NEW EVIDENCE ON VASECTOMY AND MALE INVOLVEMENT IN FAMILY PLANNING IN RWANDA

Joshua Davis, MSPH

Overview

Context and program background

Data and MethodsResearch objectiveMethodsResultsConclusions

Background – Rwanda

Population: 10,473,282 Pop. Growth: 2.7 (17th Worldwide) TFR: 5.5 children/woman (22nd worldwide) Most densely populated country in Africa

(similar in density to Netherlands)• 48% of women want no more children• 38% of women have unmet need for FP (want to limit or space

births but weren’t using contraception) Government of Rwanda has made family

planning a national priority

Background – No-scalpel vasectomySafe, effective, underused

Percentage of women of reproductive age who rely on vasectomy for contraception

Worldwide 2.7%Africa 0.0%Asia 3%Latin America/Caribbean 1.3%Europe 2.9%North America 10.3%Oceania 7.4%

Background – IntraHealth’s Pilot Program Funding from USAID’s Office of

Population NSV initially introduced in two

districts Created supply of trained providers Generated demand for services in

population Introduced data collection system for

clients

Data – Program Evaluation

Conducted in Summer of 2009 Goal was to evaluate aspects of

the pilot program that were successful and develop recommendations for a country-wide scale up

Data – NSV client records

Parallel to standard HMIS to gather additional information on male acceptors

Additional questions were integrated into the patient screening form: Demographic information on clients Qualitative responses on use and

attitudes towards family planning Service outcomes and statistics

Objective

To assess the profile of vasectomy acceptors and to identify key aspects of the program that led to relatively high uptake rates compared to similar efforts in Sub-Saharan Africa

Methods – Program Evaluation IntraHealth M&E staff conducted

evaluation in Summer 2009 Focus groups and individual

interviews with 50 stakeholders Process evaluation of pilot

implementation

Methods – Records Review

IntraHealth staff visited 10 sites where NSVs were preformed by project-trained staff

Records were entered into a database

Qualitative responses were categorized by in country staff

Results

Socio-demographic characteristic of the males in the Rwandan NSV pilot program Mean n Std. Dev. Min. Max.Client's Age 44.8 450 9.6 24 85Spouse's Age 38.3 440 7.4 24 65Number of Children 5.7 453 2.1 0 14

Number of Sons 2.9 453 1.5 0 7Number of Daughters 2.8 453 1.6 0 9

  % n Education Level

None 25.8% 113Primary 63.5% 278Secondary 10.7% 47

OccupationFarmer 91.3% 411Unemployed 0.2% 1Skilled Manual 2.7% 12Prof., Tech., Manag. 3.3% 15Sales, Services 2.0% 9Unskilled manual 0.4% 2

HIV StatusNo Answer 62.3% 286Negative 26.8% 123Positive 10.9% 50

NSV clients compared to DHS sample

NSV clients under 25 - 59 compared to DHS married sampleNSV Clients 25 -59 DHS married

n Mean n MeanAge 412 43.2 1583 39.9Number of Children 412 5.6 1583 4.5  n % n %Education Level

None 95 23.9% 339 20.7%Primary 256 64.3% 1002 63.3%Secondary 47 11.8% 252 15.9%

Occupation Farmer 371 90.5% 650 41.1%Prof., Tech., Manag. 15 3.6% 116 7.3%Skilled Manual 12 2.9% 127 8.0%Sales 9 2.2% 56 3.5%Unskilled manual 2 0.5% 73 4.6%Not working 1 0.2% 555 35.1%Other 0 6 0.4%

NSV clients compared to sample

Reason for wishing to cease having children

Reasons for choosing vasectomy

Rumors heard about FP and vasectomy

Previous contraceptive use

Results – Program evaluation• Sustainable Approach• 10 doctors and 25 nurses trained in NSV• Service expanded to 8 other (10 total)

districts• Community Health Worker outreach• 252 men (54%) reported speaking to a CHW

before deciding to have a NSV• Service Extension Model• 59% of NSVs were done as part of extension

service• Engagement of Political Stakeholders

Conclusions

Given access and information, men in Rwanda are willing to accept sterilization as a from of family planning

Supply creation and demand generation need to be coordinated

IEC materials can be delivered at a community level in the absence of a mass media strategy

Thank you