Monday May 12 2014

Why this father of 19 opted for vasectomy


By Agatha ayebazibwe

It is not common for a man in Uganda to come out publicly about his sexual life, especially so, if it involves a procedure many men still fear to talk about or even undergo. But 47-year-old Musa Kanene has defied this norm and openly talks about what made him undergo a vasectomy.

It all started in 1983, when Kanene, then a young soldier, was fighting alongside the National Resistance Army, the rebel outfit that would bring President Museveni to power. With the mobile lifestyle of the military, this meant that soldiers moved from one station to another quite often. During such mobility, Kanene found solace in siring children at any given opportunity.

“The orders of transfer always came abruptly. And I never moved with the woman I had at a particular time. I would always find a new woman in another district or area where I was deployed. I lived a careless lifestyle and fathered children all over the place,” he narrates, adding that it ceased becoming news if a woman called to inform him that she was expecting his child.

“In fact, I never even questioned any of them because all my children look like me. And I was always aware when I made a woman pregnant,” Kanene says of his days in the army.

Fathering 25 children
In fact, he ended up fathering 25 children from six women. Of these children, 19 are alive. And even though as a young man Kanene never dreamt of having a big family, he has no regrets of having fathered all these children. He retired from the army at the rank of Lieutenant in 2000, and is now employed as a boda boda operator.

Turning point
So what made him change his mind and want to stop having children? Kanene says his turning point came in 2005. At the time, he had 14 children. It was at this point that he felt the number of children he had were enough, and needed to find a long-term solution that would make him unable to impregnate any of his wives again.

“But before I could do that, I tested for HIV. Given the lifestyle I was living as a soldier, as well as my sexual behaviour, I was not sure if I had many years to live. Nevertheless, I felt a strong need to plan for my children when I still had the time, says Kanene.

After several HIV tests all turned negative, Kanene decided he would stick to only two wives. After long consideration, Kanene walked into the Kavule- based Marie Stopes Clinic in Bwaise, a Kampala suburb to have a vasectomy performed on him. He had heard about the procedure through a radio campaign.

“I explained my situation to the doctor and he asked why I was choosing permanent method when I was just 30. When I told him the number of children I had, he immediately gave me an appointment in three days,” says Kenene.But he did not return to the clinic as had been scheduled because his friends, with whom he had shared his intentions, discouraged him, claiming it would cause him impotence.

Although the thought of becoming impotent discouraged Kanene from his own plan, what he did not let go was his wish to stop having more children. And so he asked his wife to go for family planning.

He escorted her to a private clinic where she was given a depo provera, an injectable contraceptive method. However with this method, she would need to get a new shot after every three months. Kanene’s wife managed to stay on family planning for only eight months.

He says his wife started to experience side effects from the use of the contraceptive including heavy and prolonged menstrual flow and headache, which prompted her to stop using the method, but she did not inform her husband.

“When she got pregnant again, I became frustrated and confused. And my elder wife also became pregnant about the same time,” Kanene explains
Between 2005 and 2014 when he first consulted a doctor about the possibility of having a vasectomy, and when he finally had the procedure carried out in January this year, Kanene says he had fathered six more children.

At this point he was convinced that no one was going to help him to stop having children – not even his wives. And when another opportunity presented itself at one of the Marie Stopes outreaches in Nsambya, a Kampala suburb, Kanene embraced it.

Outreach campaigns
The Marie Stopes outreach programme involves using a mobile van goes around communities offering several services such as family planning, HIV testing and counseling. Kanene walked into the van and asked about vasectomy – a birth control procedure that involves cutting the tubes that carry a man’s sperm from his scrotum to testicles so that he cannot make a woman pregnant.

“I was given a card and told to go to the Marie Stopes clinic in Namuwongo. I went there the next day and met the doctor who would carry out the procedure on me two days later,” he says.
When he returned home, Kanene told his wives about his decision, which they supported.

And so, on February 2, 2014, Kanene had the surgery performed. In fact a few hours after the procedure, he was able to return to work.
But at the back of his mind, although he considered himself a free man, he worried about the possibility of becoming impotent, despite assurances from his doctor.

Today he says he is happy with the decision he made. But his colleagues and friends think he is impotent.
To the men who still think that family planning is only a woman’s role, Kanene says that they ought to know that for every unprotected intercourse, another pregnancy will result.

In fact, he says that it is largely ignorance that keeps men away from undertaking long term family planning methods and urges the Ministry of Health to create awareness about access of the different methods of family planning.

“If you are like me and you feel you have attained the number of children you want, vasectomy should be the right option to take because it will help you plan for those children and you will also enjoy your sex life without worrying about another pregnancy,” he says.

