To snip or not to snip? Men take centre stage in family planning

Snip. Snip. Stitch. Barely 30 minutes later, he walked out a changed man forever. In his own words, put in the same situation again, he would make the same decision.

Eleven years ago, Dr Charles Ochieng’ walked into a small health facility to have a vasectomy. He says he made this important step because he wanted to play an active role in family planning.

“I was brought up in a large family where I saw how my father struggled to provide for us,” he recalls.

It was May 17, 2008 when Dr Ochieng’ booked his appointment. At the office, his colleagues knew and were curious to see his look after the procedure.

So at around 10am, he walked out of the office into the doctor’s room, where he was received by two nurses. “The only sting I remember feeling was when the anaesthesia drug was being injected. Many people thought I had lost my mind and that I was being castrated,” Dr Ochieng’ says.

“At home, the situation was the same, because my wife was rather hesitant about the procedure. But my mind was already made up.”

BIRTH CONTROL

A part of him knew that since that day, his wife would be monitoring him to see if there would be any changes in their sex life. However, a decade later, he says everything is normal.

To snip or not to snip? This is the question that Kenyan men are grappling with as the conversation about male contraceptives gains momentum.

For many years, discussions around family planning have been one-sided, with little to no male involvement.

From pills, injections, coils, rings, patches, caps, condoms to tubal ligation, there are more female contraceptive options than one can poke a stick at.

For this multiplicity of female birth control methods, however, sexually active men only have vasectomy — considered a non-reversible technique — condoms and the dubious pull-out method.

Vasectomy (male sterilisation) has remained unpopular, though the procedure has been available globally since 1823.

It is a surgical procedure to cut or seal the vas deferens — the tubes that carry a man’s sperm — to permanently prevent pregnancy.

ABORTION

The operation is usually carried out under local anaesthesia, where the patient is awake but does not feel any pain. It takes around 15 minutes.

While in the United States approximately 500,000 men undergo vasectomy every year, Kenya’s uptake is dramatically low.

In Africa, the procedure has been hampered by cultural and religious beliefs.

According to the Population Council, over four in 10 pregnancies in Kenya are unintended, either mistimed or unwanted.

Consequently, approximately 14 percent of pregnancies end in abortion, which have seen about 2,600 deaths of women and girls every year.

According to a 2018 study published by The Lancet Global Health, 44 percent of pregnancies around the globe are unintended, and about 40 percent of these end in termination.

The cost of a vasectomy in Kenya ranges from Sh15,000 to Sh150,000.

MISCONCEPTIONS

Dr Ochieng’, a vasectomist at Family Health Options Kenya (FHOK), a sexual health NGO, says the organisation partners with experts from No Scalpel Vasectomy International to provide sterilisation for low-income earners at no cost.

“If a man with seven children shows up and wants a vasectomy, I will do it for free,” Dr Ochieng’ says.

According to the doctor, the biggest, and probably the most damaging, untruth is that vasectomy destroys your manhood.

Another reason for the low uptake is men’s poor health-seeking behaviour, which has contributed to ignorance and misinformation.

“I always have to explain that no pills are given, no hormones are injected and no, the 'transformer' is not chopped off. Some people equate it with castration because they think all the genitals are cut off and you remain like a woman,” he says.

PARTNERSHIP

Dr Ochieng’ chose to have a vasectomy for two reasons: he already had enough children and his wife was reacting adversely to contraceptives.

“The responsibility of family planning cannot entirely be left to women,” he says. “Men ought to play an active role. The family planning method that my wife was using was making her very sick and her health was deteriorating. So, I took it upon myself to look for an alternative that did not involve her getting sick.”

He also wanted a different life because he came from a polygamous family where his father, a casual labourer, had 10 children with no money to take care of them.

“My father could not give us the quality education a parent would want to give their child due to strained resources,” Dr Ochieng’ says. “I didn’t want my children to go through what I went through.”

Although nine of every 10 contraceptive users in the world rely on modern methods, female sterilisation is the most common, used by 19 percent of women aged 15 to 49 who are married or in a union.

However, in the past three years, fertility experts have noticed a new trend — more men are embracing vasectomy.

SAFETY

According to Dr Ochieng’, the procedure is easy, painless, bloodless and really quick.

“It entails making a small window in the scrotum, hooking and pulling out the vas deferens (the tube that carries semen out of the testes), cutting it and clamping or burning off the cut ends and dropping them back where they came from,” the doctor says.

This ensures the sperms can no longer travel out of the testes to fertilise an ovum because their pathway has been disrupted. But it has to be done by a professional, he emphasises.

“First, the procedure is permanent,” he says. “If you mess up a man’s scrotum, the damage will be long-lasting.”

Vasectomy is deemed a permanent method of contraception, suitable for men who are satisfied that they have enough offspring.

According to Dr Nelly Bosire, an obstetrician gynaecologist, it is also important to know that though the procedure is painless, one needs to avoid lifting anything strenuous for a few days.

RISING UPTAKE

She says one should avoid sex for a couple of days to allow healing and reduce complications such as bleeding into the scrotum and resultant infection.

In 2016, nearly 130 men turned up for vasectomies on World Vasectomy Day. A team of seven international doctors performed the non-hormonal surgical procedure.

Some of the men came all the way from Kwale, Kericho, Gatundu and Marsabit. The procedure was offered free. The service will also be available on Saturday.

Dr Ochieng’ performs between 10 and 20 vasectomies daily. By the end of last year, an estimated 663 men had undergone vasectomies in Kenya.

Statistics also show that about 1,596 men faced the knife between January and June this year. “They often come during lunch hours. We perform the procedure and they go back to the office,” Dr Ochieng’ notes.

While he has performed the procedure on men as old as 70 years old, a majority of them are aged between 30 and 40.

DATA ACCURACY

Statistics from DHIS-2, the Health ministry’s information system, indicate that Kakamega County had the highest number of men who have undergone a vasectomy in the past one year.

Whereas the data shows that about 1,059 men underwent the snip, the county government has disputed the figures.

Health officials in facilities that recorded an improved rate of vasectomies in the region have disputed the figures as inaccurate, saying the number of procedures were fewer and far apart.

They said some facilities failed to record any procedure in the past six months. “We have cross-checked the figures in the respective facilities where the procedures were conducted and established that the number of men who underwent vasectomies was much smaller,” said Ms Amelda Barasa, a nurse specialising in midwifery and reproductive health.

“There were only 17 vasectomies reported in the last six months.” It is unclear how the errors occurred leading to the posting of unreliable figures.

CULTURE

Looking at the numbers, the dynamics of the practice changes depending on the county.

For instance, whereas in the North Rift counties Uasin Gishu is leading with 85 vasectomies, in neighbouring Elgeyo-Marakwet no man took up the family planning method.

“We have only women coming to our facilities to get family planning advice,” said Elgeyo-Marakwet Health executive Kiprono Chepkok.

“And so, it is hard reaching out to the men on vasectomy because the whole population still believes that family planning methods belong to the women.”

In Makueni, no single man is reported to have undergone the procedure in the past three years, according to county reproductive health coordinator Christine Muindi.

Additional reporting by Pius Maundu, Edith Chepngeno and Benson Amadala