The Future of Vasectomy in Asia John M. Pile EngenderHealth Presented at National Conference on Voluntary Surgical Contraception Phnom Penh, Cambodia June 26-27, 2003

EngenderHealth  Sterilization is the most widely used contraceptive method and will remain so over the next decade Why Give Attention to Vasectomy?

EngenderHealth  Sterilization will remain the most widely used contraceptive method over the next decade  The number of female sterilization users exceeds the number of vasectomy users by six to one Why Give Attention to Vasectomy?

EngenderHealth  Sterilization will remain the most widely used contraceptive method over the next decade  The number of female sterilization users exceeds the number of vasectomy users by six to one  Vasectomy is safer, simpler, and less expensive than female sterilization Why Give Attention to Vasectomy?

EngenderHealth Trend in Vasectomy Prevalence Over the Past Decade  On the rise in Latin America  Negligible prevalence in Africa  Declining in Asia

EngenderHealth Characteristics of Vasectomy Acceptors For the “typical” Asian couple using vasectomy  the wife is in her mid-to-late 30s and has little or no education  They have three or more children  They live in a rural area  The procedure was performed in a public sector facility

EngenderHealth Why is Vasectomy Underutilized?  Men and women are less aware of vasectomy than other FP methods

EngenderHealth  Men and women are less aware of vasectomy than other FP methods  Even when men and women are aware of vasectomy, the information they have is frequently incomplete or incorrect Why is Vasectomy Underutilized?

EngenderHealth  Men and women are less aware of vasectomy than other FP methods  Even when men and women are aware of vasectomy, the information they have is frequently incomplete or incorrect  Services less available and accessible Why is Vasectomy Underutilized?

EngenderHealth  Men and women are less aware of vasectomy than other FP methods  Even when men and women are aware of vasectomy, the information they have is frequently incomplete or incorrect  Services less available and accessible  Program and Provider ‘bias’ Why is Vasectomy Underutilized?

EngenderHealth Program and Provider biases  Health professionals lack of knowledge, misinformation or personal dislike  Providers of family planning and reproductive health services are accustomed to working with women and may not be comfortable with or know how to talk to men or provide them with care  Untested presumptions about what men think and want

EngenderHealth  Men and women are less aware of vasectomy than other FP methods  Even when men and women are aware of vasectomy, the information they have is frequently incomplete or incorrect  Services less available and accessible  Program and Provider ‘bias’  Family planning is still perceived as very much a woman’s responsibility Why is Vasectomy Underutilized?

EngenderHealth Characteristics of Successful Programs Address both the demand and supply side of the equation, including:  Effective promotion  Attentive to the needs of men  Skilled providers  Strong leadership

EngenderHealth Characteristics of Successful Programs: Effective Promotion  Develop messages that are relevant to men ’ s perceived concerns  Use several channels to deliver messages  Use satisfied vasectomy clients to recruit new clients  Target messages to women as well  Failure of promotional strategies is more often a consequence of poor media selection/targeting rather than a lack of response by men

EngenderHealth Characteristics of Successful Programs: Skilled Providers  Training needs to focus on attitudinal shifts in addition to just imparting information  On-site training—Male friendly services

EngenderHealth Characteristics of Successful Programs: Strong Leadership At the head of almost every energetic “vasectomy program” is a director who is personally interested in involving men in family planning and who is committed to the program’s success

EngenderHealth A Strategy for a Successful Vasectomy Program Gaps Demand  Low knowledge  Misinformation Interventions Demand  Media Campaign  Community outreach

EngenderHealth A Strategy for a Successful Vasectomy Program Gaps Demand  Low knowledge  Misinformation Supply  Less available  Provider ‘bias’ Interventions Demand  Media Campaign  Community outreach Supply  Clinical/counseling training in NSV  Create ‘male- friendly’ services

EngenderHealth Closing thoughts  “ “Vasectomy is as much an IEC operation as a surgical operation.” R. C. M. Kaza, Indian urologist  “The shoe that fits one person pinches another: There is no recipe for living that suits all cases.” Carl Gustav Jung, Swiss psychologist