Where Vasectomies Are Rare, Some Men Challenge Tradition

MPERERWE, UGANDA — Three years ago, Abubaker overheard one of his three wives telling a friend she wanted to have more children. She already had three daughters but dreamed of a boy like her co-wives.

But Abubaker — who asked not to use his surname for fear of being stigmatized — says he didn’t want more children. He’d fathered 10 and felt that was enough.

He decided to undergo a vasectomy, a rarity for men in Uganda.

In Zimbabwe, Solomon, who also requested that only his first name be used, underwent the procedure for different reasons. His wife, who was involved in the decision, had given birth to three children through cesarean section. The couple was worried another surgery could lead to complications. They didn’t want to take the risk.

“I decided it was time I took some of the responsibility from her by having a vasectomy,” says the 47-year-old from Manicaland, a province in eastern Zimbabwe. Although condoms were an option, he says he wanted a more permanent solution.

In both Uganda and Zimbabwe, it’s uncommon for men to undergo vasectomies. The reasons vary, but misconceptions and stigma associated with the procedure are rife. Abubaker and Solomon count themselves among a growing number of men upending the traditional views of gender roles and identity in the eastern and southern Africa regions where such perspectives still hold sway. In the process, they are relieving women of the burden of family planning.

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Numerous studies show the procedure, which involves closing off tubes that carry a man’s sperm into semen, is the most effective family planning method for men.

While the number of vasectomies is substantial in places such as North America and Oceania, the highest prevalence rate in African countries is only a fraction of a percent, according to research by Patson Ndlovu, a family planning researcher and practitioner who works for a health and family planning organization in Zimbabwe.

Ndlovu attributes the low prevalence to lack of information, myths and misunderstandings. In both Uganda and Zimbabwe, men who undergo vasectomies face ridicule. In some cases, they are considered castrated.

The misconceptions are partly why Abubaker chose not to tell his wives about his decision to undergo the procedure. The 56-year-old art teacher from Mpererwe, a neighborhood in Kampala, Uganda’s capital, says he had his reasons. What if his wives began to doubt his performance in bed?

But unlike Abubaker, who underwent the procedure and kept it secret, Sam Iga from Uganda openly considered it.

Each time Iga’s wife was pregnant, she became quite sick. The 55-year-old says he felt obliged to relieve her of this burden. But he never went through with the procedure. Iga says he worried a vasectomy would free him to become promiscuous. “It would scatter my family life,” he says.

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Health workers see these perceptions starting to change. Groups like Marie Stopes Uganda — a local office of a nonprofit that provides reproductive health and family planning services worldwide — ask people who underwent the procedure to share their experiences.

“We have done awareness to rectify myths like impotence, which was a common misconception,” says Faith Kyateka, head of communications at Marie Stopes Uganda.

Dennis Chemonges, coordinator at Population Services International, a nonprofit in Uganda that provides health counseling, says the organization has carried out vasectomy outreach programs in collaboration with other nonprofits.

The process has been slow, but Chemonges says his organization is happy with the response. More men in Uganda are taking family planning seriously and unburdening women of this responsibility, he says. “We are seeing some movement, an increase in men who are becoming more involved in family planning.”

Vasectomies make sense in a polygamous culture such as Uganda, he says, where it’s legal for a man to have multiple wives at once. “It’s easier for a man who has four women to do vasectomy than each of his four women looking for family planning methods.”

In Zimbabwe, the government is collaborating with nonprofits to increase vasectomy awareness, says Dyson Masvingise, Manicaland provincial manager for the government-run Zimbabwe National Family Planning Council, which provides family planning and sexual reproductive health services.

Solomon says men in Zimbabwe who have undergone vasectomies could help the government educate the public. He finds most men worry about losing their sexual prowess. But as partners in marriage, he says, men need to step up and help women bear the burden of family planning.

But Veronica Mazhindu, a Zimbabwean mother of two, has some reservations about the procedure. Although she agrees vasectomies could help women, especially those like her who have had complications with other family planning methods, she wonders about a situation in which a man becomes promiscuous. Where will the evidence of his promiscuity come from?

“Men do stray at times,” Mazhindu says. “They fear having children out of wedlock more than infections, and for some they will no longer use protection.”

Rugira Francis, a 56-year-old Ugandan, also worries about vasectomies, although his reasons differ. Suppose, he says, “an accident claims all your children. What would you do?”

For Abubaker, a vasectomy was a necessary decision, one that will allow him to enjoy his approaching retirement. He likens the cycle of a person’s life to the shifts in a day. Morning brims with energy, but in the afternoon, energy wanes. The evening is frail, and night is like death.

“My life is at 4 o’clock in the afternoon,” Abubaker says, “with the sunset in proximity.” He sees no need for more children.