In the spotlight: SA’s low vasectomy numbers

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According to ‘Unwanted
Fertility in South Africa’
, a recently published report from Statistics
South Africa, “about 20% of all births in the five years preceding the 2016
Demographic and Health Survey (including pregnancies at the time),
happened when women were not planning on having any more children”.

The report,
based on demographic health data from 1998 and 2016, shows an increase in the
percentage of unwanted births from 17.3% in 1998 to 20.4% in 2016.

Various forms of temporary contraception
are already available in the public sector in South Africa – including condoms
and birth control pills, intra-uterine devices and contraceptive implants for
women – although availability of these various options varies between
healthcare facilities. There are no registered contraceptive pills or implants
for men – although research in this area is ongoing.

There are also more permanent birth control
options such as female and male sterilisation – the latter in the form of
vasectomy. According to this
Lancet article
, “vasectomy is simpler to perform, less invasive, safer, and
more cost effective than female sterilization”.

Vasectomy is a surgical procedure where the
sperm tubes (vas deferens) are tied off so that there is no longer sperm in a
man’s semen – thus rendering the man sterilised. A vasectomy does not have any
impact on a man’s sex drive and men who have had vasectomies still produce
semen.

As some
have argued
, vasectomies offer men a means by which to help shoulder the
burden of birth control. A man in a sexual relationship with a woman may, for
example, get a vasectomy so that she can stop taking the birth control pill.

Low
rates in South Africa

Popo Maja, spokesperson for the National
Department of Health, does not try to hide the fact that vasectomy rates in
South Africa are very low. According to Maja, only 639 vasectomies were
performed in South Africa in 2020.

This is close to half of the 2019 number of
1 391 and 2018’s 1 205. In 2017, 689 vasectomies were performed and
in 2016, the number stood at 564. Maja could not clarify whether these figures
were for the public sector alone or for both the private and public sector
combined (we suspect the prior) given how low these numbers are.

Though up-to-date figures are hard to find,
what evidence there is indicates South Africa, like most African countries, has
dramatically lower vasectomy rates than many other countries. (This UN
Population Division report
gathers much of the available data.) While fewer
than 1% of men aged 15 to 49 in South Africa have had vasectomies, the rate in
many wealthier countries is over 10%.

“We obviously are far below when it comes
to our figures on vasectomies. I guess our citizens still want to expand,” says
Maja.

He points out that in South Africa the Sterilisation
Act
regulates sterilisation. Among others, the Act explicitly states that
“a person capable of consenting may not be sterilised without his or her
consent”.

Spotlight previously
reported
on instances where female sterilisations were allegedly performed
without consent on women living with HIV.

How
easy is it to get a vasectomy in SA?

The Department of Health’s 2020 National
Sexual and Reproductive Health and Rights Policy
lists male sterilisation
as one of several modern contraception services that should be available in
public health facilities.

Maja confirmed that the service is available in public
sector facilities in all nine provinces, but could not confirm whether a target
in the 2012 National
Contraception Clinical Guidelines
to make the service available at a
minimum of one facility per district has been met.

The National
Clinical Guidelines for Contraception 2019
states that: “Vasectomy is a
permanent choice of contraception and, as such, requires serious consideration.
It has fewer side effects and complications than most contraceptive choices for
women.

It is, therefore, suitable for men who definitely do not want to have
any more (biological) children.” It also says that vasectomy is the “preferred
method of sterilisation” if a couple is sure that they do not wish to have any
more children.

Having a vasectomy in the private sector
typically costs a few thousand rands, with costs varying depending on factors
like the type of sedation being used. Some medical aid schemes will cover the
procedure, either partially or in full.

The
Metro Men’s Health Centre

While we have not been able to establish
how easy or how difficult it is to get a vasectomy in the public sector in
South Africa – it probably varies significantly from place to place-– there are
some initiatives that are trying to make the procedure more widely available.
One such example is at a men’s health centre in Cape Town.

“We are trying to focus on a holistic and
comprehensive list of services which would include vasectomies,” says Dr Abdul
Sungay, director at the Metro Men’s Health Centre at the Karl Bremer Hospital.
“We saw a need as some of our clients have been asking for the service.

“We then
approached the Tygerberg Urology team who have been running this service before
the Covid-19 lockdown and they’ve agreed to perform the procedures at our
facility,” Sungay says.

“Clients asking for this service should
call and make an appointment. When they arrive, they will be seen by a fertility
counsellor before the procedure. They may need to go to Tygerberg Hospital for
a follow-up test.

“Then, if all is well, the client’s next visit will be the
procedure. Boys aged 15–18 years can also access the facility for healthcare
support, but they will need a guardian to accompany them,” says Sungay.

Danelo Du Plessis is a lecturer from
Stellenbosch University’s Urology Department and has been offering his services
at the Men’s Health Centre. “We do vasectomies one morning per week, with five
to six per list,” he says. “I started at [the] Men’s Clinic on 3 May 2021.

“Prior to Covid-19 lockdown, we have been performing six per list (once a week)
at Karl Bremer Hospital, for many years (about 10 years).” He adds that the
service is free and that extensive counselling is done by a dedicated nurse
when the booking is made.

A
safe procedure

On the risks involved during surgery, Du
Plessis says the procedure is “very safe”. “Having said that, it always carries
inherited risks; in this case pain, infection, and bleeding would be most
common.”

The procedure, according to Du Plessis, is
99% effective and takes a minimum of 10-15 minutes. “Only the local anaesthetic
is felt, thereafter no pain. Full recovery by day five is the norm,” he says,
adding that men with chronic illnesses can also undergo it.

He explains that the procedure does not
work immediately.

“The sperm remaining in the vas deferens
and ejaculatory ducts needs to clear, which takes time. It is very important
that men confirm that there is no sperm in ejaculation at three months
post-procedure by means of a semen analysis,” he says.

Du Plessis says that a vasectomy can be
reversed, but that it should be regarded as a permanent form of contraception,
“as the reversal is not widely available and very expensive without guarantee
of success”.

Raising
awareness

Spokesperson for the national men’s organisation
Takuwani Riime, Sipho Barnes strongly believes that vasectomies have a vital
role to play in preventing unplanned pregnancies.

“We have made great strides in stressing
the importance of condoms to men to avoid STIs and HIV and with vasectomies, we
are encouraging men to use it to prevent unplanned pregnancies.

“But having said
that, we are also stressing to men that condom use is still important, whether
or not one has had a vasectomy.”

“Over the past years, we have been engaging
men about the importance of avoiding unplanned pregnancies,” he says.

“Many
children are wandering the streets because of unplanned pregnancies. Hence, we
are reaching out to communities to spread the message of vasectomy to men.”

*This article was produced by Spotlight– health journalism in the public interest.



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