About five years ago, Douglas and Sheila decided not to have any more children so that they could provide better for the ones they already had. "We wanted to educate them well," says Douglas, "and we realized that if we were to continue having children, we could not do that."

Douglas is one of several men who has utilized the vasectomy services supported by AVSC in Ghana. After having the procedure, he talked openly about it with friends and family members who were curious about his experience. Now, he travels around the region speaking publicly about the matter--even though he considers it to be very personal--because he believes that more people should have information about vasectomy, a family planning option that is unfamiliar to most members of his community.

Trading Places

"In Ghana, when there are problems in the marriage or family, we push it to the women," says Douglas. "So, it is the women who are doing most of the family planning."

When he and Sheila decided to stop having children, Sheila went to a nearby clinic to find out more about female sterilization. During the gynecological exam, the provider discovered that Sheila had fibroid tumors in her uterus, which--unless treated beforehand--could present complications during a tubal ligation. Sheila told Douglas that she was afraid to have the surgery.

Douglas turned to his next-door neighbor, a nurse, for advice. She told him that he and Sheila had options beyond female contraception. One option was vasectomy, which is a simpler and less costly procedure than tubal ligation.

"Why don't I trade places with you and have a vasectomy?" Douglas suggested to Sheila. "We can use the money we save to look after the children. Besides, I am not afraid."

Trust Is Key

Douglas was one of the first men to have a vasectomy at the local hospital in Kumasi. Looking back on the experience, he reflects, "If I had not asked my neighbor, I might never have found out about vasectomy. In my language, the words for vasectomy and castration are the same, and many people in my village think the procedures are also the same. But I trusted my neighbor. She is from my village. I knew she was not telling me lies."

After years of work in public health in Ghana, AVSC trainer Mark Asare knows that trust is a crucial factor in decision-making on reproductive health. "We have learned that men talk to their friends--other men--while women talk to other women in the community," he says.

Asare and Rose Nyarko-Dokyi, who also conducts training for AVSC, teach female and male clients such as Douglas to become experts in public speaking, basic contraceptive technology, and teamwork. By telling their own stories, these clients can educate people in their communities about family planning and reproductive health.

"Giving Testimony"

Once trained, the clients talk to people both informally and during outreach visits with local doctors and nurses. At times, they escort friends or family members to hospitals and clinics to get more information about family planning. Douglas enjoys passing on information about vasectomy to others. So far, he has referred five men to the local hospital.

The clients also tell their stories and give interviews on the radio, a process Nyarko-Dokyi calls "giving testimony": "It is very important that people give testimony on their experiences with family planning. Then the people listening think, 'Hey, this person went through the same thing that I'm going through. Maybe this could work for me.' In addition, hearing from people who have actually used family planning methods like vasectomy and Norplant implants takes the mystery out of them."

Value of Peer Education

Peer education is by no means a new method of outreach in public health. Researchers have found that just having information about a health issue usually is not enough to change an individual's behavior. It is often only after the person sees his or her peers performing or expressing support for the behavior that change occurs. For this reason, it is often more effective for community members, rather than providers or other "experts," to pass on positive messages and experiences regarding reproductive health.

According to Asare, this peer-education program in Ghana is especially important because it involves men in family planning and reproductive health. Traditionally, men have not been involved in or gotten information about reproductive health, so family planning clinics have come to be known as "women's clinics," where few men seek assistance. "We are merely trying to make informational networks more reliable and accurate," says Asare. "After all, male clients talk to each other; they often don't talk to the doctors."

Learning to Be Partners

The program also gives the clients an opportunity to learn more about partnership between men and women, especially in the context of reproductive health.

"Many men would never dream of taking part in family planning," says Nyarko-Dokyi. "They have never really been partners with their wives, only dictators. This program does more than merely educate these men and women about family planning methods. It also teaches them how to talk about partnership. This often comes out in their stories."

Presently, the program trains individual clients to serve as educators in three regions of Ghana. Nyarko-Dokyi hopes to expand the program to five regions and to include both individuals and couples. "I think it would be very good to work with couples," she says. "That way, we could show the positive effects of joint decision-making."

Peace of Mind

Life has gotten a lot better for Douglas and his family since he had a vasectomy four years ago.

"Now I have my peace of mind," he says. "My wife and I do not have to worry about pregnancy and caring for another child. I mean, poverty is everywhere, money problems are everywhere. But there's been a big change in our lives--a big change."

Eliza Mahony works with AVSC's Men As Partners program. Nicholas Kanlisi manages AVSC's program in Ghana.