NEW EVIDENCE ON
VASECTOMY AND MALE
INVOLVEMENT IN FAMILY
PLANNING IN RWANDA
Joshua Davis, MSPH
Overview
Context and program background
 Data and Methods
 Research objective
 Methods
 Results
 Conclusions

Background – Rwanda
Population: 10,473,282
th
 Pop. Growth: 2.7 (17 Worldwide)
 TFR: 5.5 children/woman (22nd worldwide)
 Most densely populated country in Africa
(similar in density to Netherlands)

•
•

48% of women want no more children
38% of women have unmet need for FP (want to limit or
space births but weren’t using contraception)
Government of Rwanda has made family
planning a national priority
Background – No-scalpel vasectomy
Safe, effective, underused
Percentage of women of reproductive age who rely on
vasectomy for contraception
Worldwide
2.7%
Africa
Asia
0.0%
3%
Latin America/Caribbean
1.3%
Europe
2.9%
North America
10.3%
Oceania
7.4%
Background – IntraHealth’s Pilot
Program
Funding from USAID’s Office of
Population
 NSV initially introduced in two districts

 Created
supply of trained providers
 Generated demand for services in
population
 Introduced data collection system for clients
Data – Program Evaluation
Conducted in Summer of 2009
 Goal was to evaluate aspects of the pilot
program that were successful and
develop recommendations for a countrywide scale up

Data – NSV client records
Parallel to standard HMIS to gather additional
information on male acceptors
 Additional questions were integrated into the
patient screening form:

 Demographic
information on clients
 Qualitative responses on use and attitudes towards
family planning
 Service outcomes and statistics
Objective

To assess the profile of vasectomy
acceptors and to identify key aspects of
the program that led to relatively high
uptake rates compared to similar efforts
in Sub-Saharan Africa
Methods – Program Evaluation

IntraHealth M&E staff conducted
evaluation in Summer 2009
 Focus
groups and individual interviews with
50 stakeholders
 Process evaluation of pilot implementation
Methods – Records Review
IntraHealth staff visited 10 sites where
NSVs were preformed by project-trained
staff
 Records were entered into a database
 Qualitative responses were categorized
by in country staff

Results
Socio-demographic characteristic of the males in the Rwandan NSV pilot program
Mean
n
Std. Dev.
Client's Age
44.8
450
9.6
Spouse's Age
38.3
440
7.4
Number of Children
5.7
453
2.1
Number of Sons
2.9
453
1.5
Number of Daughters
2.8
453
1.6
%
n
Education Level
None
25.8%
113
Primary
63.5%
278
Secondary
10.7%
47
Occupation
Farmer
91.3%
411
Unemployed
0.2%
1
Skilled Manual
2.7%
12
Prof., Tech., Manag.
3.3%
15
Sales, Services
2.0%
9
Unskilled manual
0.4%
2
HIV Status
No Answer
62.3%
286
Negative
26.8%
123
Positive
10.9%
50
Min.
24
24
0
0
0
Max.
85
65
14
7
9
NSV clients compared to DHS sample
NSV clients under 25 - 59 compared to DHS married sample
NSV Clients 25 -59
DHS married
n
Mean
n
Mean
Age
412
43.2
1583
39.9
Number of Children
412
5.6
1583
4.5
n
%
n
%
Education Level
None
95
23.9%
339
20.7%
Primary
256
64.3%
1002
63.3%
Secondary
47
11.8%
252
15.9%
Occupation
Farmer
371
90.5%
650
41.1%
Prof., Tech., Manag.
15
3.6%
116
7.3%
Skilled Manual
12
2.9%
127
8.0%
Sales
9
2.2%
56
3.5%
Unskilled manual
2
0.5%
73
4.6%
Not working
1
0.2%
555
35.1%
Other
0
6
0.4%
NSV clients compared to sample
Mean children by age of client, NSV and DHS
10
9
Children (mean)
8
7
6
5
DHS
4
NSV
3
2
1
0
25
30
35
40
45
Age
50
55
60
Reason for wishing to cease having
children
70%
60%
60%
50%
40%
30%
Enough children
Financial concerns
32%
Health
Other
20%
10%
8%
0%
n = 455
1%
Reasons for choosing vasectomy
50%
Concern about wife's
health
45%
40%
43%
Convienence/ease/eff
ectiveness of NSV
35%
30%
Enough children
25%
25%
20%
Financial concerns
15%
10%
5%
0%
12%
10%
5%
4%
n =448
Side effects of other
methods
Other
Rumors heard about FP and vasectomy
30%
25%
26%
26%
20%
Castration
20%
Decreased libido
15%
15%
13%
10%
Impotence
None
Other
5%
0%
n =196
Previous contraceptive use
45%
40%
40%
35%
30%
Injectables
25%
Pill
20%
Condom
21%
None
15%
15%
Other
14%
10%
10%
5%
0%
n = 461
Results – Program evaluation
•
Sustainable Approach
•
•
•
Community Health Worker outreach
•
•
252 men (54%) reported speaking to a CHW
before deciding to have a NSV
Service Extension Model
•
•
10 doctors and 25 nurses trained in NSV
Service expanded to 8 other (10 total) districts
59% of NSVs were done as part of extension
service
Engagement of Political Stakeholders
Conclusions
Given access and information, men in Rwanda
are willing to accept sterilization as a from of
family planning
 Supply creation and demand generation need
to be coordinated
 IEC materials can be delivered at a community
level in the absence of a mass media strategy

Thank you