FACTORS INFLUENCING MALE ATTITUDES TOWARDS VASECTOMY IN

KILIFI DISTRICT, KENYA/^

BY
LUGWE KIDZUGA

IY OF NAMWt

Research Project Report Submitted in Partial Fulfillment of the Requirement for

the Award of degree of Master of Arts in Project Planning and Management of the
University of Nairobi

2012
 DECLARATION

This research project report is my original work and has not been presented for a degree
or any other award in any other University.

h\ /iib ix

Musa Lugwe Kidzuga Date

Registration Number: L50/65296/2010

This research project report has been submitted for examination with my approval as the
University Supervisor.

a lii
Date
Lecturer, University of Nairobi

11
 DEDICATION

This project report is dedicated to my family. My mother Margaret Kidzuga and my

brother Hassan Kidzuga for being my greatest blessing and source of encouragement
throughout the research work. May God bless them always.
 ACKNOWLEDGEMENT

I am grateful to the Almighty Allah the most Merciful for his unfailing love, provision,
protection and unmerited mercy. My sincere thanks go to all lecturers and staff of
University of Nairobi, Nairobi Extra Mural Center for their support throughout the
Master’s program in general and in particular this project.

Special thanks to Dr Anne Aseey for her unwavering support and advice as my
supervisor. Her effort and sacrifice really challenged and encouraged me. Special thanks
go to all my colleagues in the Masters class especially Group 7 members ( Jecinta
Anyiso, Joram Kihumba, Isaac Kariuki and Anne Misiko) for their encouragement and
support. To all, may the Good Lord bless you abundantly.

IV
 ABSTRACT

Vasectomy is unique among the modem methods of contraception as it enables the male
partner to take primary responsibility for fertility control; its availability broadens the
choice of methods for family planning users and contributes to promoting male
involvement in family planning. This therefore led to the need of undertaking a study of
the factors that influence the male attitudes towards vasectomy in Kilifi District.
Specifically the study assessed how independent variables like education level, economic
factors, cultural and religious factors and reproductive health service providers and had
an influence on the male attitudes towards vasectomy in the district which is the
dependent variable. Descriptive survey design was used and a sample of 3 health centers
was selected through purposive sampling methods. Reproductive health service
providers’ and men from different parts of the division formed the study respondents.
Questionnaires with both closed and open ended questions were used to collect data as
well as an interview guideline. The study findings identified the main factors influencing
male attitudes is culture, low education levels, ignorant educated men and health service
providers bias. The study findings recommend vasectomy sensitization campaigns,
training of service providers and long term commitment of government, donors and other
stakeholders towards vasectomy programs in terms of leadership and resources.

v
 TABLE OF CONTENTS

CONTENT PAGE

DECLARATION................................................................................................................ ii
DEDICATION........ .......................................................................................................... iii
ACKNOWLEDGEMENT................................................................................................. iv
ABSTRACT........................................................................................................................ v
TABLE OF CONTENTS................................................................................................... vi
LIST OF TABLES.............................................................................................................. x
LIST OF FIGURES........................................................................................................... xi
ABBREVIATIONS AND ACRONYMS......................................................................... xii

CHAPTER O N E................................................................................................................1
INTRODUCTION..............................................................................................................1
1.1 Background to the Study................................................................................................1
1.2 Statement of the Problem.............................................................................................. 2
1.3 Purpose of the Study..................................................................................................... 3
1.4 Objectives of the Study................................................................................................. 3
1.5 Research Questions....................................................................................................... 4
1.6 Justification of the Study.............................................................................................. 4
1.7 Scope of the Study........................................................................................................ 4
1.8 Limitation of the Study................................................................................................. 5
1.9 Delinptations of the study............................................................................................. 5
1.10 Definition of Significant Terms...................................................................................6
1.11 Organization of the Study........................................................................................... 7

CHAPTER T W O .............................................................................................................. 8
LITERATURE REVIEW ................................................................................................ 8
2.1 Introduction................................................................................................................... 8
2.2 Education Level of Men........................................................................ 8

■ J H p lO II r y r
vi
2.3 Economic Factors.............................................................................. .9
2.4 Cultural and Religious Factors.......................................................... 10
2.5 Reproductive Health Service Providers’........................................... 13
2.6 Conceptual Framework..................................................................... 15
2.7 Summary of the Literature Review................................................... 17

CHAPTER THREE.............................................................................. 18
RESEARCH METHODOLOGY........................................................ 18
3.1 Introduction....................................................................................... 18
3.2 Research Design................................................................................ 18
3.3 Study Variables................................................................................. 18
3.4 Target Population.............................................................................. 19
3.5 Sample Size and Sampling Procedure.............................................. 19
3.6 Research Instruments........................................................................ 20
3.6.1 Validity of the Research Instruments..................................... 21
3.6.2 Reliability of the Research Instruments................................. 21
3.7 Data Collection Procedures............................................................... 21
3.8 Data Analysis.................................................................................... 22
3.9 Ethical Considerations...................................................................... 22

CHAPTER FOUR................................................................................. 23
DATA ANALYSIS, PRESENTATION AND INTERPRETATION 23
4.1 Introduction....................................................................................... 23
4.2 Response Rate................................................................................... 23
4.3 Demography of the Respondents...................................................... 25
4.3.1 Age of the respondents........................................................... 25
4.3.2 Tribe of the respondents......................................................... 26
4.3.4 Education level of respondents.............................................. 27
4.3.5 Religious affiliation............................................................... 28
4.4 Education Level of Men.................................................................... 28
4.4.1 Vasectomy awareness.......................................................... 28

Vll
 4.4.2 Vasectomy is a good family planning method?.............................................. 30
4.4.3 Respondents that have undergone vasectomy or can consider it in the future 31
4.4.4 Personal Opinion about Vasectomy from the respondents............................. 32
4.5 Economic Factors........................................................................................................ 32
4.5.1 Income earning levels of respondents.............................................................. 32
4.5.2 Family planning to ease financial worry......................................................... 34
4.5.3 Basic Needs...................................................................................................... 35
4.6 Cultural Factors........................................................................................................... 35
4.6.1 Vasectomy a form of castration....................................................................... 36
4.6.2 Vasectomy affects a man sexual ability?........................................................ 37
4.6.3 Vasectomy affects a man’s respect?................................................................ 38
4.6.4 A man cannot ejaculate after a vasectomy procedure...................................... 39
4.7 Religious Factor.......................................................................................................... 39
4.7.1 Vasectomy against your religious faith?.......................................................... 40
4.8 Reproductive health service providers........................................................................ 41
4.8.1 Training of the officers.................................................................................... 41
4.8.2 Facilities for providing vasectomy................................................................... 42
4.8.3 Attitudes of men towards vasectomy............................................................... 42
4.8.4 Obstacles towards vasectomy service and solutions........................................ 44

CHAPTER FIVE............................................................................................................ 46
SUMMARY OF THE FINDINGS, DISCUSSIONS, CONCLUSIONS AND
RECOMMENDATIONS................................................................................................ 46
5.1 Introduction................................................................................................................. 46
5.2 Summary of findings................................................................................................... 46
5.2.1 Education Level of Men................................................................................... 46
5.2.2 Economic Factors............................................................................................. 47
5.2.3 Cultural and Religious factors......................................................................... 47
5.2.4 Reproductive health service providers’ ........................................................... 48
5.3 Discussion of Findings................................................................................................ 48
5.4 Conclusions................................................................................................................. 51

viii
5.5 Recommendations....................................................................................................... 51
5.6 Suggestion for further studies..................................................................................... 53

REFERENCES................................................................................................................ 54

APPENDICES................................................................................................................. 59
APPENDIX I: LETTER OF INTRODUCTION.............................................................. 59
APPENDIX II: MALE QUESTIONNAIRE.................................................................... 60
APPENDIX III: INTERVIEW SCHEDULE FOR SERVICE PROVIDERS.................. 65

IX
 LIST OF TABLES

CONTENT PAGE

Table 3.1: Target population..............................................................................................19

Table 4.1: Questionnaires Response rate.......................................................................... 23
Table 4.2: Interview Response Rate................................................................................. 24
Table 4.3: Age of Respondents......................................................................................... 25
Table 4.4: Ethnical groupings of the respondents............................................................. 26
Table 4.5: Marital Status of Respondents......................................................................... 26
Table 4.6: Education level of respondents........................................................................ 27
Table 4.7: Religious affiliation......................................................................................... 28
Table 4.8: Vasectomy awareness...................................................................................... 29
Table 4.9: Vasectomy a good family planning method.................................................... 30
Table 4.10: Respondents that have undergone the vasectomy procedure........................ 31
Table 4.11: Respondents that can consider the vasectomy procedure in the future......... 31
Table 4.12: Income earning levels.................................................................................... 33
Table 4.13: Family planning to ease financial worry....................................................... 34
Table 4.14: Ease of financial worry on providing food.................................................... 35
Table 4.15: Vasectomy a form of castration..................................................................... 36
Table 4.16: Does Vasectomy affect a man sexual ability................................................. 37
Table 4.17: Vasectomy affects a man’s respect................................................................ 38
Table 4.18: A man cannot ejaculate after a vasectomy procedure.................................... 39
Table 4.19: Vasectomy against your religious faith......................................................... 40
Table 4.20: Religious Faith............................................................................................... 40

x
 LIST OF FIGURES

CONTENT PAGE

Figure 2.1: Conceptual Framework................................................................................. 15

*•/ rc ffa ii r of NAiftofr

| i n o a e »
 ABBREVIATIONS AND ACRONYMS

CHAK _ Christian Health Association of Kenya

CHW - Community Health Worker

ECP - Emergency Contraception Pill

FP - Family Planning

FPAK - Family Planning Association of Kenya

FPPS - Family Planning Private Sector

MYWO - Maendeleo ya Wanawake Organization

NCPD - National Council for Population and Development

STIs - Sexually Transmitted Infection

TBA - Traditional Birth Attendant

TFR _ Total Fertility Rate

 CHAPTER ONE
INTRODUCTION

1.1 Background to the Study

Vasectomy is unique among the array of modem methods of contraception as it enables
the male partner to take primary responsibility for fertility control, (Kincaid et al., 1996).
Its availability broadens the choice of methods for family planning users and contributes
to promoting male involvement in family planning, (NCPD, 2004). Furthermore,
vasectomy is highly effective in preventing pregnancy independent of subsequent
behavior modification by the vasectomized man and the non scalpel vasectomy procedure
is convenient and safe for the client and simple to perform, (FHI, 2002). While
sterilization is the most widely used family planning method worldwide, in most settings
the number of women sterilized for contraceptive purposes far exceeds the number of
men, (NCPD, 2004).The lowest rates of sterilization in the world are found in Africa
where fewer than three percent of married women of reproductive age rely on
sterilization to avoid pregnancy and male sterilization is negligible, (Ross and
Frankenberg, 1993).

