1. NEW EVIDENCE ON VASECTOMY AND MALE INVOLVEMENT IN FAMILY PLANNING IN RWANDA Joshua Davis, MSPH

2. Overview  Context and program background  Data and Methods  Research objective  Methods  Results  Conclusions

3. Background – Rwanda  Population: 10,473,282  Pop. Growth: 2.7 (17 th Worldwide)  TFR: 5.5 children/woman (22 nd 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

4. Background – No-scalpel vasectomy Safe, effective, underused Percentage of women of reproductive age who rely on vasectomy for contraception Worldwide 2.7% Africa0.0% Asia3% Latin America/Caribbean1.3% Europe2.9% North America10.3% Oceania7.4%

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Results Socio-demographic characteristic of the males in the Rwandan NSV pilot program MeannStd. Dev.Min.Max. Client's Age44.84509.62485 Spouse's Age38.34407.42465 Number of Children5.74532.1014 Number of Sons2.94531.507 Number of Daughters2.84531.609 %n Education Level None25.8%113 Primary63.5%278 Secondary10.7%47 Occupation Farmer91.3%411 Unemployed0.2%1 Skilled Manual2.7%12 Prof., Tech., Manag.3.3%15 Sales, Services2.0%9 Unskilled manual0.4%2 HIV Status No Answer62.3%286 Negative26.8%123 Positive10.9%50

12. NSV clients compared to DHS sample NSV clients under 25 - 59 compared to DHS married sample NSV Clients 25 -59DHS married nMeann Age41243.2158339.9 Number of Children4125.615834.5 n%n% Education Level None9523.9%33920.7% Primary25664.3%100263.3% Secondary4711.8%25215.9% Occupation Farmer37190.5%65041.1% Prof., Tech., Manag.153.6%1167.3% Skilled Manual122.9%1278.0% Sales92.2%563.5% Unskilled manual20.5%734.6% Not working10.2%55535.1% Other0 60.4%

13. NSV clients compared to sample

14. Reason for wishing to cease having children

15. Reasons for choosing vasectomy

16. Rumors heard about FP and vasectomy

17. Previous contraceptive use

18. 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

19. 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

20. Thank you