Why Vasectomies Are Good for Kenya

By Paul Kuria, Research Officer,  and Jean-Christophe Fotso, Research Scientist with Sherine Adhiambo, Project Coordinator

July 9, 2012

Thanks to efforts made by a community-based family planning program in Western Kenya funded by the Packard Foundation (known as Packard Western Kenya Project), interest in the use of vasectomies (male sterilization) as a long-acting family planning method is now growing in Kenya. In 2011, Kenya managed to conduct 3,652 vasectomies, compared to 246 recorded between 1987 and 1991[1] and with efforts from the Packard Western Kenya Project; the numbers are likely to increase even more in 2012.

This news is reason for excitement for those of us at APHRC who are working on related reproductive health programs that specifically promote voluntary family planning, child and maternal health services. This new trend is also good news for Kenyan families interested in more family planning options particularly since vasectomies are simple, safe procedures that can be done quickly and at a lower cost to the patient than the equivalent procedures for women.

Why Family Planning in Western Kenya?

The Western and Nyanza regions of Kenya have unique fertility patterns, the total fertility rate is 5.5, higher than the national average of 4.6. The Packard Western Kenya project led by APHRC started in 2009 with the hope of gaining a better understanding and addressing the complex drivers of this high fertility and to reverse the fertility trend by increasing uptake of modern methods of family planning and over the long-term, reduce total fertility rates. Recent studies in the region show that most women who desire to limit births are using short-acting spacing methods. The project employs multi-pronged strategies that include increased access of a wide range of contraceptive methods to both men and women and encourages greater involvement of men in family planning programs.

Why Vasectomy?

Compared to other methods of family planning, the permanent male fertility control methods are generally less popular around the world. 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 where less than 0.1 percent of married women rely on a partner's vasectomy as a contraceptive method.

It is possible that vasectomy’s underutilization is due to an intrinsic unpopularity of the method. Perhaps the low levels of knowledge of, access to and use of vasectomy are not an important concern in family planning panorama.  However, certain characteristics of vasectomy make it a potentially attractive option within the family planning contraception menu. It is effective (on the individual and population levels); it is a simple procedure with few complications, and it is one of the few available “modern” methods that involve men directly.

The Packard Western Kenya Vasectomy Project:

In May 2012, the project partners in the Western and Nyanza regions partnered with three medical doctors from Non-Scalpel Vasectomy International, USA to provide vasectomy services to men in the intervention area and address the low rate of vasectomies as a family planning option. The Packard partners jointly supported the initiative through the Marie Stopes Kisumu office led by MSK resident surgeon, Dr. Ochieng. The program office and field staff worked closely with the Packard Western Kenya supported community health workers and the local health centers to sensitize community members and their leaders about male sterilization family planning services.

                    

Photo caption: Packard Western Kenya Project CHWs and health practitioners wearing the trademark suit of Packard Western Kenya Project. Source: http://www.nsvi.org/where-we-work/kenya/first-nsvi-mission-to-kenya-may-2012/

Education is Key:

As part of the project, the Packard Western Kenya Project worked very hard to educate clients and potential clients about the benefits of vasectomy and to dissolve any fears and concerns the male clients had about vasectomy.

Clients were informed that vasectomy is a non-complicated permanent family planning method that has fewer complications compared to female sterilization and is safe and very effective. Clients also learned that although vasectomy is very effective as a family planning method it does not protect clients from HIV/AIDS or sexually transmitted infections. One concern for many men was what the impact of a vasectomy could be on sexual drive, but health professionals explained that studies show the vasectomy method does not in any way reduce sexual drive for men.

For the program to be successful it was vital for the community health workers to maintain regular contact with potential clients and to respond to their questions and concerns from the initial period of recruitment through the time when the service is performed.

As a result of the due diligence of the community health workers, a total of 72 clients were booked to receive the vasectomy service and 53 turned up the day of the procedure. The rest refrained from taking the services due to various reasons including indecisiveness, distance from home to the service center, fear of side effects, and overwhelmingly high negative perceptions about vasectomy.

After the procedure, the community health workers followed-up with the 53 clients at home and addressed their fears, helped them heal faster, and counseled them about post-service sexual behavior. All clients healed quickly and resumed their normal duties only three days after taking the service. These clients are now a key resource in the community, not only by introducing new users of family planning services, but also as a resource to promote male sterilization services in the region. The Packard Project has clearly demonstrated that with correct targeting, increased supply of services, and consistent demand creation activities, vasectomy can be a popular method of family planning in low resource settings. The Packard project will be scaling up these strategies in the next three years to make vasectomy a preferred method of choice among poor rural men who have achieved their desired family size.

More details about the May 2012 vasectomy services in Kenya are available here: http://www.nsvi.org/where-we-work/kenya/first-nsvi-mission-to-kenya-may-2012/.

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 [1] AVSC working paper No. 4 / September 1993 and DHIS2 Kenya report 2011