Quote of the month: “What is required to promote vasectomy is changing the mindset of the menfolk especially in male dominated culture.” (Tusharkanti Dey, HIFA member, Community Health Specialist at the Center for Total Development in India)
Undergoing a vasectomy (or ‘having the snip’) can be a daunting prospect for a lot of men. In recent years, however, the emergence of the “no scalpel” vasectomy means that there is no longer any need to fear incisions, stitches, and bleeding. Vasectomy continues to be – as it always has been - a cheap, simple and effective method of contraception. Yet the experiences of HIFA members, shared on the forum during June, indicate that a significant number of men in low- and middle-income countries (LMICs) refuse to even contemplate having a vasectomy, deflecting the decision about contraception to their female partners.
The organisers of World Vasectomy Day (WMV) believe that, if men are given accurate and compelling information about contraceptive methods, they will engage in conversations – and decisions - about family planning. Dedra Smith (HIFA member, USA) is the Producer of WMV and, in a posting on the HIFA forum during June, she explained how community health workers (CHWs) could play a vital role in spreading the word to families about the advantages of adopting “no scalpel” vasectomy as their preferred method of contraception. “We are willing to train both providers and CHWs”, Dedra stated, “and have created videos, talking points, presentations, flash cards, and brochures in English for both training CHWs and outreach to families that we used very successfully in Kenya in 2016”.
CHWs may not be the appropriate cadre in all countries. Tusharkanti Dey (HIFA member, India) noted: “Vasectomy is a surgical procedure, and in India, only medical persons are allowed to do the surgery”. In any case, as Tusharkanti suggests in our Quote of the Month, there is a much more fundamental challenge to address if “no scalpel” vasectomy is to gain acceptance in LMICs.
“The belief is that once a man has vasectomy the man will not be sexually active”, Rebecca Ngalande (HIFA member, Liberia) told the HIFA forum, “and in some it’s believed that the man will get sick and die.” This is a stark example of the false beliefs that make up the 'mindset of the menfolk' to which Tusharkanti refers. Rebecca also reported that it is widely believed by both men and women that the accumulation of sperm within the scrotum, post-vasectomy, causes prostate cancer. In many cases, however, men are simply unwilling to talk about their fears in regard to vasectomy. This has meant that responsibility for the choice of contraception method has fallen to women, who usually elect to undergo tubal ligation, a far more invasive and expensive procedure.
It’s vital that such myths and misconceptions are debunked. Tusharkanti believes that the best way to tackle this is to begin sharing information about sex and family planning from an early stage, ideally in the school classroom. In India, this is a challenge in itself. “Introduction of sex education for school children has many opponents in India”, he told the forum, “as many parents want it to be closely guarded and teachers feel uneasy to teach the matter in the classroom”.
“Men believe that for continuity of human race or procreation they are supposed to have children”, stated Stanley Chilumbu (HIFA member, Malawi) on the HIFA forum. Therefore, they consider it their responsibility to impregnate women and to undergo a vasectomy would be to renege on that responsibility.
Metrics: In June 2018 we exchanged 201 messages from 86 contributors in 24 countries (Australia, Cameroon, Canada, Cote d'Ivoire, Ethiopia, Gabon, Ghana, India, Indonesia, Iran, Ireland, Kenya, Liberia, Madagascar, Malawi, Netherlands, Nigeria, South Africa, Switzerland, Tanzania, Uganda, UK, USA, Zimbabwe). Our top contributors were Joseph Ana, Nigeria (11), Tusharkanti Dey, India (6), and Eben Afarikumah, USA/Ghana (4). Thank you all for sharing your views and your experience.
Martin Carroll was previously Head of the International Department at the British Medical Association, London UK, and has worked on issues affecting health in LMICs since 2003. He represented the BMA on the HIFA Steering Group from 2008-16 and is now an independent HIFA Steering Group member. Martin is a member of three HIFA working groups: Multilingualism, Evaluating the Impact of Healthcare Information, and Social Media. He is also the HIFA blogger. Twitter: @MMCarroll
