Racial Disparities in Unmet Need for Family Planning among Men Ages 15–44 in the United States

The Healthy People 2020 goal with respect to family planning is to improve pregnancy planning and spacing, and prevent unintended pregnancy in the United States.¹ Several studies have documented that men were underserved in terms of sexual and reproductive health care service utilization and prompted advocacy for such services.^2,3,4 This suggests that unmet family planning needs of men and the role they have in family formation require further investigation. The literature on the issues of sexual and reproductive health of men has primarily focused on men’s sexual behavior and the prevention of sexually transmitted infections.^5,6,7 In the U.S., these studies have shown men to be at risk for poor health outcomes, as they are more likely than women to engage in risky sexual health behaviors and initiate sexual experiences at earlier ages. Another study documented that men start engaging in sex at earlier ages, with the average age of first sexual intercourse being 17.⁸ In addition, 53% of African American men and 42% of men from low-income backgrounds have had intercourse by the age of 15. Eighty-two percent of men have had sexual intercourse by age 20.^9,10 Men are also more likely than women to have multiple sexual partners, increasing their risk of sexually transmitted infections.⁸ Despite these risky and unhealthy behaviors, men still lag behind women in the access and utilization of reproductive health care services, particularly the use of contraceptives and other family planning methods.

The purposes of this paper are (1) to provide a framework in which unmet need for family planning for men is defined; and (2) to explore factors associated with unmet family planning needs for men across different racial/ethnic backgrounds, including the impact of poverty, using National Survey of Family Growth (NSFG) data.

Family planning among women and men

Much is known about family planning needs for women, including contraceptive use, birth spacing, and accessibility of family planning services. Women of childbearing years (ages 15–44 years) are a primary population of interest for contraceptive use to prevent unintended pregnancy.¹¹ In the United States, approximately 66 million women are of this reproductive age and the majority (70%) are sexually active.¹² Of the women of reproductive age who have engaged in sexual intercourse, 99% have ever used at least one method of contraception in their life time.¹¹

From the 2006–2010 NSFG study of 12,279 reproductive aged women, non-Hispanic Blacks (54%) reported lower contraceptive use than their Hispanic (60%) and White (66%) counterparts.¹² In fact, more White women (21%) reported use of the pill as a contraceptive method than Hispanics (12%), Asians (12%), and Black females (9.9%).¹²

Unlike women, men have few contraceptive methods from which to choose. These methods include withdrawal, sterilization, and condoms. Vasectomy, or male sterilization, is highly effective in preventing pregnancy; however, a study found that only 11.4% of men in the U.S. have undergone this procedure. White men are more likely to have received a vasectomy (14.1%) than Hispanic (4.5%) and non-Hispanic Black (3.7%) men.¹³ In addition, receipt of vasectomy is also associated with having been married, older age, and having a higher income.¹³

Condoms are the most commonly used method of contraception among men; however, the rates of condom use decline with age.¹⁴ Sixty percent of adolescent men report using condoms at last sexual intercourse while 16% of men over 30 years of age report condoms as their method of contraception.¹⁴ Rates of condom use also differ by race/ethnicity and relationship status. Non-Hispanic Black men and Hispanic men have higher rates of condom use than non-Hispanic White men. Men who are married or co-habiting are less likely to use condoms than men who are having sex with casual partners.¹⁴ Although condoms are the method of choice, they...