Why does the burden of preventing pregnancy fall mostly on women?
Kampala, Uganda | FLAVIA NASSAKA | At the National Conference on Family Planning held in Kampala on Sept.27, it emerged that there is a simple question about contraceptives that many men cannot answer.
It all started when one of the delegates, Ngora LC 5 Chairperson Bernard Eumu, pointed out an issue that many ignore when talking about family planning – the male specific contraceptives. It was missing even on the programme for the two day long national conference in Kampala that brought together policy makers, community leaders, and advocates to gauge the gains and losses made in the year.
When The Independent asked Dr. Edson Muhwezi, the Country Representative of UNFPA which is a UN body that focuses on childbirth and population, why the issue of male contraceptives did it come up in the discussions, he said it is “an uphill task”.
“When Programming you have to go to the low hanging fruits rather than going for an uphill task engaging the men,” he said. He noted, however, that for Uganda to achieve its development targets, men who are the decision makers need to get involved and take up birth control options.
Uganda is one of the four countries in the world with the highest fertility rate above 5 children per woman. For the country to achieve its development targets including Vision 2040, the fertility rate should be 2 children per woman. Muhwezi says to achieve this, contraceptive use in the country should be at 67% yet the recent 2016 Health Demographic Survey put family planning use in the country at 35%, a contribution made largely by women.
It is only Eumu who spoke about it.
An orator with a politician’s gift of the garb and a sense of humour, Eumu spoke passionately about embracing contraceptives. He said if men do not take up family planning they “will be Internally Displaced in their own homes”.
““I fear this,” he said, “that’s why I’ve chosen to stop at three children.”
It was a loaded metaphor coming from a leader of an area still recovering from civil war and Internally Displaced Peoples (IDP) camps.
Ngora, a relatively new district in eastern Uganda has one of the highest fertility rates at 6.3 whereas the national rate stands at 5.4. As a leader in this area, Eumu is leading by example. He says he has chosen to reverse this statistic at least to half. His advocacy focus is also on men who for long have been left out on the family planning or contraceptive discussion.
He said every Friday, in Ngora, they talk about family planning on radio. They recently held a meeting exclusively for men.
“When we talk to them we tell them about the discomfort of having a big family. We tell them to support their wives in choosing methods,” Eumu said.
Men apparently have three contraceptive options – either to use withdrawal method which most health workers do not support because of unreliability, use the male condom, or undertake vasectomy; which involves blocking the tube that transports sperms.
Statistics show condom use among cohabiting and married males reduced to 54% from 71% in 2011. This poses questions as to why the condom is shunned yet it has no threat of side effects and has triple advantage of protecting against pregnancy, HIV and other sexually transmitted diseases. Vasectomy with its 100% efficacy in preventing pregnancy only attracts less than 1% of the men.
Eumu says many men lack information and the confidence to use these methods. To him it’s the assurance issue that needs to be tackled.
So why doesn’t he; a strong family planning advocate, undergo vasectomy. After all he already has the three children he wants. That proved to be a simple question that even Eumu could not answer.
“For a man to maintain a family you should be able to perform marital duties,” Eumu fumbled, “The fear is that once it’s destroyed your family is gone.”
His answer was interesting because it exposed how fear was blocking out even what he knows – that a vasectomy does not affect one’s sexual performance.
Dr. Charles Kiggundu a consultant Obstetrician at the National Referral hospital Mulago says men prefer condoms to vasectomy because “having a condom is just a tool used to bargain for sex”.
“It is not used consistently,” he said.
Kiggundu, who traverses the country to train health workers on how to conduct vasectomies, says part of the problem is also that not many doctors can do the surgery well, yet it is on a very sensitive part of the body.
“In a year, only one man or none will seek the service and as a result some health workers see no need of getting a skill they will only keep to themselves,” he says.
Vasectomy is shunned mainly because it is irreversible. Many men apparently say scientists should revise and come up with a temporal method that can be reversed in case one wants to change their decisions just like it is for women.
According to Dr. Placid Mihayo, the in charge of Reproductive Health at Ministry of Health this could soon happen with the advances in research. Already scientists in the U.S. have done a study on a jab for men that showed 96% efficacy. For experts, this hormone injection whose study results were released last year will end the need for vasectomies when it is rolled out for everyone to use outside trial setting.