'Why I keep my vasectomy a secret' By Ashley Lime

BBC Africa, Nairobi Published duration 14 July 2018

Michael is one of the few African men to have had a vasectomy, but he's ashamed. He tells the BBC how cultural beliefs in Africa make it impossible to talk about the procedure, which some experts believe could provide a solution to the continent's rapid population growth.

"I wanted it to be a gift to my wife, a sacrifice," he says.

"To show her I really love her and that I could go an extra mile to do something extraordinary."

Michael - not his real name - had a vasectomy a few months ago, but he hasn't told anyone about it other than his wife.

"I would be very angry if anyone was to find out. There's so much stigma and I don't want people to judge me or get into my personal life," the 34-year-old says, explaining why he doesn't want to be identified for this article.

Unlike in Europe and the US where it is a commonplace procedure, male sterilisation provokes fear in many African countries.

What is a vasectomy?

media caption How a vasectomy works

A vasectomy (male sterilisation) is a surgical procedure to cut or seal the tubes that carry a man's sperm, to permanently prevent pregnancy.

The operation is usually carried out under local anaesthetic, where the patient is awake but does not feel any pain, and takes around 15 minutes.

It is more than 99% effective at preventing pregnancy.

A vasectomy does not affect a man's sex drive or his ability to enjoy sex. He will still have erections and ejaculate, but his semen will not contain sperm.

It does not protect against sexually transmitted infections (STIs), for which condoms remain one of the best contraceptives (98% effective if correctly used).

As few as 0.1% of African men have undergone vasectomies, according to a UN report from 2013 which remains the most detailed study on Africa to-date.

In South Africa and Namibia the rate is higher, at 0.7% and 0.4%, respectively. Worldwide, some 2.2% of men have had vasectomies compared to 18.9% of women who have been sterilised.

But Michael says he did not let culture get in the way of easing the suffering his wife endured from contraceptive injections.

They already had three children, he says, and didn't want any more.

"She was experiencing serious side-effects, like pain when lifting things," he adds. "Her skin was dry and rough, and she was losing weight very fast."

His wife says she can now live without the worry of having children she did not plan for.

But she worries that her community will one day find out, which is why she wants it to remain a secret. She was also surprised that her husband went through with it.

"I couldn't believe he would do it for me because no African man can do that," she tells the BBC.

"Where we come from people say men must have as many children as possible."

Calling all 'brave men'

One of the biggest reasons Africans have not embraced vasectomy, according to experts, is that many men are still ignorant and misinformed.

"Some people equate it with castration, because they think all the genitals are cut off and you remain like a woman," says Dr Charles Ochieng, a vasectomist at Family Health Options Kenya (FHOK), a sexual health NGO.

image copyright AFP/SONNY TUMBELAKA image caption Doctors are seen here performing a vasectomy on a man in Indonesia

A campaign for free, mass vasectomies in Kenya this year saw a number of men come forward. FHOK brought over a team of volunteer vasectomists from the US.

Family planning is traditionally left to women in Kenya. But during the four-day awareness drive, the NGO called on 100 "brave men" to shoulder the responsibility themselves by having a vasectomy.

About 70 men turned up, with the majority not wanting their identities to be revealed.

And this should concern Africans, since the continent's population is set to double by 2050 according to UN projections made last year

"The concentration of population growth in the poorest countries presents its own set of challenges," says John Wilmoth, director of the population division in the UN's Department of Economic and Social Affairs.

"It makes it more difficult to eradicate poverty and inequality, to combat hunger and malnutrition, and to expand educational enrolment and health systems."

You may also like:

Michael says his parents could not afford to provide three meals a day for him and his three siblings.

He describes dinnertime as a fight for survival, when his entire family would scramble to eat as much of the food on offer as possible.

"I come from a very big family and I saw the struggles my parents went through raising us," he adds. "I didn't want to go down that path".

"I just wanted to have a family I could easily manage."

The father-of-three says his vasectomy procedure took less than 20 minutes and the pain was minimal. In fact, he went back to work at his office the same day.

'Not a real man'

Michael says men should be fully informed before taking such a step.

"Some people think you're not a real man once you get a vasectomy," he tells the BBC.

Dr Ochieng says that there are some disadvantages to male sterilisation, but the pros outweigh the cons.

A man may feel a little pain a few hours after the procedure and is not allowed to lift heavy things for the following two days or so, he says.

Yet the operation has very few risks or complications, says the African Population and Health Research Centre (APHRC). It says vasectomies rarely last more 30 minutes.

Very few vasectomies fail, according to the APHRC, and in very rare cases the duct spontaneously reconnects. Indeed, as few as one in every 500 women has an unintended pregnancy in the year following their partner's vasectomy.

But surveys in recent years have shown that many African men are not aware of vasectomies as an effective means of family planning.

This contrasts with wealthy nations like Canada, where in 2013, the UN found that 22% of women of reproductive age who were married or in a union with a man relied on a vasectomy for contraception. In the the UK it was 21%, New Zealand 19.5%, and the US 11%.

In Kenya meanwhile, only 38% of married women and 48% of married men have heard of male sterilisation or vasectomy as a method of family planning, according to the latest study by the Kenya Demographic and Health Survey in 2014.

Its counterpart in Nigeria found that 16% of married women and 27% of married men surveyed in 2013 were aware. In Liberia, the figure is 20% for both married men and women, according to the 2013 Liberia Demographic and Health Survey.

Rwanda has encouraged men to consider vasectomies since 2011 in a bid to stem the small landlocked country's growing population.

"Those who will be willing to join the programme of family planning will be allowed to have a vasectomy," said the nation's health minister at the time.

Despite encouragement from the medical community, Michael says he does not expect to see great numbers of African men lining up for the snip anytime soon.

"Men are so cultured against it, so convincing them to undertake such a thing could be a tall order."