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Realin' in Alaskan salmon, halibut

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Posted: Friday, October 23, 2009 12:00 am

Who went: Pete Reinstein.

Where he went: Sitka, Alaska.

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It started with an offhand comment from a urologist’s secretary: More men than usual were calling to discuss sterilization or to schedule a vasectomy.

At that moment six years ago, Dr. Marc Goldstein and his colleague at Weill Cornell Medical College in New York, wondered whether they were witnessing the contraceptive effects of a global economic downturn.

Could financial pressures and the anticipated cost of raising additional children drive men to seek a permanent form of surgical birth control?

Goldstein and his colleagues presented evidence at a meeting of the American Society for Reproductive Medicine in Hawaii this week that seemed to confirm the impressions of many urologists — men were 35 percent more likely get a vasectomy after the recession than before it, they found.

“That was statistically significant,” said Dr. Bobby Najari, a fellow of male reproductive medicine. Najari estimated that the increase translated to roughly 125,000 more vasectomies each year.

The researchers have yet to publish their findings in a medical journal, but they argue that their findings highlight the economy’s effect on family planning.

According to economists, the Great Recession began in December 2007 and ended in June 2009.

To test their hunch, Goldstein, Najari and Dr. Peter Schlegel consulted the National Survey for Family Growth, which interviewed more than 9,000 single and married men, ages 18 to 44, from 2006 to 2010.

Among other things, they found that 5.8 percent of the surveyed men had undergone vasectomies before the recession. The rate jumped to 7.5 percent after the downturn — a 35 percent increase.

They also found that the men were more likely to report a lack of full-time work and insurance in the wake of the recession, as well as a drop in annual income.

Najari said the urologists inferred that men were seeking vasectomies on the basis of economics.

“It’s not like there’s a specific survey question that asks, ‘Did you get a vasectomy because you were concerned about your financial status?’” Najari said.

Fellow urologists said they believed economics certainly played a role, but noted that there were probably other reasons for the increase.

Dr. Mary Katherine Samplaski, an associate professor of urology at Keck Medicine of University of Southern California, who did not participate in the study but listened to the presentation, said growing acceptance of the procedure also played a role.

“There’s some cultures that believe when you have a vasectomy, it takes away some sexual function or virility,” Samplaski said. “There’s no truth to that, but there’s still a fear.... As more men talk to other men about having the procedure, they become more educated.”

Traditionally, men who seek vasectomies have higher incomes, so the researchers’ argument is somewhat counterintuitive. The procedure, which involves cutting or blocking the vas deferens — the duct that carries sperm from the testes to the urethra — costs an average of $750, the urologists said.

Najari and his colleagues did not investigate the economy’s effect on other forms of birth control. However, the National Center for Health Statistics reported last year that the pregnancy rate for women in 2009 was the lowest in 12 years, or 102.1 births per 1,000 women aged 15 to 44.

While the doctors’ conclusions appeared to confirm the anecdotes of urologists, not everyone was convinced of the connection.

Gladys Martinez, a statistician at the U.S. Centers for Disease Control and Prevention, who did not participate in the study, said the question the urologists set out to answer was a complicated one.

“The factors that go into a man’s decision to have a vasectomy are many and complex,” Martinez wrote in an email message. “When analyzing a research question there are a set of assumptions that are made, and your results are as good as your assumptions.”

Najari said the findings had implications for national health policy. He noted that the Affordable Care Act covered birth control for women without a co-pay, while procedures for men involved an out-of pocket expense.

He said this could make it even more likely that the burden of contraception would be further weighted toward women.

“What we’re seeing is that family planning is sensitive to financial pressures,” Najari said.

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