More than Partners: Men as Family Planning Users
Twelve years ago, I sat in a waiting room in a small clinic on the outskirts of Byumba, Rwanda, and listened as one man after another stood up and asked the nurse at the front of the room what methods of family planning they could use, as men. The nurse had just completed a presentation of different family planning methods, and these men were hungry for an option besides condoms, the only male method available at that facility. It was powerful and moving to witness men who wanted to directly engage in family planning, not just as supportive partners, but as users themselves.
Many years later, I had the privilege to work alongside the Ministry of Health in Rwanda (2009- 2012) as they introduced and scaled up a state-of-the-art vasectomy technique—no-scalpel vasectomy with thermal cautery and fascial interposition—with technical assistance from FHI 360. The government provided over 2,500 vasectomies in just two years, demonstrating their commitment to meeting the contraceptive needs Rwandan men and women, and challenging a general belief that sub-Saharan African couples would not choose the method. Today, vasectomies continue to be provided across the country in both district hospitals and using periodic outreach services.
In order to help more decision-makers and program planners understand and advocate for the advantages of including vasectomy within the method mix, FHI 360, with funding from the Evidence Project, recently produced several resources. “How to Create Successful Vasectomy Programs” summarizes key learnings from an extensive review of vasectomy projects and research in low-resources settings over the past decade and provides concrete recommendations for how to create an enabling environment for vasectomy programming while simultaneously increasing supply of and demand for services. This globally relevant document provides a useful primer for those interested in advocating for or designing effective vasectomy programs.
In addition, we have developed tailored briefs for eight countries—Burundi, Ethiopia, Haiti, Kenya, Malawi, the Philippines, Rwanda, and Uganda—that identify the potential financial and health benefits of strengthening vasectomy services. Using country-specific FP goals and data on population and current method mix, the briefs illustrate the impact that a small proportion of current FP users switching to vasectomy would have on health outcomes and the corresponding economic savings. These briefs can be used by advocates in those countries to make the case for supporting quality voluntary vasectomy services.
As I look at the current contraceptive development pipeline, I am optimistic about expanded choices for the men in Rwanda and elsewhere. While we wait for those new methods to become available, I hope that these vasectomy advocacy tools will help men and women who wish to limit births to access this extremely safe and cost-effective method and will encourage men to not only be active partners but to become users of FP/RH services themselves.