Male attitudes are often blamed for the underutilization of vasectomy method, (Wilkinson
et al., 1996).Frequently cited examples of attitudes which discourage the use of
vasectomy include men’s lack of interest in or responsibility for avoiding pregnancy, the
association of vasectomy with castration, and fear of the procedure, (FHI,2002).
However, some advocates of vasectomy believe more than negative attitudes among
potential male adopters underlie the low levels of use, (Liskin, Benoit, and Blackburn,
1992).

The use of vasectomy in the world varies significantly by region and country. Almost
three-fourths of the 37 million couples who use vasectomyt live in Asia, with China and
India alone accounting for more than two-thirds of this total, (NCPD, 2004). Four and
one-half million men in the developing world outside of these two countries use
vasectomy. Vasectomy use in Latin America has increased four-fold in the past 10 years.

1
Prevalence remains less than 1% in most of the region, with the exception of Brazil, 14
Colombia, 19 Guatemala, 7 and Mexico, 12 where programs benefited from donor
support in the 1980s and early 1990s, (FHI, 2002). Vasectomy rates in almost all of
Africa are 0.1% or less, although vasectomy services have been introduced within a
number of Sub-Saharan African countries, such as Kenya, Ghana, Malawi, and Tanzania,
(NCPD, 2004). Still, vasectomy has been adopted by at least some men in every country
where it has been introduced. Vasectomy, which can be provided in a variety of primary
care settings, has a potentially important role to play in helping individuals and programs
meet the ever-growing family planning and reproductive health needs outlined above,
especially as donor support declines and national family planning programs increasingly
need to focus on cost-effective services and methods, (Ross and Frankenberg, 1993).

One major shortcoming in the current national effort in Kenya is with regard to male
involvement towards FP. For a long time, FP has been packaged and directed primarily at
women. The success achieved to date in reducing the Total Fertility rate (TFR) is
attributed to the involvement and use of contraceptives by women, (FHI,2002). As in
other countries, when modem family interventions began in Kenya, women became the
immediate focus of programmes and services, resulting in minimal or no minimal
participation, (FHI, 2002). The women bear the biological responsibility of pregnancy
and childbirth, that the female anatomy seems easier to accommodate a wider range of
contraception’s options, that FP was and continuous to be justified as a women’s health
issue and most FP services are based in health facilities seldom used by men, have
combined to perpetuate the emphasis on female contraception, (FHI, 2002). Thus while
culture and traditions expect men to decide on issues of fertility and family size, FP has
been directed mainly to women who now constitute 99% of modem FP users in Kenya,
(NCPD, 2004).

1.2 Statement of the Problem

The exclusion of men in FP programmes has resulted in ignorance about the need and
means for modem contraception, leading to suspicions and misgivings about the motives
and intentions behind FP, (FHI,2002).Consequently, male support for FP has suffered

2
greatly. Men have not seen their role in jointly discussing and deciding on FP issues with
their spouses and the limited range of modem male contraceptive methods has
constrained their wider acceptance and utilization, (NCPD, 2004) thus there is need for
research on male attitudes and participation on family planning.

Despite the various factors affecting male uptake of vasectomy, there is limited research
in the area. No local or international study has been carried out on the factors that
influence male attitudes towards vasectomy in Kenya. This has negatively impacted the
success of vasectomy programmes and direct involvement of men in family planning,
(NCPD, 2004). There is need for realization of the significance of strong direct male
involvement in family planning, because of the high population growth rate in Kenya,
(NCPD, 2004). This research seeks to investigate the factors that influence male attitudes
towards vasectomy.

1.3 Purpose of the Study

The purpose of this study is to investigate factors influencing male attitudes towards
vasectomy in Kilifi district, in Kenya.

1.4 Objectives of the Study

The major objective of this study was to investigate factors influencing male attitudes
towards vasectomy in Kilifi district. The specific objectives were:
1. To explore the extent to which education level influences male attitudes towards
vasectomy in Kilifi district.
2. To establish how economic factors influence male attitudes towards vasectomy
in Kilifi district.
3. To examine the extent to which cultural and religious factors influence male
attitudes towards vasectomy in Kilifi district.
4. To investigate the influence of reproductive health service providers on
vasectomy services in Kilifi district.

3
1.5 Research Questions
The overall research question for this study was to investigate factors influencing male
attitudes towards vasectomy. In order to answer the research question the study sought to
answer the following specific questions.
1. To what extent do education levels affect male attitudes towards vasectomy in
Kilifi district?
2. What is the extent to which economic factors influence male attitudes towards
vasectomy in Kilifi district?
3. How do cultural and religious factors influence male attitudes towards
vasectomy in Kilifi district?
4. What is the extent to which reproductive health service providers influence male
attitudes towards vasectomy in Kilifi district?

1.6 Justification of the Study

The study creates awareness of the vasectomy method in a time of reduced resources for
family planning and of growth in the numbers of couples who want to limit their families.

The study addresses the sense of equity and choice in matters of family planning by
establishing vasectomy as a routine option among family planning method choices.

The study provides a source of reference for future studies on vasectomy. It will also act
as a source of literature for academics in the field of family planning.

1.7 Scope of the study

The study was done in Kilifi district, and this gave an opportunity of carrying out
research in both urban areas such as Mtwapa and rural areas, therefore providing
comprehensive report on the factors that influence male attitudes towards vasectomy in
Kilifi district.

4
1.8 Limitation of the Study
The limitation involved the issue of confidentiality. This was overcome by sending the
questionnaires together with the introductory letters with specific information on the
purpose of the research and the confidentiality of information provided to the chiefs and
community heads of the area. The researcher, with the assistance of community leaders
facilitated questionnaires at agreed convenient time with households and individuals and
carried interviews with service providers at agreed time over a two weeks period.

1.9 Delimitations of the study

The study was delimited to a representative sample drawn from the target population in
Kilifi District to save on time and money.

5
1.10 Definition of Significant Terms.

The following are concepts used in the study:

An attitude: is a favorable or unfavorable evaluation of something. Attitudes are

generally positive or negative views of a person, place, thing, or event.

Family planning: is the planning of when to have children, and the use of birth control.

Family planning services: are defined as: "comprehensive medical activities which
enable individuals, including minors, to determine freely the number and spacing of their
children and to select the means by which this may be achieved.

Tubal ligation or tubectomy): is a surgical procedure for sterilization in which a

woman's fallopian tubes are clamped and blocked, or severed and sealed, either method
of which prevents eggs from reaching the uterus for fertilization. Tubal ligation is
considered a permanent method of sterilization and birth control.

Vasectomy: a minor surgical procedure which stops sperm from being released when a
man ejaculates.

Reproductive health service providers’: Medical personnel who inform, educate,

communicate and provide Sexual and Reproductive Health services
in the area of family planning.

6
1.11 Organization of the study

The study is organized into five chapters. Chapter One provides a general background
into the subject of study. The chapter also provides focus on the objectives of the study
with specific questions to be answered. The objectives and questions developed provide a
precursor to better understanding and articulation of the significance of the study.

Chapter Two presents available works and literature done on factors influencing male
attitudes towards vasectomy by scholars who have studied the subject in other vasectomy
contexts. The chapter provides a conceptual framework which outlines the relationship
between the dependent and independent variables identified in the subject of study.

In Chapter Three, the researcher presents the research design, target population, data
collection instruments and methodologies used in the study.

Chapter Four presents analysis and interpretation of the data collected from the field.
Both Quantitative and Qualitative methods were used in the analysis of the collected data.

Summary of the key findings from the study as per the set objectives and discussion of
the findings and recommendations developed thereof, including suggestions for further
research, are provided in Chapter Five.

7
 CHAPTER TWO
LITERATURE REVIEW

2.1 Introduction
The purpose of this chapter is to provide a review of the existing literature perceived to
be relevant in discussing male attitudes towards vasectomy. The aim is to identify issues
that are key to understanding male attitudes towards vasectomy.

The chapter also presents a conceptual framework reflecting the relationship between the
identified dependent and independent variables.

2.2 Education Level of Men in Relation to Vasectomy

Knowledge and approval rates of vasectomy method have been observed to vary
considerably by various demographic and socioeconomic characteristics, (Posner and
Mbodji, 2009). Consistent with findings from female interviews, both knowledge and
approval rates have been observed to be highest among the younger, higher parity, better
educated men and those in professional/skilled occupations, (Posner and Mbodji, 2009).
Isiungo-Abaninhe (2003) found that educated men in Nigeria preferred significantly
smaller families. Relative to men with no formal schooling, those with primary and
secondary education were about twice as more likely to want no more children. A family
planning survey in Senegal singled out education as the most important factor affecting
desired family size and subsequent contraceptive use (Posner and Mbodji, 2009).

f J
Knowledge of contraceptives in sub-Saharan Africa varies from country to country,
(Gachango, 2003). Furthermore, knowledge varies with age and place of residence. The
differences are most pronounced in West Africa. Urban residents have more knowledge
of contraceptives than the rural residents, young people more knowledgeable than older
people, and educated men more knowledgeable than uneducated men, (Oni and
McCarthy, 2001). The differences inVsqge of contraceptives in Nigeria reflect education
and regional differences. For instance, only 2 percent of women without education were
using contraceptives, while 30 percent of women with secondary education use a method.

8
The regional differences are also glaring, with only 1 percent of women in the northeast
using contraceptives, against 15 percent of women in the south west, (Kim Y M, 2001).

