Vasectomy was once the most common birth control method in both Sichuan Province, China and the world. However, since the 1990s the prevalence of vasectomy in Sichuan, has declined significantly compared to female sterilization in Sichuan and national prevalence of male/female sterilization during the same period. To explore possible reasons for this decline, 27 focus group discussions (FGDs) and 8 in-depth interviews (IDIs) were conducted in four strata of Sichuan. Procedures for qualitative data analysis were used. The findings reveal the decline in vasectomy in Sichuan Province is influenced by multiple factors, including shifts in demographics, changes in family planning working approach and people's perceptions of reproduction, lack of information and misunderstandings about vasectomy, the stereotype of male dominance, bias and preference of program and provider, and the impact of a market economy. Several implications arise from the study for future program development.