Vasectomy knowledge, attitudes, and intentions among men in Ethiopia: a systematic review and meta-analysis

Vasectomy is a highly effective (99.9%) and safe permanent family planning method for men. Despite these advantages, it remains one of the least utilized and most misunderstood contraceptive options. This systematic review and meta-analysis aimed to explore men’s knowledge, attitudes, and intentions toward vasectomy in Ethiopia by synthesizing scattered evidence to present a comprehensive national picture. This systematic review and meta-analysis were conducted according to the Joanna Briggs Institute methodological guide and were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for relevant literature in major databases, including PubMed, Google Scholar, ScienceDirect, Web of Science, and Scopus. Citation tracking and reference lists were also reviewed to ensure a complete search. The search was conducted from inception to 31 December 2024; the final search was run on 5 January 2025. Pooled prevalence estimates were calculated using the DerSimonian–Laird random-effects model. Heterogeneity was assessed with the Cochrane Q-test and the I² statistic, and publication bias was evaluated using funnel plots and Egger’s test. All analyses were performed using Stata version 17. Of the 393 articles initially identified, nine met the inclusion criteria, with a combined study population of 3,705 men. Only 39.8% (95% CI: 25.3–54.4) of men had good knowledge of vasectomy, 29.3% (95% CI: 16.8–41.7) had a positive attitude, and 20.8% (95% CI: 16.7–25.0) intention to use vasectomy. Higher education was linked to better knowledge, and having ≤ 4 children was associated with lower likelihood of having knowledge about vasectomy. Positive attitude toward vasectomy use was the strongest predictor of intention to use vasectomy. Among Ethiopian men, knowledge, attitudes, and intentions regarding vasectomy remain low. Educational attainment and family size play important roles in knowledge, and attitude is a key driver of intention. To boost vasectomy uptake, efforts must focus on dispelling myths, fostering positive perceptions, and encouraging male engagement in family planning decisions. This review was registered with PROSPERO (CRD420250634669). • Vasectomy is the only permanent and highly effective long-term family planning option for men. However, in places like Ethiopia, it remains widely misunderstood and underused, with many men having little information or having misconceptions about the procedure. • Researchers searched for and reviewed studies on what Ethiopian men know and feel about vasectomy, combining the evidence to see the bigger picture and understand the gaps. • Fewer than one in three men had good knowledge or a positive attitude about vasectomy, and only about one in five intended to use it. Men with higher education tended to know more but men with ≤ 4 children tended to know less about vasectomy. Those with positive attitudes were much more likely to consider vasectomy. These results demonstrate the importance of education and advocacy to help men make more informed family planning choices.