Factors affecting vasectomy acceptability in Tanzania.
BACKGROUND
Calls for increased inclusion of men in matters of reproductive health emphasize the need for research into vasectomy acceptability and decision making. Vasectomy is a safe, simple and effective method of contraception, but is underused worldwide.


METHODS
Focus group discussions and in-depth interviews were conducted with potential and actual sterilization clients and their partners in the Kigoma Region of Tanzania. Content analysis was used to search for emergent themes related to vasectomy decision making.


RESULTS
Six themes emerged as overarching factors contributing to the vasectomy decision-making process: economics, spousal influence, religion, provider reputation and availability, uncertainty about the future, and poor vasectomy knowledge and understanding. There was substantial communication between partners regarding the vasectomy decision, and wives had a strong influence on the outcome; however, men and women agreed that husbands would resist vasectomy if wives initially raised the topic. Vasectomy acceptance is limited by the scarcity of skilled vasectomy providers and by the fact that men and women hold many of the same misunderstandings about vasectomy, including a fear of decreased sexual performance as a result of the procedure.


CONCLUSIONS
Spousal discussions are important in the decision to get a vasectomy, but these discussions should be initiated by the male partner. Programs need to educate men about contraceptive options, including vasectomies. Detailed, culturally relevant knowledge of the barriers and facilitators individuals experience during their decision- making process will enable vasectomy promotion programs to more successfully target appropriate populations.
Bunce
Arwen
A
Family Health International, Research Triangle Park, NC, USA. gguest@fhi.org
Guest
Greg
G
Searing
Hannah
H
Frajzyngier
Veronica
V
Riwa
Peter
P
Kanama
Joseph
J
Achwal
Isaac
I
D000328:Adult; D003142:Communication; D003268:Contraception Behavior / Q000523:psychology; D003657:Decision Making; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010342:Patient Acceptance of Health Care; D012747:Sexual Partners / Q000523:psychology; D013636:Tanzania; D014659:Vasectomy / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*