2.3 Economic Factors in Relation to Vasectomy

In Burkina Faso, males predominantly discussed the financial implications of having
many children, especially in urban settings where large families are viewed as being too
expensive, (Ntozi, 2003). In the Kenyan study, both users and non users were found to
have positive dispositions toward modem contraceptives. They both perceived users as
people who have come to terms with economic realities and are trying to minimize
financial difficulties by having small families, (McGinn et al., 2009). The study suggests
that messages to easing of financial worries and promoting of good health and happiness
for the whole family would be acceptable to most couples. This is consistent with the
suggestion that policy makers should not dwell excessively on changing male attitudes
since, as in Burkina Faso, male attitudes in most African countries may be more positive
than supposed, (Ntozi, 2003). FP is advantageous to men too and they can be relied on to
recognize its benefits such as easing their economic load and contributing to healthier
family (McGinn et al., 2009).

A survey carried out in Tanzania shows economic hardship was the most frequently
mentioned reason for vasectomy acceptance, (Stover 2001). Respondents commented on
the general economic benefits of a smaller family, and anticipated problems covering the
basic needs of many children, including adequate food, health care and education. One
participant explained: "When we were increasing the generation, we found that we did
not get any progress in life even buying soap was a problem; seeing that the children we
had were enough, we decided to accept the services. By this time we had five children."-
Vasectomy client, Kibondo, (Green, 2004).

The ability to afford to educate one's children was the most frequently mentioned
economic motivation for vasectomy, , (Stover 2001).Many respondents said that
education is a necessity for both males and females, and that smaller families allow
parents to send all of their children to school, which in turn will allow them to advance in

9
life, (Khasiani,2001).0ne respondent explained it this way: "For example, if you cannot
educate your child if she is a female, you may cause her to be selling oranges or to
become a sex worker. If he is a male and you can't give him education, expect him to be a
hawker. Those are the consequences I was trying to look at, and decided that the family I
had by that time of five children was enough." -Vasectomy client, Kigoma, (Mbizvo and
Adamchak, 2001).

2.4 Cultural and Religious Factors in relation to Vasectomy

When looking at attitudes, one aspect of male role is particularly important to understand
- that men culturally have been socialized to be decision makers in their relationships,
(NCPD, 2004). Some men oppose FP for fear that it will undermine their authority as
household heads. This is particularly so in the case of vasectomy, which clouded by many
far reaching misconceptions. The most common misconceptions are that ‘vasectomy may
affect one’s health and disturb one’s work and that a man is not sterilized (Lam, 2003).
Many people associate vasectomy with castration.

Generally, men who oppose vasectomy have a wide variety of reasons influenced by
cultural beliefs about birth control, most of them erroneous, (NCPD, 2004). Some
believe that if their wives used FP, they would become unfaithful, while others worry
about contraceptive side effects, erroneous beliefs about physiology, the mode of action
of contraceptives, and traditional beliefs, (NCPD, 2004). Accomplishing FP goals in the
face of male resistance to such involvement is likely to take a very long time.
Undoubtedly, the real change will come about only when more fundamental changes take
place in society as a whole. In the meantime, we are convinced that programmes based on
realistic but compassionate understanding of men and their cultural roles are important
steps in the right direction, (Rappaport, 2001). Family planning programmes should
remain sensitive to the reasons why men are put off by FP responsibility and formulate
relevant strategies to fight these barriers, (NCPD, 2004).

Vasectomy is one of the least known and the least popular modem FP methods in sub-
Saharan Africa thanks to largely cultural beliefs, (Khasiani, 2001). This unpopularity has

10
been attributed to the association of vasectomy with loss of manhood and respect, being
permanent and irreversible, seen to represent castration which is only suitable for bulls
and is associated with retention of protein in the blood causing allergies (Khasiani, 2001).
Despite being simple and highly effective, overwhelming negative attitudes overshadow
the positive aspects of vasectomy. Most countries in sub Saharan Africa have vasectomy
prevalence rates well below 1%. A male fertility survey in Uganda observed that
vasectomy had never been used by any of the respondents, (Ntozi, 2003). In Tanzania
too, vasectomy prevalence among males interviewed was observed to be neglible. A
disappointing low of 0.5% of the respondents stated intending to use the method in future
(BSPC, 2003).

Surveys in Kenya have similarly shown vasectomy to be as low as 0.3% (Gachango,

2003). In a baseline survey of men in Nairobi and Mombasa, only 2 out of 618 men
interviewed had undergone vasectomy. However, 22% of the respondents were observed
to be potential vasectomy clients (ICS.JHU/PCS, 2002). The 2003 KDHS finding showed
that despite reasonably high awareness levels of vasectomy among Kenyan men (56%),
the proportion using this method was negligible. The future of vasectomy is not brighter
either, with only 0.5% of men intending to use the method in future (NCPD, 2004).

Many people are still conservative in accepting the male responsibility concept in family
planning because of their cultural background. Psychologists have long noted the
extraordinary assistance of males to seeking any kind of assistance when in physical or
emotional distress, (Rappaport, 2001). The rigid culture role requirement in that men
appear tough, objective, strong, achieving, unsentimental and emotionally unexpressive
makes self-disclosure of any kind of masculinity. This problem is particularly intense in
the area of sexuality and sexual relationships. The male role is so rigid that for many
men, especially adolescents, asking for health about anything sexuality is an open
discussion of sexual naivete and failure. It places in the class of ‘weak men’ disapproved
of by male peers and unattractive to women (Rappaport, 2001). This social prejudice
against the expression of feelings presents enormous barriers to providing effective
counseling to male clients, (FHI, 2002).

H J V z H S lf Y o f n a i m it*
'•WJYtl L I B R A * ? * *
11
The Catholic Church has been opposed to contraception for as far back as one can
historically trace, Chandra,(2001).Many early Catholic Church Fathers made statements
condemning the use of contraception and various other, The Catechism of the Catholic
Church specifies that all sex acts must be both unitive and procreative, In Hershberger,
Anne K (2000). In addition to condemning use of artificial birth control as intrinsically
evil,_non-procreative sex acts such as mutual masturbation and anal sex are ruled out as
ways to avoid pregnancy.

Anglicanism, the Church of England accepted birth control in the 1930 Lambeth
Conference, Meyendorff, John (1975). In the 1958 Lambeth Conference it stated that the
responsibility for deciding upon the number and frequency of children was laid by God
upon the consciences of parents 'in such ways as are acceptable to husband and wife'
Meyendorff, John (1975).

Lutheranism, The Evangelical Lutheran Church in America allows for contraception in

the event the potential parents do not intend to care for a child, Zion, William Basil
(1992). Other Lutheran churches or synods take other positions, or do not take any
position at all. For example, in 1990 the Lutheran Churches of the Reformation passed a
resolution titled "Procreation" stating that birth control, in all forms, is sin, although they
"allow for exegetical differences and exceptional cases (casuistry)", for example, when
the woman's life is at risk, Meyendorff, John (1975).

Methodism, the United Methodist Church, holds that "each couple has the right and the
duty prayerfully and responsibly to control conception according to their circumstances,"
Kotva Jr., Joseph J. (2002). Its Resolution on Responsible Parenthood states that in order
to "support the sacred dimensions of personhood, all possible efforts should be made by
parents and the community to ensure that each child enters the world with a healthy body,
and is bom into an environment conducive to realization of his or her potential." To this
end, the United Methodist Church supports "adequate public funding and increased

12
participation in family planning services by public and private agencies,” Christopher
West, (2000).

Presbyterianism, the Presbyterian Church (USA) supports “full and equal access to
contraceptive methods,” Kotva Jr., Joseph J,(2002). In a recent resolution endorsing
insurance coverage for contraceptives, the church affirmed that “contraceptive services
are part of basic health care” and cautioned that “unintended pregnancies lead to higher
rates of infant mortality, low birth weight, and maternal morbidity, and threaten the
economic viability of families,” Gordon B. Hinckley,( 2002).

Birth control is permissible according to Islam, which recognizes that the sexual act is
more than just a means of procreation, but permanent methods that include, Vasectomy in
males and Tubecotomy in females, all the scholars unanimously agree that permanent
methods of family planning are prohibited since they involve changing human
physiology, (William Basil, 1992). Modem temporary methods such as pills are
allowed, especially in circumstances like, the woman may rest between pregnancies, if
either partner has a transmittable disease. For the sake of the woman's health, for example
if she is already breast-feeding a child it would be damaging for both her and the child to
have another pregnancy and if the husband cannot afford to support any more children,
William Basil (1992).

2.5 Reproductive health service providers’ influence on vasectomy

The attitude of FP providers to male methods, particularly vasectomy, is a crucial
ingredient to family planning services to men (Gill, 2001). Since counseling is a critical
component of vasectomy service, well trained counselors must be employed in clinics
offering the service. Rappaport (2001) noted that one mistake that is made in hiring
personnel for male programmes has been to assume that “any man” will do. Even though
his motivation may be good (useful role model for clients and staff), merely being a man
does not make a good counselor for men. What is required is a man who is both
committed to ending sexist roles in himself and other men and, at the same time, feels
real compassion for men and the trained and absurd situations they are forced into by this

13
role. For women counselors, it is crucial that such work be assigned to women who want
to genuinely do this kind of counseling (Forde, (2001). Training should there focus on
instilling these desirable qualities in a counselor. Some health personnel providing family
planning services still hold the traditional belief that “Family planning is a woman’s
responsibility” (Khasiani, 2001). This attitude needs to be changed through appropriate
training before such personnel can be effectively involved in FP services for men.

A major impediment to men’s utilization of vasectomy is provider bias, (Stover 2001).

Some providers assume that men are not interested in family planning while others are
poorly informed regarding male contraceptive methods, while may share the same
misconceptions as their clients, (Stover, 2001). Common indicators of provider bias
against male involvement include the fact that: providers may not offer male methods or
may provide inadequate information about them; providers may present male methods
negatively; other providers may make men feel uncomfortable visiting clinics and
seeking more information on family planning (Donald, 2006).

