South Africa has a fairly low vasectomy rate

When will SA males start taking responsibility? Unplanned pregnancies and unwanted births are on the rise currently. Less than 1% of men between the ages of 15 and 49 have undergone vasectomies, according to statistics. The findings of a 2020 report titled “Unwanted Fertility in South Africa” were based on demographic and health data collected from 1998 to 2016.

The National Department of Health’s spokesperson, Popo Maja, makes no attempt to hide the reality that South Africa has very low rates of vasectomy. Only 639 vasectomies were carried out in South Africa in 2020, claims Maja. This is almost exactly half of the 1 391 in 2019 and the 1 205 in 2018. Vasectomy procedures were done 689 times in 2017 compared to 564 times in 2016. Given how low these numbers are, Maja was unable to specify whether they applied to the public sector just or to both the private and public sectors together.

Despite the difficulty in locating recent data, what is known suggests that South Africa, like most African nations, has significantly lower rates of vasectomy than many other nations. (Much of the information is compiled in this UN Population Division report.) While the rate of vasectomies among men aged 15 to 49 is less than 1% in South Africa, it is over 10% in many wealthier nations.

“We obviously are far below when it comes to our figures on vasectomies. I guess our citizens still want to expand,” says Maja.

He draws attention to the fact that the Sterilization Act governs sterilization in South Africa. A person capable of agreeing may not be sterilized without their agreement, among other things, according to the Act. Spotlight has previously covered allegations that women with HIV were subjected to female sterilizations without their knowledge or consent.

The report states: “20% of all births in the five years preceding 2016 Demographic and Health Survey (including pregnancies at the time), happened to women who were not planning on having any more children”.

The majority of black children grow up fatherless

When compared to their counterparts of other races, black children aged 0 to 17 were the least likely to live at home with their biological father, according to a Statistics South Africa (Stats SA) report on the country’s population categories. Only 31.7% of black kids stayed with their biological dads, compared to 51.3% of colored kids, 86.1% of Indian/Asian kids, and 80.2% of white kids, according to the research. Between 74% and 92.6% of kids stayed with their mothers across all four racial groupings.

Unwanted Fertility in South Africa

New research from Statistics South Africa titled “Unwanted Fertility in South Africa” states that 20% of births in the five years prior to 2016 Demographic and Health Survey (including pregnancies at the time) took place when women had no plans to have any more children. The percentage of unintended pregnancies increased from 17.3% in 1998 to 20.4% in 2016, according to the research, which is based on demographic health data from 1998 and 2016.

In South Africa, the public sector already offers a number of temporary contraceptive methods, such as condoms, birth control pills, intrauterine devices, and contraceptive implants for women. However, the accessibility of these methods differs amongst healthcare facilities. Despite current research, there are no approved contraceptive pills or implants for guys.

There are alternative options for birth control that are more long-term, such as male and female sterilization, the latter of which takes the form of a vasectomy. Vasectomy is easier to execute, less intrusive, safer, and more affordable than female sterilization, claims this Lancet paper.

Vasectomy is a surgical surgery in which the sperm tubes (vas deferens) are tied off to remove all sperm from a man’s semen, making him sterile. Men who have had vasectomies still make semen, and a vasectomy has no effect on a man’s sex drive.

How does a vasectomy work?

Going to the hospital as a day patient is necessary for a vasectomy. During the procedure, either a general anesthetic or sedation along with local anesthetic will be used to manage pain. A patient can be prohibited from drinking for roughly six hours prior to the surgery and won’t be permitted to drive home.

“The procedure involves making a little incision over the scrotum (sac of skin containing the testicles which are responsible for producing and storing sperm). We make one little cut on the left side and one little cut on the right side. Each cut is less than a centimeter in size. And then we get to the vas (duct responsible for carrying sperm to the testes) to do the procedure. Finally, we do the operation through the incision and close it up with dissolving stitches and the patient can go home on the same day.”

The purpose of a vasectomy is to block or cut the vas so that sperm cannot go up from the testicles into the combination of semen. As a result, it cannot result in pregnancy if there is no sperm inside. The sperm cannot combine with the semen because the vas is blocked. Therefore, the only kind of semen that is ejaculated is sperm less semen.

Where can men go for the procedure?

Vasectomies are offered in private and public health facilities.“The urologists at the public hospitals can do these procedures, but it’s such a low priority and it always has been a low priority,” said Gellman. This means that a patient can be on the waiting list for a vasectomy for about six months to a year.

How much does it cost?

A vasectomy typically costs between R15,000 and R16,000. Depending on the patient’s choice, the treatment can be performed under sedation or anesthesia; the cost varies.

Is it permanent?

Patients should regard the operation as an irreversible form of sterilization rather than a method of contraception, said Gellman.“In practice, we do get asked to reverse vasectomies. It’s usually due to a family situation like a divorce, or some other tragedy which then leads to the man deciding to have another child and it may become a problem. Although technically, you can reverse it, you can join the tubes together again, but the success rate is not 100%. You cannot tell which patient it will work on,” he explained.

Three years after a vasectomy and after performing a reversal, the chances of a successful pregnancy are probably around 70%. When you wait 15 years, it drops to roughly 30%.

Will medical aid cover it?

Yes. Most medical aids do cover vasectomy procedures.“There is a diagnosis code and procedure code indicating what the medical aid is going to cover for their client, at the rate available to them.  You usually don’t have to motivate for a vasectomy.”Surgery to reverse a vasectomy is not covered by any medical aids as it’s considered an infertility procedure.

How long after the procedure can I have sex?

A patient has to wait seven days before he can ejaculate.“The sexual function of the penis and any other sexual features remain the same. The orgasm, ejaculation itself is not affected.”

Does it work immediately?

No, a man is not often sterile for three months following the surgery. Ejaculating and testing the semen are the only ways to confirm that there are no sperm still present in the tubes.“The sperm blocked in the vessel can’t get to the partner. But the sperm in the rest of the tube, can. The only way to clear that sperm is by ejaculation. It takes an average of 18 to 20 ejaculations to achieve this.”

Are there any other options for male contraception?

No. Condoms and vasectomy are the two methods of birth control available to males. Male hormonal therapy is not a possibility, according to Gellman, because the adverse effects are too severe.

What are the side effects?

A little bleeding is one of the side effects. This blood, according to Gellman, originates from the blood veins in the scrotum wall. During the procedure, if one of those blood arteries is cut, the blood constricts all the way up to the scrotum and may appear blue. He claimed that it doesn’t hurt and goes away in ten days.

“To get significant bleeding from a vasectomy is unusual. An infection can also occur, but if it’s done in a sterile theatre, it is extremely unusual. Research shows that the complication rates of a vasectomy are between 1% and 2%. Ongoing pain is also a concern for some patients. This is caused by the build-up of sperm collecting in the tubules of the epidermis (thin layer of outer skin), but is successfully treated with anti-inflammatories and goes away,” he said. Another adverse effect is a possible slight reduction in the amount of fluid discharged during ejaculation compared to before the surgery.

Is the procedure painful?

Gellman says that because the process is brief, there is little discomfort involved. He indicated the patient might feel better in a day and be able to get back to their regular activities.

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