1. SLIDE 1 Factors Affecting Acceptance and Use of Vasectomy in Kigoma and Dar es Salaam Tanzania Regions, Tanzania Authors: Emmanuel philipo 1, Festo mboya 1, Mengi Ntinginya 1, Mwemezi Ngemera 1, Olivia Nuccio 2 AMREF International Conference Nairobi Kenya 25 th November,2014 Presenter: Mengi Ntinginya Marie Stopes Tanzania

2. SLIDE 2 Background Vasectomy is a simple, safe, effective and permanent method of contraception available for men. Despite being a highly effective, vasectomy is relatively underutilized throughout the world, compared to tubal ligation. This is particularly true in Tanzania, where less than 1% of the population undergo vasectomy.

3. SLIDE 3 Study Objectives Purpose – To explore motivations and barriers to uptake of vasectomy services in the Kigoma and Dar es Salaam regions of Tanzania in order to design behaviour change communication strategies, to expand access to vasectomy services in Tanzania. Objectives – To identify how the community perceives men who have undergone vasectomy – To identify how the community perceives the wives of vasectomy clients

4. SLIDE 4 Methodology Study design Explorative: qualitative data collection Focus group discussions In-depth interviews Study population Adults men and women Married and unmarried 25 years and above Coverage Temeke and Ilala district, Dar es Salaam region Kasulu district and Kigoma urban, Kigoma region Sample: 16 Individual community groups(Total respondents 196) 43 in-depth interviews 13Vasectomized men 10 wife of the vasectomized men 20 non-vasectomized men All data were transcribed and coded for thematic analysis

5. SLIDE 5 Demographic Characteristics of Study Population More male(129) than female(110) participated in this study The average respondent was over 40 years, married, had a primary level of education, and worked in agriculture.

6. SLIDE 6 Why men accept Vasectomy? Desired family size Economic hardship ‘’....I am the second born in my family; I know what I have gone through caring for my younger sisters and brothers. I promised myself that I would have only two children at an interval of five years. My wife used implants until we got our second child. Then I said now it is my right time …… I undergone vasectomy…’’ (Vasectomized men, IDI- Ilala) ‘’…that is what motivated me, after the birth of our fifth child things were not going well and caring for those children was a challenge, so I decided to go for vasectomy so that I can have additional income to take care of my children …’’ (Vasectomized men, IDI- Kigoma)

7. SLIDE 7 Why men accept Vasectomy? Maintained sexual drive Evidence from the satisfied clients “…… my husband had vasectomy four years ago and up to this time he is doing fine, I can say he trusts me more now than ever since I have not gotten pregnant and this has improved our relationship and trust” (Wife of Vasectomized men, IDI- Kasulu) Male concern about partner’s health “….because she has high blood pressure and diabetic … so I decided to undergo vasectomy “ (Vasectomized men, IDI-Kasulu) “.... since undergone vasectomy, I have been able to motivate other men and three of them undergone vasectomy” (Vasectomised Men, IDI- Ilala) “… I didn’t see any change after vasectomy I am having sex as usual and I can see my sex drive has improved, I am 45 now but it seems like I have gone back to adolescence”(Vasectomi zed men, IDI-Ilala)

8. SLIDE 8 Why do men not choose Vasectomy? Lack of knowledge about vasectomy ‘’…. this information about male sterilization is new, what we know is women sterilization but for us men… it is a new lesson”(Male FGD Ilala) ‘’…..men think that the procedure is complicated and dangerous ”(Female FGD) Fear of the procedure and its side effects

9. SLIDE 9 Why do men not choose Vasectomy? Religion ‘’….based on Gods’ principles, religion does not agree with any harmful act concerning child birth when it can be avoided” (Male FGD Ilala) Desire for more children Concerns about the loss of sexual performance Partner’s disapproval of vasectomy

10. SLIDE 10 Community Perceptions of Vasectomized Men TeasedLaughed atCastratedUseless Man without power ‘’In our community when you tell a man to undergo vasectomy is like you have insulted him. He can even inform your parents and this will bring conflicit ” (FGD, female Ilala)

11. SLIDE 11 Vasectomy Services Data From 2012 to September 2014, a total of 392 male clients accessed vasectomy services at Marie Stopes..

12. SLIDE 12 Implications for programming A BCC campaign should address fears and misconceptions by providing facts about vasectomy. – Use a variety of communication channels and platforms Strengthen FP information and education by including FP messages targeting men. Engage satisfied clients to share their vasectomy experiences Encouraging spousal communications among partners about all FP methods, including vasectomy, will increase knowledge and acceptance.

13. SLIDE 13 Implications for programming Train more service providers to perform vasectomy, so that supply-side issues do not create a barrier. Improve pre and post vasectomy counselling, to improve knowledge and attitudes.

14. SLIDE 14 Thank You!