Original Article

SAGE Open Nursing

Volume 4: 1–10
Married Men and Vasectomy: ! The Author(s) 2018
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DOI: 10.1177/2377960818790380

Urban Community in Ghana journals.sagepub.com/home/son

Stella Appiah, PhD, MPhil, RN1, James Kwaku Agyen, Bsc, MSc,
MPhil2 , Isabella Garti, MN, BSc, RM1 , and Awube Menlah, MN,
BSc, RN1

Abstract
An effective method of birth control in men yet least accepted and patronized is vasectomy. Vasectomy provides health
benefits to the user, his direct family, and the entire population as it helps to control population growth. This article explored
the beliefs and attitudes of commercial drivers on vasectomy in an urban community in Ghana. The study employed quali-
tative exploratory design using focus group discussion. Data were collected from 12 married men between the ages of 45 to
60 years who were selected through purposive sampling method. The focus group discussions were audiotaped, handwritten,
and recorded. Recorded data were then transcribed verbatim, and the current version of the NVivo software for analyzing
qualitative data was used to manage the data. Three major themes emerged from the study: knowledge of respondents on
vasectomy, beliefs, and attitudes of married men toward vasectomy. Each of the themes had three subthemes. The study
revealed that vasectomy was perceived by some of the respondents to be synonymous to castration which comes with
negative effects. Inadequate knowledge, negative perceptions, future uncertainty, and the irreversible nature of vasectomy
emerged as contributing to the low patronage and some of the reasons why most of the respondents had no intentions of
opting for vasectomy. In view of these findings, it is imperative for all stakeholders to give urgent attention to behavior change
strategies that can be put in action to ameliorate the effects of these negative attitudes and misbeliefs. Ultimately, the tide can
be turned around and vasectomy will be a preferred alternative when it comes to family planning in Ghana.

Keywords
attitude, men, beliefs, qualitative research<research, vasectomy

Date received: 12 February 2018; accepted: 28 June 2018

growth rate exceeds by almost 3% per annum in most

Background African countries including Ghana (Ghana National
The world’s population has risen from 2.5 to 7.4 billion; Population Council, 2017; United Nations Economic
this alarming rate has contributed in part to resource Commission for Africa, 2016; World Bank, 2018).
depletion, environmental degradation, and social Family planning has been deliberated upon and
issues (Onasoga, Edoni, & Ekanem, 2013; World accepted as a means of reducing rapid world population
Population Data Sheet, 2016). Of all the world contin-
ents, Africa’s population is expanding enormously and is
said to contribute to almost half of this figure (United 1
Nursing Department, Valley View University, Accra, Ghana
2
Nations Economic Commission for Africa, 2016). School of Education, Valley View University, Accra, Ghana
Overpopulation has been the trend in Africa and this is Corresponding Author:
not expected to decline even in the next 30 years (World Stella Appiah, Nursing Department, Valley View University, Accra, Ghana.
Population Review, 2018). Currently, the population Emails: [email protected]; [email protected]

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-Non-
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bution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://
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2 SAGE Open Nursing 0(0)