It is essential that all family planning programmes, whether male or female oriented,
emphasize appropriate training for their personnel and responsible and through
counseling at its clinics if they are to be successful, (Khasiani,2001).Some health
personnel are not well informed about available family planning methods and cannot,
therefore, be expected to offer satisfactory services. In a family planning KAP study
among health centre personnel in western province of Kenya, (Terefe, 2009) observed
that, while clinical based staff (clinical officers and community nurses) had good
knowledge of family planning procedures, to the field staff (traditional birth attendants,
family health field educators, community health workers (CHW) and public health
technical staff), whose work is mainly educational and motivational, the procedures were
less clear. This situation is particularly damaging for vasectomy, a procedure that is
already shrouded in serious misconceptions. The study concludes that to improve family
planning programs in the province, health personnel need more training on family
planning, (Green, 2004).

14
2.6 Conceptual Framework

Independent Variables T. . . .,
^ Intervening Variables

Figure 2.1: Conceptual framework

Independent variables
The male attitudes towards vasectomy is influenced by; education level, cultural factors,
reproductive health service provider and religious factors.

Education Level of Men in relation to vasectomy

This variable looked at how men with different educational levels are opinionated
towards vasectomy. It gives insight whether education background really affects men
attitude towards vasectomy.

15
Economic Factors in relation to vasectomy
This variable looked at economic realities like income level of respondents and their
number of children, whether financial implications of having many children is making
men in Kilifi district have positive attitudes towards vasectomy or not.

Cultural and Religious Factors in relation to vasectomy

This variable is very important as it looked at the various misconceptions that men in
Kilifi district have towards vasectomy which originate from their cultural beliefs for
example vasectomy is a form of castration reduces sexual performance and threatens
men’s sexual identity and self-image and also whether their religious backgrounds
example Muslim, Catholic or Anglican affects their attitudes towards vasectomy.

Reproductive Health Service Provider influence on vasectomy

This variable is looked at reproductive health service provider attitude towards
vasectomy, for example common indicators of provider bias against vasectomy may
include the fact that: providers may not offer vasectomy or may provide inadequate
information about them; providers may present vasectomy negatively; other providers
may make men feel uncomfortable visiting clinics and seeking more information on
vasectomy, which in turn influence negative attitude towards vasectomy on men.

Dependent Variable
The dependent variable is male attitudes towards vasectomy. The study looked at
particularly Kilifi District because of major towns in this area such as Mtwapa known for
its night life and rural areas such as Kikambala. This is to improve our understanding of
the degree or extent of male attitudes towards vasectomy in both urban and rural areas.
The extent of male attitudes was measured by looking at their education levels, cultural
factors, reproductive health service provider influence and religious factor.

16
2.7 Summary of the Literature Review
From the foregoing review, the importance of direct male involvement in family planning
especially having vasectomy could not be overemphasized. Most of the literature on
vasectomy however highlighted the need to have the family planning programs
incorporate men not to emphasize family planning on women alone. Male attitudes
towards vasectomy are dependent on many other variables which come into play. This
study set out to assess these factors that might influence male attitudes towards
vasectomy in Kilifi District.

17
 CHAPTER THREE
RESEARCH METHODOLOGY

3.1 Introduction
This chapter describes the research design, study variables, target population, sample size
and sampling procedure, research instrOOOument data collection procedure and data
analysis.

3.2 Research Design

The study used both qualitative and quantitative research paradigms. Qualitative research
involves several methods of data collection, such as focus groups, field observation, in-
depth interviews and case studies. In all of these methods, the questioning approach is
varied. In other words, although the researcher enters the project with a specific set of
questions, follow-up questions are developed as needed (Wimmer and Dominick, 2003).

The study adopted descriptive survey design to assess the factors influencing male
attitudes towards vasectomy in Kilifi district. Descriptive survey design is used in
preliminary and exploratory studies to allow the researcher gather information,
summarize, present and interpret it for the purpose of clarification (Orodho 2002).
Kothari (2003) also recommends descriptive design as it allows the researcher to
describe, record, analyze and report conditions that exist or existed.

The design allowed the researcher to generate both numerical and descriptive data that
can be used in measuring correlation between variables. Descriptive survey research was
intended to produce statistical information about aspects of male attitudes towards
vasectomy that interest stakeholders such as policy makers. The location of the study was
Kilifi District.

3.3 Study Variables

The research variables are the factors that are manipulated to achieve different outcomes
and hence determine the findings of a study. Variables will therefore assume different

18
values when conducting research analysis. Variables can be classified as dependent and
independent. Independent variables forms the core part of the research and are aligned to
the research objectives. The dependent variable shows the outcomes at different levels of
manipulation of the independent variable.

In this study, the dependent variable was clearly inclined towards influence of male
attitudes towards vasectomy. The independent variables which have been identified in
this study according to the research objectives and questions included: education level,
economic factor, religious and cultural factor and reproductive health service providers’.

3.4 Target Population

Kombo, K. and Tromp (2006) define a population as a group of individuals, objects or
items from which samples are taken for measurement. The study was done in Kilifi
District in coast Province of Kenya. The target population was 135 people drawn from
the males in the community and the reproductive health service providers.’

Table 3.1: Target Population

Category Source Target Percentage (%)

Population
Reproductive health 3 Registered 15 (5 officials per health 20
service providers health centres. centre)
Males. 6 divisions 120 (20 males per 80
division)
Total 135 100

3.5 Sample Size and Sampling Procedure

According to Orodho and Kombo (2002) sampling is the process of selecting a number of
individuals or objects from a population such that the selected group contains elements
representative of the characteristics found in the entire group.

19
In this study, the sampling method to be used will be purposive sampling. This technique
allows the researcher to use cases that have the required information with respect to the
objectives of the study (Mugenda and Mugenda, 2003). This is because although Kilifi
District has total of 73 health facilities distributed across the district. Accessibility of
health services is, however low. The doctor patient ratio stands at 1:100,000 which in
itself a manifestation of staff shortages in the District. There are only 3 centres in Kilifi
District that have well established family planning services and have staff providing
family planning. These health facilities are Kilifi District hospital, Vipingo health centre
and Mtwapa health centre. Purposive sampling will still be used on each of the health
centres to identify 5 health services providers that are well informed on family planning
services.

The study adopted cluster sampling when it came to sampling males in Kilifi district.
There are 283, 807 males according to 2009 census results in Kilifi district but due to
vastness and sparsely population of the district, 20 households were clustered per division
each household a purposive sample of one man was done bringing a total of 20 men per
division, this reduced field costs as a result of saving of travelling time and distance
covered, because there are six divisions in the district this translated to a target population
of 120 men

3.6 Research Instruments

Data refers to all the information a researcher gathers for his or her study. The study used
both primary and secondary data sources. Quantitative data was gathered through open
and close ended questionnaires for the men sampled in the communities. A quantitative
method is defined by Kasomo (2006) as that which yields data which is quantifiable.
Qualitative data was collected by in depth interviews of all the reproductive service
providers. In depth interview is distinguished as a method that allows the researcher to
explore the deeper structure of ideas and also verify the ideas presented (Stylianou,
2008). An interview guide was used to get in depth answers from the respondents. The
researcher sought maximum co-operation from respondents by establishing a friendly

20
relationship prior to conducting the interviews. They were assured of confidentiality of
information given.

3.6.1 Validity of the Research Instruments

Mugenda and Mugenda (1999) contend that the usual procedure in assessing the content
validity of a measure is to use a professional or expert in a particular field.

To ensure the validity of the research instrument the researcher sought opinions of
experts in the field of study, the service providers for example clinical officers and the
researcher’s supervisor. This facilitated the necessary revision and modification of the
research instruments thereby enhancing validity.

3.6.2 Reliability of the Research Instruments

Reliability is a measure of the degree to which a research instrument yields consistent
results after repeated trials, (Mugenda & Mugenda, 1999). This was ensured through
pilot testing. The researcher used test-retest technique of evaluating reliability of the
questionnaires. The same instrument was re-administered to the same respondents after
one month to test whether similar responses would emerge. The two scores of the
respondent was checked to analyze the consistency of responses. Scores from the first test
were correlated with scores from the final test.

3.7 Data Collection Procedures

Data was collected though questionnaires and interview schedules so as to get data on the
set objectives of the study. The questionnaires (open and close ended questions) and
interview schedule were tested for validity and reliability through piloting. The
respondents were administered questionnaires and interviews carried out in person at the
health centres and in the communities.

21
3.8 Data Analysis
The data collected was analyzed using descriptive statistics. Quantitative data was coded
manually, organized, and analyzed using percentages and frequencies. In order to save
time and money, while increasing accuracy of the results, computer Statistical Program
for Social Sciences (SPSS) was used for processing data. The results were presented in
tabulated form for easy interpretation.

Qualitative data generated from questions were organized into themes, categories and
patterns pertinent to the study. This helped to identify information that was relevant to the
research questions and objectives. Data was tabulated and classified into sub-samples for
common characteristics with responses being coded to facilitate basic statistical analysis.
Orodho (2003) argues that the simplest way to present data is in frequency or percentage
tables, which summarizes data about a single variable. Both Microsoft Excel and the
Statistical Package of Social Sciences (SPSS) was used to analyze the data which will be
presented using frequency tables.

3.9 Ethical Considerations

The research maintained utmost confidentiality about the respondents. All the
respondents were given a free will to participate and contribute voluntarily to the study.
Necessary research authorities were consulted and permission granted while due
explanations were given to the respondents before commencement of the study.

22
 CHAPTER FOUR
DATA ANALYSIS, PRESENTATION AND INTERPRETATION

4.1 Introduction
This chapter presents the findings of the data collected from the sampled reproductive
health service providers and males in Kilifi district coast Province, Kenya on factors
influencing male attitudes towards vasectomy. Out of 135 respondents that the study
targeted there were 129 respondents. This is 95.5% of the target group. The data was
interpreted according to the research questions. The analysis was done through
descriptive statistics and findings of the study were presented in form of frequency tables.
The discussion of the outcomes is based on the outputs from Statistical Package for
Social Sciences (SPSS).

The chapter provides results and discussions of the findings and data analysis of the
study. The discussion is linked to the questions of the study and research objectives in
accessing the factors influencing the male attitudes towards vasectomy in Kilifi District.

