See related articles by Jacobstein et al. and Jacobstein et al.

I salute Jacobstein et al. for their brilliant description of the worldwide state of vasectomy in 2022.1 Their analysis and recommendations to increase the use of vasectomy in the family planning mix of methods available globally are comprehensive and clear. The article should be widely disseminated to governmental and nongovernmental funding agencies and organizations.

However, there are limitations associated with using the United Nations (UN) survey database to estimate national prevalence rates for vasectomy and tubectomy. I will use data from Canada as an example. Jacobstein et al. reported that the percentages of vasectomy and tubectomy use in Canadian women of childbearing age were 22.0% and 11.0%, respectively, in 2002 and 7.4% and 7.0%, respectively, in 2006.1 Even if no vasectomy had been done in the country over this 4-year period, a relative decrease by 66% (from 22.0% to 7.4%) is unlikely. The vast majority of the couples using vasectomy in 2002 were likely still using this permanent method in 2006. A reference and details about the …