Differences in permanent contraceptive use in the United States by demographic characteristics

To examine racial/ethnic and income differences in the prevalence of vasectomy and tubal sterilization use among US men and women who do not want more children.

We used the male and female samples of the National Survey of Family Growth (2015-2019) and identified respondents ≥ 21 years of age who did not want any or more children. We computed the weighted prevalence of vasectomy use among men and tubal sterilization use among women. We used gender-stratified Poisson regression models that included respondents' race/ethnicity and income separately and controlled for age, number of children, marital status and educational attainment.

The sample included 3822 men and 5713 women aged ≥ 21 years who did not want any or more children. Vasectomy prevalence was significantly lower among men who were Black (6.1%), Hispanic (10.1%), and had incomes ≤ 149% of the federal poverty level (FPL; 5.4%), compared to white men (18.3%) and men with incomes ≥ 300% FPL (19.6%). Tubal sterilization prevalence was significantly higher among women who were Black (35.4%), Hispanic (34.7%) and had incomes ≤ 149% FPL (38.8%), compared to white women (24.8%) and women with incomes ≥ 300% FPL (16.5%). Racial/ethnic and income-based differences in vasectomy use remained after multivariable adjustment, whereas differences in tubal sterilization use were attenuated after accounting for demographic characteristics.

We observed pronounced differences in permanent contraceptive use by respondents' race/ethnicity and income. A diverse set of sociocultural, partner, and structural factors likely contribute to these differences.

The prevalence of permanent contraceptive method use in the US varies markedly by race/ethnicity and income and trends in opposite directions for vasectomy versus tubal sterilization. Addressing inequitable access to knowledge, health services and insurance coverage would ensure equitable availability of both available for individuals who do not want children.