Female oral contraceptives—aka "The Pill"—have long been the birth-control mainstay in America. That hegemony may be changing.
Why are vasectomies cool again?
Since the U.S. Supreme Court earlier this year overturned Roe v Wade, a landmark 1973 federal law legalizing abortion nationwide, urologic healthcare providers have reported a sharp uptick in men seeking vasectomies—the male equivalent of women “having their tubes tied.”
With more than a dozen states banning abortion outright and others severely limiting its legal applications, plus other Republican-led states aggressively pursuing draconian new abortion laws, vasectomies are suddenly in vogue again as a compelling birth-control option, National Public Radio (NPR) reported in December.
“One small snip for man, one giant leap for humankind(ness),” read a sign at Planned Parenthood (PP) in St. Louis, Missouri, which was hosting a recent mobile vasectomy clinic.
Urologist Dr. Esgar Guarín, who assisted with the St. Louis PP vasectomy clinic, told NPR that his Iowa medical practice “saw a surge in website traffic, and the number of patients coming for procedures nearly doubled from June to July.”
“What has happened is that since Roe v. Wade was overturned, many men have realized that they perhaps have been absent in contraception, particularly in contraceptive decisions,” Guarín told NPR.
With strict new state abortion laws being unveiled across the country, some inflexibly prohibitive, even punitive, couples and single women are concerned more than ever before about unwanted pregnancies, because abortion may no longer be a legal option where they live. Certainly, Americans who want an abortion in a state where it’s now illegal or extremely constricted may still choose to travel to a state where abortion is easier to obtain. But many people can’t afford that route.
KFF, an independent nonprofit offshoot of the Henry J. Kaiser Family Foundation that analyzes national healthcare issues, summarized the risks and inconveniences that overturning Roe entails for pregnant women and their partners:
State laws range from complete abortion bans with criminal penalties to abortion protections that include funding for clinics, and legal protections for clinicians. In some states, abortion provision will remain legal and available because the states have had policies in place prior to the Dobbs decision that protect access even in the absence of Roe. Another group of states do not have any explicit laws either upholding abortion rights or prohibiting abortion, and access to services is mixed in these states. Finally, since the Supreme Court ruling, several states have already outlawed provision of abortion services, and more states are expected to act in the coming weeks. These 17 states had policies in place prior to the decision that would effectively outlaw abortions soon after a ruling to overturn Roe v. Wade. Many of these states are in the South, which has large shares of Black and Hispanic women, the Plains which has a large Indigenous population, and the Midwest. To obtain an abortion, women in states that prohibit abortions would likely have to travel out of state, which will result in disproportionate barriers to accessing abortions for people of color.
So vasectomies have recently become a preferred birth-control option that would allow people to avoid legal crises due to unwanted pregnancies, along with the emotional turmoil they entail.
A spokesman for the American Urological Association explained to NPR that, although comprehensive national data as yet is unavailable, healthcare professionals nationwide are anecdotally reporting increased vasectomy demand in the past few months.
Since Roe was overturned, vasectomies are being performed at Ohio’s renowned Cleveland Clinic “at sky-high, record rates,” assistant professor of urology Dr. Sarah Vij told NPR, and Planned Parenthood North Central States in the Midwest reports it has received “a surge of calls” in the region about vasectomies since the stunning Supreme Court decision.
It’s not surprising, perhaps, that vasectomies have long been seen as a far distant second to other birth-control methods, primarily “The Pill,” in terms of preferability. Vasectomies require surgery, after all, and have long been viewed (albeit falsely) as virtually irreversible, while effective oral contraceptives can be started and stopped at will with no residual, permanent effect.
However, it’s important to note that vasectomies, with a failure rate of only 0.15% to 0.50%, are far more effective against unwanted pregnancy than the most popular birth-control method: oral contraceptives for women (The Pill), which are about 9% ineffective, according to the American College of Obstetricians and Gynecologists.
Because of past male resistance to vasectomies, scientists have long labored, so far unsuccessfully, to create a male contraceptive pill. Only about 5% of U.S. men ages 18 to 45 have received a vasectomy, versus close to 20% of women opting for the much more medically risky female version: tubal ligation, according to the Association of American Medical Colleges (AAMC).
Although vasectomy reversal surgery is expensive and not foolproof—the success rate (ending with a pregnancy) ranges from 73% to 91%, depending on surgeon skill, type of procedure, etc.—its effectiveness is far from marginal. And there are back-ups, including freezing of sperm before vasectomy if patients are worried that a desired reversal later might fail, and harvesting of sperm from the testes for post-vasectomy in vitro fertilization.
Such encouraging features of vasectomies after the Supreme Court’s jettisoning of Roe v Wage are manifestly causing many men to re-evaluate their past resistance to them.
Aaron Zeleske, 39, of Wisconsin, is one of them. He explained in an AAMC website article:
My partner and I make decisions together and work on the direction of our life together. We don’t plan on having children, and it’s consistent with my values to share responsibility for contraception. I thought, “I need to get my act together and do this.” Given the current environment [concerning abortion], vasectomy seems almost like a political act.
Zeleske’s apprehension is national post-Roe.
Stephanie Page, MD, Ph.D., a male contraceptive researcher at the University of Washington Schoolof Medicine, Seattle, warns of similar cascading worries across the country:
We are facing what is becoming a crisis in unplanned pregnancies in this nation, and we know there are enormous health and economic consequences from unplanned pregnancies. We need expanded contraceptive options for men if we are going to protect the health and well-being of men, women, and their offspring.
Will vasectomies and perhaps an as-yet-developed male contraceptive become the new normal, supplanting The Pill’s ubiquity in post-Roe America?
Certainly, something effective will need to replace abortion if we don’t want to return to a time when a tsunami of unplanned and unwanted pregnancies are standard practice in the United States.
If vasectomies are it, so be it.
And if conservative Americans are so bent on banning abortion everywhere, they should—to greatly reduce the need for such interventions—be in favor of increasing government funding for voluntary vasectomies of men who can’t afford them.
They should also remind themselves that one-and-done vasectomies are cheaper in the long run than periodically one-a-day birth-control pills.