Adding vasectomies: One agency's story
How many men enter the doors of your family planning clinic, and what services can you offer them outside of free condoms? Consider vasectomy: It is simpler, safer, less expensive, and as effective as the currently available methods of female sterilization, according to Contraceptive Technology.1
Low-income, minority, and less educated men are less likely to be vasectomy recipients due to costs, according to a survey of vasectomized men.2 The Reproductive Health Program of the Oregon Department of Human Services (DHS) Public Health Division launched a vasectomy pilot project in 2005 to offer low- or no-cost vasectomies to Title X-eligible men. The project, which operates as a collaboration between the state's Reproductive Health program, Title X delegate agencies, and local vasectomy providers, has provided more than 130 vasectomies since its inception, says Lesli Leone Uebel, MPH, CHES, a DHS social marketing coordinator. Those numbers may be higher; with mandated 30-day waiting periods for the procedures, more men are set to receive services, Uebel explains.
Eight Oregon county health departments — Baker, Grant, Hood River, Jefferson, Lane, Linn, Malheur, and Tillamook counties — along with Planned Parenthood of Columbia-Willamette and Planned Parenthood of Southwestern Oregon, signed up for the pilot project. Kicked off with a $50,000 grant from federal Title X monies, the project was awarded a similar amount from Title X for the current fiscal year. It has now been opened to other interested Title X clinics in the state, notes Rian Frachele, DHS family planning program manager.
What is involved?
In developing the pilot project, Oregon officials looked at a similar program operated by the Washington State Department of Health's Family Planning and Reproductive Health Section. Introduced in 1995, the Washington project has offered low or no-cost vasectomies to state residents who are eligible for medical assistance and who are not covered under any insurance plan for vasectomy. (Editor's note: To learn more about the Washington state project, see the state Department of Health's Family Planning & Reproductive Health's page on the subject, www.doh.wa.gov/cfh/FPRH/vasectomy.htm.)
In the Oregon project, the state provides procedural guidelines, forms for project enrollment and informed consent, vasectomy education materials, and an optional client satisfaction questionnaire. Agencies participating in the project are responsible for outreach as well as sterilization education and counseling to interested men. Agencies also set up agreements with local vasectomy providers. When men have received vasectomy counseling, they are referred to the local provider. After the federally mandated 30-day waiting period, the provider performs the vasectomy as well as the recommended post-vasectomy sperm counts. The agencies then are responsible for invoicing the state for costs of the counseling and the actual vasectomy service. Oregon reimburses participating agencies $105 for counseling services and $300 for vasectomy procedures, says Uebel.
What do men say?
How have participating agencies gotten the word out about the vasectomy project? According to Uebel, word of mouth has been very effective. Many men have come as a referral from a partner or family member who has used family planning clinic services. About 80% of men participating in the pilot phase of the project said their vasectomy counseling visit was their first time at that particular clinic.
Men have been very pleased with the service, says Uebel. A survey was designed to measure satisfaction in five areas: welcome from clinic staff, ability to ask questions, usefulness of the written material about vasectomy, degree to which the client's questions or concerns were addressed, and whether the client would recommend the clinic to others. Almost all responses were positive, she notes.
Project billing data indicate that about 94% of men who were counseled went on to receive a vasectomy. This is good news for unintended pregnancy prevention, given the reported contraceptive practices of the men and their partners, note Oregon public health officials. In surveying men who participated in the pilot phase, 11% said that they and their partners were not using any form of birth control prior to considering vasectomy; about 48% were using less effective methods, such as condoms, withdrawal, or rhythm.
"One man said in his survey, 'Thank you for helping me to get a free vasectomy and for helping a small family live better,'" said Uebel. "Men recognized the value of the service that they were getting, and they were extremely appreciative of it."
References
- Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology: 18th revised edition. New York City: Ardent Media; 2004.
- Barone MA, Johnson CH, Luick MA, et al. Characteristics of men receiving vasectomies in the United States, 1998-1999. Perspect Sex Reprod Health 2004; 36:27-33.
For more information on the Oregon Vasectomy Project, contact:
- Rian Frachele, Family Planning Program Manager, Oregon Office of Family Health Family Planning Program, Portland, OR. Phone: (971) 673-0364. E-mail: [email protected].
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