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Value of Male vs. Female Sterilization Population Reference Bureau. Family Planning Worldwide 2013 Datasheet. Washington, DC, USA: Population Reference Bureau, USAID, Smith GL, Taylor GP, Smith KF. Comparative risks and costs of male and female sterilization. American Journal of Public Health. 1985;75(4):370-4 Marie Stopes. What is a couple year of protection? Access: https://mariestopes.org/sites/default/files/MSI-CYP-Infographic.pdf
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Motivation and barriers to vasectomy in low and middle income countries,
a review of the literature.
Emily Jane Sullivan, MSc.London School of Hygiene & Tropical Medicine
Submitted Thesis 2014
Did you know?
Q: Most children born to one women?
A: 69 children by Russian women, Feodor Vassilyev
16 pairs of twins, 7 triplets, & 4 quadruplets
Q: Most children fathered by one man?
A: 1,042 children by Moroccan Sultan Moulay Ismail
4 wives and 500+ partners
*LSTHM Lecture September 2014. Photo Credit: Wikipedia
Value of Male vs. Female Sterilization
Male
Female
Couple Years of Protection = 10-13 Years
Effectiveness = 99%
Cost (direct 3X & indirect bedrest)
Safety (high risk complications 20X)
Population Reference Bureau. Family Planning Worldwide 2013 Datasheet. Washington, DC, USA: Population Reference Bureau, USAID, 2013. Smith GL, Taylor GP, Smith KF. Comparative risks and costs of male and female sterilization. American Journal of Public Health. 1985;75(4):370-4Marie Stopes. What is a couple year of protection? Access: https://mariestopes.org/sites/default/files/MSI-CYP-Infographic.pdf
Value of Male vs. Female Sterilization
Male
Female
Global ; 3%
Global ; 18%
LMIC ; 1%
LMIC ; 13%
Prevalence, 2013
Population Reference Bureau. Family Planning Worldwide 2013 Datasheet. Washington, DC, USA: Population Reference Bureau, USAID, 2013.
Value of Male vs. Female Sterilization
Male
Female
Global ; 3%
Global ; 18%
LMIC ; 1%
LMIC ; 13%
Prevalence, 2013
Note: There are approximately six countries where male sterilization is more common than female.
Population Reference Bureau. Family Planning Worldwide 2013 Datasheet. Washington, DC, USA: Population Reference Bureau, USAID, 2013.
Value of Male vs. Female Sterilization
Male
Female
Global ; 3%
Global ; 18%
LMIC ; 1%
LMIC ; 13%
Prevalence, 2013
?Population Reference Bureau. Family Planning Worldwide 2013 Datasheet. Washington, DC, USA: Population Reference Bureau, USAID, 2013.
Aim
To understand the low prevalence of vasectomy in LMIC:
by identifying the profile of vasectomy users or acceptors, including their
motivations and barriers.
Methods: Inclusion Criteria
• Type: Primary studies, peer-reviewed or grey literature
• Publication date: 1980 to 2014
• Language: English
• Setting: LMIC
• Findings: Quantitative, qualitative, and mixed-methods
• Topic: Focus on describing acceptors or users of vasectomy
• Availability: Full text
Methods: Search, Quality, Analysis
• Systematic Literature Search: – Screen abstracts & full articles: 1,365 studies.– Final inclusion: 18 studies.
• Quality Appraisal: – 8 strong, 8 moderate, 2 poor.
• Data Analysis: Integrated Narrative Approach– Qualitative, Quantitative & Mixed studies.
Results: Study Characteristics
• Study Locations: – Bangladesh, Costa Rica, Ghana (2), Guatemala, India
(4), Iran, Kenya, Mexico, Nepal (2), Nigeria, Philippines, Rwanda, Sri Lanka, Tanzania, Turkey.
• Study Participants: – 12,744 men, 1,322 women, 29 healthcare providers.
• Study Designs:– Qual (8) Quant (6), Mixed Methods (4).
Results: Strong Motivations
Limit number of children, exceeded desired, multiples
Economic Stability
Feeling of responsibility
InformedDifference
between male & female
Misinformation corrected PH
Nurse
Talk with a sterilized man or
couple
Spouse Approval
Aware of man’s other partners
Misinformation Corrected
Man initiate conversation
Diagnosis or illness
Side effects from other methods
(IUDs)
Women’s Health
Near miss mortality or frequent pregnancy
Improve Love Life
Confidently avoid pregnancy with
wife
Or with other partners
Religious Views
Only have children can care for
Education & Services provided
at faith- center
Results: Strong Barriers
Concerned if she gets pregnant
Spouse Disapproves
Misinformation Man will seek out other partners
Keep vasectomy a
secret
Community Perception
Loss on control within family
Loss of authority in community
Religious ViewsHeightened when
confused with castration
Similar to other forms of family
planning
Can’t remarry if wife changes her
mind
Future Uncertainty
Maternal or child
mortality
Improvedeconomic
circumstances
Lack of AccessDelayed, have
unintended children
No designated provider
Discouraged or humiliated by
providers
MisinformationSide effects &
Operation
Procedure is castration
Local language
General poor health, gain or loose weight
Sexual desire or dysfunction
Summary of Results• Frames sterilized men as: – Economically stable, in good health, able to work,
and with normal sexual function.
• Educational resources include: – Procedure details;– Difference between male and female sterilization;– Testimonials from sterilized men or couples; – Endorsement statements from faith leaders.
Recommendations:
• Improve access to services:–Mobile clinics & accepting providers;
• Targeted education: –Adverse health event or FP side effects;
• Continually assess motivations and barriers:–Vasectomy camp users (not static clinics);–Apply nuanced findings to educational
materials and counseling.
Looking Forward: Global Commitments & Local Actions
Commitment: To not make assumptions. Men may be interested
and willing undergo vasectomy.
Action: To incorporate thoughtful and ethical vasectomy awareness,
education, and services into in all family planning programming.
Vasectomy has the potential to alleviate burden from women and healthcare systems.
Thank you! Questions?
Acknowledgements:Joelle Mak, London School of Hygiene & Tropical Medicine;
Susannah Mayhew, PhD, London School of Hygiene & Tropical Medicine;Lynda Clarke, PhD, London School of Hygiene & Tropical Medicine;
Johns Hopkins Bloomberg School of Public Health.
Emily J. Sullivan, MSc.E-mail: emsully71@gmail.com
Photo Credit: International Conference on Family Planning 2015 website
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