In Botswana the phrase “family planning” has a feminine twang. Family planning is widely considered a woman’s responsibility. For a longtime, this was even the unspoken official line.
When the Ministry of Health drafted the Sexual and Reproductive Health (SRH) guidelines (2001), policy makers only had women in mind. The responsibility of Batswana men in family planning came as an afterthought. It was only after the (SRH) guidelines had left the drawing room that a addendum was added to the guidelines. This gendering of family planning has not helped Batswana men’s reluctance to be involved in family decisions about fertility and has limited their access to family planning services.
Orapeleng Phuswane-Katse, a physician with the Ministry of Health says, “gender inequalities remain a significant barrier to addressing such health issues. Harmful gender norms and attitudes have a negative influence on both men’s and women’s health and well-being, shaping men’s behaviors in ways that have a direct impact on the sexual and reproductive health and rights of their partners, their families, and themselves. At the same time, SRH and family planning issues are often treated as women’s responsibility. Global frameworks have traditionally failed to adequately address the ways in which inequitable gender dynamics and masculinities play a role in perpetuating poor sexual reproductive health outcomes, a paradigm that ensures women continue to bear the responsibility of family planning, exacerbates gender inequalities, and leads to suboptimal health outcomes for men, women, and children.”
As a result, the contraception gap is one of the most striking and persistent gender inequities in Botswana. While a lot of women take steps, at some point in their lives, to prevent pregnancy, the vast majority of them shoulder that burden alone. Fewer than one in 10 rely on condom use – a contraceptive method that requires men to take action.
The Ministry of Health has launched an aggressive campaign to involve men in family planning. Old habits, however, die hard and the campaign seems to be floundering on the rocks of old habits.
The Sexual and Reproductive Health Unit (SRH) has established District Male Action Groups (DMAG) in 12 districts in Botswana. The groups have coordinators who give other men brief talks on SRH issues, especially during soccer matches, and also offer the male vasectomy.
For men who have already had children or know they don’t want children, vasectomy is the safest, easiest and most effective method of contraception. It is also safer and easier to reverse than tubal ligation. It allows men more control over their own fertility. It gives men with female partners an opportunity to equally share in the work of planning their families.
As would be expected, the uptake of male vasectomy among Batswana men has been disappointingly low. SRH Program Coordinator, Molly Rammipi says although she does not have exact statistics of men who have undergone vasectomy in Botswana, it is mostly expatriates who are showing interest in it.
Dr Sophie Moagi, a Gaborone Clinical psychologist, says, “if it is successful, vasectomy could drastically change the field of contraception. Vasectomy is currently the only reliable contraceptive option available to men. It is a minor surgical procedure where the duct that conveys sperm from the testicle to the urethra is tied or cut. The challenge is that it is not reversible. In 2013 only 2.2% of men globally had vasectomies. This compares to 18.9% of women who underwent female sterilisation. Although some countries like Canada have higher rates of men who have undergone a vasectomy (22%), in Africa only 0.1% of men have undergone vasectomies. In the continent, vasectomies could be one of the most effective male birth control methods because they are inexpensive and could therefore have a major impact on sustainable development and population growth. But the procedure is misunderstood and, as a result, is poorly used.”
As Dr Moagi explained, there is a knowledge gap about the vasectomy procedure as a family planning method in several African countries. It, however, is a fairly quick, simple and straightforward procedure which lasts barely 30 minutes. It can be done in a doctor’s practice or clinic on an outpatient basis, and under local anaesthesia. There are also very few risks or complications. Very few vasectomies fail or go wrong. In very rare cases, the duct spontaneously reconnects. But only about 1 in every 500 women have an unintended pregnancy in the year after their partner has undergone a vasectomy.
Vasectomy involves a surgical procedure that severs or blocks the tubes (vas deferens) which carry sperm to the ejaculatory ducts. Gossypol, which is administered orally or through injection, is a synthetic compound that suppresses sperm production.
Despite all of this, the uptake of vasectomies in Botswana remains consistently low. Men who go for vasectomies risk stigma and contempt. There are several myths and misconceptions surrounding the procedure. These include: local beliefs associating vasectomy with de-masculinisation, framing it in terms of castration. Notions that vasectomy causes painful sex, weight gain and obesity among men, and makes men develop female features, such as breasts. Fears that it would reduce their sex drive and sexual satisfaction. The acceptability of and intention to use vasectomy as a family planning option remains very low. Cultural beliefs, societal norms, lack of knowledge about the procedure for vasectomy, and misconceptions influence the acceptability of vasectomy greatly. Men can’t seem grasp the concept of a family planning method that is as permanent as vasectomy.