Vasectomy in developing countries

Vasectomy is an acceptable technique of sterilisation in affluent societies; however, cultural barriers exist in most parts of Africa. The object of this study was to establish the prevalence of vasectomies at King George V Hospital (KGH), Durban, over a 3-year period, to determine attitudes towards vasectomy, and to identify ways of improving its acceptability. This was a retrospective study. Clinical details of case files were analysed and interviews of clients who had vasectomy were conducted telephonically or through home visits. A total of 308 (88.3%) clients were contacted. The mean age at vasectomy was 35 years (range 15-51 years). The majority, 50.3%, were Indians; 21% whites, 15.6% coloured and 12.3% were Africans; 290 of the men were married with a mean duration of marriage of 10.3 years (3-25 years). Ninety-four per cent were in a monogamous relationship and all remained married to date. Sixty-four per cent had above-matriculation educational status. Most of the patients became aware of vasectomy through family planning clinics or health personnel; only 4.9% received information through the media. Fifty-three per cent (n=164) of couples had problems with previously used contraception prior to decision for vasectomy. The complication rate was 6.5% while 1% regretted having had the procedure. Only two men (0.7%) desired reversal. On direct questioning, sexual activity remained unchanged in 95.1%, and actually improved in 3.2% of the men following vasectomy. Most believed that there is not enough information on vasectomy available, especially through the media, and that with appropriate counselling vasectomy is a safe permanent contraception that should be actively promoted.