His dream now, is to educate all his children. Kanenene urges men to take responsibility of the number of children a couple should have, and not leave the decision to their wives.

What you should know about vasectomy

A vasectomy is a permanent birth control surgical procedure that involves cutting the vas deferens – the tubes that carry sperm from the scrotum to testicles.

The procedure prevents sperm from mixing with semen that is ejaculated from the penis. According Dr Milton Awudo, the director for medical development at Marie Stopes Uganda, after a vasectomy is performed, sperm cannot move out of the testes, and therefore, a man who has had such a procedure cannot make a woman pregnant.

This procedure, he says is recommended for men who feel that they have had their desired number of children and wish not to have more children in the future.

Men can also undergo a vasectomy for health reasons.
“For instance, if a couple is a carrier of sickle cell disease, this means any children they sire will have the disease. In most cases we do not recommend the use of non-permanent methods of birth control. Vasectomy is the best option for men or tuba ligation for women,” says Dr Awudo.

However in Uganda, although vasectomy is not yet the preferred choice of birth control method, more people are embracing it. Statistics from the Ministry of Health family planning division show that in 2013, a total of 2,721 men had a vasectomy, indicating a rise of 700 more people compared to 2012.

However, majority of these procedures were carried out in private health facilities such as Marie Stopes.
In fact, only 113 of the over 2700 procedures were carried out at public health facilities across the country.

For instance, between January and March this year, Marie Stopes Uganda carried out 397 vasectomy procedures while at Mulago hospital, the country’s largest referral facility, only one vasectomy was carried out between the same period.

But despite these seemingly low figures, the Health ministry believes this is a step in the right direction given that for a long time, the responsibility for birth control lay entirely on the woman.

“For a long time, men have had only one option of family planning – the condom, and because of the misconceptions they had heard about vasectomy, they never came up to utilise this option. However, given that the number of men who have been opting for it has been increasing over the years, we are excited,” says Dr Collins Tusingwire, the assistant commisioner for reproductive health at the ministry.

According to Alice Batwala, a nursing officer at the vasectomy theatre at Mulago hospital, misconception of what will happen to a man after undergoing a vasectomy keeps many away from taking it up. “Many people think it is castration and that they will lose their erection if they do a vasectomy,” he says.

Dr Awudo agrees, adding that a lot of public education will be required to change perceptions and convince men that they will not fail to perform if they undergo a vasectomy. He adds that little or no deliberate efforts have been put in place to educate men on vasectomy, and how different it is from castration,” he says.

When performing a vasectomy, Dr Awudo says the surgeon looks out for the vas deferens in the man’s scrotum – which is the duct that transports the sperm from the scrotum to the penis, and has nothing to do with interfering with a man’s sexual performance.

Instead, it is another tube called the neuro vascular bundle – which contains blood vessels and arteries that supply blood to a man’s sexual organ and also facilitate an erection. Other than the misconception, Awudo says most public facilities have not emphasised family planning for men.

“At public facilities, you will most likely get family planning services attached to female clinics such as the antenatal clinic, labour suite, immunisation and post natal services. “Even the condoms for family planning distributed at these facilities are put in women-only accessible areas.

This deters men from seeking such services,” he says, adding that even when men escort their wives to these facilities, the centres, the messages and discussions are tailored for women.

Matters are not helped by the fact that most of the family planning service providers are women.A quick tour to the different clinics that offer family planning services at Mulago hospital confirmed this, with none of the five facilities visited having a male family planning service provider. But the misconception is not just about the procedure.

Most men who have had a vasectomy do not talk about it openly. “As a result, we do not get satisfied users to propagate the message as much as women have done. We have a few in every region except northern Uganda where vasectomy has met serious resistance due to deep rooted cultural beliefs,” Dr Awudo says.

He recounted a case of a man who underwent a vasectomy, only for his wife to take the matter to the family division of the High Court, threatening to leave because she thought her husband had become impotent. Besides, there are a few doctors specially trained in this area across most public facilities in the country. Equipment also remains a challenge.
The Ministry of Health earlier this year procured vasectomy sets to be distributed in 230 public facilities across the country, according to Dr Tusingwire. However, he acknowledges that the uptake remains low because of lack of awareness, a challenge he says are being addressed through media campaigns and training of health workers.

How effective is vasectomy?
Being one of the most effective birth control methods, vasectomy has only a two per cent risk of making a woman pregnant, especially in cases where a man’s semen has not been checked three months after the procedure while for those who have done a semen analysis, it is one in 1000 risk of pregnancy.