More Ugandan Men Take Up Vasectomy

When Julius(not real names), 34, had his fourth child, he knew he didn’t want to have another child. However, his wife, only 28, still had hope to have more.

To plan better for their future, he proposed that they undertake measures to first stop giving birth and the first line of thought was to have his wife undertake family planning.

It did not go well.

“We opted for a temporary family planning method but she had a terrible experience and she didn’t react well to the methods available,” Julius explains

Julius comes from a big family, due to this recourse, he had to share the little resources they had at home with his siblings and it was a struggle. His father in his 60’s is still giving birth and the burden for him just keeps increasing.

He swore to do better by his children and his wife.

“I had a terrible childhood because resources were never enough so I vowed that I will never do that to my children,” He adds.

With this history he was sure that he couldn’t add another child, and he couldn’t force his wife into a more permanent situation. 

“I tried bringing up the topic to my wife indirectly and her reaction made realize that she would find it selfish of me if I asked her to undertake a more permanent measure,”

His plan was to always have a small family, one he would holistically manage but his options were running thin.

About 3 months ago, Julius heard an advert on the local radio station, it was making a call for men to have a vasectomy at no cost.

This call was sponsored by World Vasectomy Day an organization that focuses on creating awareness on vasectomy as a mode of family planning and Reproductive Health Uganda (RHU) a not-for-profit organization that provides reproductive health services in Uganda.  

It was a call of a lifetime.

“When I heard the announcement on CBS fm, I didn’t hesitate, I knew that it was what I needed, in fact it was God answering my prayers and on that day I showed up ready,”

The advert had noted that the procedure would be done at Katego Clinic, a Sexual and Reproductive Health Rights (SRHR) center under Reproductive Health Uganda. 

On arrival, Julius was educated and counseled by the doctors and made to understand what it meant to have a vasectomy

Julius was asked questions to ascertain whether he understood what he wanted and he wasn’t going to regret his decision. 

The doctors wanted to be sure it was a well thought out decision.

In his words, they were preaching to the converted. Nothing at that moment could change his mind, if not for him, he was ready to do it for his wife and children.

His was an act of love.

“I had walked with money, honestly I was ready to pay any amount, but fortunately  for me it was free,” 

According to Dr Ssenyonjo Rogers the Vasectomy surgeon at Katego, away from the counseling, the patients are checked for STIs, and asked for their history to ascertain if they have had previous surgeries on their scrotum. All this is to ascertain that the patient qualifies for the Vasectomy.

Outside of that, any man that feels that he has reached the maximum number of children or feels like they have no desire to have children is eligible for vasectomy. 

How Vasectomy works.

Vasectomy is minor surgery in which the tubes that carry the sperm from the testicles to the penis are cut.

This method of contraception is sometimes also called sterilization or ‘the snip’.

It’s a 15-20 minutes long procedure.

A vasectomy works by stopping the sperm traveling through the tubes from the testicles–where the sperm are made to the penis. As semen is mostly made up of fluid that is produced outside of the testicles, the amount of semen you ejaculate should not change. However, the semen will no longer contain any sperm.

Vasectomy procedures are done using local anesthesia, which means the patient will be awake and have medicine to numb the surgery area.

“Patients are never worried because we walk them through every step of the procedure, so except the pinch when we inject the anesthesia they never feel any pain and we are mostly just calm and talking through the process,” Dr. Ssenyonjo explains.

A vasectomy can be done using a scalpel or a no-scalpel technique. Using the scalpel technique, a small cut of 1 to 2 cm is made on each side of the scrotum to access the tubes that carry sperm out of the testicles.

In Uganda the no-scalpel technique is used as it leaves no scars and has little to no side effects.

“With the no-scalpel technique, a sharpened instrument is used to pierce the skin over the tubes, making an opening in the skin of about 1 cm which allows us to access the tubes,” he explains. 

Once the tubes are located by the doctor, they are cut and a small piece of tissue is removed.

The ends of the tubes are then sealed with a stitch or using diathermy–heat.

“The recovery time from the no-scalpel technique might be a little shorter than from the scalpel technique,” Dr. Ssenyonjo explains

Once the procedure is done, the patients are told to have bed rest for at least 1-2 days and are given pain relievers and antibiotics to help them.

For Julius, one day was enough to rest and he was able to go about his day without any trouble and has no form of scarring from the procedure.

Post-surgery.

