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A man's right to choose 

Unwanted pregnancies could be prevented

Rod (not his real name) sat in a south Charlotte reproductive health clinic, hugging his wife, who was there for a medically induced abortion. She didn't speak. Tears streamed down her cheeks.

"We're both in agony about this," Rod, 31, said. "I don't understand how it happened. We were so careful." The couple already has four children, and their combined incomes for a household of their size put them only slightly above poverty level. "We struggle now to make it from paycheck to paycheck. There's no way we could afford day care, diapers, formula, unpaid leave from work ... we'd end up homeless."

Working for a small company, Rod doesn't receive health insurance. He said he applied for a state-funded vasectomy months ago after he and his wife agreed they were done having children. He was approved for the funding but has yet to get an appointment for the procedure.

"My county doesn't even have anywhere that will do it," said Rod, who lives in Gaston. "The closest place is about 45 minutes away, and last I heard, there was a pretty long waiting list."

North Carolina offers a free, voluntary sterilization program to families at or below 195 percent of the federal poverty level through the Be Smart. Family Planning initiative and the Department of Health & Human Services. The program uses Medicaid to fully fund vasectomies for men who qualify. It was established with the intention of spending fewer Medicaid dollars on unwanted, unintended or inadequately spaced pregnancies and births. And although the exact data would be nearly impossible to measure, it would also reduce the number of abortions in our state. In 2011, 28,600 North Carolina women exercised that right.

But men have options, too, though they may be unaware of them. The availability of Medicaid for vasectomies isn't widely discussed outside of a pamphlet at the health department and some copy on the DHHS website. In 2011 (the last year data is available), only 114 men in the entire state had the Medicaid-funded procedure.

That low figure may be a result of plain old fear. Some men may not realize a vasectomy involves less risk and pain than a surgical abortion, the estimated recovery time is two to three days, and in many cases is reversible.

But what about men, like Rod, who do know about the Be Smart program and are totally down for it? After following the tedious process of filling out an application, gathering and providing documentation of their income and living expenses, meeting with a caseworker, waiting for approval, only to be told it would be months before they could get an appointment — it's no surprise they would give up.

There are only 33 urologists in the state who perform the procedure and accept Medicaid. Additionally, the counties with the highest populations — Mecklenburg, Guilford and Wake — only have one each to serve their entire population. (Again, based on data from 2011.)

Most abortions are self-pay and range in price from $300-$500, including follow-up appointments. A self-pay vasectomy will run its patient $1,000-$3,000, possibly not including follow-up appointments. It's far more cost-prohibitive. For the state, that cost is a bargain, considering the alternative is funding the prenatal care, delivery and first year medical expenses for every continued pregnancy these Medicaid-eligible vasectomies would've prevented. The vast majority of Medicaid dollars are spent on children and pregnant women, but the state rejected an expansion of federal Medicaid funds to help offset the cost of this increase. That's a recipe for disaster.

Last year, Gov. McCrory signed into law new restrictions on abortion clinics, but even so, most providers can schedule their patients' procedures within a week of their initial phone calls. For lawmakers who despise a woman's right to choose, perhaps they should consider making vasectomies equally easy to obtain.

Lawmakers who have promised to draft more restrictions on abortion should also consider this math: A decrease in abortions means an increase in babies being born to parents who can't afford to take care of them.

Now is the time to invest in a public awareness campaign about vasectomies and the state's willingness to pay for them, and then offer more incentives to urologists who will provide them and accept Medicaid as payment. It's time to look at putting the ball (pun intended) in the men's court and letting them bear some of the responsibility for stopping unwanted pregnancies. Support their right and ability to choose.

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