4.2 Response Rate

Table 4.1: Questionnaires Response Rate
M a le R e s p o n d e n t p er Q u e s tio n n a ir e s Q u e s tio n n a ir e s % R e s p o n s e ra te a s p er

d iv is io n . issu e d p e r r e tu r n e d p e r q u e s tio n n a ir e

d iv is io n . d iv is io n . is s u e d .

Vitengeni 20 20 16.7 100%

Bahari 20 20 16.7 100%
Chonyi 20 20 16.7 100%
Kikambala 20 20 16.7 100%
Ganze 20 20 16.7 100%
Bamba 20 20 16.7 100%
T o ta l 120 120 100%

23
The study targeted 135 respondents of this 120 was supposed to be males in the
community comprising of 20 males from each of the 6 divisions and 15 reproductive
health service providers from 3 health centers. 120 questionnaires were administered to
the males in the community and each of them returned thus a total of 100%. The Tables
4.1 shows the response rate on the males sample in the community

Table 4.2: Interview Response Rate

Health Center No of health service No. of service provider %
provider targeted interviewed
Kilifi District Hospital 5 3 20
Mtwapa Health Center 5 3 20
Vipingo Health Center 5 3 20
Total 15 9 60

A total of 15 reproductive health service providers from 3 health centers were supposed
to be interviewed, 5 service providers from each of the health Centre but the researcher
got 3 service providers from each of the health Centre bringing a total of 9 reproductive
health service providers thus a total of 60%, this is because of shortage of health service
providers in the district. The Table 4.2 above show the response rate on the health service
providers.

24
4.3 Demography of the Respondents
The study targeted males o f 18 years and above and reproductive health service providers
o f the three major health centres in Kilifi district.

4.3.1 Age of the Respondents

Table 4.3 records the age distribution of the respondent.

Table 4.3: Age of Respondents

Age Frequency Percentage
18-25 25 20.8
25-30 33 27.5
31-35 17 14.2
Over 35 45 37.5
Total 120 100.0

Table 4.3 above reveals that, majority of the respondents 37.5% were over the age of 35
while 14.2 % , 2 7 .5 % and 20.8% were 30-35 years, 25-35 years and 18-25 years
respectively

25
4.3.2 Ethnical Grouping of the Respondents
The researcher asked the respondents their ethnic group because it will be the basis of
cultural factor which is one of the main objectives of this research. Cultural opinions
originate from one’s ethnical group and it was therefore important to ask respondents
their ethnical background.

Table 4.4: Ethnical Grouping of the Respondents

Tribe Frequency Percentage
Mijikenda 110 91.7
Kikuyu 4 3.3
Kamba 5 4.2
Meru 1 0.8
Total 120 100.0

The study was done in Kilifi district which is inhabited mainly by Mijikenda people and
they comprise majority of the respondents at 91.7% followed by Kamba 4.2%, then 3.3%
Kikuyu and lastly 0.8% Meru as shown in Table 4.4 above.

4.3.3 Marital Status of Respondents

Respondents were asked to state their marital status.

Table 4.5: Marital Status of Respondents

MaritalStatus Frequency Percentage
Single 40 33.3
Married 74 61.7
Divorced 4 3.3
Widowed 2 1.7
Total 120 100.0

Table 4.5 shows majority of respondents are married with 61.7% followed by single
people 33.3% then divorced and widowed who were 3.3% and 1.7% respectively.

26
4.3.4 Education Level of Respondents
The respondents were asked to indicate their education levels

Table 4.6: Education Level of Respondents

Level Frequency Percentage
Primary 52 43.4
Secondary 36 30.0
Tertiary 19 15.8
No Formal 13 10.8
Education
Total 120 100.0

Table 4.6 above shows primary level respondents are majority 43.4%, followed by
secondary at 30.0%, tertiary level is 15.8% and no formal education is 10.8%. Education
level of respondents was important demography for the researcher as it is the objective of
the study

27
4.3.5 Religious Affiliation
The respondents were asked to indicate their religious affiliation since religion is the
main objective of the study

Table 4.7: Religious Affiliation

Level Frequency Percentage
Muslim 35 29.2
Catholic 26 21.7
Protestant 46 38.3
No Religion 13 10.8
Total 120 100.0

The table 4.7 shows there are more Protestants to the study 38.3%, followed by Muslims
29.2%, then Catholic 21.7% and lastly respondents who said they had no religion or
(atheists) were the least at 10.8%.

4.4 Education Level of Men

Kilifl District has 230 primary schools. To cope with the increasing population in this age
group, there is need to improve the facilities in the schools, a lot of infrastructure needs to
be done to build more primary and secondary but there is the notorious problem of school
drop outs in Kilifi district, most kids drop out of school when they finish primary and
become beach boys in the hope of getting a rich white woman, a get rich quick scheme
where most end up indulging in drugs and getting HIV/AIDS infection.

4.4.1 Vasectomy Awareness

The researcher asked the respondents whether they heard about vasectomy, this was to
know whether the respondents basically were aware of the vasectomy procedure,
surprisingly majority of the respondents even men who had no formal education 84.6% of
the men are aware there is a vasectomy procedure only 15.4% with no formal education
said they have never heard of the male vasectomy. This was surprising considering low

28
levels of education and poverty in Kilifi where most people do not have television sets
but majority of them said they have heard about vasectomy from the radio. These shows
how radio is a powerful communication channel and therefore radio can be used as a
mass communication channel to create awareness in rural areas.

Table 4.8 illustrates the distribution as per the response.

Table 4.8: Vasectomy Awareness

Education level Frequency Percentages
Yes No Totals Yes No Totals
Primary 46 5 52 88.5 11.5 100
Secondary 31 5 36 86.1 13.9 100
Tertiary 17 2 19 89.5 10.5 100
No formal education 11 3 13 84.6 15.4 100
Total 105 15 120

29
4.4.2 Vasectomy is a good family planning method?
The researcher asked the 105 respondents who had said yes they have heard about
vasectomy whether vasectomy is a good family planning method, the researcher wanted
to get the attitude towards vasectomy from the respondents whether it is positive or
negative.

Table 4.9: vasectomy a good family planning method

Education level Frequency Percentages
Yes No Totals Yes No Totals
Primary 15 31 46 32.6 67.4 100
Secondary 10 21 31 32.3 67.7 100
Tertiary 6 11 17 35.3 64.7 100
No formal education 1 10 11 9.1 90.9 100
Total 32 73 105

Table 4.9 illustrates how majority of the respondents said vasectomy is not a good family
planning method including respondents who have tertiary education majority 69.4 % of
them said they do not think family planning is a good method showing there is generally
a negative attitude towards vasectomy among all male respondents regardless of one
education level. This make the assumption of men with higher education would readily
accept vasectomy quite wrong.

30
4.4.3 Respondents that have undergone Vasectomy
The study also sought to establish whether respondents had undergone vasectomy as
presented in Table 4.10.

Table 4.10: Respondents that have undergone the vasectomy procedure

Frequency Percentage
Yes 2 1.9
No 103 98.1
Total 105 100.0

Table 4.10 shows the respondents that have undergone vasectomy procedure are only two
people. Surprisingly the two vasectomized respondents have no formal education. They
had the same characteristics both were in advanced age, have elderly children and both
were convinced to undergo vasectomy procedure by colleagues who had medical
backgrounds.

The researcher also asked the respondents if they can consider having a vasectomy in the
future

Table 4.11: Respondents that can consider the vasectomy procedure in the future
Education level Frequency Percentages
Yes No Totals Yes No Totals
Primary 15 32 47 31.9 68.1 100
Secondary 11 20 31 35.5 64.5 100
Tertiary 4 13 17 23.5 76.5 100
No formal education 1 9 10 11.1 88.9 100
Total 32 73 105

Table 4.11 illustrates majority said they cannot consider vasectomy procedure in the
future including respondents who have tertiary education of which majority 76.5% said
they cannot have a vasectomy in the future, this information confirms Table 4.9 above

31
when respondents were asked if they think vasectomy is a good family planning and
majority gave out a negative response and therefore if vasectomy awareness programs
are carried out then they should target males of all education backgrounds including
those with tertiary education for them to be successful.

4.4.4 Personal Opinion about Vasectomy from the Respondents.

The researcher was interested to find out how respondents opinions about vasectomy.
Majority of the response was generally negative with most respondents saying vasectomy
was like castration, others said they are against it because it is a permanent method,
others cited that it is against African culture and others said it is against their religious
faith.

4.5 Economic Factors

Economic factor can influence any one attitude towards family planning. People have
generally embraced family planning so as to have small families to ease their economic
load and have a healthy family. The researcher wanted to establish whether men can
accept vasectomy due to economic hardship.

4.5.1 Income earning levels of Respondents

The study explored the influence of current economic and financial environment to males
access to sustainable livelihood in Kilifi. Males interviewed through questionnaires
confirmed that they engage in varied economic activities as part of their livelihood
strategy namely; business and employment i.e. running grocery ‘kiosks’, tailoring/ dress
making, working as domestic workers, undertaking food vending, casual work at
construction sites, working in restaurants, perform acrobats in hotels , as security guards,
sell second hand clothes and shoes, boda boda operators, subsistence farmers, police
officers, drivers, making of art crafts and some are jobless.

32
The researcher sought to understand respondents’ levels of income from the different
income sources as illustrated in Table 4.12

Table 4.12: Income earning levels

Earning levels Frequency Percentage
1,000-4,999 10 11.7
5,000-9,999 14 15
10,000-14,999 58 51.7
15,000-19,999 9 9.2
20,000 and more 3 4.1
No eamings/jobless 8 8.3
Total 102 100.0

Table 4.12 shows that the statistical mode earnings amongst males in Kilifi is between
Kshs. 10,000 and 14,000 from either casual employment or business. Fewer males in
Kilifi earn amounts above Kshs. 15,000. Given the low income levels, males reiterated
that they are not able to make any savings as expenditures in most cases surpass their
income levels. These groups of males live below their livelihood thresholds as their
disposable income is significantly low.

33
4.5.2 Family planning to ease financial worry
The researcher asked the respondents generally if they believe in practicing family
planning to have a smaller family to ease your financial worry, they responded as shown
in Table 4.13.

