Our SUV bounced along the dirt road through the Rwandan mountains, which are noted for roads complicated by switchbacks and steep descents but dotted with stunning sites. On one side of the car, tea farmers pruned the lush green bushes atop raised beds of rich, black soil. We were destined for the Kinihira Health Facility, and our goal was to provide vasectomies. We looked forward to hearing more from our clients, usually husbands and wives who want to provide better lives for their children, about what led them there.
After two decades of experience in East Africa, I could not imagine that we would have many clients. Worldwide, less than 2.4 percent of men of reproductive age have had a vasectomy.1 In Africa, the prevalence of vasectomy is negligible, less than one percent. Studies on vasectomy in Africa have found that men and women have limited knowledge of the method and many misconceptions, including equating vasectomy with castration and attributing the procedure to a reduction in sexual performance or desire, weight gain and laziness.
In reality, vasectomy is safe, effective and the least expensive long-acting or permanent contraceptive method.
Since 2010, FHI 360 has been providing technical assistance to the Rwandan Ministry of Health to scale up the delivery of enhanced vasectomy procedures, such as no-scalpel vasectomies (NSV). NSV has significant advantages, including a very low failure rate (0.15 percent) and a decreased risk of surgical complications like bleeding. To increase demand for vasectomy, Rwanda’s Vasectomy Scale-up Program — one of the first national vasectomy scale-up efforts in sub-Saharan Africa — has strived to provide reliable access along with facts to dispel common myths about the procedure.