Trends in the Contraceptive Method Mix in Low- and Middle-Income Countries: Analysis Using a New “Average Deviation” Measure

This is a great article, but it is too dismissive of the prospects for the introduction of the no-scalpel vasectomy technique. For example, "Where the public in a country clearly dislikes a method and the national authorities neglect it, as with male sterilization in most countries..."

This seems to be a self-fulfilling prophecy that has not been tested by trials of adequately funded marketing program to address common myths about vasectomies. In addition, recent clinical research has shown much better effectiveness of vasectomy using hand-held, low-cost thermal cautery units - 99% or better; versus the simple ligation and excision technique that had been commonly used in developing country programs resulting in failure rates on the order of 5% [1], which may have contributed to programmatic failures.

At least two countries have introduced vasectomy programs that deserve mention, in both cases without any significant external support. In Iran, vasectomies were introduced and flourished, with vasectomy going from virtually zero in 1990 to over 3% by the 2000's [Appendix 2; and reference # 2 below]. Recently, vasectomy was outlawed by Iran [2], apparently because its political leadership decided that the national family planning program was too effective.

In Rwanda, the Minister of Health - a woman - weighed the pros and cons of female versus male sterilization, and initiated a national vasectomy program. Small amounts of external funding provided training in the no-scalpel vasectomy (NSV) technique and the use of hand-held, low- cost thermal cautery units powered by double AA batteries [3, 4]. The program deserves study and emulation by other countries.

References

1. Sharlip ID, Belker AM, Honig S, Labrecque M, Marmar JL, Ross LS, et al. Vasectomy: AUA guideline. J Urol. 2012 Dec;188(6 Suppl):2482-91.

2. Farrokh-Eslamlou H, Oshnouei S, Alinejad V. Novel restricted access to vasectomy in Iran: addressing changing trends in vasectomy clients' characteristics over 16years in northwestern Iran. Contraception. 2015 Nov;92(5):488-93.

3. Labrecque M, Kagabo L, Shattuck D, Wesson J, Rushanika C, Tshibanbe D, et al. Strengthening vasectomy services in Rwanda: introduction of thermal cautery with fascial interposition. Contraception. 2013 Mar;87(3):375-9.

4. Shattuck D, Wesson J, Nsengiyumva T, Kagabo L, Bristow H, Zan T, et al. Who chooses vasectomy in Rwanda? Survey data from couples who chose vasectomy, 2010-2012. Contraception. 2014 Jun;89(6):564-71.

Conflict of Interest:

None declared