年减少了 2700 万人。相比之下，有 2.19 亿妇女使用输卵管结扎术，比 2001 年增加了 800 万人。在 84 个 LMICs 中，有 7 个报告输精管切除术普及率高于 2%。在 56 个 LMICs 中，每 1000 名妇女中不超过 1 人依赖输精管切除术。全球永久性避孕方法使用方面的男女差距扩大，从 5:1 扩大到 13:1，在一些地区和国家更高（例如，印度为 76:1）。输精管切除术普及率最高的国家也是性别平等程度最高的国家之一。
输精管切除术的使用在全球范围内令人惊讶地低，且呈下降趋势。在几乎所有的 LMICs 中，使用率仍然微不足道，这反映了需求低和项目优先级低。要使输精管切除术成为一种可获得的、基于权利的选择，项目工作需要全面，确保创造有利环境，同时协调需求和服务为重点的努力。各级输精管切除术的支持者都应该得到持续的支持。在需求方面，利用大众和社交媒体来增加对输精管切除术的准确知识，使其成为一种方法和服务，将特别有价值。来自玻利维亚的证据表明，相对较少的经过培训的提供者和程序可以使一个国家达到 1%的输精管切除术普及率。
