A Successful Multi-Component Program for Expanding Vasectomy Services by MSI Reproductive Choices Bolivia

A program designed to improve the availability of vasectomy in public-sector clinics trained physicians at 43 facilities in no-scalpel vasectomy between 1993 and 1995. Among the 38 clinics that responded to a follow-up survey in 1996, the number of clinics providing vasectomies rose from 23 to 32, an increase of almost 40%, while the number of vasectomies performed rose by 18%. Seventeen of the 32 clinics performed more vasectomies after the training; 10 of the 17 had not previously provided the procedure. In-depth interviews with staff from seven sites that experienced large caseload increases and from seven that experienced decreases identified three elements for the successful establishment or expansion of vasectomy services-sufficient numbers of trained providers, funds to subsidize vasectomies for men who cannot afford them and activities to raise awareness about the availability of low-cost or free vasectomy.

The Ghana vasectomy initiative: Facilitating client–provider communication on no-scalpel vasectomy

Strengthening vasectomy services in Rwanda: introduction of thermal cautery with fascial interposition

Participation rate of men in the use of contraceptives in Indonesia is still very low, at only 2.1 % men and they generally using a condom. Yet unsupported use of vasectomy as a contraceptive program is because of the social environment, culture, society and family are still considered male participation has not been or is not important, knowledge and awareness of men and their families in family planning still low. The purpose of this research was to know the correlation between knowledge, perseption and social culture in men’s active participation on vasectomy program. This research was observational with Cross Sectional study. This research was using simple random sampling technic. Based on the result of this research, there was significant correlation between perception and men's participation on vasectomy program (p value=0.047), there was significant correlation between social culture and men's participation on vasectomy program (p value=0.002), there was no correlation between knowledgeand men's participation on vasectomy program (p value=0.054). Vasectomy acceptors were suggested to become models by doing a persuasive approach through a familial conversation, so the other men have desire to contribute on vasectomy program.

Despite global consensus on the importance of male involvement in family planning, disparities persist in low- and middle-income countries, where women continue to bear the responsibility for these initiatives. The Philippines, with a high fertility rate and unmet family planning needs, exemplifies this challenge. We present the experiences and lessons learned from implementing the no-scalpel vasectomy (NSV) program in Davao City, showcasing its potential for increasing male engagement in family planning decisions. Launched in 2008, the program aimed to address gender disparity by promoting NSV as a safe and effective contraceptive alternative to female-centric methods. Through the use of culturally sensitive information campaigns and couple-focused counseling, the program challenged traditional notions of masculinity and encouraged shared decision-making. Strong local government commitment and public-private partnerships played key roles in driving the program's success. Results showed an average annual increase of 80% in NSV clients over the past 3 years compared to before the COVID-19 pandemic, underscoring its effectiveness. The program presents a compelling intervention model for similar initiatives, highlighting how overcoming cultural barriers, infrastructure limitations, and budgetary constraints through policy advocacy, strategic partnerships, and tailored approaches can significantly boost male involvement in family planning and improve reproductive health outcomes within communities.

Vasectomy is a highly effective and safe contraceptive method for couples who want to stop childbearing, but only 2.4% of men around the world use this method. We conducted an extensive review of the vasectomy research literature and programmatic reports, published between April 2005 and April 2015, to synthesize barriers and facilitators to vasectomy adoption. Of the more than 230 documents initially retrieved in our search, we ultimately included 75 documents in our review and synthesized the findings according to the Supply-Enabling Environment-Demand (SEED) Programming Model. Regarding promoting demand for vasectomy services, we found there was a general lack of awareness about the method among both men and women, which often fueled erroneous assumptions about how vasectomy affects men. Several types of programmatic activities directly addressed knowledge gaps and negative misperceptions, including community-based and mass media communications, employer-based promotion, and group counseling. For supply of services, the lack of or inaccurate knowledge about vasectomy was also prevalent among providers, particularly among community-based health workers. Programmatic activities to improve service delivery included the use of evidence-based vasectomy techniques such as no-scalpel vasectomy, whole-site trainings, task shifting, cascade training, and mobile outreach. Finally, programmatic approaches to building a more enabling environment included engagement of governments and other community and religious leaders as well as campaigns with gender transformative messaging that countered common myths and encouraged men's positive engagement in family planning and reproductive health. In summary, a successful vasectomy program is comprised of the mutually reinforcing components of continual demand for services and access to and supply of well-trained providers. In addition, there is an underlying need for enabling policies within the cultural and gender environments that extend beyond vasectomy and include men not just as default partners of female family planning clients but as equal beneficiaries of family planning and reproductive health programs in their own right. Accelerating progress toward meaningful integration of vasectomy into a comprehensive contraceptive method mix is only possible when political and financial will are aligned and support the logistical and promotional activities of a male reproductive health agenda.

