Vasectomy – Population Matters-USA

I was walking down the street in Mountain View, California when I noticed a man coming toward me wearing a white T-shirt with small black lettering: “SEEDLESS”. I wonder if he was advertising his vasectomy?

Vasectomy motivators in Northern Sumatra use humor in their presentations to men about vasectomy. Perhaps they should wear shirts with “KESIP” (Indonesian for “seedless”) on them! From what I can tell, these motivators need all the help they can get, since very few men get vasectomies in Indonesia. However, Indonesian husbands tend to be quite supportive of their wives’ contraceptive choices, even if very few men actually use a male method of birth control.

Indonesia is a mixture of more than a thousand ethnic groups speaking over 700 languages, living on over 6000 large and small islands. Fortunately, they are united by a single official language, although most Indonesians are multilingual. The motto of their National Family Planning Program is: “Realizing Quality Families”.

The country has supported family planning for decades. When we visited Bali (another Indonesian island) in 1996, we learned about banjars—the community organizations for a small village or neighborhood. The banjar serves perhaps 1,000 people, and helps its members through thick and thin. Banjar members organize religious ceremonies, dances, weddings and funerals. I was surprised to learn that each banjar also keeps track of every family’s fertility plan; the husband registers if his wife is trying to conceive, is pregnant or if they are using contraception. Although this would be considered an invasion of privacy in the USA, Balinese society does not have a problem with this openness.

The fertility rate in Bali is a bit above replacement, but is similar to the average for Indonesia. Sumatrans, on the other hand, tend to have larger families, averaging 2.5 children per woman. This is where vasectomy could really be helpful!

Only a tiny number of men in Indonesia have had vasectomies—just 3 per 1000 men. The vasectomy peak in that country was 30 years ago, with double that number. Unfortunately, this is true globally; the number of vasectomies has declined rather than increased. I am proud that the USA is one of two countries bucking that trend; the other is South Korea.

I know of two heroes who are working to change this trend—in addition to the vasectomy motivators in Sumatra. One is Dr. Charles Ochieng, whom I met at an international family planning meeting. He performs vasectomies, using the latest techniques, in his native Kenya. Another hero is Dr. Doug Stein, one of the co-founders of World Vasectomy Day (WVD). Trained as a urologist, Stein has limited his practice to male sterilization procedures. Each year he travels to a different country to train doctors there, and together they do a bunch of procedures—on WVD. This year it will be Zambia, November 24^th. WVD is not just a day—in fact, they have 9 events scheduled in Zambia, all relating to vasectomy!

When I was practicing and a patient expressed an interest in being sterilized, I would suggest that vasectomy for her partner was safer and less expensive. I just read another, unfortunate statistic: 1 in 12 women will become pregnant within a decade after tubal ligation. To make things worse, many of these pregnancies will be in a Fallopian tube. A tubal pregnancy can cause serious—even fatal—bleeding.

I am happy that WVD, Dr. Ochieng and the vasectomy motivators in Sumatra are all promoting vasectomy. They are helping put the responsibility for family planning where more of it belongs—with men.

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.