1. Vasectomy knowledge, attitudes and practices in Nairobi County,
Kenya: An exploratory study
Raphael Ofware1
, Olivia Nuccio2
, Vitalis Akora1
, Jeremia Ochieng1
, Edward Kubai1
, Julie Taft2
, and
Cristin Gordon-Maclean2
Background:
Unmet need for family planning (FP) is high in Kenya, with an estimated 25% of women of
reproductive age needing services but not accessing them. In order to support universal access to
comprehensive FP and reproductive health services, Marie Stopes Kenya (MSK) maintains a network
of 23 static clinics, 15 teams who provide outreach services at over 600 sites every quarter, and 400
social franchise providers, who are private-sector partners. Service providers across channels
counsel clients for all FP methods, including vasectomy. However, uptake of vasectomy services
remains low across the network; on average, outreach teams in Nairobi provided just four
vasectomy services to clients each year since 2012. We sought to identify the types of messaging
and awareness-raising activities that could increase knowledge and acceptance of vasectomy.
Main research questions:
Our main research questions were:
 What are the current levels of knowledge, attitudes and practice for vasectomy?
 What are the community perceptions on availability and quality of vasectomy?
 How do the community perceptions on availability and quality of vasectomy impact on their
utilisation of these services?
 What are the most appropriate (trusted and reliable) sources of vasectomy messaging and
mediums for communication?
Methods:
Data for this exploratory research were collected using qualitative methodologies, including both
focus group discussions (FDGs) and in-depth interviews (IDIs). FDGs were held with men in the
general population who had not received vasectomy services and women whose husbands had not
received these services. IDIs were conducted with: men who had received vasectomy services;
women whose husbands had received vasectomy services; community health workers, who mobilise
men eligible for vasectomy services; and vasectomy providers.
Discussants for FGDs were purposively selected with the assistance of the network’s clinic staff.
People from across the community were invited to participate to enable triangulation of findings and
to incorporate wide-ranging perspectives. Purposive sampling was also used to recruit key
informants for IDIs; community health workers, community health extension workers and service
providers were selected based on their roles as key points of contact within the community and their
1
Research, Monitoring & Evaluation Team, Marie Stopes Kenya
2
Research, Monitoring & Evaluation Team, Marie Stopes International

2. knowledge of vasectomy. In addition, we used snowball sampling to recruit vasectomy acceptors for
IDIs.
Data were collected from January to February 2014, in Nairobi County, Kenya, and analysed using
content analysis
Results:
We conducted eight FDGs with 80 participants, and 12 IDIs interviews. Analysis of the resulting data
indicate that vasectomy is a widely known FP method, but negative attitudes about vasectomy are
common and hence uptake is low. The main identified factors were the belief that vasectomy is
equal to castration; that it causes an interference with testosterone production; the permanent
nature of the procedure; religious and traditional values; and negative attitudes towards limiting the
number of children. A prevalent perception was that vasectomies interfere with testosterone
production, which participants identified as the hormone that makes a man ‘a man’. Some
participants thought a man would regret having a vasectomy: “Our men’s dignity is eroded when
they are denied their right to have more children, something that would greatly affirm the male ego”
[Male, FGD]. Some women felt that vasectomy could lead to sexual promiscuity among
vasectomised men, as they would no longer have to worry about an unintended pregnancy.
Vasectomy acceptors were satisfied with the method and typically expressed positive attitudes. For
example, one acceptor said: “I am an outspoken and determined champion of [vasectomy] use as a
family planning method and I believe that if more men chose vasectomy, it could dramatically
improve the lives of Kenyan families.” [Vasectomy champion, IDI]
Knowledge contribution:
Although we found awareness of vasectomy as an FP method was moderately high, myths and
misconceptions inhibit utilisation of vasectomy services in Nairobi County and probably throughout
Kenya. A robust communication strategy is required to address the myths and misconceptions
surrounding vasectomy services. The network is using the findings from this study to advocate for
better public policies to promote vasectomy and to improve attitudes and practices among the
community. They have also set-up Well Man Clinics, which have a strong focus on the promotion of
vasectomy and other male-oriented contraceptive and general health services, in various outreach
sites in Nairobi. Trained male peer educators mobilise the communities around the Well Man Clinics,
educating and referring clients for services.