Table 4.13: Family planning to ease financial worry

Do you believe in practicing family planning to have a smaller family to ease your
financial worry
Frequency Percentage
Yes 86 69.2
No 19 15.8
No response 15 15.0
Total 120 100.0

The response was positive with majority of the respondents 69.2% they believe family
planning eases financial worry of one having a family that he can manage. This shows
majority of the respondents know the importance of family planning in terms of having
smaller families that they can manage.

34
4.5.3 Basic Needs
The researcher asked the respondents if they can have a vasectomy to maintain a small
family to ease their financial worry of providing adequate food to their children the basic
need of every family. They responded as shown in Table 4.14

Table 4.14: Ease of financial worry on providing food

Can you have a vasectomy so as to maintain a small family to ease your financial worry of
providing adequate food to your children
Frequency Percentage
Yes 32 26.7
No 73 58.3
No response 15 15.0
Total 120 100.0

4.5.4 Opinions about Economic Factor

The researcher was interested to find out why majority of the male respondents believe in
practicing family planning to have a smaller family to ease their financial worry while
they cannot take a personal responsibility themselves of having a vasectomy. Majority of
the respondents cannot have a vasectomy they prefer their spouses or wives to be
sterilized instead of them having a vasectomy, or the wife continues to do the temporary
methods of family planning. The researcher noted that most of the men took family
planning as women’s responsibility therefore lack of male involvement in family
planning is the biggest hindrance to vasectomy acceptance.

4.6 Cultural Factors

The vasectomy procedure is clouded by many far reaching misconceptions. The most
common misconceptions are that ‘vasectomy may affect one’s health and many people
associate vasectomy with castration. The researcher posed questions that are common
misconceptions about vasectomy in order to gauge the understanding of respondents in

35
relation to their cultural background. The respondents were to say whether they agree or
disagree with the statements.

4.6.1 Vasectomy a Form of Castration

One of the biggest cultural misconceptions of vasectomy is that vasectomy is a form of
castration. The researcher asked the respondents whether they think vasectomy is a form
of castration. Table 4.15 illustrates the response.

Table 4.15: Vasectomy a Form of Castration

Frequency Percentage
Agree 60 50.0
Disagree 36 30.0
Unsure 9 5.0
No Response 15 15.0
Total 120 100.0

Unfortunately, majority of the respondents 50% in Kilifi district think vasectomy is

castration those saying vasectomy is not castration were only 30% those unsure were 5%,
no response were 15%. The researcher notes that this can be blamed on the low
awareness levels of the vasectomy procedure and the low education standards in the
district. The reproductive health also said that vasectomy being categorized as castration
is the biggest hindrance of low uptake of vasectomy services in Kilifi district.

36
4.6.2 Vasectomy affects a Man Sexual Ability?
The researcher asked the respondents whether vasectomy affects a man sexual ability or
libido. Table 4.16 illustrates the distribution per response

Table 4.16: Does Vasectomy affect a Man Sexual Ability

Frequency Percentage
Agree 53 44.2
Disagree 28 23.3
Unsure 24 17.5
No Response 15 15.0
Total 120 100.0
Majority of the respondents 44.2% think that vasectomy affects sexual ability; only
23.3% said they do not think vasectomy affect, 17.5% of the respondents were unsure
and 15% did not respond. The scientific fact is vasectomy does not affect a man sexual
libido at all, the man continues to function as normal. This is one of the misconceptions
that make men fear vasectomy and it can be addressed by educating men and increase
their level of awareness.

37
4.6.3 Vasectomy affects a M an’s Respect?
The researcher asked the respondents the question whether vasectomy affects a man’s
respect. Table 4.17 illustrates the distribution per response

Table 4.17: vasectomy affects a Man’s Respect

Frequency Percentage
Agree 63 50.0
Disagree 35 29.2
Unsure 7 5.8
No Response 15 15.0
Total 120 100.0

Majority of the respondents 50% agree that vasectomy affects a man’s respect, those who
disagreed were 29.2%, those unsure at 5.8% and those who did not respond were 15%.
These information shows how culture is a major influence on male attitudes towards
vasectomy, men fear talking about vasectomy among fellow peers as they see their
friends will think less of you if they hear you have been vasectomized.

38
4.6.4 A man cannot ejaculate after a Vasectomy Procedure
The researcher asked the question if a man cannot ejaculate after a vasectomy procedure.

Table 4.18 illustrates the distribution per response

Table 4.18: A man cannot ejaculate after a Vasectomy Procedure.

Frequency Percentage
Agree 33 27.5
Disagree 20 16.7
Unsure 52 40.8
No Response 15 15.0
Total 120 100.0

Majority of the respondents were unsure at 40.8%, 27.5% of the respondents agreed that
a man cannot ejaculate after a vasectomy procedure, 16.7% disagreed with the statement
while those who did not respond were 15%. This information was a confirmation to the
researcher that most of the respondents are not fully aware of the details or facts of the
vasectomy procedure. The scientific fact is one can still ejaculate after the vasectomy
procedure.

4.7 Religious Factor

Religion is a very important factor that can influence male attitudes towards vasectomy.
One faith may influence his or her attitudes towards contraception. Religious
denominations have different opinions for example the Catholic church is well known
for its opposition towards modem contraception methods, Muslims are against permanent
methods of contraception specifically vasectomy in men and tubal ligation in women
while generally most protestants churches such as Anglicans have no problem with
contraception.

39
4.7.1 Vasectomy against your Religious Faith?
The researcher asked the respondents whether vasectomy is against their religious faith.
Table 4.19 illustrates the distribution per response.

Table 4.19: Vasectomy against your Religious Faith

Frequency Percentage
Agree 41 34.2
Disagree 51 40.8
No Response 28 25.0
Total 120 100.0

The response had a slight difference. The majority disagreed at 40.8% while those who
agreed at 34.2% and who did not respond at the question were 25%. Those who did not
respond were people who are not aware about vasectomy or had no religion.

The table below shows how different religious affiliations responded to the question;
Table 4.20 illustrates the distribution as per the response.

Table 4.20: Religious Faith

Religious affiliation Is vasectomy against your religious faith
Frequency Percentages
Yes No Totals Yes No Totals
Muslim 22 10 32 66.7 33.3 100
Catholic 7 15 22 46.7 53.3 100
Protestant 14 24 38 36.8 63.2 100
Total 43 49 92

Majority of Muslim respondents 66.7% said vasectomy is against their religious faith
giving reasons such as vasectomy is a sin and it is against the teachings of the Holy
Quran. Surprisingly most of the Catholic faith respondents 53.3% said vasectomy is not

40
against their faith, although their church advocates for natural family planning methods.
The Catholic faith respondents said they see no bad reason with the vasectomy procedure
because of the economic difficulties of raising many children, just like their women
counterparts practice family planning regardless of their church standing and others said
having a vasectomy is a personal decision and their religious faith is least of their
concern. The Protestants respondents as assumed majority of them 63.2% said vasectomy
is not against their religious faith.

4.8 Reproductive Health Service Providers

The study sought to establish the influence of reproductive health service providers on
vasectomy services in Kilifi district and they were interviewed by the researcher guided
with an interview guideline.

4.8.1 Training of the Officers

The reproductive health service providers comprised of mainly registered nursing
officers in the three health centers namely Kilifi district hospital, Mtwapa health Centre
and Vipingo health Centre except only one clinical officer in Mtwapa health Centre. The
researcher was not able to get a medical doctor from the three medical centers even in
Kilifi district hospital. Medical doctors are usually notified when there is a complicated
case especially which requires surgery. There are no gynecologists in Kilifi district; one
has to be notified from the nearby Mombasa district occasionally when there is a
complicated surgery to be undertaken. There only 3 nurses in the family planning unit in
Kilifi district hospital only assisted by student nurses serving a large population of
patients. This confirms the World Health Organization report of 2009 that there is
shortage of medical staff in Kilifi district.

In Kilifi district hospital the three nurses the researcher interviewed have no training on
vasectomy therefore they cannot perform a vasectomy procedure. They can only provide
counseling services to a vasectomy client thanks to the training they got during the four
years period in Kenya Medical Training College (KMTC). This was also the same case in
Vipingo health Centre. When asked if they require training vasectomy services, all the

41
service providers said they had no interest as there is no demand of vasectomy services.
The researcher noted already there is a negative attitude towards vasectomy in both Kilifi
district and Vipingo health Centre.

In Mtwapa health Centre the two nurses and one clinical officer have been trained on
performing a vasectomy procedure. The researcher found out they received on job
training of one month from Marie Stopes a non-governmental organization which had set
an outreach center in Mtwapa. They were also trained by Marie Stopes to counsel
vasectomy clients.

4.8.2 Facilities for Providing Vasectomy

Both Kilifi district hospital and Mtwapa health Centre have a theatre and all necessary
facilities of providing vasectomy but both have not provided any vasectomy procedure
for the last one year.

Surprisingly Mtwapa health Centre has not provided any vasectomy procedure even with
occasionally presence of Marie Stopes outreach Centre due lack of sensitization of the
vasectomy procedure to the public. Marie Stopes did not have any sensitization
programmes although they provided the services. The service providers also confessed
that they do not discuss the vasectomy method with women.

Vipingo health Centre has a theatre but does not have the necessary facilities to provide
vasectomy. This shows the negative attitude towards vasectomy services by the health
Centre itself where no facilities are provided for the vasectomy procedure even if there is
a potential vasectomy client, then he cannot be provided the service.

4.8.3 Attitudes of Men towards Vasectomy

The researcher asked the service providers the attitudes of men towards vasectomy and
family planning generally. The service providers said the major problem is culture which
confirms the information from the male questionnaires that most men attitudes are
affected negatively by culture. The service providers noted most men do not participate in

42
family planning because they see it as a women’s responsibility. In fact there are many
cases where women have to get permission from their husbands to practice family
planning. Male chauvinism is rampant in the district that’s why service providers do not
see the need to undergo vasectomy training as they see it is a waste of time, because of
no demand for the vasectomy service.

According to the service providers’ men prefer their wives to be sterilized but not them
citing reasons of vasectomy is like castration, he may develop erectile dysfunction
problems or he may gain weight. Service providers noted that low education levels
contributes to negative attitude towards vasectomy, but they also noted sometimes low
education level is an advantage because low educated men regard them with high esteem
and therefore if they explain to them a new medical procedure they readily agree, another
disadvantage they explained highly educated men can be ignorant and therefore very hard
to convince to accept a vasectomy procedure.

