Sterilization – Page 2 – Population Matters-USA

Dr. Charles Ochieng at the International Conference on Family Planning

Sixteen years ago the Durango Herald published my column “Do your Partner’s Vasectomy”; it got lots of laughs on April Fool’s Day! Unfortunately, the latest news on male sterilization is not so funny.

There is some recent good news, fortunately. In some states, men are rushing to get permanently sterilized because of the recent Supreme Court decision about abortion. My experience, however, is that they will be moving a little more slowly after this minor procedure. I was sore for a couple days after my vasectomy, many years ago.

Remember that vasectomy is much safer and easier than a tubal ligation, the female sterilization procedure. Male sterilization is done with local anesthesia and is finished in just 10 or 15 minutes. There are only two drawbacks to vasectomy. While female sterilization is effective immediately, it takes a couple of months after the procedure before a man starts shooting blanks. The other drawback is that many men are frightened to have it done.

It is interesting to note the countries where vasectomy is most popular. The top five are: South Korea, Australia, Bhutan, the USA and New Zealand. Bhutan? Yes! Perhaps it is because that little country’s government has promoted this simple surgery. Bhutan has had mobile vasectomy camps which bring the service to villagers. Furthermore, men tend to take responsibility for family planning in this enlightened country.

The bad news is that we seem to have reached “peak vasectomy”. Worldwide, the maximum number of couples who use vasectomy for protection from unintended pregnancy was reached in 2001. That year, 44 million couples worldwide were safeguarded by this simple procedure. The latest figures show a sad decline to just 17 million couples who are dependent on vasectomy.

What can be done to bring back vasectomy? One group is doing its best to spread the good word all over the world. World Vasectomy Day, www.wvd.org, has worked in several countries to introduce people—especially men—to this simple surgery. They claim: “World Vasectomy Day is the largest male focused family planning movement ever”. WVD was started by a New York film producer, Jonathan Stack, and urologist Doug Stein. Together, they have built an amazing crusade to not only to do the surgery, but also to train doctors to perform the procedure.

Stein is a master of the No Scalpel Vasectomy technique. It uses a couple of special instruments that make it possible to perform this delicate procedure with tiny incisions. Because it involves less cutting, NSV has fewer complications than older methods.

Vasectomy would be ideal for couples in developing countries who want to stop childbearing, since it doesn’t require a fancy facility. Dr. Charles Ochieng of Nairobi, Kenya has become an evangelist for vasectomy. He had his own vasectomy years ago, and has done hundreds since then. An award-winning family practice doctor, he is devoted to providing vasectomies and teaching other physicians the NSV technique. He learned the NSV technique while spending time in Florida with Dr. Stein.

I met Ochieng at an international family planning convention in Kigali, Rwanda. He told me that he even offered to do his father’s vasectomy! His dad has 3 wives (polygamy is legal in Kenya) and many children. He was sad that his father turned down the gift. For some cultures, a large family is a status symbol, especially for men.

Now, as restrictions on women’s reproductive health increase in the USA, I hope more men will take this small, but important, step to prevent unintended pregnancies.

SHAPESHIFTER

I have to make you sick to make you well,

The oncologist says, five months

we’ll scour each cell of your abdomen clean.

INTRAPERITONEAL CHEMO

It always burns, multiples thousands of bone splinters

stinging cells, murdering nerves, dulling

my mind, my spine alive, a drawn bow

aimed at heaven, sprouting agony’s three stingy feathers.

Both from Refugee; poems by Pamela Uschuk

When I first learned that our friend Pamela Uschuk had ovarian cancer, I despaired for her life. Ovarian cancer is one of the worst killers. By the grace of God, and the Mayo Clinic, she is still alive and well 10 years later.

Unfortunately, there is no screening test, like the Pap smear, for this terrible disease. Ovarian cancer has usually spread widely by the time that it is detected, so heroic treatment is required. Despite medical advances, most women who get ovarian cancer are killed by it.

Mysteriously, the risk of getting ovarian cancer is reduced by using birth control pills, by tubal ligation or by hysterectomy. Even more puzzlingly, about a decade ago it was discovered that most ovarian cancers actually start in the Fallopian tubes.

Ovarian cancer is not that rare—about 1 in 80 women will develop it. Some women are at higher risk because they carry a genetic mutation such as BRCA, but they only account for about one tenth of the people who develop this disease. Pamela was at normal risk; she is BRCA negative.

Now, rather than just blocking a woman’s tubes to prevent pregnancy, it is recommended to consider removing the tubes entirely (salpingectomy). The final word isn’t in because the recommendation is too new, but bilateral salpingectomy has the possibility of preventing hundreds of cases of ovarian cancer, saving many lives annually!

If a woman has a planned Cesarean with what she intends to be her last child, why not have a salpingectomy at the same time? After all, her tubes are exposed and this procedure only adds 5 minutes to the surgery.

Regrettably, that may not be possible in some hospitals under Catholic control. They must abide by the “Ethical and Religious Directives for Catholic Health Care Services” of the United States Conference of Catholic Bishops. This document states:

“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present or serious pathology and a simpler treatment is not available.”

This statement has unintended consequences. Many women have hysterectomies in Catholic hospitals because the simpler, safer and less expensive tubal ligation is prohibited. Worse, this policy leads to unplanned pregnancies and abortions. Remember, the most effective way of preventing abortions is with effective contraception!

Of course, there is the option for the new mother to go to another hospital at a later time for her tubal surgery, but that means a second anesthesia, additional cost, plus more pain and recovery time. What mother wants to leave her newborn child and not be able to breastfeed?

All healthcare institutions should endeavor to prevent illness and death. A study examined the number of women having tubal ligations at the time of cesarean birth and calculated that over 900 cases of ovarian cancer and 550 deaths every year in the USA could be prevented by doing salpingectomies for women who want sterilization at the time of cesarean.

Let’s look at this issue from a different viewpoint. What if it had been shown that vasectomy decreased the risk of testicular cancer (it doesn’t, unfortunately). Do you think that the Catholic patriarchy would deprive their priests and other men of this potentially life-saving surgery?

Preventing sterilization, especially salpingectomy, at the time of cesarean is a case of religious doctrine standing in the way of good medical care.