Vasectomy and the Kenyan Man

Sometime in 2013, I made my way to the Sarit Center food court to meet a man with a curious story. I had met him, virtually first, through the surgeon who had done his vasectomy barely seven months before. Finding both of them, 34-year-old Moses Kimani and his doctor, Dr. Charles Ochieng’ had at first felt like doing a story on an underground movement.

In February 2013, Kimani, a young pastor with a city church, had left his small family on a journey to the lakeside city of Kisumu. It was a long journey, perhaps long enough for him to think even more about his mission. On the other side of that trip was a man called Charles Ochieng, a passionate vasectomist and a former patient himself. Kimani was an outlier, in my view, because he hadn’t been pushed into taking the procedure by anyone or circumstance. He had a young family, with two healthy daughters, and a budding pastoral ministry.

I thought Kimani was an outlier because I evaluated his situation from the perspective of our collective masculinity. Perhaps most importantly, vasectomy and any loss of fertility by a man is viewed as a surrender of masculinity. African cultures, obsessed with procreation, ensured that no man remained without children of his own. The more the merrier. An African man did not count his cattle or his children. The goal was always to have a male heir to carry on the family name but in a time of very little maternity care, infant mortality was high and it was necessary to spread one’s risk. So one got many children, boys pointed to a future, while girls were considered a source of wealth, pride, and socio-political alliances. Sometimes economic ones too. If one couldn’t sire, he called upon his brothers, and friends, to help. Sometimes they did anyway.

But Kimani has two daughters and he didn’t want any more kids. He had sat his wife down, repeatedly, and begged her to let him go through with it. He had told her about it before they got married, and once they agreed to have two children. Two kids were all he would ever want, their gender regardless. She was hesitant about it and asked for time to read up. She needed to know how it would affect him, and his sex drive, amongst other things, before she said yes.

To my rather insistent questioning on why it feels wrong, and perhaps strange, for a man like Kimani to make such a decision, Dr. Ochieng called my BS. His exact words were ‘Culture is just an excuse for ignorance.’ That shut me up. Not only was he a brilliant doctor with a passion for snipping men, he had been a patient too. A living testimony of just how little a vasectomy changes someone. His decision was slightly different. He had watched his wife go through the pain of childbirth and then have to suffer trying to find the right method of contraception. Sex was a shared pleasure, but contraception seemed like her burden alone. He decided to do something about it.

A few weeks before this series of interviews, a lady had written to a newspaper counsellor with a rather intriguing problem. She had tried all methods of contraception but there was a problem with all of them. Some were too expensive, others too invasive (she had already had two C-sections) and she was allergic to condoms. All she wanted, she said, was for her husband to seriously consider getting a vasectomy. What actually caught my eye was her assertion that vasectomies are reversible, and the husband could get it fitted back together if he ever wanted to have kids.

Vasectomies are reversible. The chances of getting the sperm tributary flowing back to the main semen river decrease with time though. If done within the first ten years, there’s a 55 percent chance of the procedure, known as vasovasostomy, working. If after a decade, there’s only 25 percent chance of it ever working. That solves a key issue in the argument against vasectomy as a means of contraception.

Which brings us to the next question, access. Vasectomists like Dr. Ochieng are battling an odd problem. They are few in the country, partly because demand is rather low. Another surgeon, Dr. Allan Gohole, estimates that they collectively perform about 200 surgeries in a year. In 2011, the number was probably a lowly 67. Most of them were done during free medical drives offered by the No-Scalpel Vasectomy International (NSVI) and the Winam Safe Parenthood Initiative. There are most likely procedures done in hospitals that never get clocked largely because of the stigma around the subject and the fact that it is a quick procedure. Interest, according to Dr. Ochieng, seems most prevalent in men above 35. In 2012, the oldest man at the NSVI camp was a 70-year-old man with 13 kids.

The main problem is that family planning was introduced in Kenya as a female issue in the 1960s. Birth control in its modern form is a foreign concept, and even then not one where there is consensus because influential social bodies like the Catholic Church are so vehemently opposed to it.  In the 1980s, during a time when a global pandemic forced Kenya to reopen the discussion around sex and family, bodies such as Engender Health did extensive research on vasectomy in Kenya. Only 35 percent of men and 20 percent of women interviewed knew about it. Compared, 83 percent of men knew about female contraception while only 73 percent of women did. Vasectomy was then among a list of things whose advertising was banned by the prudish Ministry of Health. Which meant men knew more about female contraception than even women did. Only 185 procedures were done between January 1976 and September 1988, and with the support of NGOs, 246 were done between 1987 and 1991.

Research around the topic in modern-day Kenya is hard to come by, partially because our socio-cultural systems still look at contraception as the duty of the woman. The systems, perpetuated by both men and women, explain why men are so hesitant to consider the idea of getting the snip. They see it as a loss of masculinity, a perspective furthered in part by how social systems have shaped the modern Kenyan family.

The politics of the penis are primarily to blame for the low uptake of vasectomy as a form of birth control. For most people, there is no difference between vasectomy and castration. In fact, the Luo slang for the procedure, for example, is puodo or royo, both whose closest meaning is castration. The politics of the penis do not even begin around castration but around circumcision and its role in masculinity. Around that issue alone exists enough controversy, solved somewhat by scientific proof that it reduces the risk of contracting HIV/AIDs, not that it makes better men. Some conversation around the penis has made a comeback with several cases of bobbiting, where sadistic women cut off their husband’s private parts. The act of bobbiting itself was often a war strategy for the conqueror to further dehumanize the conquered. Vasectomy in Kenya thus falls around this broad socio-culture quagmire, where emotions are high, myths are prevalent, traditions misunderstood, and misconceptions accepted as truths.

Whenever socio-cultural systems meet with just the right dose of ignorance, myths spring up to keep certain things out. Around vasectomy, for example, lies the myth of the role and composition of male ejaculate. What happens, one asks, if sperm generated is not ejaculated? Does it fill up in the balls and possibly explode, or does it get reabsorbed into the body? It gets reabsorbed into the body, because nature did not design you to have blue balls, willingly or otherwise.

For men like Dr. Ochieng whose life mission is to promote snipping as an easier form of contraception, such questions are indicative of the battle to come. At the heart of it is the struggle to define Kenyan masculinity at a time when we are nostalgic about the past and possessive about the present. If all that makes a man is his fertility, then what about those who decide to never have children? Or is just the knowledge that one can still sire enough to promote a superhero perspective towards life?

In Kimani and Ochieng, I saw a challenge to these diminishing interpretations of masculinity. There was nothing less manly about them, none of the mythical surges in estrogen or even a walk to suggest a pair of testicles had explored somewhere. In fact, by the mere confidence in tackling their individual problems with a solution, the seemed to edify where Kenyan masculinity should be heading. 

Featured Illustration from www.pleaseenjoy.com

A previous version of this story was published in Destination Magazine, June 2014 Edition.

Owaahh, 2015

  • Very informative and well-written. I think this needs to continually be spoken and written about to further demystify vasectomy. Contraception should not be a female burden.