The researcher asked the service providers if other factors such as economic levels and
religious factor affects attitudes towards vasectomy among males. The service providers’
response was the two factors do not have major impact such as culture. For a factor such
as religion they said most women even Catholics do come for family planning therefore
they see religion no hindrance when it comes to men having a vasectomy. About
economic factor the service providers pointed out that men who understand the
importance of family planning in having smaller families due to economic hard times still
cannot accept vasectomy due to negative cultural tendencies associated with vasectomy,
they will prefer their wives to do family planning but not them, this information
collaborates with the information the researcher got from the male questionnaires where
men agree to practice family planning to ease their financial worry but the men
themselves cannot accept to have a vasectomy procedure.

43
4.8.4 Obstacles towards Vasectomy Service and Solutions
One of the major obstacles towards vasectomy acceptance the reproductive service
providers noted is lack of government support towards vasectomy service. They gave an
example of whereby in the 1990s’ the NORPLANT procedure one of the female planning
methods was virtually unknown but in 2004 when the government started supporting it
the NORPLANT procedure is one of the most well-known and widely used procedure by
women in the country. Another problem is cultural tendencies of men, which quickly the
reproductive health service providers say the problem starts from the policy level where
family planning programs are skewed towards women which fuels cultural tendencies of
men to think family planning is women responsibility.

Low levels of education are also a problem which brings a negative attitude towards
vasectomy as it compounds the problem of cultural tendencies of men. The district officer
informed the researcher that the Kilifi education office is trying to solve the problem by
carrying out education awareness to curb early marriages, reduce child labour and reduce
the number of drop outs. The solutions advocated by the service providers is
sensitization of the vasectomy service in the Kilifi district especially through the mass
channels such as radio as most households have radios.

The service providers advocated first for community health workers to be educated about
the vasectomy procedure then later various chief barazas or community forums to be held
in the district targeting men with the educated community health workers spearheading
the sensitization of men about vasectomy during this barazas. The service providers
advocated for door to door strategy whereby the community health workers go in and
each every house holds targeting men and sensitizing them about vasectomy. The service
providers who were not trained especially in Kilifi district hospital and Vipingo health
centre advocated for them to be trained only when there is an indication that vasectomy
sensitization programmes will be carried out in the district.

44
4.9 Summary
The researcher has presented in this chapter an analysis and interpretation of the data
collected and the key findings from the field based on the objectives that were set in
Chapter one. In the succeeding Chapter Five, summary and discussion of the findings,
recommendation, conclusion to the study and suggested area for further research will be
presented.

45
 CHAPTER FIVE
SUMMARY OF THE FINDINGS, DISCUSSIONS, CONCLUSIONS AND
RECOMMENDATIONS

5.1 Introduction
This chapter discusses the summary of the findings; conclusions reached and then give
the recommendations as per the responses from the respondents. This is in relation to
education level, economic factors, cultural and religious factors, and lastly reproductive
health service providers. The chapter also looks at the conclusions and recommendations
as deduced from the study findings. Finally the chapter points out the areas the researcher
thought would require further research in related fields.

5.2 Summary of findings

This section highlights the key findings from the study.

5.2.1 Education Level of Men

The study revealed that majority of men even those who are highly educated have
negative attitude towards vasectomy. The assumption was educated men especially those
with tertiary education will have a positive attitude towards vasectomy. This assumption
was proved wrong when the researcher asked the respondents if they think vasectomy is a
good family planning method majority of the respondents said they do not think
vasectomy is a good family planning method including respondents who had tertiary
education 69.4 % and secondary educated respondents 67.7% said vasectomy is not a
good method. The study further revealed majority of the respondents in all education
levels cannot consider vasectomy in the future. The tertiary educated respondents 76.5%
and secondary educated respondents 64.5% said they cannot have a vasectomy in the
future confirming the negative attitude towards vasectomy even by educated men.

Majority of the respondents negative attitude even the highly educated was founded by
the belief that vasectomy is like castration which gave the impression how cultural beliefs
is very strong in our African societies regardless of education backgrounds. Other

46
respondents gave out reasons such as vasectomy is against their religious backgrounds or
they cannot have a vasectomy because it is a permanent method.

5.2.2 Economic Factors

On economic factors the study revealed generally majority of men 6 9 .2 % are aware of
the significance of practicing family planning to have smaller families because of the
financial difficulties of having a large family. This was good news considering the fact
majority of the respondents earnings 51.7% are between the bracket 10,000 and 15,000
which is significantly low.

The study also revealed majority of the respondents still cannot have a vasectomy even
when faced with economic hardship. This was accounted by majority of the respondents
58.7% who said they cannot have a vasectomy even when faced with challenges of
providing food, education, shelter and other basic needs for their children. The
respondents said they would encourage their wives to practice family planning but them
personally as men cannot take a personal responsibility.

5.2.3 Cultural and Religious factors

Findings from this study reveal culture is a big hindrance to vasectomy acceptance.
Majority of the respondents 50% think vasectomy is a form of castration, only 30%
saying they do not think vasectomy is a form of castration shows how culture contributes
mostly negative attitudes towards vasectomy. Majority of the respondents 50% were also
worried that vasectomy affects sexual desire and desire with only 30% saying they do not
think so while the other 20% were unsure, the fact is vasectomy does not affect sexual
desire or libido which shows many people are not aware the details about the vasectomy
procedure.

On religious factor the study revealed that religious denominations have different
attitudes towards vasectomy. The researcher asked the respondents whether they find
vasectomy is against their religious faith, majority of Muslim respondents 66.7% said yes
vasectomy is against religious faith giving reasons such as vasectomy is a sin and it is

47
against the teachings of the Holy Quran. Surprisingly most of the catholic faith
respondents 53.3% said no to the question although their church advocates for natural
family planning methods. The Catholic faith respondents said having a vasectomy is a
personal decision and their religious faith is least of their concern. Respondents from
protestant churches majority of them 63.2% said vasectomy is not against their religious
faith. This latter information confirms that most Protestants churches support family
planning.

5.2.4 Reproductive health service providers’

The study reveals reproductive health service providers bias against the vasectomy
method. In Vipingo health Centre and Kilifi district hospital the service providers have no
training in carrying out a vasectomy with the exception of Mtwapa health centre
providers. Vipingo health Centre does not even have the facilities of providing a
vasectomy procedure. The researcher noted the service providers were assuming men are
not interested in family planning as most of them saw no need of undergoing vasectomy
training.

The study also reveals service providers do not talk about vasectomy option at all even
with the women clients in the family planning clinics, this brings the assumption the
service providers in take family planning as women’s responsibility. Service providers
are also faced with challenges of lack of vasectomy sensitization awareness being carried
out in the district. The service providers revealed that community health workers the
people responsible to sensitize the communities about various family planning methods
are not trained about vasectomy procedure. The study reveals lack of sensitization and
service providers who are not trained is the reason why there has no vasectomy procedure
that has been done for the last one year.

5.3 Discussion of Findings

This section provides a contrast and comparison analysis of the findings in reference to
works undertaken by other scholars on male attitudes towards vasectomy.

48
This study reveals that majority of the highly educated men also have negative attitude
towards vasectomy. This is total contrast of (Posner and Mbodji, 2009) who said
knowledge and approval rates of vasectomy have been observed to be highest among the
younger, higher parity, better educated men and those in professional/skilled occupations.
Majority of the highly educated men even those with tertiary education in this study
revealed that they do not think vasectomy is a good family planning method and they
cannot consider having a vasectomy even in the future. The researcher was surprised
when they also argued vasectomy is like castration or it may affect their sexual desire
which shows that educated men can exhibit strong cultural tendencies regardless of their
exposure to education.

Majority of the respondents seemed to be generally aware of the significance of

practicing family planning to have smaller families because of the financial difficulties of
having a large family, but the same respondents still cannot have a vasectomy. Most men
prefer their wives to do family planning but they cannot take personal responsibility of
having a vasectomy themselves even in times of hardship. This is because men take
family planning as women’s responsibility. If men realize the importance of family
planning in reducing economic hardship (McGinn et al., 2009) suggested that vasectomy
sensitization campaigns can use economic motivation for vasectomy acceptance
explaining how vasectomy can be relied on to recognize its benefits such as easing their
economic load and contributing to healthier family

The study identified cultural factor as the biggest contributor of male negative attitude
towards vasectomy. Educated men with tertiary education exhibited cultural
misconceptions of vasectomy that it is like castration, one loses sexual desire or one may
gain weight after the procedure. This establishment is mirrored in the study by (Khasiani,
2001) who acknowledges that vasectomy is the least popular modem family planning
methods in sub-Saharan Africa thanks to largely cultural beliefs. This explains why the
study found out in the 3 major health centres in Kilifi district no vasectomy procedure for
past several years. This information corresponded in the study by (Khasiani, 2001 who

49
says most countries in sub Saharan Africa have vasectomy prevalence rates well below
1%.

Findings from the study reveal that religious factor is not a big hindrance to vasectomy
acceptance except Muslims. Most muslim respondents said vasectomy is against their
religious faith. This finding resonates with the assertions of William Basil (1992) in the
study he implies Muslim scholars unanimously agree that permanent methods of family
planning are prohibited in Islam since they involve changing human physiology. The
catholic respondents said they can have a vasectomy regardless of the church standing
which advocates for natural family planning methods giving reasons such as family
planning is an economic reality in this harsh economic environment. The protestant
respondents as assumed do not see vasectomy is against their religious faith, this
establishment is mirrored in the study by Kotva Jr., Joseph J. (2002) in the study he
implies most protestant churches have no problem with artificial contraception most have
a religious that “each couple has the right and the duty prayerfully and responsibly to
control conception according to their circumstances."

