Abstract
Despite being a reliable and cost effective family planning method, vasectomy remains underutilized in many low resource settings such as East Africa. We explored rural women’s perceptions and beliefs regarding barriers to vasectomy use in the low resource setting of Pwani, Tanzania. The qualitative study used in-depth semi-structured interviews to obtain data. Purposive sampling was used to recruit 20 married/cohabiting women with two or more children. Thematic analysis guided the data analysis, with qualitative data reporting informed by COREQ guidelines. Most participants were Muslim and had between two and six children. Most had completed primary-level education and were engaged in small-scale farming. We extracted three main themes with associated sub-themes:1) lack of education, which included men’s education levels and inadequate knowledge and misinformation 2) religious beliefs, social pressure and stigma, which included community stigma and the belief that vasectomy was not good for men with multiple wives; and 3) promoting men’s involvement in family planning which included educating men and the women’s perceived role in promoting vasectomy. Participating women perceived vasectomy uptake to be affected by a lack of low knowledge (among men, women, and the community), misinformation, and various sociocultural barriers. Efforts to promote vasectomy and male involvement in reproductive health services should be directed to addressing deeply-rooted sociocultural barriers. Women may have an essential role in encouraging their partners’ vasectomy uptake. In addition, engaging couples in family planning education is critical to enhance knowledge. Ideally, such community based education should be conducted in partnership with communities and healthcare providers.
Highlights
As women are the main users of family planning methods, understanding their perceptions and beliefs regarding barriers to vasectomy uptake is needed to support efforts to involve men in reproductive health and promote vasectomy as an effective, low cost option
Women in this study perceived that a low level of formal education among men in their communities was a major barrier to vasectomy uptake
Some women were supportive of men undergoing vasectomy while others were not
Summary
As women are the main users of family planning methods, understanding their perceptions and beliefs regarding barriers to vasectomy uptake is needed to support efforts to involve men in reproductive health and promote vasectomy as an effective, low cost option. Understanding of local culture and context enhanced the interpretation of data and added to credibility of this study Of note such pre-understanding might have lead to researchers presenting their own perceptions rather than solely those of participants, potentially affecting the trustworthiness of the results. This was mitigated by frequent discussion among the local research team and international researchers involved in this study, to ensure a reflected critical position. This helped the research team remain conscious of advantages and potential risks involved in the research process and ensure the results represented barriers as perceived by participating women
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