No-scalpel vasectomy at the King's birthday vasectomy festival

Vasectomy: AUA Guideline

Operations research findings are presented based on data collected from vasectomy programs in Brazil Colombia and Mexico. Operations research was conducted in the following contexts: a mass media vasectomy promotion in Sao Paulo Brazil in 1985; male-oriented clinics and promotion campaigns in medium-sized cities in Colombia; worksite talks and brochure distribution among clients of a Mexico City clinic in 1988-89; IEC videos and male promoters in clinics in Mexico City and two provincial cities in 1994; a follow-up of vasectomy acceptors in a Mexico City clinic in 1988; and vasectomy promotion at a Mexico City clinic in 1988. Vasectomy acceptors are characterized as averaging 32-35 years of age and with a high level of education small families and an urban residence. 56-98% of vasectomy clients or their wives were using contraception at the time the decision was made. 18-39% were using male methods. Decision making among respondents in the six projects followed four stages: awareness information-seeking evaluation and adoption. The awareness involved the realization that their desired number of children was reached or exceeded and that the present method of contraception was inadequate. Most vasectomy acceptors were informed about vasectomy through friends and relatives wives health personnel and mass media. The most common way of assessing promotion effectiveness is identified as the designation of the mass media as acceptors referral source. Ineffectiveness of interpersonal promotion strategies was attributed to poor audience segmentation and targeting. Men who were relatively young more educated and had fewer children were considered the most likely to have potential demand for vasectomy. It is concluded that potential clients were well-defined and informal interpersonal sources were very influential during the decision-making process. During the evaluation stage health personnel were the most consulted sources. Mass media was more effective in large cities with high quality services. Specific vasectomy messages are identified. Couples are expected to be open to vasectomy after family size is completed.

In India, family planning is considered to be the woman's responsibility and tubal ligation is much more popular compared to vasectomy. For every 98 women who undergo tubal libation, only...

Background: The objective of this study was to compare the standard vasectomy method and no scalpel vasectomy and complications, effectiveness, safety and acceptability of standard vasectomy (SV) versus no-scalpel standard vasectomy (NSV).Methods: Informed man who does not want to become father of any children and who desires an inexpensive outpatient method of voluntary permanent surgical sterilization, explain to patient and his wife regarding both procedure, semen analysis done after 3 months in every patient. Results: In NSV 72% patients required 10 to 20 minutes and in SV 100% required 20 to 35 minutes operative time. NSV, out of which 28% and in SV performed 60% having perioperative pain. NSV only 8% and 40% in SV having pain during follow up. In NSV average analgesic requirement was 2-3 days while among SV average analgesic requirement was 6-8 days. NSV, average antibiotic requirement was 5 days while among SV average antibiotic requirement was 7-10 days. In NSV 8% and in SV 32% were having infection during follow up. In NSV8% having wound problem during follow-up. In SV 32% having wound problem during follow-up. NSV 0% and in SV4% having vasectomy failure.Conclusions: Compared to the standard vasectomy technique, the no-scalpel vasectomy approach to the vas resulted in less bleeding, less pain during or after the procedure, and infection, as well as a shorter operative time, no longer day’s analgesic and antibiotic requirement and a more rapid resumption of sexual activity.

