PRB

(December 2011) “Vasectomy is like putting money in the bank. [It] is a long-term investment, money you [would] have otherwise used to buy expensive birth control methods,” says Dr. Charles Ochieng, a medical doctor in Kenya. In addition to undergoing the procedure himself, Ochieng has performed vasectomies in Kenya and in the United States, so he offers a unique perspective, having been both a client and a provider. A husband and father of two, he is also chairman of the Winam Safe Parenthood Initiative (www.wispivas.com). He helped found the group as a post-vasectomy club, a place where men could share their experiences.

While a variety of modern contraceptive methods are available for women in sub-Saharan Africa, men’s options for modern methods are more limited: condoms and vasectomy. Ochieng points out this inequity: “Condoms and vasectomy are both safe and nonhormonal. There are a number of birth control methods for women which have been introduced and withdrawn from market due to their negative side effects. Are women guinea pigs?”

Vasectomy Is Cheaper and Safer Than Tubal Ligation

No-scalpel vasectomy (NSV) was developed in China in 1973 and introduced in the 1980s in developing countries by EngenderHealth and other agencies.¹ Unlike surgical vasectomy, NSV avoids an incision in the scrotum, meaning less pain, fewer complications, and shorter recovery time. Sperm tubes are heat-sealed, divided, and then put back. An average NSV costs one-third as much as tubal ligation. Plus, female sterilization is much riskier. Compared with NSV, tubal ligation is 20 times more likely to result in major complications.² Ochieng thinks it’s unfair that “a woman bears all the burden of carrying a pregnancy to term plus all the dangers and risks of childbirth, [so] why should she undergo tubal ligation when the family is complete?”

Rob Jamieson, who ran and owned the Chronicle newspaper in Malawi, witnessed his first birth—of his fifth child. Seeing the pain his wife suffered changed his role in family planning. He says, “The experience left me with a resolve never again to allow my wife to go through the same experience. In fact, the doctor had to leave my wife to attend to me because I was on the point of passing out.” Jamieson chose to have a vasectomy in 1978, when the procedure was virtually unheard of in Malawi. “Vasectomy is not an end in itself but a beginning of taking responsibility for the family’s welfare,” he explained.

Few Vasectomy Services in Sub-Saharan Africa

Only 3 percent of couples worldwide use vasectomy as their primary contraceptive method, even though it is permanent, safe, and cost-effective—and the only long-acting contraception available for men. The rate is even lower in sub-Saharan Africa: Less than 0.1 percent of married women rely on a partner’s vasectomy as a contraceptive method.³ However, according to EngenderHealth, a smattering of sub-Saharan African countries have vasectomy services: the Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Namibia, Rwanda, South Africa, Tanzania, Uganda, and Zimbabwe.⁴

But Rwanda’s government is actively encouraging men to undergo NSV, part of an overall message that it is easier to provide for smaller families.⁵ The vast majority of Rwanda’s population is made up of farmers whose families have been poor for generations; food is insecure and land is scarce. The government says that in order to keep its economy growing at an average of 7 percent to 8 percent a year, the birth rate must be below three children per family.⁶ In February 2011, the government launched the vasectomy campaign, targeting families who have more than five or six children, alongside their HIV prevention campaign to encourage all men to be circumcised. They are offering the NSV procedure for free, in hopes that men will share responsibility for family planning. Ochieng agrees: “Why should we call it family planning if the man is not in the picture? It’s a fallacy.” In addition to education and awareness campaigns, the initiative is community-driven, by men who have undergone the procedure going door-to-door to promote vasectomy, speaking from personal experience about the benefits of the procedure.

Success for Rwanda’s Vasectomy Campaign

Rwanda’s plan for reducing the birth rate seems to be working, if the most recent data available for the country’s 2010 DHS are any indication. The survey interviewed men and women from September 2010 to March 2011. The total fertility rate (TFR) obtained from the survey was 4.6 children per woman—down from 5.5 in the previous 2007-2008 DHS.⁷ And there is a large increase in the number of married women using modern contraception—from 10 percent in 2005 to 45 percent in 2010. The latest DHS from several sub-Saharan African countries show varied progress in health and fertility, and no progress in fertility decline has been as pronounced as Rwanda’s.⁸

In September 2011, Ochieng traveled 14 hours by bus from his home in Kisumu, Kenya, to Kigali, Rwanda, to meet with master vasectomy trainer Dr. Leonard Kagabo to determine the feasibility of conducting vasectomy missions in both countries.⁹ In Rwanda, the health ministry is committed to making contraceptives more widely available and affordable, and to training providers. As part of the government’s initiative, Kagabo teaches and mentors others in performing vasectomies.

Ochieng believes there is much to learn from what’s happening in Rwanda: “We need mass education and individual counseling on NSV—there are still so many entrenched misconceptions and rumors on the procedure,” he said. Jamieson thinks that advocating for change is essential: “What Malawi needs are a few champions for vasectomy. Unfortunately, because the feeling is that it would not take, the service providers are reluctant to even accept an offer of those who would stand up and be counted in the paradigm change needed to create opportunity for responsible men to take up the challenge.”

Tyjen Tsai is a writer/editor at PRB.

References

1. Roy Jacobstein and John M. Pile, “Vasectomy: The Unfinished Agenda” (New York: The ACQUIRE Project/EngenderHealth, 2007).
2. Grace Shih, David K. Turok, and Willie J. Parker, “Vasectomy: The Other (Better) Form of Sterilization,” Contraception 83, no. 4 (2011): 310-15.
3. Adrienne Kols and Robert Lande, “Vasectomy: Reaching Out to New Users,” Population Reports D6 (June 2008), accessed at www.populationreports.org/d6/, on Sept. 23, 2011.
4. Isaiah Ndong, “Is That a Vasectomy in Your Pocket?,” presentation delivered at the International Conference on Family Planning, Kampala, Uganda,  Nov. 17, 2009.
5. Anne Kirya, “Rwanda: Can the World Sustain 7 Billion Inhabitants?” (Oct. 31, 2011), accessed at http://allafrica.com/stories/printable/201111010240.html, on Nov. 18, 2011.
6. Graham Holliday and Themistocle Hakizimana, “Rwanda Touts Vasectomies to Stem Population Growth,” Reuters, Sept. 6, 2011, accessed at http://af.reuters.com, on Sept. 28, 2011.
7. National Institute of Statistics of Rwanda, 2010 Rwanda Demographic and Health Survey (Calverton, MD: ICF Macro, 2011).
8. Carl Haub, “Rwanda’s 2010 Demographic and Health Survey Shows Remarkable Drop in Fertility and Child Mortality,” Oct. 7, 2011, accessed at http://prbblog.org, on Dec. 9, 2011.
9. Charles Ochieng, “Study Tour of the Rwandan Vasectomy Program,” report submitted to Ramon Suarez, president, Non-Scalpel Vasectomy International (NSVI), Kisumu, Kenya, Sept. 12, 2011.