|Year : 2016 | Volume
| Issue : 4 | Page : 201-205
Knowledge and attitude toward vasectomy among antenatal clinic attendees in a tertiary health facility in Nigeria
Nyengidiki Kennedy Tamunomie, Oriji Vademene, Olaka Ebienju Walter
Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
|Date of Web Publication||21-Dec-2016|
Nyengidiki Kennedy Tamunomie
Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State
Background: Nigeria is the most populous nation in Africa and has a high fertility rate and low contraceptive prevalence. Various strategies have been developed to reduce the fertility rates, all aimed toward increasing contraceptive prevalence. Male sterilization is a safe, cheap, and effective method of contraception, but female perception and awareness of vasectomy may greatly affect its utilization. Objective: To determine the knowledge and attitude of antenatal patients in a Nigerian tertiary health facility toward vasectomy. Subjects and Methods: A cross-sectional study was conducted among antenatal clinic attendees. The participants were selected via systematic random sampling technique and a structured pretested questionnaire was used to assess their knowledge and attitude toward vasectomy. Data analysis was done using SPSS version 17 statistical software for windows XP and results were expressed in percentages. Results: One hundred and fifty respondents participated in the study, 83 (55.3%) were aware of vasectomy, 59 (71.08%) accepted it as a method of male contraception, and only 23 (38.98%) approved its use for their spouse. The main source of information on vasectomy was from health workers 53 (63.86%). Almost half of the women (47.8%) who accepted vasectomy did so because they felt men should also participate in family planning. Most of the women who disapproved of vasectomy cited it as an unpopular method. Conclusion: The approval of use of vasectomy by female partners is poor. Majority of these patients would not recommend it to their spouse as they have wrong perception of the procedure. Re-education of medical workers and wider public education through mass media may improve the approval of vasectomy by women for their spouses.
Keywords: Awareness, choice, perception, Port Harcourt, vasectomy
|How to cite this article:|
Tamunomie NK, Vademene O, Walter OE. Knowledge and attitude toward vasectomy among antenatal clinic attendees in a tertiary health facility in Nigeria. Sahel Med J 2016;19:201-5
|How to cite this URL:|
Tamunomie NK, Vademene O, Walter OE. Knowledge and attitude toward vasectomy among antenatal clinic attendees in a tertiary health facility in Nigeria. Sahel Med J [serial online] 2016 [cited 2020 Feb 17];19:201-5. Available from: http://www.smjonline.org/text.asp?2016/19/4/201/196363
| Introduction|| |
The 2006 census revealed that the population of Nigeria was a little above 140 million persons with a national population growth rate of 3.2% per annum.  Current estimates have it that the population of Nigeria is well over 170 million and rising with a high fertility rate of 5.5 births per woman and a relatively high mortality ratio of 576 per 100,000 live births.  These data suggest that more Nigerian women get pregnant and more are dying from pregnancy and its related complications. Thus, there is a need to limit family size by reducing the number of unwanted pregnancies.
The Safe Motherhood Initiative, a global campaign to reduce maternal mortality, launched in 1987, identified family planning as one of four strategies to reduce maternal mortality in developing countries, where 99% of all maternal deaths occur.  Family planning or contraceptive services have helped reduce maternal mortality and population growth in developed countries. The contraceptive prevalence rate in Nigeria is low compared to those of Ghana, South Africa, and the United Kingdom. , The low rates of contraceptive use in Nigeria and other developing countries is largely influenced by cultural perceptions and misconceptions about family planning methods, poverty, low levels of female education, as well as the unmet need for family planning from unavailability, and lack of access to family planning services. 
In Nigeria, the level of unmet need for family planning (20%) exceeds the level of contraceptive use (15.1%). , Male contraception is a viable addition to the range of contraceptive options, but there are, however, few options for male contraception and account for only 14% of contraception worldwide.  Vasectomy is a safe and simple outpatient procedure which has been performed worldwide with low failure rates and less incidence of complications.  While high acceptance rates have been reported in developed countries such as the USA, vasectomy is still not widely accepted in many African countries including Nigeria.  It is seen as a neglected form of permanent contraception in Nigeria and has very low acceptability rates. ,, This low level of use may be attributable to lack of public awareness of its effectiveness, safety profile, and convenience. , The Nigerian demographic and health survey 2013 reported that the knowledge of vasectomy was 15.5% among all women and 42.8% among men. 
