Campaign to Expand Vasectomy Brings a "Permanent Smile" to Ghana Family

EngenderHealth's Project Provides the Capacity for No-Scalpel Vasectomy

Danso and his friends were out celebrating the birth of his fourth child when he saw the poster. The slogan “Get a permanent smile” ran beneath the beaming face of a confident man who proudly advertised his new vasectomy. Danso had also heard radio spots on this same theme, and the message was making an impression. Of course, Danso was thrilled to have another healthy baby. Yet he and his wife Akosua knew they did not want to have any more children. They would like to send all of their kids to school, but on Danso’s salary it will be difficult to afford school fees for all of them. Danso picked up one of the brochures displayed below the poster and put it in his pocket to look over later.

The poster, brochure, and radio advertisements were all part of a pilot project in Ghana to educate men about no-scalpel vasectomy (NSV) and to increase their access to quality NSV services. The initiative was funded by the U.S. Agency for International Development (USAID) through the local EngenderHealth office in Ghana. With marketing technical assistance from Meridian Group International, Inc., EngenderHealth established this project in two regions in Ghana to test whether vasectomy could become a viable contraceptive choice in a country where misconceptions about this method are common.

Vasectomy Can Play a Crucial Role
Long-term methods of contraception are an integral part of the solution to ending unintended pregnancy and helping couples limit the size of their family. When a couple has decided that they do not want any more children, vasectomy and tubal ligation, two of the most common surgical methods of sterilization, are often an ideal way to prevent future pregnancies. NSV has many benefits, including the fact that it is the easiest, fastest, and safest type of sterilization, as well as that it is a less complex procedure than tubal ligation. A trained doctor can perform the procedure in less than 20 minutes and the client generally suffers no side effects beyond a few days of soreness.

While 42 million couples worldwide have decided that vasectomy is the right choice for them, the number relying on this method varies widely by region: 5.6 million couples in North America rely on vasectomy, but only 120,000 couples in all of Africa do. Vasectomy is underutilized in Africa, in part because it is one of the least-known methods of contraception. Prior to the public awareness campaign in Ghana, only three-out-of-five married men were aware of vasectomy, although nearly all men (99.6 percent) knew about at least one modern method of contraception. The lack of information has fueled the circulation of myths and misinformation, which in turn has contributed to misgivings about using the method. Another major obstacle is that many providers do not know how to provide vasectomy or are biased against doing so.

EngenderHealth is addressing all these barriers head on by training and equipping providers to perform quality services, by creating “male-friendly” service-delivery sites by training all clinic staff to better address men’s reproductive health concerns, and by implementing a telephone hotline and media and community outreach campaigns that provide men and women with accurate and accessible information. This successful project model is now being replicated in other countries via the ACQUIRE Project, a global cooperative project funded by USAID and managed by EngenderHealth that aims to improve voluntary family planning and reproductive health services and link those services to the communities that need them. ACQUIRE partners include Meridian Group International, Inc., and three other organizations.

Vasectomy Campaign Changes Minds—and Lives
Like many of his friends, Danso had equated vasectomy with castration, but when he read the brochure he began to question these beliefs. The next day, he called the hotline number listed on the brochure. The staff person who answered the phone was friendly, helpful, and able to answer all of his questions. He learned that NSV would be safer and faster than a tubal ligation for his wife and is just as effective, and he liked the fact that vasectomy was a permanent alternative to the pills, condoms, or IUDs that the clinic also offered. In addition, at a cost of 190,000 Ghanaian cedis (about $20 in U.S. currency), it was affordable. After discussing it with Akosua, he decided to undergo the procedure. Thanks to the work done by EngenderHealth, Danso’s vasectomy was performed by a trained doctor at his local clinic.

Preliminary findings suggest that the pilot project to raise interest in vasectomy in Ghana has been very successful. Awareness of the method among men has more than doubled, according to early results from a campaign evaluation study. And in the project’s first six weeks, the number of vasectomies performed in the five cities surpassed the total for the previous fiscal year. The hotline received approximately 30 calls per week, and seven out of 10 callers asked for information on where they could get the procedure.

Now Danso and Akosua are the proud parents of four children and are very relieved they will not have more. It has been six months since Danso had his vasectomy, and he and his wife are very pleased with their decision and its outcome. “Now all of my children will be able to go to school,” Danso comments, “and like the posters say, ‘I've got a smile!’ The surgery was over very quickly, and it didn't hurt. My wife and I are very happy we made this decision. I’ve encouraged my two brothers and several of my friends to get an NSV. Once they saw that it didn't make me less of a man, they began to consider it. We all want to be able to provide for our children, and that means being able to plan when and how many babies we have. Thanks to this safe method, we can.”

Danso and Akosua are only one out of the 670,000 couples in Ghana who want and need contraception. Yet almost 350,000 have not accessed the services they need. Clearly, continued support and funding for NSV is a part of the long-term solution to unmet family planning needs in Ghana and many other countries.