Vasectomies in RwandaMaziyateke | Category: Opinion
Family planning in Africa – also known as the fertile and nurturing ground for all humanity – is met with slight resistance and hostility. African culture is very tied to the ideologies of procreation and fertility but regardless of these traditions, there are concerns about the rate with which the global population is increasing, especially for Africa which ranks as the poorest and most under developed continent in the world. In 2010, Rwanda had a population of 10,624,000 (World Bank), this is more than 1000 people per square mile and as such Rwanda is the most densely populated country in sub-Saharan Africa. Although the Rwandan economy is growing fast the population is growing even faster thereby contributing to the factors that thwart the Government’s efforts to meet their ‘middle-income economy’ target by 2020.
The current fertility rate in Rwanda is 5.5, and the Government’s aim is to reduce that to 3, while the average annual economic growth remains at 8%. According to Dr Agnes Binagwaho, Minister of Health, ‘Rwanda’s population policy, of which family planning and spacing is but one component, is carefully crafted and calibrated to match population to growth. ’However, despite the improvements in family planning during the last decade the Government is facing major challenges to include the 38% of the population that has no access to modern family planning methods.
Voluntary vasectomies campaign
Fuelling this debate is the ‘voluntary’ vasectomies campaign; a campaign introduced by the Ministry of Health in late 2010 to sensitise men about no-scalpel vasectomy (NSV), a permanent birth control/ male sterilisation method. The Rwandan opposition has rejected this policy; in a statement issued in February 2011, Sylvain Sibomana – the Secretary General of FDU-Inkingi – said, “this mass emasculation policy should stop with no further debates. The idea that those who can’t afford to pay for their family needs must enrol in a draconian birth control system is nothing but pure discrimination against the poor.”
The use of ‘emasculation’ is certainly questionable in this context, since medical studies have proved that sterilisation does not rid you of your masculinity nor your virility. However the belief that vasectomy is synonymous to castration is the main reason why Rwandan men have fear of undergoing the procedure.
Nevertheless, reports from Syfia Grands Lacs show that for some women – especially in the rural areas – vasectomies offer a sliver of hope as they take away the fear of financial hardships as well as pre-natal and post-natal health issues caused by multiple pregnancies.
In response to the opposition, Dr Binagwaho said, “I will end where I begun. The Rwandan Government’s Family Planning Policy, is evidence based, ethical, and is participatory. It is built on many pillars, family planning being one, albeit important one. It has no room for rigid ideologies, or unhelpful political posturing. There is no left, right, or centre in this program, just the reality of the imperative to match Rwanda’s population growth with her capacity to provide her sons and daughters with the Wealth and dignity they deserve.”
A forceful and inhumane act
In a recent Twitter exchange with Dr. Agnes Binagwaho about vasectomy policy in Rwanda she reaffirmed that ‘the sensitization of the population for voluntary vasectomy is on-going. [The] response is good. People are responding and have created an association of men who have benefited from vasectomy in Rwanda but there is room for better outcomes. [There is] no time limit, no target, it is a voluntary and personal choice’
While there is room to agree with this response, from a population overflow context, it is difficult to determine how voluntary it is. Dr Charles Kambanda, a former lecturer at the National University of Rwanda, questioned the use of ‘voluntary’ to describe this policy, in an article titled ‘Rwanda: Why Sterilise the Poor?’ In this article, Dr Kambanda looks back at the government of Rwanda’s implementation of the habitant and land reform policy in 1994, which encouraged ‘voluntary’ repatriation from traditional homesteads to settlement areas called imidugudu. He described the process as “forceful and inhumane” then goes on to say that, “the Government’s policy of what was called voluntary sharing of land between the Hutu owners and the Tutsi returnees ended in the forceful grabbing of land from the Hutu in many regions of the country.”
Family Planning: whose decision?
According to a study coordinated by USAID and the Capacity Project in 2005, the reason behind the choice of male over female sterilisation in Rwanda is due to the fact that there are less post-operative complications. The World Health Organisation (WHO) also confirmed this by stating that it is the safest and most effective contraceptive method. In addition, an article published by Vernon et al (2007) called Introducing Sustainable Vasectomy Services in Guatemala, argued that with vasectomies men have more say in the ‘reproductive decision-making’. While it is commendable that women do not have to bear the brunt of a national problem, it does not take into consideration the already patriarchal culture that exists in Rwanda.
An interesting and somewhat ironic factor to this ‘voluntary’ vasectomy is that it has to be a joint decision between a couple, and the partner must come along to the operation to prove that she is in agreement. But we must ask these questions: in a relationship, who decides when it is time to have children? Who decides whether a condom is used or not? Who initiates the sexual act?
While Rwanda has made giant leaps in female representation within the Government, the 2010 MDG Report shows that there are still considerable challenges to achieve the real essence of gender equality. Poor women from rural areas are not benefitting from the opportunities available to women nationwide.
There are several safe, effective and long acting reversible contraception (LARC) methods such as the contraceptive implant, the IUD and IUS – that have a life span of five to ten years. These methods when correctly monitored by health professionals can aid child spacing, and at the same time contribute to reducing maternal and child mortality. Speaking with Dr Binagwaho, I probed about the availability and accessibility of LARC methods in Rwandaand whether the mutuelles de santé covered women to have these 15 to 30 minute procedures done. She said that these methods were available in Rwanda today and added that while ‘consultation is covered by the “mutuelle” … the tools are sponsored by the Government so FP (family planning) is almost free.’ It is unclear as to what was meant by ‘almost free’, perhaps it depends on whether you view the glass as half-full or half-empty.
A reduction in fertility can be attributed to a higher rate of education enrolment as well as gender equality according to several studies (Basu, 2002). This means that a woman who has more control over her resources and her life can choose when she wants to have a child. However, in some cases, like inIndiawhere a boy-child is preferred to a girl-child, a better education did not necessarily reduce fertility rather it reduced early pregnancies. An analysis of World Bank data has shown that there is a link between a country’s economy and the annual population growth. TheUnited States of America, theUnited KingdomandBelgium, had an average growth rate of below 1% in comparison toRwandawhose annual population growth stood at 3 % in 2010.
While it is worrying that the Rwandan population is growing at a staggering speed, it has definitely not reached boiling point where the Government should have to make sterilisation the best option available on the market. The weight given to this initiative, somehow takes the magnifying glass away from the other ills that need to be rectified to move Rwanda’s economy closer to its target. Instead of assuming the responsibility for the economic issues it faces, the Government of Rwanda is using the vasectomy policy to scapegoat the poor population – who have little or no decision-making power. In the end it looks as if the poor are the ones slowing down Rwanda’s economic development, and not the world order, the dependency theory, corruption, unequal distribution of wealth among many well- known theories blamed for the state of African development.
It is good that the services are available and that a lot has been invested in the program to train health professionals and equip medical facilities, however the promotion of the campaign and what its real intentions are remains unclear. It would be far more beneficial for the Government of Rwanda to concentrate on tackling the causes of poverty which have been shown to have a significant effect on fertility rather than on finding radical solutions, which do not guarantee positive effects for the country’s economy or long-term prospects for the people.
Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with current age-specific fertility rates.