#permanent methods

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Brian Okemwa, Law student, University of Nairobi

Nairobi, Kenya

I think that the juice will go out of the vasectomy and family planning conversation if it’s based too much on gender. Playing the gender card, the juice goes out of the conversation. I think family planning should be an intrinsic decision.

Interviewer: Liz Futrell

Photographer: David Alexander

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Alyssa Yee, World Vasectomy Day Supporter

Resident Physician, Urology, Maimonides Medical Center

Brooklyn, New York, U.S.A.

I wish that more people would talk to their friends about vasectomy. I’ve met so many men who’ve had a vasectomy, and they are really happy with the result. I want them to talk to their friends. Word spreads by mouth, and I wish that vasectomy would be more commonplace in conversation among other people, not just among men who have had a vasectomy. I want it to be a normal thing for a woman to bring up to her partner and for all health care providers to really discuss that as an option. I know that vasectomy may not be the right choice for everybody, but it is a choice that could be introduced more often than it is.

Interviewer: Liz Futrell

Photographer: David Alexander

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Nankya Faridah, Family Planning Client, Marie Stopes Kavule Clinic

Kampala, Uganda

I have five children. The first one was born in 1980, and the last one was born in 2000. After that last birth, I didn’t want to add any more children to my family. In 2010, I got a tubal ligation. I didn’t use a contraceptive method for those 10 years in between my last baby and the tubal ligation, although I was scared of getting pregnant.

In 2010, I came to the Marie Stopes Clinic for a tubal ligation. I realized my firstborn had started having children—I couldn’t also be having children at the same time! I’m very happy with my choice, because I have no side effects. I’m very comfortable. My husband and I made the decision together. He has children from another woman, too, and we realized we could not manage our whole big family if we continued to have more children. I even brought my sister to have a tubal ligation like me, and she is also happy with the method. I’m very happy that there is such a method to help a woman control her fertility and stop having more children than she can take care of. My daughters’ husbands still want children—they want about seven children. But when the time comes, I will talk to them about family planning, too.

Interviewer: Liz Futrell

Interpreter: Dorcas Tuhirirwe, Clinic Manager

Photographer: David Alexander

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Alyssa Yee, World Vasectomy Day Supporter

Resident Physician, Urology, Maimonides Medical Center

Brooklyn, New York, U.S.A.

I think a really important point in some of the communities I work with is to explain that [vasectomy] doesn’t change their hormones or their masculinity in any way. It just allows men to stop having more kids, and that’s great. It doesn’t alter their body in a noticeable way. They shouldn’t feel any different after the procedure, and they can continue to live a happy and healthy sexual life without worrying about contraception.

Photographer: David Alexander

Interviewer: Liz Futrell

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Dr. Charles Ochieng, Founder and Director, Winam Safe Parenthood Initiative (WISPIVAS)

Medical Director, No Scalpel Vasectomy International (NSVI)

Nairobi, Kenya

Personally, I’m very excited about vasectomy because I had mine eight years ago, and I’ve seen its wonders in my family, so I’m very passionate about it. My life was just pushing me towards vasectomy. I was brought up in a polygamous family. My dad had two wives and several children. I saw the way we were brought up was not very good. In terms of health care and education, it was a struggle. From that very early age, I started thinking that maybe because there were too many in our family, that’s why our life was difficult. That’s why I started thinking that, as a man, I should take responsibility for family planning. And also, my wife when she started using family planning, she had health challenges from the method that she used. So when we had our second child, I said that now was my time to do something.

Photographer: David Alexander

Interviewer: Sarah V. Harlan

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Ruth Mbogah, Vasectomy champion, wife of vasectomy client George Mbogah

Kenya

Our friends and family were surprised [when my husband got a vasectomy]. They were expecting us to have more children, not just one child, and just one girl. And in our culture, a girl is often not counted the same.

My hopes for my daughter are many. I want my daughter to get the best education and to become a doctor.