Introduction:Karimnagar District has consistently achieved highest rates of no-scalpel vasectomy (NSV) in the past decade when compared to state and national rates. This study was conducted to elucidate the underlying causes for higher acceptance of NSV in the district.Materials and Methods:A community-based, case control study was conducted. Sampling techniques used were purposive and simple random sampling. A semi-structured questionnaire was used to evaluate the socio-demographic, family characteristics, contraceptive history and predictors of contraceptive choice in 116 NSV acceptors and 120 other contraceptive users (OCUs). Postoperative complications and experiences were ascertained in NSV acceptors.Results:Age (χ2=11.79, P value = 0.008), literacy (χ2=17.95, P value = 0.03), duration of marriage (χ2=14.23, P value = 0.008) and number of children (χ2=10.45, P value = 0.01) were significant for acceptance of NSV. Among the predictors, method suggested by peer/ health worker (OR = 1.5, P value = 0.01), method does not require regular intervention (OR = 1.3, P value = 0.004) and permanence of the method (OR = 1.2, P value = 0.031) were significant. Acceptors were most satisfied with the shorter duration required to return to work and the most common complication was persistent postoperative pain among 12 (10.34%) of the acceptors.Conclusion:Advocating and implementing family planning is of high significance in view of the population growth in India and drawing from the demographic profile, predictors, pool of trainers and experiences in Karimnagar District, a similar achievement of higher rates of this simple procedure with few complications can be replicated.

Social marketing adopts marketing tools to achieve voluntary behaviour change, and has been effective in promoting a variety of public health and social wellbeing causes including, but not limited to, alcohol harm reduction (Kubacki, Rundle-Thiele, Pang, & Buyucek, 2015a), improving rates of physical activity (Gordon et al., 2006; Xia et al., 2016) and promotion of healthy eating (Carins & Rundle-Thiele, 2014). As social media have become an integral driver of modern communication in recent years (Lovejoy et al., 2012), social marketers have started incorporating the use of social media in their communications (Evans et al., 2019; Kubacki et al., 2015b; Li, Lia, & Lin, 2017; Neiger et al., 2013). Although the prominent advantages of social media include their ability to engage communities through two-way conversations (Jaakkola & Alexander, 2014; Lariviere et al., 2017), along with allowing them to create their own content (Ashley & Tuten, 2015; Kietzmann, Hermkens, McCarthy, & Silvestre, 2011), research suggests that social marketers have little knowledge about the use of social media for creating customer engagement in social marketing programmes (James et al., 2013; Justice-Gardiner et al., 2012; Neiger et al., 2012; 2013; Overbey, Jaykus, & Chapman, 2017). Further, social marketers have struggled to engage their audiences on social media, despite their potential to scale up programme reach and build ongoing community support to help resolve social issues (Rodriguez, Ostrow, & Kemp, 2017). Recognising the importance of creating customer engagement to bring about behaviour change, and also the noticeable dearth of research assessing the effectiveness of social media in creating such engagement, this PhD seeks to provide new insights into how to engage customers in social marketing programmes through the use of social media. This research was carried out as a series of inter-related studies. Study 1 is a systematic literature review to identify, analyse and evaluate social marketing programmes that have included the use of social media to engage their programme participants. Specifically, this study aims to better understand the use of social media in creating participant engagement across various social and health-related social marketing programmes. Study 2 involved qualitative in-depth interviews with social marketing practitioners who use social media to create engagement in their social marketing programmes as well as users who are engaged in these programmes via social media. The purpose of this study is twofold. First, it aims to gain an understanding of social marketing practitioners’ perceptions of customer engagement and the objectives and practices that guide their social media activities. Second, this study aims to develop insights into social media users’ perceptions of factors influencing their engagement in social marketing programmes. As a result, this study concludes with the proposition of a dynamic multi-actor social media engagement framework which is then applied in practice in Study 3. Study 3 consists of a netnography focusing on the communication of a social marketing initiative via social media. This study aims to explore the interactions between social marketing practitioners and users of their social media platform using the dynamic multi-actor engagement framework. Exploring their interactions provides insight into how these two groups engage with one another, and helps to identify the characteristics of their engagement on social media. The review of the existing social marketing programmes in Study 1 showed that social marketers were not harnessing social media’s potential in developing customer engagement and building relationships with their customers; rather, in most of the thirty-one social marketing studies examined, social media were mainly used to disseminate the programmes through one-way communication, with only a handful of programmes using social media to interact with users or to build enduring relationships with them. Moreover, conducting thirty-two interviews with social marketing practitioners and social media users allowed insights to be gained from both key stakeholder groups. Consequently, a new practical framework for multi-actor engagement in social marketing programmes was proposed along with measurement tools necessary for assessing its components. The multi-actor engagement framework recognises the dynamic and iterative engagement between multiple actors on social media, in contrast to simple dyadic interactions between the focal customer and organisation, which lead to the development of enduring and long-term relationships. The framework identified four distinct levels of engagement ― connection, interaction, loyalty and advocacy — all equally important constituents of engagement, and thus, equally important to developing sustainable social marketing impact. In addition, the application of this multi-actor engagement framework to understand, analyse and assess engagement behaviours in a real-life and ongoing social marketing programme on social media provided further insights into the applicability of the framework and identified additional measurements to further refine the overall applicability of the framework.

