Vasectomy: Reaching Out to New Users

This 24-page article from the Johns Hopkins Bloomberg School of Public Health Population Reports discusses how family planning programmes can introduce or expand vasectomy services. The thesis of the article is that "[w]hen information and services are available, many men who do not want more children choose vasectomy. Yet few programs offer vasectomy services." This publication includes information on the body of programme experience and research that show how to attract clients for the procedure, how to motivate providers, and how to expand access to vasectomy.

The report identifies and addresses the barriers that discourage men from choosing vasectomy, describes the selection of communication channels and the design of persuasive messages, describes the development of provider training for both counsellors and those carrying out the procedure, and advises on planning and scaling up vasectomy services. The section "Vigorous Promotion Attracts Clients" is based on designing messages to change the views of vasectomy of both providers and clients through communication campaigns. Communication foci for moving forward are centred on promotion by mass media campaigns and interpersonal communication.


According to the report, a communication campaign needs to:

1. "Make people aware of vasectomy;
2. Dispel myths and rumors;
3. Disseminate accurate information about the procedure;
4. Tell men where the method is offered;
5. Prompt men to discuss vasectomy with family and friends;
6. Encourage men to call and visit clinics; and
7. Increase the number of vasectomies performed."

The communication section of the report highlights both finding a receptive audience and analysing themes that are well received. The example of a receptive audience for communication campaigns in Latin America is "men who are relatively well-educated, urban, married, and in their late 20s to mid 30s; these men have two or three children and already rely on a family planning method." Six themes from audience analysis studies world wide that promote the positive benefits of vasectomy are the following:

1. Providing for the family (resulting from limiting family size), including offering greater opportunities to the children men already have, including more schooling.
2. Love and concern for the wife, including protecting the wives’ health from the effects of more pregnancies by taking responsibility for family planning.
3. Advantages over other contraceptive methods, particularly for those dissatisfied with other family planning methods.
4. Permanence, for couples who have decided they do not want more children.
5. A simpler choice - male sterilisation being simpler and more cost effective than female sterilisation.
6. Sexual satisfaction - like other permanent methods, decreased concern may increase men’s and women’s sexual enjoyment.

Because different themes are important in different countries, the report recommends conducting audience research and pretesting messages with men who might consider vasectomy to make sure that messages respond to local interests. It also recommends including women in counselling and, in some countries, addressing women directly. An example of the latter is the approach of a hospital in Guatemala that discussed vasectomy with women who have just delivered a baby. Some facilities use similar counselling for women who have just sought abortions. The report suggests and gives examples of the effectiveness of using women's positive perspectives in campaign messages, when supported by audience testing.


Studies on which sources of information are convincing men to seek vasectomies show that both mass media and interpersonal communication can be effective. Mass media can increase general awareness and willingness to inquire about vasectomies. The incorporation of telephone hotlines with mass media campaigns has shown itself to provide confidentiality and the ability to direct men to service locations and health counseling. Recruiting satisfied clients as promoters and finding venues for their messages, as stated here, can change community attitudes. If men are reluctant to talk about their vasectomies because of perceived community disapproval, communication campaigns, including mass media, can address this barrier.


Sustained campaigning shows resulting statistical increases over single campaign efforts; but research also suggests that, with each campaign closure, statistics remain above precampaign levels, showing the likelihood of cumulative effects of subsequent campaigns. Ghana’s “Permanent Smile” campaign is an example of the use of particularly crafted messages disseminated through multiple communication channels that was, as reported here, successfully scaled-up for use in a different cultural setting: Honduras.


The report continues with strategies to promote vasectomy at health care facilities through: outdoor signs that advertise the availability of services; leaflets and brochures to disseminate accurate information; staff members who are prepared to inform clients about the method and direct them to services; and thorough, accurate, and balanced counseling. Staff training can include orienting all staff members, including receptionists, laboratory technicians, and providers who offer other health services, to a basic understanding of vasectomy and its benefits in order to increase the comfort level of discussing with clients the possibility of vasectomy. Training for staff of primary care facilities on the value of vasectomy can increase the number of referrals to clinics prepared to provide the service.


The document conclusions include adopting a gender perspective: "What works for women clients does not necessarily work for men. To reach men, family planning programs must understand men’s point of view, address men’s concerns and questions, and tailor services - including the setting, staff, and services offered - to men’s needs. A convenient location and hours, men-only clinics or clinic hours, and male providers can be helpful. Offering an array of male reproductive health services, such as treatment of STIs, sexual dysfunction, and urinary problems, can appeal to some men. It is also important to understand and respect how men’s behavior as health care clients differs from women’s. For example, men ask more questions and more often need convincing. At the same time, they may need more information and reassurance.”