How misinformation has slowed down uptake of vasectomy services

Forty-one-year-old Alexis Kamanzi’s initial plan was to have two children, but after two girls, his desire for a son kept pushing him and before he knew it, he had fathered two more. It is then that he and his wife decided that he should have vasectomy. “We were done with having children and I didn’t want to see my wife go through the pain that comes with the side effects of family planning again. In 2018, I decided to have a vasectomy,” he said. Although Kamanzi was confident about his decision, he was reluctant to share the news of his procedure with family and friends because he feared the possibility of being stigmatised. “Most people in our society don’t understand how as a man, I can be involved in family planning and of course I feared speculation about my sex life. I didn’t want people, especially men in our community to think less of me,” he says. And so, he and his wife kept the procedure a secret. 40-year-old Beatrice Mukamakombe is a mother of five who hails from Gashari Sector, Karongi district. She says that although she deals with very heavy periods as a result of using an Intrauterine Device (IUD) as her family planning method of choice, she would never endorse her husband to get a vasectomy. “It sounds very delicate to me. We don’t have issues in our marriage but what if this procedure goes wrong? We may have intimacy issues and I cannot accept that,” she said. The biases around vasectomy are many and they are not only tied to religious and cultural Africa alone. Although medical experts consider vasectomies the easiest, safest and most cost effective family planning method, only three percent of the men in the world have had this procedure. Dr Fazil Hakizimana is a National Trainer on Permanent Method Vasectomy and Tubal Ligation at Nemba Hospital in Gakenke District. In a telephone interview with The New Times, Hakizimana says that the low uptake of the vasectomy method of family planning is tied to many myths around the procedure with most African men comparing it to castration. Yet, he says that the procedure, which takes between seven to ten minutes is far from that. He explains that a vasectomy involves sterilising a man by cutting or blocking both the right and left tubes through which sperm passes into the ejaculate. While the rest of the world is still using scalpels to cut through their patients’ scrotums, Hakizimana says that doctors in Rwanda, Kenya and Egypt are the only ones who have advanced to the fastest and side-effect-free non-surgical vasectomies in Africa. “We have advanced to a point where the non-surgical procedure doesn’t require to walk away with a wound or to stay in hospital for observation for five days as it was in the past. We work on you and in minutes, we send you home,” he explained. He says that the non-surgical vasectomy has a success rate of 99 percent as compared to the surgical one which starts at about 82 percent. The procedure Hakizimana, who has so far performed more than 600 vasectomies countrywide says that the process involves making a tiny opening into the scrotum where the doctor then reaches in, brings the tubes out, cuts, ties, seals and then places them back in the scrotum. Where necessary, a dissolving stitch or two will be used to close the incision and a dressing will be placed over the tiny opening. “Once the procedure is done, sperm can’t get into the semen or out of the body. This means that a man is still able to ejaculate but the semen doesn’t contain sperm which is responsible for making babies,” he explained. Five days after the procedure, the patient is required to have sex twenty times in a span of three months in what Hakizimana says is meant to clear the tubes. During the three months, the couple is encouraged to continue using the family planning method that they were using until the doctors give them a green light. Need for sensitisation Hakizimana explains that the low uptake of vasectomies can partly be blamed on lack of enough sensitisation programs targeting women. He said that based on his sessions, there should be targeted sensitisation especially for women since it has been observed that most of them tend to discourage their spouses from getting the procedure. He explained that most women especially in rural areas believe the myths around the procedure including diminished sex drive and satisfaction. “When you talk to these couples, you notice that there is little understanding of this permanent family planning procedure as compared to others used by women. We also noticed that most women are not on board and continue to discourage their partners,” he said. On the side of men, some continue to associate vasectomies with emasculation akin to castration while others fear stigma. The Reproductive Health Officer at Rwanda Biomedical Center (RBC) Joel Serucyacya, told The New Times in an interview that although the vasectomy program was introduced ten years ago, only about 3,400 men have had the procedure. He attributed this to poor mind-set where men still believe that family planning is a woman’s responsibility. “When it comes to pregnancy, childbirth, raising children and basically almost everything around reproductive health or family planning, men tend to leave the burden of responsibility to women,” he explained. Although the procedure only costs Rwf2,000 for those with Mutuelle Insurance, the procedure is still being offered at district hospitals which are usually located far from the target groups. According to the Rwanda Demographic and Health Survey (RDHS) 2014-15, at least 19 per cent of married women have an unmet need for family planning services. Eleven per cent are in need of spacing and 8 per cent in need of limiting. The survey says, at 53 per cent, more than half of married women are using contraceptives, the majority of them using artificial methods. The methods most commonly used by married women are injections (24 per cent), pills (8 per cent), and implants (8 per cent). Use of modern methods increased from 45 per cent in 2010 to 48 per cent in 2014/15. The survey states that 3 per cent of women use traditional methods.

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How misinformation has slowed down uptake of vasectomy services