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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