Unexpected profiles in vasectomy demand during a national campaign in Bolivia: cross-sectional study and associations in age, number of children, and motivations for seeking vasectomy

Vasectomy utilization has historically been very low in Bolivia, constituting just 0.1% of the contraceptive method-mix. To address one of the perceived barriers to vasectomy utilization—cost—MSI Reproductive Choices Bolivia partnered with World Vasectomy Day, No-Scalpel Vasectomy International, and Laval University in 2021 to train in-house providers, and reduced the previous cost of contracting private urologists by half. Demand for procedures during the training campaign was considerably higher than expected; although just 77 vasectomies were provided in 2019, 882 men contacted MSI Bolivia in 2021 to request appointments in the one-month campaign. A cross-sectional survey of vasectomy clients was implemented post-procedure to capture demographic characteristics as well as to assess motivations for getting a vasectomy. Among the 262 vasectomy clients who completed the survey, the average age was 31, and half (50.4%) of respondents had one or two children, 3.1% had four or more, and 30.5% had none. Motivations varied by client type with most clients reporting “wanted only the number of children they had”, while higher percentages of young clients who were often without children reported the “costs of children”, “overpopulation and the environment”, and “violence and social unrest” as their top motivations. The results of this study and the related vasectomy campaign reflected a high unmet demand for affordable vasectomy services in Bolivia. The relatively high proportion of single and/or childless men under 30 years old in the sample may also reflect a larger societal shift in pregnancy intention among younger generations and merit further investigation. These results have implications for demand-generation strategies and pre-vasectomy counseling, and may reflect a market for reversible male contraceptive technologies still in development.