Demystifying vasectomy, male involvement in family planning

Vasectomy, the only long-term male contraceptive method available in Malawi, is shunned by most males in the country. According to Banja la Mtsogolo (BLM) national statistics, 40 males underwent vasectomy in six months last year, while 73 161 females sought long-term family planning methods. JOHN CHIRWA writes.

John Mhango, from Bwengu, T/A Jalavikuwa in Mzimba, has five children. He never planned to have them. His wife, Esnart Harawa, was using contraceptive pills as a short-term family planning method upon deciding to have four children.

“This other day, we slept together, but unfortunately for us, my wife forgot to take her pills which resulted in an unplanned pregnancy,” he explains.

This prompted them to consider long-acting family planning methods.

In 2012, they agreed that the wife should undergo tubal ligation. Mhango says he had never heard   of a long-acting family planning method for men known as vasectomy.

“I thought family planning was for women only. The only contraceptive I knew to be for men was the condom. My wife didn’t even bother asking me to go for vasectomy. But if I had known, I would have done it,” says Mhango, who is also chairperson for Jalavikuwa Action Group Network in the area.

While ignorance was the barrier for him to undergo vasectomy, other men in the area associate it with myths.

Juston Gondwe says it does not make sense for a man to undergo vasectomy when it is a woman who gives birth.

According to medical experts, vasectomy is a minor operation where two tubes, called vas deferens, that carry sperm cells from testicles are cut or blocked to prevent sperms mixing with semen.

“Semen is not made in the testicles, and vasectomy does not affect the semen or how it is ejaculated. It is just that after vasectomy, a man’s semen contains no sperm, so he cannot make a woman pregnant,” says Dr Owen Musopole, a health expert.

But for most men in Bwengu, vasectomy is synonymous with castration.

“I doubt if I would perform in bed after undergoing vasectomy,” says Gondwe.

In addition to limited knowledge on vasectomy and gender imbalances in the area, not all health facilities in the Northern Region provide vasectomy services.

A medical assistant at Bwengu Health Centre, Chawezi Mtonga, says the clinic does not offer the service because they do not have the technical knowhow.

A BLM Clinic in the heart of Mzuzu City also lacks expertise on vasectomy.

“An expert on vasectomy travels from Lilongwe whenever we have clients seeking for the service,” says BLM centre manager Tiwonge Nkhana.

She says statistics at the clinic indicate that four men have undergone vasectomy and 40 females have sought for long-acting methods in the first three months of this year.

BLM national statistics show that between July and December last year, 40 males underwent vasectomy while 73 161 females acquired long-acting family planning methods such as tubal ligation and the IUD (loop). On the other hand, 108 021 females accessed short-term contraception such as the pill and depo provera.

“The percentage of males undergoing vasectomy is almost zero when compared with the number of females seeking for long-term contraception,” said BLM communications and social marketing manager Patrick Zgambo.

According to experts, lack of men’s involvement in family planning affects the fight against rapid population growth.

A 2012 presentation titled Malawi: Investing in Our Future Now developed by the then Ministry of Finance and Development Planning and the Ministry of Health with support from the Population Reference Bureau (PRB) observes that family planning is a key strategy in reducing rapid population growth in the country.

Malawi has a high fertility rate with an average of six children per woman, according to the 2010 Demographic and Health Survey (DHS).

If the fertility rate is not checked, states the DHS, Malawi’s nearly 15 million population will quadruple to 60 million people by 2050.

Northern Region zone health officer Dr Owen Musopole says male involvement is a promising strategy to prevent unintended pregnancies and reduce unmet need for family planning.

“Men play many key roles in families and their decisions and actions make a difference during pregnancy, delivery and after delivery,” he says.

Musopole, however, notes that male involvement is challenged with various social and cultural factors.

He suggests that messages on family planning should be tailored towards a family rather than a woman.