Conditional vasectomy: public hospital gatekeeping, masculinity, and reproductive citizenship in pronatalist China

Following China's shift towards pronatalist governance, vasectomy has been reported as difficult to obtain in some public hospitals, even as online narratives frame male sterilisation as responsible partnership and protection of women's health. Treating access as an institutional and discursive problem, this article analyses public-facing justificatory discourse rather than clinical practice itself. Using qualitative document analysis and reflexive thematic analysis, it examines a purposive multi-genre corpus of policy and legal texts, statistical reporting, English- and Chinese-language journalism, hospital public accounts, and peer-reviewed studies on vasectomy trends, reversal demand, and social media narratives. Four linked logics recur across the corpus: eligibility tied to administratively legible marital/parental status; refusal justified through regret-and-risk talk that protects both patients and institutions under policy ambiguity; responsibility recognised mainly when aligned with pronatalist family-completion trajectories; and opaque service boundaries that shift information work onto individuals and couples. These dynamics produce conditional reproductive citizenship: vasectomy remains legitimate in principle but is practically available chiefly to men legible as stable husbands and fathers and low risk for hospitals.