For Lianne Harris, it was a question of odds. She and her husband Ashley had planned to have two children: they ended up with three, welcoming twin boys when their son was two. At that time, Lianne learned that her age (32), combined with her family and medical history, meant that if she were to conceive again, her chance of having more twins was higher than 40%. ‘No way did I want to jump to five,’ says Lianne, now 35, from Essex.
Together for over a decade, and adamant that their family was complete, the couple decided that Ashley would get a vasectomy. ‘The snip’, as it’s known, achieves permanent sterilisation by severing or sealing the tubes that carry sperm. It’s straightforward and swift, carried out under local anaesthetic in as little as 15 minutes – then close to 100% effective in preventing pregnancy for good.
For committed couples who have children and are certain they don’t want any more, a vasectomy may seem a neat solution. But many in exactly that position say that of the contraceptives offered after childbirth, vasectomy is rarely mentioned. What’s more, couples like Lianne and Ashley, who seek out the procedure, report being met with resistance from doctors.
Lianne says that when she and Ashley asked about a vasectomy at their six-week postnatal check-up, her GP was reluctant, emphasising the invasiveness of the procedure. ‘She seemed to fob us off – like, “Why don’t you just go on hormonal contraception?”’ But Lianne had been on the Pill since she was 13, when it was prescribed to regulate her moods and periods. ‘I just wanted to let my body rest,’ she says.
Managing fertility has always been seen as the responsibility of women. When the contraceptive pill became available in the UK in 1961 (for married women only; single women had to wait until 1974), it reinforced this idea. Sixty years later, society is still reluctant to let men share the birth- control burden, with only two relatively crude options (condoms or vasectomy), versus dozens for women.
Lianne was determined to avoid hormones and saw the coil, a non-hormonal contraceptive, inserted in the uterus, as ‘a last resort’. But those wishes did not seem to be taken as seriously by her doctors as the possibility that she and Ashley might one day regret his vasectomy. When Ashley asked his own GP for the procedure, he was told to go away and think about it. When he confirmed he’d like to go ahead, his GP never got back in touch to book the surgery. ‘They just don’t seem willing,’ Lianne says.
That was three years ago; in the ensuing stalemate, Lianne reluctantly had a coil fitted. The possibility of becoming pregnant causes her ongoing anxiety. ‘It is really frustrating,’ she says. ‘It’s not like we’re young and will change our minds. We don’t want any more children… You’d think this is a really good case for having the snip – but they’re just like, “No, go on the Pill.”’
Because reversing a vasectomy is difficult and not always successful, it is treated as permanent, meaning careful consideration is warranted. In most areas of the UK, GP referral is necessary for an NHS op. Some may recommend counselling before signing off, or refuse to do so for men under 30. Of the 9,000+ vasectomies carried out by the NHS each year, most are on men aged 30-49; there are only ever a few dozen reversals.
But in some areas, vasectomies are not available on the NHS, due to budget cuts. The result is that couples must either pay around £500 for a private procedure or turn to other contraceptive options. The pandemic has been another barrier, with a 63% drop in vasectomies carried out on the NHS in England over the last year.
Comparatively, hormonal contraceptives are easy to access, despite mounting evidence and awareness of deleterious side effects. In 2016, a large Danish study found a link between use of pills, patches, implants or hormonal coils and treatment for depression. More recently, concerns about rare blood clots associated with the AstraZenaca Covid vaccine were dismissed as being lower risk than taking the combined pill – sparking discussion about whether women with prescriptions were adequately informed. Not only may barriers to vasectomy commit women to potentially decades more hormonal manipulation, in the bigger picture, it reinforces the expectation that pregnancy prevention is their sole responsibility.
Katherine*, 37, says she felt pressured by her GP to go back on the Pill after having her second child, though her husband was willing to have a vasectomy. ‘It was all very much my problem… as if a vasectomy was a terribly drastic route, whereas me being on hormonal contraception for another three decades was just a walk in the park,’ she says. ‘It was like they didn’t listen to us, either. We didn’t go in on a whim: we were trying to be smart and not have an unwanted pregnancy.’
With vasectomy not available on the NHS in their area, Katherine’s husband had the procedure done privately in 2019.
‘I found the whole thing really frustrating,’ she says. ‘It feeds into this whole narrative that children are the responsibility of their mothers, rather than of two parents. For men to take the step of going to the GP about it is quite a big deal – to be told they’ve got to go private adds to the obstacles.’
Jessica Craven, the UK vasectomy clinical services matron of MSI Reproductive Choices, which carries out vasectomies for NHS and private patients, says many tell of having to overcome resistance from doctors. Because of the range of reversible contraceptive options, ‘GPs may see a vasectomy as a drastic choice,’ says Jessica. ‘But that places the contraceptive burden back on the woman. Of course, because it’s a permanent procedure, it’s important that an individual is sure and well-informed, but that doesn’t make that decision less valid.’
Introducing self-referral for vasectomy would ease the pressure on GPs and potentially help men to be seen quicker,
she says. ‘It’s important to find a balance between counselling people and making sure they are aware of their options and trying to avoid those unnecessary hurdles.’
But the fact that there is demand (MSI carries out 6,000 vasectomies a year) signals increasing awareness of a shared responsibility. ‘Of the men who come in who are in relationships, it’s been a decision they have made alongside their female partner… We should be respecting people’s choices.’
Three years on, Lianne and Ashley plan to ask again for a vasectomy. ‘I’m hoping they’ll consider it now we’re a bit older,’ says Lianne, ‘rather than saying “You might change your mind.”’
*Name has been changed