Vasectomy: What Rwandans say

The family planning crusade is gaining momentum. Government is championing vasectomy, a surgical procedure in which the vas deferens – tubes through which a mans sperm travels – are severed or sealed, so that he cannot impregnate a woman. With a surface area of 26,338 square kilometers, Rwanda is the most densely populated African country. Its huge population – over 10 million – bears down heavily on scarce resources. Instead of forcibly limiting couples to less than three children, government opts to inform Rwandans to control their families’ size. Two children per family are considered ideal. This is a challenge. Another is countering negative criticism of government’s family planning policy. Vasectomy is not castration, says Health Minister Dr. Richard Sezibera. He says people who equate the two “are simply male chauvinists.” Government’s policy, he stresses, is evidence based, ethical, participatory, and “has no room for rigid ideologies, or unhelpful political posturing.” But what do people actually think about vasectomy and its inevitability? A mini-survey reveals mixed feelings, albeit with a considerable understanding of the state of affairs. Men should also get involved, directly Robinah Uwera, a working-class mother of four says “men and women, together, form the core of the social structure called family. And so, the responsibility of a secure and healthy family rests on both.” “Women give birth to children. But is it possible to conceive without the contribution of men? Men should also involve themselves, directly, by adopting precautionary measures like vasectomy,” she says. Uwera is not alone. Richard Ndahiro, the Marketing and Product Development Manager of Banque Populaire du Rwanda (BPR), says he understands Rwanda’s population dilemma. “I support vasectomy and would be ready to do it. It’s about time men took it into their hands too. By the way, it is even a question of gender equality in some instances!” Even though he is still single, Ndahiro says that, “for Rwanda, family planning is a must, not an option.” “One of the factors why family planning has not succeeded, especially in rural areas, is because it is only a female initiative. Or that the options are all female based, often not supported by men who, in most cases, don’t cooperate or even prohibit their spouses from putting a halt to giving birth,” he adds. Cultural nuisance Solange Mutesi, a mother of two, also believes in family planning, be it through tubo ligation or vasectomy, but also acknowledges a challenge in the campaign. “It is very difficult to convince Rwandan males because of cultural beliefs,” she says. And some men are really at the crossroads when it comes to vasectomy. Recently married Daniel, a businessman who preffered anonymity, does not believe in vasectomy, “or any other family planning method that stops someone from being able to reproduce permanently or semi-permanently.” He argues that, “anything may happen and the need for other off-springs may arise.” He is against the use of permanent family planning procedures on his wife or himself. John, a father of a six-year old baby son, concurs with Daniel. He says vasectomy is mostly irreversible and not a method he would encourage. “I am not being selfish and leaving it [family planning] to women. Women have got many approaches which can be stopped at any point,” argues John. “Imagine if you go for vasectomy and an accident happens and you lose your children! You would remain haunted for the rest of your life.” What seems to put some men off is the realization that vasectomy is regarded as ‘permanent’ because its reversal is costly and often does not restore the pre-vasectomy condition. Nonetheless, Dr. Sezibera insists, the scheme is based on voluntary consent, not coercion. “Over the next three years,” he says, “government will sensitize men on their need to fully participate in family planning, which has too often been left only to women. Rwandan women have taken advantage of tubo ligation for years with no outcry from those who today proclaim themselves champions of anti-vasectomy.” Sexual desire Most studies find that sexual desire after vasectomy is not affected. However, Dr. Michael Mugaba, a father who supports vasectomy, believes that if there is any difficulty, it is entirely to do with mindset.“I would go for it. Why do people think that only a woman should? It all comes down to dialogue between couples,” says Dr. Mugaba.He argues that, “there is no change in a man’s sex drive because vasectomy prevents only the escape of sperm, not the release of testosterone, which drives a man’s libido.” However, he warns that the only catch is that “there will still be some sperm present in a man’s ejaculate, for a couple of months after the operation”. Mugaba advises men to use some form of birth control until all is clear. karuhanga_james@yahoo.com