Most of the information women had heard were incomplete or incorrect and their perceptions of vasectomy were driven by information which were influenced by some cultural beliefs and practices which might discourage their partners from having a vasectomy.  Women just like men have doubts about vasectomy and have great influence on the choice of contraceptive method by their spouse.  It is against this background that this study aims to determine the influence of awareness and perception of vasectomy among women attending antenatal clinic in the University of Port Harcourt Teaching Hospital (UPTH) and how it will influence the choice of vasectomy by their husbands.
| Subjects and methods|| |
This is a cross-sectional study involving 150 antenatal clinic attendees at the UPTH. The study recruited 150 women who attended routine antenatal care between July 07, 2014 and July 21, 2014 following the administration of 150 pretested structured questionnaires after due consent was obtained from the patients. The antenatal clinic runs Monday to Friday every week and had an average antenatal attendance of 150 women per day. The prestructured questionnaires were administered on every 15 women as they presented to the antenatal clinic over period of 3 weeks. Ten women were systematically randomly selected each day and questionnaires administered to them. Women who refused to give consent for the study were excluded; in addition, women who had already received the questionnaire previously were excluded subsequently. Sample size was determined using the formula proposed by Kish for the estimation of single proportions.  The required minimum sample was 150. Information obtained included: Age, educational status, religion, parity, awareness, and perceptions of male sterilization (vasectomy). The data was analyzed using SPSS version 17 statistical software (SPSS, Inc; Chicago USA). The data were presented in a tabular format and compared using simple percentages. Regression equation was applied when indicated and Chi-square test was used to test categorical variables with P < 0.05 considered statistically significant.
| Results|| |
One hundred and fifty questionnaires were administered and retrieved. The age range of respondents was 19-50 years with a mean age of 31.2 ± 6.4 years. Seventy-two respondents (48%) were of ages 30-39 years. One hundred and forty-two women were Christians (94.6%) and 138 (78.7%) had at least secondary education. Fifty-two respondents (34.7%) were nullipara. This is shown in [Table 1].
Eighty-three women (55.3%) were aware of vasectomy as a form of contraception. Fifty-three (63.9%) of them got their information about vasectomy from healthcare professionals, 13 (15.7%) from the internet, 9 (10.84%) from the mass media, 6 (7.2%) from friends, and 2 (2.4%) from relatives.
[Table 2] highlighted the perception of vasectomy, which was determined by asking the question "do you think that men should have this operation for family planning?" Of the 83 women who were aware of vasectomy, only 59 (71.1%) accepted vasectomy as a method of contraception for men, whereas 24 (28.9%) would not accept vasectomy. [Table 3] showed reasons for acceptance of vasectomy: among the 59 women who accepted vasectomy as a form of male contraception, 43 (72.9%) cited their desire for men to also participate in family planning as a reason for acceptance. Others cited reasons such as "vasectomy has less side effects," 7 (11.9%) and "it is effective," 6 (10.2%).
When asked "if they would allow their spouse to have a vasectomy," 23 women (39.0%) approved it whereas 36 (61.0%) disapproved its use. Thirteen (36.1%) of the 36 women who disapproved of vasectomy for their spouse said it was an unpopular method, 8 (22.2%) expressed fear of its side effects, 6 (16.7%) had fear of sexual dysfunction thereafter, 4 (11.1%) felt that having a vasectomy might encourage infidelity in the spouse, 3 (8.3%) stated religious prohibition, 1 (2.8%) stated cultural prohibition, and 1 (2.8%) complained of the irreversibility of the procedure. This is as shown in [Table 4].
There was a significant positive relationship between awareness and approval of vasectomy as a method of contraception (odds ratio [OR] =0.50, χ2 = 5.6, P = 0.018) and also between acceptance of vasectomy and approval of its use by the spouses (OR = 3.9, χ2 = 14.6, P = 0.00014).
Most of the respondents were Christians, however, comparing religion to approval of vasectomy (OR = 0.6, χ2 = 7.4, P = 0.1), this was not statistically significant.
A comparison of educational status with approval of vasectomy showed a nonsignificant relationship (χ2 = 9.1, P = 0.2)
When asked about their preferred choice for sterilization, 64.2% chose vasectomy as against 35.8% who choose bilateral tubal ligation (BTL).
| Discussion|| |
The women in this study were within the same age range as women from other studies. , In this study, the awareness of vasectomy as a method of male contraception was 55.3% which was higher than that observed in Uyo (11.5%), Jos (24.5%), and other parts of Nigeria. ,, It was however lower than the 94.5% from a study conducted in India.  Earlier studies had highlighted the influence of low knowledge on the acceptance of vasectomy. , The most common source of information on vasectomy in this study was from health care professionals. This situation is also reflected by other studies in Nigeria. , This emphasizes the need for counseling on vasectomy to be intensified in health institutions.
The acceptance of vasectomy as a form of contraception by the women was high in this study; however, the approval of vasectomy for the spouse was relatively low. This trend was reflected in the study by Mutihir et al., which reported an incidence of 0.28% over a 10-year period in Jos Nigeria.  In general, any form of sterilization is not widely accepted among Nigerian women. A study in Ilorin reported rates of 0.34% for BTL and 0.03% for vasectomy.  The low level of acceptance for spouse for vasectomy is attributable to the high level of ignorance and the misconceptions associated with the procedure.  The awareness level for male contraception can be increased with greater public awareness, re-education of health care workers, and continued patient counseling.
This study also shows that women desire more male participation in family planning. This is reflected in the fact that most women (72.9%) accepted vasectomy for contraception simply because they feel the man should participate. Other reasons for its acceptance were its effectiveness (11.9%) and safety (10.2%).