Reproductive health service providers are bias towards the vasectomy procedure. This is
shown by how the service providers except Mtwapa health centre but of the two major
Centre’s; Kilifi District hospital and Vipingo health Centre have no training on providing
a vasectomy procedure. Vipingo health Centre does not even have the facilities of
providing a vasectomy procedure. The researcher also noted that the service providers see
family planning as a women’s’ responsibility as they did not see the need to undergo
vasectomy training, creating a situation is particularly damaging for vasectomy, a
procedure that is already shrouded in serious misconceptions. Scholar (Khasiani, 2001)
emphasizes that it is essential that all family planning programmes, whether male or
female oriented, emphasize appropriate training for their personnel and responsible and
thorough counseling at its clinics if they are to be successful. If all health reproductive
health service providers are not trained on how to perform and counsel potential
vasectomy clients then it will have a negative impact on the vasectomy service.

50
5.4 Conclusions
The study establishes that male attitudes towards vasectomy in Kilifi district are generally
negative. This negative attitudes emanate from strong cultural tendencies by men who
believe family planning is a woman’s’ responsibility. This problem is compounded by
reproductive health service providers’ bias towards the vasectomy procedure. Other
challenges include low education levels, ignorance from highly educated individuals, and
religion in the case of Muslims.

5.5 Recommendations
Based on the findings of the study the following recommendations were made:
Reproductive health service providers should be trained in providing vasectomy and
counseling services. The training objective will be to make providers be able to perform
vasectomy procedure, be able to provide adequate counseling on vasectomy clients; be
able to present vasectomy positively; be able to make men feel comfortable visiting
clinics and seeking more information on vasectomy.

There are very serious misconceptions about vasectomy; in view of this a wide variety of
communication channels should be used to disseminate accurate information about
effectiveness, safety and benefits of vasectomy. Mass media campaigns using community
health workers, physicians and satisfied vasectomy clients should be created to address
myths and misinformation.

To enable vasectomy sensitization campaigns to be effective. Community health workers

have to be educated about the vasectomy procedure. They have to be well aware of its
advantages, disadvantages and all the details about the vasectomy service. They should
be trained on how to devise culturally relevant approaches and maintaining good
interpersonal relations with men.

Sensitization campaigns should highlight the economic benefits of smaller family size to
make vasectomy more attractive to men. For example, a media campaign might convey
the notion of a "satisfied spouse," who no longer has to be concerned about problematic

51
childbirths, is sexually satisfied and has a family that is financially secure and well
provided for. Such messages may resonate among women, as well as among men who are
concerned about their spouse's health.

Given a spouse's potential role in the decision-making process promotional efforts should
be directed toward women as well as men. Women could receive education regarding
vasectomy in maternal and child health clinics. Mass media programs such as radio
dramas can provide role models for couples discussing vasectomy. Reproductive health
service providers should routinely discuss the option of vasectomy with female clients
interested in long term methods.

Family planning services should be tailored towards men needs. Existing clinics should
consider offering broader men's reproductive health services to enhance the appeal of
family planning to men. Clinics can include male only settings to support vasectomy
programs and integrated services with separate hours for men. The latter may offer
broader men’s reproductive health services, such as urology, infertility treatment, testing
for and treatment of sexually transmitted infections and counseling for sexual problems.

To ensure consistent levels of vasectomy service provision, it is recommended that

vasectomy outreach services should be regularly scheduled (example on a weekly basis),
and linked with community outreach and mobilization. Each facility should always be
stocked with the necessary equipment and supplies, so that services can be performed
whenever the provider is on-site.

“Change takes time,” especially in medical settings, which are generally conservative,
hierarchical, and change resistant. This is even more the case when the change entails
adoption and provision of an unknown or widely misunderstood procedure, such as
vasectomy. It is recommended that the government, donors, policy makers and other
stakeholders to have a long term commitment towards the vasectomy programs in terms
of sustained attention, leadership and resources.

52
 5.6 Suggestion for further studies
The following are recommendations for further research;
1. Barriers facing vasectomy services and their impact on men attitudes in Kenya.
2. The effectiveness of vasectomy mass media communication strategies on men
attitudes in developing countries.
3. Influence of spousal/partners communication on men attitudes towards vasectomy
in Kenya.

I 53
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C o n d o m s a s a C o n tra c e p tiv e M e th o d in U rban M exico, ” International Family

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Im p o r ta n t S o c ia l R e fe re n ts o n B e lie fs a n d In te n tio n s to use C o n d o m s, ” Journal of

Advanced Nursing, 17:699-703.

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M a k e " a D iffe re n c e ? ” American Journal of Public Health 83(11): 1567-71.

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 APPENDICES

APPENDIX I: LETTER OF INTRODUCTION

University of Nairobi,
College of Extra Mural studies,
School of Continuing and Distance Education,
Nairobi Center.

The Management

Health Centre
Box...................................
Kilifi District
Dear sir/ madam.

RE: Academic Research

I am a student of University of Nairobi pursuing a Masters Degree in Project Planning
and Management. Am conducting an academic research on factors influencing male
attitudes towards vasectomy in Kilifi district.

Your health facility has been chosen to provide information relating to reproductive
health service provider influence towards vasectomy. The information that you will give
is confidential and will be used only for the purpose of my academic research. Thank you
in advance.

Yours faithfully,

Musa Lugwe Kidzuga

L50/65296/2010

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 APPENDIX II: MALE QUESTIONNAIRE

TODAY’S DATE_________________ _____________

M y n a m e is Musa Lugwe. I a m a p o s tg r a d u a te stu d e n t a t the U n iv e rsity o f N a iro b i. I a m

c o n d u c tin g re se a rc h in K ilifi district. The p u r p o s e o f the s tu d y is to le a rn the fa c to r s th a t

in flu e n c e m a le a ttitu d e s to w a rd s va secto m y. T his in fo rm a tio n w ill b e u s e d to d e te rm in e

th e le v e l o f m a le p e r c e p tio n to w a r d s v a se c to m y w ith th e a im o f in c o rp o ra tin g m en in

fa m il y p la n n in g p r o g r a m s in fu tu r e .

R e g a r d in g th is I w o u ld a s k y o u so m e q u estio n s. S o m e o f th e se q u e stio n s a re p e r s o n a l b u t

th e a n s w e r s y o u g iv e w ill n o t be sh o w n to anyone. T his is CONFIDENTIAL DATA th a t

w ill o n ly be tr e a te d w ith u tm o st c o n fid e n c e a n d s h a ll o n ly be u s e d f o r re se a rc h p u r p o s e s

o n ly

Section A: Background Information

1. How old are you

a) Under 25 yrs
□
b)26 - 30 yrs □
c) 31 - 35 yrs □
d)Over 36 yrs. □

Which tribe are you?

a) Mijikenda
b) Other (Specify)

3. What is your occupation?

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4. What is your marital status?
a) Single □
b) Married □
c) Divorced □
d) Widowed □

e) Separated □

5. What is your religious affiliation?

a) Muslim
□
b)Catholic □
c) Protestant □
d)Other (Specify).....

6. What is your education level? I I

a) Primary |---- 1
b) Secondary | |
c) Tertiary I I
d) No formal education I I

7. a).Do you have children?

Yes [ ] No [ ]
b).If yes please specify how many.......................

Section B: Education Level

8. Do you know anything about family planning?
Yes [ ] No [ ]
9. Have you heard about male methods of family planning?
Yes [ ] No [ ]
10. Do you know anything about vasectomy?
Yes [ ] No [ ]

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11. Do you think it is a good family planning method?
Yes [ ] No [ ]
12. Have you undergone the vasectomy procedure?
Yes [ ] No [ ]
13. If not vasectomized, can you consider vasectomy in the future?
Yes [ ] No [ ]
14. What is your personal opinion about vasectomy?

Section C: Economic Factors

14. What is your income earning level?
[ ] 1,000-4,999
[ ] 5,000-9,999
[ ] 10,000-14,999
[ ] 15,000-19,999
[ ] 20,000 and more
[ ] No earnings
15. Do you believe in practicing family planning to have a smaller family to ease your
financial worry?
Yes [ ] No [ ]
16. Can you have a vasectomy so as to maintain a small family to ease your financial
worry of providing adequate food to your children?
Yes [ ] No [ ]
If no why...............................................................................................................
17. Can you have a vasectomy so as to maintain a small family to ease your financial
worry of providing healthcare to your children?
Yes [ ] No [ ]

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18. Can you have a vasectomy so as to maintain a small family to ease your financial
worry of providing adequate education to your children?
Yes [ ] No [ ]

19. Can you have a vasectomy so as to maintain a small family to ease your financial
worry of providing adequate shelter to your children?
Yes [ ] No [ ]

Section D: Cultural and Religious Factors

No. Questions and fdters Coding Categories Skip to
State whether you agree or disagree Agree Disagree Unsure
with the following statements
20. Is Vasectomy a form of castration □ □
21. Does vasectomy affect a man □ □
sexual ability
22. Does vasectomy affect a man □
sexual desire
23. Does vasectomy affect a man’s □
respect
24. A man cannot ejaculate after a □
vasectomy procedure
25. Having a vasectomy will make □ □ □
your wife become unfaithful
26. The vasectomy procedure causes a □ □ □
man to gain weight.

27. Is vasectomy against your religious faith?

Yes [ ] No [ ]

63
(a) If yes why?

(b) If no why?

(•*

T he E n d

T h a n k yo u .

64
 APPENDIX III: INTERVIEW SCHEDULE FOR SERVICE PROVIDERS

1. What are your medical Qualifications?

2. Have you been trained to provide vasectomy services for potential male vasectomy
clients?
a) If yes where and how long was the training?
b) If no, do you require the training?
3. Have you been trained to provide counseling for potential male vasectomy clients?
a) If yes where and how long was the training?
b) If no, do you require the training?
4. Do you provide vasectomy services?
5. Would you recommend vasectomy services to male clients?
6. Kindly tell me in figures the number of men who come for this services like per
month/year?
7. In your opinion what is the attitudes of men in Kilifi towards vasectomy?
8. In your opinion what are the factors that influence male attitudes towards
vasectomy?
9. a) In your opinion what are the obstacles towards vasectomy service?
b) What are the solutions to these obstacles you have mentioned?
10. What are the communication strategies used in this clinic to promote vasectomy?
11. What has been the response of the community?
12. Is there a need of more sensitization?
13. In your opinion which other channels can be used for vasectomy promotion?

65