How about a vasectomy?
Uganda wants more men to say yes
KAMPALA, Uganda — When Martin Owor, a father of six, told his wife he was considering a vasectomy, she told him it was out of the question. How would they live as husband and wife after his surgical sterilization?
But after a long conversation about growing up poor, the Ugandan man went ahead with a procedure that remains widely unpopular in sub-Saharan Africa, where misunderstandings are high.
To spur development, this East African country that has been a regional leader in tackling health challenges such as AIDS now hopes to lower population growth. The issue is widespread in Africa, which faces a population boom even as other parts of the world see dropping birthrates. Over half of the global population growth between now and 2050 will take place in Africa, the UN says.
Sub-Saharan Africa, with some of the world’s most impoverished nations, will continue to be plagued by poverty unless governments reduce high fertility rates, development experts say. Uganda has started recruiting “champion men” to speak publicly on television and elsewhere about vasectomies as a method of family planning. It has proven difficult. Many men fear it leads to impotence. Some worry about being stigmatized. Others ask what might happen if, after a vasectomy, they lose all their children in some catastrophe.
“Many people think that when a man goes for a vasectomy, he is not going to continue being a normal man,” said Owor. “But there is no problem. My wife is very happy.”
Owor said he was compelled to have a vasectomy because he didn’t want his children to grow up hopelessly poor.
“My father had 12 children, so we never had a chance of having a quality education,” Owor said. “I needed a number that I would try to manage.”
Uganda’s population has ballooned to more than 41 million in 2016 from 17 million in 1990.
Only 35 per cent of married women in Uganda use modern methods of contraception, according to government statistics. Abortion is illegal in Uganda, except to save the mother’s life.
Although Uganda’s fertility rate dropped to 5.4 today from 6.9 births per woman in 2001, officials say a desirable rate is four births per woman. As “champion men” speak out, the government is working to increase male involvement in family planning to meet that goal.
“We can’t coerce them, because family planning is voluntary and is supposed to be based on human rights, and we want to keep on engaging them,” said Placid Mihayo, an assistant government commissioner in charge of sexual and reproductive health.
Uganda remains one of the world’s poorest countries, with a per-capita income of $780, according to World Bank data. The situation is dire in rural areas, where health facilities often lack basic medicines and many children drop out of school.
Some warn that the country won’t come close to meeting its ambitious development targets — achieving lower-middle-income status by 2040 — without wider use of birth control.
“If you produce 100 children and create only two jobs in that period, so where are the other 98 going to get jobs?” asked Sam Mwandara, project co-ordinator for Reproductive Health Uganda, a UN-supported group. “The population is expanding so fast in relation to land, jobs, education and health. So it’s alarming.”
Vasectomies are still a small part of Uganda’s effort. Each month, two or three of the procedures are performed at a clinic run by Reproductive Health Uganda in Kampala, said Dr. Kenneth Buyinza. The vasectomy costs about $13, which Buyinza said is affordable to most Ugandans. The price is $50 or more at some private facilities.
Health worker Sylvia Marettah Katende displays reproductive health products and information at a family planning exhibition in Kampala, Uganda. More than half of the world’s population growth between now and 2050 will take place in Africa and Uganda, a leader in taking on global health issues such as AIDS, is turning to “champion men” to promote vasectomies in family planning.