Most women in the study disapproved of vasectomy for their spouses stating that it was an unpopular method (22.2%). This buttresses the earlier stated fact that counseling on vasectomy is almost not carried out effectively.  Other reasons for disapproval cited in this study such as fear of sexual dysfunction (11.1%) and marital infidelity (8.3%) which have been reported by previous authors are due to misconceptions.  In countries where vasectomy is more popular than female sterilization, women tend to encourage their partners to be sterilized as vasectomy is easier than female sterilization.  Men are more likely to consider vasectomy if their partners favor it. In Guatemala and some hospitals in Turkey, more clients were attracted after providers discussed vasectomy with women during family planning talks.  Adequate counseling and sufficient information about the operation of sterilization may improve women's attitude toward sterilization in Nigeria. 
In this study, there was no significant association between religion or level of education and approval of vasectomy. This finding varies from that of the studies in Northern Nigeria where Muslim beliefs restrict the use of contraceptive methods. , The high level of education of women in this study did not translate to increased acceptance or approval of vasectomy. They made their choices based on the information available to them, which indicated that vasectomy was unpopular among the majority.
When presented with the choice of the preferred method of sterilization, more women chose male sterilization, although in the end, they would prefer that decisions on contraception be reached jointly with their spouses. Women who have the requisite knowledge of the options of contraception are better positioned to make an informed choice with their partners.
| Conclusion|| |
The findings in this study suggest that the awareness of vasectomy among women in Port Harcourt is suboptimal. This has negatively affected its acceptance and use as a form of contraception. It is thus recommended that adequate and accurate information on vasectomy be provided during client counseling. Health workers should discard any personal prejudices they may have against vasectomy and provide effective contraceptive counseling.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
National Population Commission (NPC) [Nigeria] and ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, Rockville, Maryland, USA: NPC and ICF International; 2014.
Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: An analysis of 172 countries. Lancet 2012;380:111-25.
Mandara M. Family planning in Nigeria and prospects for the future. Int J Gynaecol Obstet 2012;117:1-4.
Utoo BT, Utoo BM. Awareness and attitude of women towards their spouse′s use of vasectomy as a fertility control method in Jos, North-Central Nigeria. Jos J Med 2010;5:26-9.
Ebeigbe PN, Igberase GO, Eigbefoh J. Vasectomy: A survey of attitudes, counseling patterns and acceptance among Nigerian resident gynaecologists. Ghana Med J 2011;45:101-4.
Mutihir JT, Ujah IA, Ekwempu CC, Daru PH, Olabisi AA. Acceptability of vasectomy in Jos, Northern Nigeria. Trop J Obstet Gynaecol 2004;21:56-7.
Mutihir JT, Pam VC. Overview of contraceptive use in Jos University Teaching Hospital, north central Nigeria. Niger J Clin Pract 2008;11:139-43.
Akpamu U, Nwoke EO, Osifo UC, Igbinovia EN, Adisa AW. Knowledge and acceptance of ′vasectomy as a method of contraception′ amongst literate married men in Ekpoma, Nigeria. Afr J Biomed Res 2010;13:153-6.
Saoji A, Hajare S, Deoke A. Awareness and perception to vasectomy among women attending antenatal clinic at Teaching Hospital, Nagpur, India. Int J Biol Med Res 2012;3:2401-4.
Jekel JF, Katz DI, Elmore JG, editors. Sample size randomization and probable theory. In: Epidemiology Biostatistics and Preventive Medicine. 2 nd
ed. Philadelphia: WB Saunders; 2001. p. 196-204.
Yakasai IA, Yusuf AM. Contraceptive choices amongst women in Kano, Nigeria: A five (5) year review. J Med Trop 2013;15:113-6.
Umoh AV, Abah MG. Contraception awareness and practice among antenatal attendees in Uyo, Nigeria. Pan Afr Med J 2011;10:53.
Allagoa DO, Nyengidiki TK. Knowledge, attitude and practice of contraception amongst antenatal patients at the University of Port Harcourt teaching Hospital, Port Harcourt. Niger Health J 2011;11:89-92.
Oye-Adeniran BA, Adewole IF, Odeyemi KA, Ekanem EE, Umoh AV. Contraceptive prevalence among young women in Nigeria. J Obstet Gynaecol 2005;25:182-5.
Adebara IO, Ijaiya MA. Recent trends in pattern of contraceptive usage at a Nigerian tertiary hospital. J Clin Med Res 2010;2:180-4. Available from: http://www.academicjournals.org/JCMR
. [Last accessed on 2015 Jul 28].
Hosseini H, Abdi F. Experiences of vasectomy: A phenomenological study. N Am J Med Sci 2012;4:619-23.
Chigbu B, Onwere S, Aluka C, Kamanu C, Okoro O, Feyi-Waboso P. Contraceptive choices of women in rural Southeastern Nigeria. Niger J Clin Pract 2010;13:195-9.
Vernon R. Operative research on promoting vasectomy in the three Latin American countries. Int Fam Plan Perspect 1989;22:26-31.
Isah AY, Nwobodo EI. Family planning practice in a tertiary health institution in north-western Nigeria. Niger J Clin Pract 2009;12:281-3.
[Table 1], [Table 2], [Table 3], [Table 4]