A program designed to improve the availability of vasectomy in public-sector clinics trained physicians at 43 facilities in no-scalpel vasectomy between 1993 and 1995. Among the 38 clinics that responded to a follow-up survey in 1996, the number of clinics providing vasectomies rose from 23 to 32, an increase of almost 40%, while the number of vasectomies performed rose by 18%. Seventeen of the 32 clinics performed more vasectomies after the training; 10 of the 17 had not previously provided the procedure. In-depth interviews with staff from seven sites that experienced large caseload increases and from seven that experienced decreases identified three elements for the successful establishment or expansion of vasectomy services-sufficient numbers of trained providers, funds to subsidize vasectomies for men who cannot afford them and activities to raise awareness about the availability of low-cost or free vasectomy.
PIP: The low utilization of vasectomy in the US by low-income, minority men reflects, in part, the lack of availability of this contraceptive method through the public sector. Nationally, only 23% of family planning agencies offer this option. To improve the availability and quality of vasectomy services for low-income men, physicians at 43 public-sector clinics in 17 states were trained in the no-scalpel vasectomy technique during 1993-95. 37% of the physicians trained had never performed a vasectomy before. Among the 38 clinics that responded to a follow-up survey, the number providing vasectomy services increased from 23 before the training to 32 in 1996. At the time of the follow-up survey, these 32 clinics were providing 1650 vasectomies annually. Thus, the training program increased the number of clinics performing vasectomies by 37% and the number of men obtaining them by 18%. In-depth interviews with physicians from 7 clinics that reported sharp increases in their vasectomy caseloads after the training and 7 clinics that experienced sharp decreases identified 3 key components of a successful vasectomy service: 1) a sufficient number of providers committed to serving men and providing a quality service, 2) marketing activities to raise awareness among women and men about the availability of vasectomy services, and 3) the commitment of funds to subsidize vasectomies for men who cannot afford them. Midlevel clinic staff (e.g., nurse practitioners and physician assistants) could be trained to perform no-scalpel vasectomy, thereby easing the burden on physicians, reducing costs, and increasing access.