A recent AVSC training program conducted in conjunction with the Navajo Nation Family Planning Corporation (NNFPC) has the potential to profoundly affect the provision of sterilization services on the Navajo Nation reservation, which covers 25,000 square miles in the four-corners area of Arizona, Colorado, New Mexico, and Utah.

Thanks to continuing support from the Richard & Rhoda Goldman Fund, The Educational Foundation of America, and another private funder, AVSC plans to continue and expand this program.

No-Scalpel Vasectomy Training

Last December, AVSC provided training in the no-scalpel vasectomy technique for Dr. Yang Wu, a family physician working at the Northern Navajo Medical Center in Shiprock, New Mexico. At the same time, AVSC also provided vasectomy counseling training for some of the Center's counseling and nursing staff.

Although Dr. Wu had not performed a single vasectomy at the Center during the first 11 months of 1995, he has performed more than 15 vasectomies since December alone--and expects to have performed more than 30 by the end of 1996. Dr. Wu attributes this increase to the fact that he and the counselors are actively offering vasectomy services and are discussing the services with the men and women they serve.

AVSC Invited to Return

After the training, Dr. Wu suggested to the nursing director that AVSC be invited to return to the Center to provide more extensive training in vasectomy and female sterilization counseling for all nursing staff at the hospital.

The Center is a one-year-old facility with 77 beds. Besides medical and surgical units, the Center includes a hogan to which family members can bring their medicine man. Through an arrangement with NNFPC, which provides family planning counseling and education on the Navajo Nation reservation, the Center has two full-time family planning counselors who work in the obstetrics-gynecology and postpartum wards counseling clients about family planning.

Nursing Staff Course

In March, AVSC and NNFPC presented a course on sterilization counseling to more than 30 nursing staff from the Center's obstetrics-gynecology, surgery, and family medicine wards. The first half of the course reviewed the provision of sterilization in the U.S. and presented videos showing sterilization techniques. The second half focused on barriers to Navajo men and women who would like to obtain sterilization.

Cultural Beliefs

Trainers and participants discussed the implications of barriers and Navajo cultural beliefs on counseling.

For example, because of strong cultural beliefs about the importance of childbearing, many Navajo women do not want their husbands to know they are going to have a sterilization, and some mention that they are afraid their husbands will abandon them if they can no longer bear children. Because of these beliefs, it is especially important for counselors to respect a client's desire to keep the procedure private from the partner, if necessary.

Also, since many Navajo women feel that their mothers' and grandmothers' approval of sterilization is very important, a counselor should suggest that they be included during counseling sessions.

Many women also express fear of early menopause or long-term chronic menstrual pain following sterilization--an indication that counselors should stress the possible changes that may occur as the result of discontinuation of hormonal methods or as part of the natural process of aging.

Men Also Affected

For men, cultural factors also affect service provision. Because of strong cultural barriers against a woman's discussing sex with a man with whom she is not intimate, female staff have particular difficulty talking to men about issues relating to men's anatomy and sexuality.

One counselor who attended the course had just returned from a men's health fair where she spoke about vasectomy to several men. She mentioned being embarrassed when talking to men about the effect of vasectomy on male sexual functioning.

The trainers recommended that, if women counselors continue to have problems discussing vasectomy with men, the Center should provide a Navajo man to do some of the counseling and outreach or have the male physicians on staff include information on vasectomy while meeting with patients.

Many of the Center's staff mentioned their reluctance to even discuss vasectomy with female patients. In light of this, the trainers emphasized during the training course that all counselors should share information on vasectomy with female clients who are in monogamous relationships and who are ready to end their fertility.

Expanded Training

In April, the AVSC vasectomy trainer returned to the Center to assure the quality of Dr. Wu's skills and to help him provide training to doctors at other health centers on the reservation. Funding from a private foundation will support this expansion of services over the next year.

Funding from the Goldman Fund and the Educational Foundation of America will allow AVSC to further expand support at the Navajo Nation reservation. As part of its worldwide Men as Partners initiative, AVSC will provide technical assistance to the male involvement program the NNFPC has been working to establish. In late 1996, AVSC also plans to provide a sterilization counseling update for all of NNFPC counselors working at centers throughout the reservation.

Jeanne Haws, director of AVSC's U.S. programs, and Georgia Crawford, executive director of the Navajo Nation Family Planning Corporation, were co-trainers for this program.