Consideration of vasectomy among patients desiring postpartum permanent contraception and their obstetrician-gynecologists: A United States-based study.

OBJECTIVES: To explore how patients considering permanent contraception and their delivering obstetrician-gynecologist (OB-GYN) address partner vasectomy in contraceptive counseling. STUDY DESIGN: From 2021-2023, we conducted in-depth semi-structured interviews with postpartum patients desiring tubal permanent contraception and OB-GYNs at four US institutions as a part of a larger study. For this analysis, we used thematic content analysis to assess factors that shaped conversations surrounding vasectomy. RESULTS: We included 65 postpartum patients and 52 OB-GYNs in this analysis. Although many OB-GYNs considered vasectomy to be a part of their standard prenatal counseling, only half of patients reported counseling about vasectomy. Both patients and OB-GYNs linked lack of counseling to social and clinical factors. Some OB-GYNs either forgot or hesitated to counsel on vasectomy when the male partner was not their patient or wasn't in the exam room. Lack of vasectomy counseling thus prompted patients to seek vasectomy information on their own or opt for female permanent contraception methods. Some OB-GYNs relied on their perceptions of patients' relationship stability or partners' ability to obtain a vasectomy to guide whether they would counsel regarding vasectomy. Lastly, some patients and OB-GYNs prioritized route of delivery, surgical ease, and cancer risk reduction as reasons to obtain tubal permanent contraception versus vasectomy contraception. CONCLUSIONS: OB-GYNs frequently deemphasized vasectomy due to their level of comfort counseling about vasectomy and tubal PC, perceptions around male involvement in contraception, and the organization of care. Instead, vasectomy should be introduced as a viable permanent contraceptive method during standard contraceptive counseling. IMPLICATIONS: Our study suggests that while patients may be interested in vasectomy as an option for permanent contraception, counseling and referral pathways to vasectomy are limited. Clinicians should use a shared decision-making approach with couples, offer educational resources, and refer to vasectomy providers as appropriate.