Photographer: David Alexander

Interviewer: Sarah V. Harlan

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George Mbogah, Vasectomy Client

Kenya

[My wife] took pills, and her legs would sometimes swell. She had a lot of backache, and her monthly period would prolong, even two months. It was so painful to me…. We said then, our time was up. We gave birth to one child—she is here. My wife underwent a bad operation after that pregnancy. In fact, the doctor told me, “If you give birth to more children, you are putting the life of your wife into jeopardy.” So I went home and sat down with my wife. We said, “We have tried this and this and this, and it’s not working, so what do we do?” I recommended for tubal ligation to her. But inwardly, I was the one who wanted to go for family planning. Where I was staying was a place called Isebania. I went to a place around there looking for male family planning. It was not there. I went to Kisii Town, to Marie Stopes, and it was not there. And then this guy, because I was speaking Luo, I asked him in mother tongue, in Luo, “You want to take me downtown to Kisii here? There’s no family planning for men?” He advised me to go up to Kisumu to Marie Stopes’ offices. The following day, I went up to Kisumu to the Marie Stopes office. There, I met Dr. Ochieng. I asked him, “I want family planning for men.” So why? I told him the reason: “I love my wife. I have seen her undergoing bad traumas, so I want to go about this.” And he told me that a visitor was coming from the U.S. So I went back... I traveled close to 1,000 kilometers from where I was up to Kisumu. And at the hospital…Dr. Doug Stein was the one who performed that vasectomy on me.

So what I want to say is this: I was not coerced. I was not forced to do vasectomy. I did it because I love my wife, because family planning has been hugely left to women. And this is now where vasectomy comes in. This is where we men should rise above our egos and accept vasectomy, because we want to show love to our wives. And actually if you look at the family planning methods, you will find that 99% are left to women, with no method for men. So that’s why I took that bold step. Nobody forced me, all those kilometers. And I’m not regretting it. I’m very happy. And at first…when I was telling people, they were telling me myths about vasectomy, like you will experience low libido. There’s nothing like that…. And mentally, I don’t have any problem, because I know I am not going to get an unexpected pregnancy.

Photographer: Sheila Gabeya

Story told during World Vasectomy Day press conference

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Sarah Miller, Faculty Physician and Family Planning Specialist, Walton Family Health Center, Institute for Family Health

Bronx, New York, U.S.A.

We have to promote vasectomy from all angles because people don’t know about it, and it’s not part of the discussion…. We’re trying to just keep talking to our brand new doctors here and the clinicians who are already working with us so that they know about it and so it’s just part of what happens when people come to see doctors. In our network of community health centers, there’s a strong push to make sure that when women of reproductive age come in, we make sure that their birth control needs are being addressed—that they’re not missing birth control, even if they come in for a cold.

We want to make sure that we’re also having this conversation with our male patients, and that’s not the standard of care in health care, even among primary care doctors. Even in family planning or clinics that focus on sexual health, it’s not something that we routinely talk to men about in health care. Part of that is because we don’t know what to talk about: “Are you having open healthy discussions with your partners? Are you thinking about pregnancy and birth control?” I feel like, “Well, what do I do? It’s not up to me.” At least when people know that vasectomy exists and that we’re doing it here, they have something that they can talk to people about. Even if it’s a young guy, even if they’re not interested in it, if we can say, “Hey, we do this here, when you’re ready or if you’re interested, you can talk to me about it, and I have someone to send you to.” We’re trying to educate our clinicians just so they can be having that discussion.

We do a lot of obstetrical care here and prenatal care, so we’re letting our pregnant patients know that this is an option—that’s a very important time to be having birth control discussions with people. We have found that in the world of vasectomy, just having signage up is a thing that can help because a lot of people don’t necessarily want to talk about it up front but may be thinking about it. We are going to be rolling out video monitors that have different pictures of birth control options, and there will be topics on vasectomy. And the World Vasectomy Day efforts have been very successful with getting the word out to people outside of our clinical settings and bringing them in to us.

Photographer: David Alexander

Interviewer: Liz Futrell