Vasectomy, Tubal Ligation and Marital Status in the US

Excerpts and commentary on: Marital Status and Female and Male Contraceptive Sterilization in the United States, Mieke C. W. Eeckhaut, Fertil Steril (103) 1509-15, 2015.

The following represents excerpts from an interesting article I Fertility and Sterility and my (limited) commentary

Common methods used to achieve Permanent Contraception

Vasectomy and Tubal ligation (as well as other tubal procedures) are the two most common methods used to achieve permanent contraception in men and women, respectively.   Permanent methods of contraception are also referred to as “sterilization”.   Sterilization is viewed in the US as a cost efficient,  highly effective and also a “forgettable” means of contraception.

Drawbacks of sterilization procedures include a very small risk of complication including pain, bleeding and infection.    For vasectomy the complication rate is well below one percent.   The other potential drawback is that these procedures are not always reversible and therefore should be reserved for people who no longer wish to have more children.

Marital Status & Permanent Contraception

Literature has often treated vasectomy and tubal ligation as competing strategies among married men and women, but research suggests sterilization  is prevalent among unmarried people as well.  Retrospective studies that looked at patients from the early to mid 1990s showed that one in three tubal ligations were performed on unmarried women and half of those, on never married women.     This contrasts to data on men from the 1980s which reported only seven percent of men who underwent vasectomy were unmarried.

Dr. Eeckhaut’s study reviewed data from 2006-10 National survey of Family Growth (NSFG).  The data was gathered from home interviews of over twelve thousand women and ten thousand men.   Results show a huge discordance between  rates of sterilization for unmarried men and women.  

Rates of sterilization for unmarried men and women

About 27% of women in the study had tubal ligation by age 45 compared with only 13% of men.    In fact, in the study, nearly a third of tubal sterilizations were performed on unmarried women, more than a half of which were never married.  Unmarried men by comparison accounted for only about  eight percent of  vasectomies and only a little over a third of them were never married men.

The severely reduced incidence of male sterilization among the unmarried and never married compared to their female counterparts is unexplained.   Speculation suggests that women continue to carry a greater responsibility for child rearing than do men in today’s society .   Speculation may also suggest that older men may look to marry younger spouses and so may not want to deprive their spouses the option of children. 

In my own practice, I have performed vasectomy on married and unmarried men.   I agree completely that the majority of my patients who undergo vasectomy are married at the time of their procedure.   I have performed a number of vasectomies on divorced men who have children.   Interestingly,  the “never married” patients who have come to me for vasectomy tend to be younger and without prior history of paternity.

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