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ARHP Letter to the American Board of Obstetricians and Gynecologists

November 26, 2013

Larry C. Gilstrap III, MD
Executive Director
The American Board of Obstetrics and Gynecology
2915 Vine Street
Dallas, TX 75204

Dear Dr. Gilstrap:

We are writing on behalf of the 12,000 members and the board of directors of the Association of Reproductive Health Professionals (ARHP) to express our grave concerns about the recent statement from the ABOG board that would restrict Obstetrician-Gynecologists from providing vasectomy services and sexually transmitted infection screening and treatment in males in order to maintain their board certification. These restrictions will deleteriously affect access to vital reproductive health care, services that are already jeopardized by onerous state laws, funding cuts, and partisan politics.

As a non-profit professional association that supports and promotes reproductive health policies based on evidence, cutting-edge science, proven clinical practices, and sound public health measures in order to ensure the best quality care for women, men, and families, we respectfully request that that the board reconsider this decision based upon the following considerations.

First, vasectomy is one of the safest and most cost-effective methods of contraception. The fact that vasectomy is safer than tubal ligation underscores how important this service is to men and women. Despite demonstrated safety and efficacy, vasectomy accounts for only 1 out of 3 sterilizations in this country. Efforts to increase male utilization of this method would be thwarted by further barriers to access. One of the barriers to vasectomy use, particularly in low-resource areas, is a lack of vasectomy providers. Ob/Gyn vasectomy providers are essential in these locales. Also, many women’s health providers—including Ob/Gyns—receive training during their residencies or fellowships that allows them to be proficient providers of vasectomy and STI services to males. As many federally-funded family planning clinics are directed by Ob/Gyns, the proposed board restrictions may end up disproportionately affecting access by underserved men to vasectomy services.

Similarly, Ob/Gyns are essential to the prevention and treatment of sexually transmitted infections. Given the high prevalence of STIs, the absence of symptoms among many carriers, and the long-term effects of untreated STIs, it is important to keep our screening and treatment programs as robust as possible. As mentioned above, many Ob/Gyns work in federally funded family planning clinics and the proposed restrictions would disproportionately limit access to these services for underserved men, negatively affecting the health of their female partners as well. If Ob/Gyns are restricted in their ability to screen and treat for STIs among men, infection rates will undoubtedly increase and both men and women’s reproductive health will suffer.

We are also concerned that the board’s restriction could send a negative message to the public and regulatory agencies about how the scope of practice should be defined for all reproductive health providers. If obstetrician-gynecologists cannot perform vasectomies, what does this mean for family physicians who also routinely train and provide this service along with other related procedures (e.g. circumcision)? ARHP is a distinctly multi-disciplinary group of reproductive health care providers, including family physicians, internists, pediatricians, obstetrician-gynecologists, advanced practice clinicians, nurses, and other clinical professionals. ARHP is committed to promoting policies that allow clinicians to work “at the top” of their training. This strategy ensures that we increase high quality services for all Americans, particularly for the uninsured and underinsured.

Finally, we consider vasectomy and male STI treatment as core reproductive health services which benefit both men and women’s health. As Ob/Gyns are central to reproductive health services, we rely on their ability to provide comprehensive family planning including vasectomy and STI treatment to men.

We hope ABOG will seriously consider reversing these exemptions since both of our organizations are committed to providing quality reproductive health care to women.

Sincerely,

ARHP Board of Directors

Linda Dominguez, RN-C, NP, Chair
Scott Spear, MD, Incoming Chair
Kristy Chambers, CPA, Treasurer
Kathy Hill Besinque, PharmD, MSEd, FASHP, FCSHP, Secretary
Wayne C. Shields, President and CEO
Sherrie Borden, CAE, CPC, PA
Linda Burdette, NPAS, PA-C
Mark Hathaway, MD, MPH
Carole Joffe, PhD
Lisa Maldonado, MA, MPH
Patricia A. Murphy, CNM, DrPH, FACNM
Katharine Sheehan, MD
Grace Shih, MD
Diana L. Taylor, RNP, PhD FAAN
Justine Wu, MD

cc: ABOG board of directors
Dr. Kenneth L. Noller