Sterilization Among Currently Married Men in the United States, 1991. (Articles).

Data from the 1991 National Survey of Men indicate that about 12% of married men aged 20-39 have had a vasectomy and about 13% are married to a woman who is sterilized. Multivariate analyses indicate that the likelihood of sterilization rises with husband's age, wife's age, duration of marriage and number of children. Black couples are significantly less likely than white couples to rely on sterilization, and interracial couples are less likely than same-race couples to be sterilized. The likelihood of reliance on vasectomy rather than tubal ligation also rises with husband's age, while black men are significantly less likely than white men to elect male over female sterilization. Use of male sterilization is strongly associated with having had a recent contraceptive failure while using a male method. (Family Planning Perspectives, 27:100-107 & 122,1995)

As a means of fertility control, vasectomy not only is highly effective, but also is less costly and complicated than tubal ligation and has fewer long-term health risks. (1) Yet U.S. men are less likely than women to seek sterilization. Between 1982 and 1988, while the prevalence of female contraceptive sterilization in the United States rose from 23% to 28% of contraceptive users aged 15-44, there was no significant increase in the prevalence of male sterilization (2) Data from the 1988 National Survey of Family Growth, a representative sample of women aged 15-44, showed that 12% of contraceptive users relied on male sterilization. Why men are less likely than women to undergo sterilization deserves further attention.

Current research on the antecedents of contraceptive sterilization has focused mostly on individuals' social and demographic characteristics. Results from various studies show that men generally are in their middle-to-late 30s when they seek sterilization, (3) and that men who have not completed high school are less likely to have a vasectomy than are men with at least a high school education. (4) Wife's education has also been found to increase the likelihood that a husband will obtain a vasectomy. (5) Race and ethnicity appear to have a large effect: Studies have consistently found that both black and Latino men are less likely than white men to choose sterilization. (6) Among black and Mexican American couples who elect sterilization, the likelihood is that a female procedure will be chosen. (7)

Studies focusing on the effect of religion on the decision to seek male sterilization indicate that Protestants are more likely to seek the procedure than are either Catholics or those with other religious affiliations. (8) Some community-level impact on the sterilization decision is indicated by the empirical association found between region of residence and the likelihood of vasectomy: Not only are couples who live in the western United States more likely to have chosen sterilization than are those living in other regions, but they are also more likely to have chosen vasectomy over female sterilization. (9)

Previous research has also shown that sterilization is a joint decision in which both husbands and wives participate, (10) and that the spouse most motivated to stop childbearing is the one most likely to become sterilized. (11) Couples with open communication regarding birth control are more likely to choose vasectomy than are couples where the wife appears to have assumed the burden of contraception. Miller and colleagues have concluded that couples who choose vasectomy are probably less traditional and more egalitarian in their marital roles than are couples who do not. (12) Another study, based on combined national surveys of married women, has suggested that couples who have dissimilar characteristics are more likely to be liberal and to be social innovators than are couples made up of individuals who are more alike, and therefore will be more likely to practice sterilization and choose male sterilization over female sterilization. (13) Results supported the hypothesis that the two types of couples differ i n their tendency to choose sterilization, but they found no relationship regarding the selection of male sterilization over female sterilization.

Finally, based on in-depth interviews with couples and single men, Mumford delineated a series of events that make up the vasectomy decision process; he identified a "scare"--a missed period or severe side effects from the pill--as an important factor. (14) About one-half of the sterilized men he interviewed had experienced a prior contraceptive scare.

Family planning research has to a large extent neglected the role of men in contraceptive decision-making. Research on sterilization in general, and on the choice of male sterilization in particular, has been based largely on survey data collected from women. Our research explores the factors associated with contraceptive sterilization using data reported by men in a national survey. We limit the sample to currently married men and examine factors influencing both the choice of contraceptive sterilization and then the choice of vasectomy over tubal ligation among married couples. The analysis focuses on the effects of both individual and couple characteristics on the sterilization decision.