A Review of 10 Years of Vasectomy Programming and Research in Low-Resource Settings
Open Access
- 23 December 2016
- journal article
- review article
- Published by Johns Hopkins School Bloomberg School of Public Health, Center for Communication Programs in Global Health: Science and Practice
- Vol. 4 (4), 647-660
- https://doi.org/10.9745/ghsp-d-16-00235
Abstract
Vasectomy is a highly effective and safe contraceptive method for couples who want to stop childbearing, but only 2.4% of men around the world use this method. We conducted an extensive review of the vasectomy research literature and programmatic reports, published between April 2005 and April 2015, to synthesize barriers and facilitators to vasectomy adoption. Of the more than 230 documents initially retrieved in our search, we ultimately included 75 documents in our review and synthesized the findings according to the Supply–Enabling Environment–Demand (SEED) Programming Model. Regarding promoting demand for vasectomy services, we found there was a general lack of awareness about the method among both men and women, which often fueled erroneous assumptions about how vasectomy affects men. Several types of programmatic activities directly addressed knowledge gaps and negative misperceptions, including community-based and mass media communications, employer-based promotion, and group counseling. For supply of services, the lack of or inaccurate knowledge about vasectomy was also prevalent among providers, particularly among community-based health workers. Programmatic activities to improve service delivery included the use of evidence-based vasectomy techniques such as no-scalpel vasectomy, whole-site trainings, task shifting, cascade training, and mobile outreach. Finally, programmatic approaches to building a more enabling environment included engagement of governments and other community and religious leaders as well as campaigns with gender transformative messaging that countered common myths and encouraged men's positive engagement in family planning and reproductive health. In summary, a successful vasectomy program is comprised of the mutually reinforcing components of continual demand for services and access to and supply of well-trained providers. In addition, there is an underlying need for enabling policies within the cultural and gender environments that extend beyond vasectomy and include men not just as default partners of female family planning clients but as equal beneficiaries of family planning and reproductive health programs in their own right. Accelerating progress toward meaningful integration of vasectomy into a comprehensive contraceptive method mix is only possible when political and financial will are aligned and support the logistical and promotional activities of a male reproductive health agenda.Keywords
This publication has 44 references indexed in Scilit:
- Nonscalpel Vasectomy as Family Planning Method: A Battle Yet to Be ConqueredISRN Urology, 2013
- Factors associated with utilization of long acting and permanent contraceptive methods among married women of reproductive age in Mekelle town, Tigray region, north EthiopiaBMC Pregnancy and Childbirth, 2012
- Experiences of vasectomy: A phenomenological studyNorth American Journal of Medical Sciences, 2012
- Predictors of no-scalpel vasectomy acceptance in Karimnagar district, Andhra PradeshIndian Journal of Urology, 2012
- Barriers and facilitators affecting vasectomy acceptability (a multi stages study in a sample from north eastern of Iran), 2005-2007Asia Pacific Family Medicine, 2011
- Vasectomy within the public health services in Campinas, São Paulo, BrazilInternational Nursing Review, 2010
- Opinions concerning male and female sterilisation in TurkeyThe European Journal of Contraception & Reproductive Health Care, 2009
- Modelling cost-effectiveness of different vasectomy methods in India, Kenya, and MexicoCost Effectiveness and Resource Allocation, 2007
- Outcome of vasectomies performed at a Turkish metropolitan maternity hospitalThe European Journal of Contraception & Reproductive Health Care, 2007
- Vasectomy in developing countriesJournal of Obstetrics and Gynaecology, 2001