BackgroundMale circumcision (MC) has been shown to reduce the risk of HIV acquisition among heterosexual men, with WHO recommending MC as an essential component of comprehensive HIV prevention programs in high prevalence settings since 2007. While Papua New Guinea (PNG) has a current prevalence of only 1%, the high rates of sexually transmissible diseases and the extensive, but unregulated, practice of penile cutting in PNG have led the National Department of Health (NDoH) to consider introducing a MC program. Given public interest in circumcision even without active promotion by the NDoH, examining the potential health systems implications for MC without raising unrealistic expectations presents a number of methodological issues. In this study we examined health systems lessons learned from a national no-scalpel vasectomy (NSV) program, and their implications for a future MC program in PNG.MethodsFourteen in-depth interviews were conducted with frontline health workers and key government officials involved in NSV programs in PNG over a 3-week period in February and March 2011. Documentary, organizational and policy analysis of HIV and vasectomy services was conducted and triangulated with the interviews. All interviews were digitally recorded and later transcribed. Application of the WHO six building blocks of a health system was applied and further thematic analysis was conducted on the data with assistance from the analysis software MAXQDA.ResultsObstacles in funding pathways, inconsistent support by government departments, difficulties with staff retention and erratic delivery of training programs have resulted in mixed success of the national NSV program.ConclusionsIn an already vulnerable health system significant investment in training, resources and negotiation of clinical space will be required for an effective MC program. Focused leadership and open communication between provincial and national government, NGOs and community is necessary to assist in service sustainability. Ensuring clear policy and guidance across the entire sexual and reproductive health sector will provide opportunities to strengthen key areas of the health system.

Background: Research evidence published 10 to 15 years ago has shown that the type of vasectomy surgical technique performed can influence the effectiveness and the safety of the procedure. The objective of this study was to determine if evidence-based vasectomy surgical techniques are integrated in the vasectomy programs of selected low-resource countries.Methods: The surgical techniques recommended to perform the two steps of the vasectomy procedure (isolation/exposition and occlusion of the vas deferens) were extracted from current evidence-based clinical practice guidelines. Documents describing male sterilisation standards and practice from Kenya, Rwanda, India, Nepal, Mexico, Honduras, Colombia and Haiti were reviewed to assess adequacy with international guideline recommendations.Results: Best recommended techniques are 1) a minimally invasive technique including the no-scalpel technique (known as the no-scalpel vasectomy (NSV)) to isolate and expose the vas deferens, and 2) cautery of the mucosa of the vas preferably combined with interposition of the fascia (FI) to occlude the vas deferens. The NSV is largely adopted and performed to isolate the vas in selected low-resources countries. Ligation and excision (LE) of a small segment of the vas deferens combined with FI is the most common vas occlusion technique mentioned in the country standards. Cautery as recommended in the guidelines is seldom used in selected countries.Conclusions: Effective and adapted vasectomy vas occlusion techniques are available, but are still underused in many low-resource countries. Providing the most effective vasectomy surgical techniques increases users’ confidence and satisfaction regarding male sterilization and may lead to higher acceptability and uptake.