If the vasectomy is successful, then there should be no sperm present in semen around 3 months after the procedure (that is, for no sperm to be present in the ejaculated semen). 

It is important to have a sperm test to check this.

“We tell our patients to take at least two weeks after the procedure to have intercourse and we then have a review after three months when we expect that the vasectomy has began working to confirm,” Dr Ssenyonjo explains

In the meantime, the patients are encouraged to use alternative methods.

Vasectomy is over 99% effective at preventing pregnancy. It is considered to be permanent.

“If you have unprotected sex before you are sure if the vasectomy worked, your partner may become pregnant. It is recommended that you and your partner continue to use another form of contraception until you are sure that the vasectomy worked,” Dr. Ssenyonjo explains

It is very uncommon for a vasectomy to stop working, however there are incidences that it may fail when the patients fail to adhere to instructions given.

Family planning is for women!… But is it?

One of the lingering challenges to the uptake of vasectomies lies in the social construction of Uganda where it is believed that the responsibility of childbirth lies on the women.

The myths and cultural misinformation have had a high contribution to this factor. 

“I can’t get a vasectomy because my job is to contribute to the growth of my clan, it’s my job as a man,” Lubyanza Benjamin, a resident of Kirombe Nsambya explains, adding that in his culture a man’s children are not counted.

His theory was not different from other men who noted that it’s a woman’s role to know the number of children they want and how to space them. 

Lubyanza’s wife agreed with this notion.

“This is my second marriage, I have 5 children, three from my first marriage. Imagine my first husband had a vasectomy and now we are separated, what would he tell his second wife,’’ She adds that it’s unfair to expect the men to cut off possibilities of having children yet women can control it with temporary methods. 

The men insist that there are far safer and reversible options for women so there is no need to castrate oneself.

“You see women have those pills they swallow, my wife gets an injection, so why should I cut off my possibilities of being a father, what if they die,” Abaho Edward, a boda boda rider in Nsambya explains.

Many men have also been misinformed about the effects of a vasectomy.

“There is a belief that vasectomy is more or less castration and it affects sexual performance which is not true,” Dr. Ssenyonjo explains adding that there is need for sensitization and awareness on the subject.

There is also the issue of stigmatization where men are willing to do the procedure secretly.

Julius says that till date he has never told his wife or any one else about getting a vasectomy because he doesn’t know how they will react.

“My wife is 28 years and I am 34, given our age we are still able to give birth and I am sure my wife still wants more children, but I am good with the four we have. I am still finding the right time to tell her but I am sure she won’t take it well,” 

He notes that even though she may not agree with him at first, he knows that she will eventually realize that it was for their own good as a family.

“ I don’t want my children to experience what I went through. I believe most of the financial struggles we went through growing up stemmed from the fact that my father had many children. He is 60 but he is still giving birth. I refuse to torment my children,”

The numbers suggest a change of attitudes.

Vasectomy as a family planning  method is new in Uganda, while there is an increase in uptake  it still remains relatively low with less than one percent (1%) of men going for it.

According to statistics from District Health Information Software, there was a great jump in the number of vasectomies performed.

Data shows that  in 2023, 7,120 vasectomies were performed, a steep increase in comparison to previous years where less than 2000 surgeries were recorded per year.

So what changed?

In 2021, a not for profit organization World Vasectomy Day opened up in Uganda (WVD), the agenda was to normalize conversations on vasectomy as a permanent family planning method. 

This year alone they have registered over 300 surgeries with partnership with community health centers.

“We work with VHT’s and radio’s to put the message across and encourage men to undertake this family planning method,” Akao Phiona the communications officer at WVD explains.

The organization runs adverts and radio talk shows on local stations that explain and educate men about vasectomy as a family planning method

In many rural communities, Village Health Teams are the first respondents to any emergence. These are seen as the first line of medication for conditions that don’t require serious health responses. They are trustable, and reliable.

They are perfect for the gospel.

“We have trained the VHT’s on Vasectomy and they help to break it down in communities we are unable to reach,” 

The average cost of a vasectomy ranges between Uganda Shs100,000(26$) to 200,000(46$).

This may be unaffordable to people in a low cost setting, and hence through partnership with different medical service providers, the organization pays for the service.

“We provide the service at all locations where our partners like Marie Stoppes and Reproductive Health Uganda are located but we also do community outreaches where we take the doctors to the communities to perform the surgeries,” She notes.