Wairimu Michengi, GPJ, Kenya
Kenya

Determined to dispel baseless fears about vasectomy, the Kenyan government and a nongovernmental organization recruit ambassadors – laymen who have undergone the procedure – to assure other men that it has no effect on their virility.

NAIROBI, KENYA – Jared Wanjala, a private security guard in Kenya’s capital, Nairobi, has four children and does not want any more.

Wanjala cannot afford more children, he says. His monthly salary, about 10,000 shillings ($115), is barely enough to cover his family’s needs, including rent and school fees.

But Wanjala leaves the responsibility of family planning to his wife. She gets a contraceptive injection every three months, and he monitors this so that there are no “accidents.”

The two contraception methods available to men – condoms and vasectomy – are abhorrent, he says. Believing that only people who do not trust in each other’s fidelity use condoms, he shuns them for fear of stirring mistrust in his marriage.

He would never consider having a vasectomy because he thinks the procedure would harm his sexual performance, reducing his pleasure and possibly inducing his wife to leave him, he says. To him, vasectomy and castration are synonyms.

“Even though I don’t want any more children, I want to continue to be a man and perform all functions that a man is supposed to perform,” the tall, bony, dark-skinned man says, turning to his two colleagues at the gate they are guarding, as though seeking support.

Men in Kenya say they resist undergoing vasectomy because they fear it might render them impotent. Determined to debunk that myth, the government and a nongovernmental organization are educating men about the medical procedure through a network of male ambassadors and community health workers.

Kenya has a population of 43.2 million people, according to the World Bank. The population increases by about 1 million every year.

The current fertility rate is 4.5 births per woman, according to the 2013 Kenya Population Situation Analysis report. The government aims to reduce this rate to 2.2 births per woman.

The Ministry of Health has no statistics on vasectomy in Kenya, says Angela Njiru, the Nairobi County reproductive health coordinator. It is in the process of collecting data.

Worldwide, about 2 percent of men have undergone sterilization, according to a 2013 U.N. report using data from 2011. Less than 1 percent of African men have been sterilized.

Asked to choose between vasectomy and condoms, most men in Kenya prefer condoms, says Dr. Charles Ochieng, a gynecologist and founder of Winam Safe Parenthood Initiative, a nongovernmental organization that promotes male participation in family planning. But they typically stop using them, leaving their wives to assume responsibility for family planning.

The contraceptives most commonly used by Kenyan women are injectables and pills, according to the Kenya Population Situation Analysis report.

Timothy Kibetu, a 25-year-old guard, says his wife is responsible for family planning in his household. She uses oral contraceptives. If he had to choose between using condoms and getting a vasectomy, though, he would choose condoms.  

“I don’t want to be sterile and impotent when I’m so young,” he says.

He has one child and plans to have two more.

Mwende Karimi, a 35-year-old mother of three, is responsible for family planning in her household. She is on Implanon, a contraceptive implant that lasts three years.

But she suspects the contraceptive has caused her to gain weight. She would be happy if her husband took over family planning, she says.

“It would be the best gift ever,” she says. “I don’t want any more children, and I don’t want to be on contraceptives for too long. You know most of the birth control methods have side effects.”

But she doubts her husband would ever get a vasectomy.

“I once tried to raise the topic with him, and he didn’t even allow me to finish the first sentence,” she says. “You see, he believes that if he gets a vasectomy, he will cease to perform sexually. I don’t know whether there’s any truth in that.”

Contrary to what most men believe, vasectomy does the opposite of hurting virility, says Ochieng, who has had a vasectomy.

“Your erections remain as stiff as ever, and since you no longer worry about unplanned pregnancies, you enjoy sex more,” he says.

Ever since the government introduced vasectomy in the early 1990s, many men have bought into the myth that it causes impotence, Ochieng says. They also tend to conflate vasectomy and castration, a different procedure.

“They are as different as day is from night,” Ochieng says. “Castration involves the removal of the testicles. On the other hand, vasectomy involves blockage of the vas deferens so that a man functions sexually but cannot make a woman pregnant.”

The gynecologist got a vasectomy in 2008 after the birth of his second child. Coming from a large polygamous family and with several siblings to bring up, Ochieng decided not to have more than two children.

His wife previously took responsibility for family planning. She was on Norplant, a hormonal contraceptive administered via the surgical insertion of six flexible matchstick-size rods into an inner upper arm. The version of the drug that she used – a version no longer produced – made her perpetually sick, he says.

“I decided to get a vasectomy to end her suffering,” Ochieng says.

The same year Ochieng got his vasectomy, he founded Winam Safe Parenthood Initiative as a club in which men who had undergone vasectomy could share their experiences and encourage other men to have the procedure. It has grown into an organization that provides vasectomy services.

The organization recruits men who have undergone the procedure to reach out to other men, Ochieng says. These vasectomy ambassadors approach men randomly and explain the procedure whenever they get an opportunity.

Ochieng attends to about six clients every week, a number he considers too small. He charges 35,000 shillings ($400) for the procedure. But whenever he gets funding from donors, he offers the services for free.

In 2012, the organization held a free vasectomy camp in Kisumu, a town in the western part of the country, after receiving funding from an international nonprofit organization. Ochieng and ambassadors educated men about vasectomy around town and encouraged them to undergo the procedure.

Of the roughly 200 men they invited, 35 agreed to have vasectomies, Ochieng says. The majority declined for fear of becoming impotent.

Boniface Ouma got a vasectomy at the camp after one of the vasectomy ambassadors, Charles Omware, explained the procedure to him.

Ouma, a conductor of a public transport van, says the contraceptive implant his wife was using made her bleed a lot. Although he wanted to end her suffering, he feared he would stop functioning sexually if he had a vasectomy. He had heard fellow conductors say that men who have had vasectomies never get erections.

“Omware assured me that every part of my body would remain the same,” he says. “I believed him. True to his word, I’m OK. It’s like nothing happened.”

The government has also shifted the focus of its family planning campaigns in recent years to target men, Njiru says. The government began a campaign in 2008 to encourage men to get vasectomies.

Like Ochieng’s organization, the government enlists men who have had vasectomies to encourage other men to undergo the procedure. The Ministry of Health trains the men and community health workers to educate men on vasectomy and debunk groundless beliefs about the procedure, Njiru says. They hold one-on-one sessions with men who are curious about vasectomy and speak at public meetings organized by village chiefs.

Vasectomy services are available free in public hospitals countrywide, Njiru says. Men need only walk in and book their appointments.

Still, program organizers and representatives must constantly challenge the myth that vasectomy causes impotence as well as the tendency to confuse vasectomy and castration, Njiru says.

“Most men reject vasectomy due to ignorance,” she says. “These myths have no basis whatsoever.”

The ministry will make future plans for its vasectomy program after it finishes compiling data on the number of men who have undergone the procedure. It has not determined a release date for this data.

Meanwhile, Ochieng plans to establish a center that exclusively offers vasectomy services. Lacking a permanent location for this element of his practice, he performs vasectomies at clinics that are convenient to his patients.

“For a long time, women have been the ones taking birth control, and some of the methods they use have side effects,” he says. “It is time men took up vasectomy, which has zero side effects, to ease the burden on women’s shoulders.”

GPJ translated some interviews from Kiswahili.