Experiences and Attitudes Towards Vasectomy in Family Planning Decision-Making: A Qualitative Study

Abstract

In Pakistan vasectomy has not been the most popular form of contraception amongst men but remains as a safe, effective and relatively simple permanent form of contraception. It was this qualitative research that attempted to discover the experiences, meaning, and the attitude of a married man who underwent vasectomy and how they negotiated the decision process about family planning in the mind of considering the social, marital, economic and religious life of Pakistan. A family planning center at the Jinnah postgraduate medical centre, Karachi was used using a descriptive phenomenological design. The sampling method used was purposive and five married males of age above 30 with one or more kids and who were interviewed in-depth until a thematic saturation was reached. The data was collected by using a demographic form and an interview guide with questions, which are open-ended questions, about family size, prior experience with the use of contraceptives, religious knowledge, socially related attitudes and a discussion on marital and expectation of vasectomy. Interviews were transcribed to audio then coded and analyzed through the thematic analysis. Seven themes were developed and they included: definition of the complete family, sources of information on vasectomy, vasectomy as the procedure, possible outcomes of vasectomy, religious attitudes, the reason of vasectomy and the use of other contraceptives. The respondents were biased towards a small family as a desirable one, the family restriction was connected to the welfare of children, and vasectomy was considered to be less of a burden in comparison to female sterilization. The majority thought that the process was not going to lead to decreased sexual prowess and lives and marriages were not going to be disrupted. The social opinion played a crucial role as well although the majority respondents were not interested in the opinion being voiced in the street but concerned with what was going on at home. Religious interpretation was the ambiguously area, with some men finding nothing wrong in the area as long as it was the care of children, and with others being assured that permanent contraception could not be something a man could be bound to. The findings are that ignorance alone can bring the acceptance of vasectomy to the men only partially and the overall effect of gender norms, economic pressure, peer pressure, spousal bargain and moral convictions are the reason. Programs that allow normalization of male participation, strengthen the counseling process and the reaction to the religious myths can increase the acceptance of vasectomy as a family responsibility in planning as a family affair.

Keywords: vasectomy, family planning, men, qualitative research, Pakistan, reproductive decision-making