Despite substantial cultural, economic, and racial differences, couples around the world undergo a remarkably similar decision-making process when choosing vasectomy as their family planning method.

So found a study conducted by AVSC International between 1992 and 1995, which was based on in-depth, qualitative interviews with couples using vasectomy in Bangladesh, Kenya, Mexico, and Rwanda, where vasectomy prevalence is relatively low, and Sri Lanka and the United States, where it is relatively high.

Somewhat surprisingly, the study found that in each of the countries, concerns about the woman's health were cited as reasons to cease childbearing and to use vasectomy as the means to do so.

According to Evelyn Landry, one of the study's principal investigators, "the fact that men and women base family planning decisions, in part, on women's health considerations is a message we haven't seen much before in other research. It really shows the idea of partnership in a relationship and in family planning decision-making." It also demonstrates the importance of looking beyond traditional stereotypes about gender roles in decision-making.

Several Factors Examined

The small, nonrepresentative sample study, which was based on 218 separate interviews with male and female partners, examined factors influencing the couples' decision to halt childbearing, factors affecting their decision to use vasectomy, and the roles of the male and female partners in the decision-making process.

In each of the countries studied, both men and women reported that their decision to end childbearing was made, at least in part, out of concern for the woman's health. The respondents talked about the toll of multiple pregnancies and how they believed that certain contraceptives, especially the pill, contributed to the poor health status of the woman.

Virtually all of the men and women interviewed described various degrees of financial hardship as contributing to the decision to stop having children. Couples in Bangladesh, Rwanda, and Sri Lanka spoke about hunger and the near starvation of their children, while couples in other countries said they wanted to provide better for the children they currently had.

Preferred Over Other Methods

When citing their reason for choosing vasectomy, some couples in each of the countries expressed dissatisfaction with, inconvenience of, or fear of the side effects of other methods. For example, responses from the male respondents in Mexico included: "I don't like condoms" and "The methods for women had more complications."

Another reason cited for choosing vasectomy over other methods was the belief that it was finally the man's turn to take responsibility for contraception, since it had always been the woman's role before. This finding, too, provides more insight into gender roles in family planning.

Risk Factors

Several reasons were given for deciding to choose vasectomy rather than tubal occlusion. Many couples in all of the countries cited a longer recovery time and greater risk associated with tubal occlusion than vasectomy. One couple in the U.S. stated their belief that tubal occlusion "is major surgery.... Men recover quickly; the woman has a couple of days of very bad discomfort."

Some of the couples indicated that men rather than women should undergo surgery because they are stronger. In addition, respondents in all of the countries except the U.S. reported that if the woman had had a tubal occlusion, she would not have been able to take care of her children while she recovered. Additionally, they stated that the man would have had to miss work to care for the woman during that time.

Social Influences

In some of the countries, the link between the woman's childbearing capacity and her social status may have influenced the decision to have vasectomy instead of tubal occlusion.

A respondent from Kenya explained that "it is wise for the man to be vasectomized.... If the woman has been sterilized, she will worry about her husband chasing her away from their matrimonial home and marrying another woman who will give him more children."

According to a Bangladeshi man with a younger partner, "She is still young.... At any time I might have an accident, but she may survive; she may even be bound for another marriage. Considering all of this, we decided for vasectomy."

Decision-Making Process

The findings on the roles of male and female partners in the decision-making process were less consistent than those about what factors led to the decision. While most couples indicated that the decision to stop having children should be made jointly by both partners, some couples in each country thought it should be the man's decision.

In Kenya, Rwanda, and Sri Lanka, for example, most of the couples reported that it was the man who decided that they had had enough children. And in all the countries except the U.S., some of the couples reported that the man had been the one to decide on family size.

Similarly, the decision to use vasectomy was often made with the participation of women, but not always. Generally, in countries where women reported having little say in reproductive decisions, such as in Bangladesh and Sri Lanka, the female respondents participated less in the decision to use vasectomy. Conversely, in Kenya, Rwanda, Mexico, and the U.S., both men and women reported that the woman had participated actively in the decision, having discussed the option with her partner before the procedure.

Lessons Learned

According to Landry, while more research is needed from the client's perspective, this body of work suggests that gender issues play an important role in a man's decision to seek vasectomy services. The fact that concern about the woman's health was cited repeatedly as a key consideration in the decision to use vasectomy to limit family size indicates that program planners and providers should work carefully with both men and women in their outreach efforts.

The findings also indicate that many of the respondents were ill-informed about the benefits, risks, and side effects of the various contraceptive methods, since several of the reasons they cited for being dissatisfied with other contraceptive methods were inaccurate. This suggests the need for greater client information, education, and counseling about family planning and reproductive health.

This article is based on Landry, E., and Ward, V. 1997. Perspectives from couples on the vasectomy decision: A six-country study. In Beyond Acceptability: Users' Perspectives on Contraception. London, U.K.: Reproductive Health Matters, pp. 58-67. Margaret Schehl is a freelance editor and writer for AVSC International.