growth (State of the World Population, 2015). In add- 2006). Among the barriers worth mentioning are limited
ition, it plays a vital role in the reduction of infant, child, information on vasectomy, lack of access as a principal
and maternal mortality and morbidity (Onasoga et al., constraint, negative attitudes, and misinformation
2013). The benefits of family planning go beyond (Bunce et al., 2007).
improvement in maternal and child health as it extends Vasectomy is an uncommon method in Ghana as in
to the individuals, families and country as a whole. many developing countries such as Mexico, Botswana,
These benefits include but are not limited to higher edu- Nepal, Nigeria, Pakistan, and Brazil among others
cation for girls, better employment and empowerment (Asare, Otupiri, Apenkwa, & Odotei-Adjei, 2017;
for higher socioeconomic status, prevention of unwanted Ghana Statistical Service, 2008; Van Lith, Yahner, &
pregnancy and related health risks in women, prevention Bakamjian, 2013). The prevalence of vasectomy is less
of the dreadful HIV/AIDS, reduction in the high inci- than 0.1% and has been more difficult to obtain in
dence of adolescent pregnancies, and slowing of popula- Ghana than other family planning methods (Asare
tion growth (Jangu, 2013; Mutombo, Bakibinga, et al., 2017; Owusu-Asubonteng, Dassah, Odoi,
Mukiira, & Kamande, 2014; Suchithra & Sujina, 2016; Frimpong, & Ankobea, 2012). Meanwhile, vasectomy
World Health Organization [WHO], 2018). is unique among the array of modern methods of contra-
There are a wide variety of family planning methods ception as it enables the male partner to take primary
which include short-term, long-term, permanent, and responsibility for fertility control. Furthermore,
emergency methods (Alireza, Shahriar, & Abdolah, vasectomy is highly effective in preventing pregnancy
2017; Ghana Demographic and Health Survey, 2014; whether or not there is subsequent behavior modification
Kenya National Bureau of Statistics & ORC Macro, by the vasectomized man (Asare et al., 2017).
2010; WHO, 2018) . Some short-term methods include Knowledge and attitudes of men toward vasectomy
condoms, spermicides, oral contraceptive pills, and nat- are known to have significant influence on its uptake
ural approaches, while long-term methods include intra- (Ezegwui & Enwereji, 2009). Nishtar, Faruqi,
uterine device (IUD), implants, and progestin-only Khowoja, and Ul-Hasnain (2012) highlighted the need
injectable. Voluntary surgical contraception, tubal liga- to improve upon the knowledge and attitudes of men
tion, and vasectomy are some of the permanent forms of because there are widespread misconceptions that vasec-
family planning, while emergency contraceptives also tomy could cause impotence and is exclusively meant for
include oral pill and IUD. These methods are more prisoners. Ignorance leading to widespread misconcep-
inclined toward women than men (Hardee, Croce- tions among males has been reported to be a major
Galis, & Gay, 2017). The male condom and vasectomy reason for low acceptance of vasectomy (Ebeigbe,
are the only methods available for men who wish to Igberase, & Eigbefoh, 2011). In addition, the belief sys-
practice family planning (Kols & Lande, 2008; tems of men have also been implicated as de-motivators
Nordqvist, 2016; Shih, Turok, & Parker, 2014). As to vasectomy. Findings show that majority of men
noted by the Ghana Demographic and Health Survey believe that sterilization is the sole prerogative of
(2015), currently more than one fourth of married women (Onasoga et al., 2013).
women (27%) are using some method of contraception. This study sought to provide data on the utilization of
Twenty-two percent use a modern form of contraception vasectomy by men in the Greater Accra Region of
with the remaining 5% using traditional methods of Ghana. Previously, Ghanaian studies done have been
contraception. Furthermore, it was recorded that 45% quantitative in nature and have largely focused on
of unmarried women are currently using some form of women (Asare et al., 2017; Owusu-Asubonteng et al.,
contraception (Ghana Demographic and Health Survey, 2012). Thus, this article contributes to empirical evidence
2015). on the acceptance of vasectomy as a measure of family
planning in Ghana.
Literature Review
Methodology
Vasectomy is a form of contraception that involves sur-
gically cutting or blocking the tubes that transport sperm A qualitative research design was employed with focused
from the testis to the penis (Nordqvist, 2016). It is con- group discussion (FGD) as an approach to solicit infor-
sidered as safe and very effective in preventing pregnancy mation from participants. Participants were gathered for
yet its patronage as a family planning method is not discussion to obtain their perceptions on the defined area
encouraging compared with the other methods (Shih, of interest. A nonthreatening permissive environment
Turok, & Parker, 2014). Vasectomy is an important was created to allow freedom of expression among the
alternative to female sterilization for couples who want group members. The study was conducted in the central
a permanent method of contraception; barriers to its business district of the Greater Accra Region in Ghana.
wider use exist in many places (Brechin & Bigrigg, The Tema station is the largest and busiest transport
Appiah et al. 3

terminal located in the heart of the district. It is the hub time to provide responses and follow-up questions were
of all commercial transportation in the capital. The asked to clarify statements made. According to Lincoln
accessible population were all the drivers who worked and Guba’s (1985) recommendations on trustworthiness,
on the day of the study. the researchers held regular debriefing sessions, kept
The study population included all male drivers who extensive field notes, and maintained a reflexive journal.
have ever been married and were between the ages of 45 Data analysis was concurrent with data collection.
and 65 years. Male passengers and bus conductors who Tape-recorded information was transcribed verbatim,
did not meet the inclusion criteria were excluded from and content analysis was done. Transcripts were read,
the study. Purposive sampling was utilized to recruit reread, and line-by-line coding was done. During this
married men in their sexual reproductive age groups process, words and phrases that captured the partici-
from 45 years and above. These men might have already pants understanding of the issues were noted. Codes
attained a desirable family size thus were likely to con- that had similar meanings were identified and put
tribute meaningfully to the study. The purpose of the together to constitute refined themes. NVivo (version:
study was fully explained to the participants and they 10.0.641.0) was used to manage the data and three
willingly participated without being compensated. themes were generated. Findings have been presented
Informed consent was obtained and confidentiality was with verbatim quotes from participants.
assured before commencement of the study. To maintain
confidentiality, participants were assigned alphabets (V)
and digits in place of their names. At any point during Results
the study, there was an opportunity for participants to
Demographic Characteristics
opt out. The study was ethically cleared by the Research
and Innovation Center of the Valley View University, The target population of participants in the study were
Ghana, under exempted review. men aged 45 years and above categorized into two
With the use of FGDs, the number to be involved in FGDs. Focus Group 1 was made up of five men who
the group was determined by the researchers; therefore, were above 60 years and Focus Group 2 comprised seven
two FGDs were predetermined and constituted with 12 men between the ages of 45 and 60 years. Participants
men. Focus Group 1 was made up of five men above 60 were of diversified ethnicity; however, they were predom-
years, whereas Focus Group 2 comprised seven men inantly Ga, Ewe, and Akan. These ethnic groups are the
between ages of 45 and 60 years. FGD guide developed commonest in the Greater Accra region of Ghana.
by the researchers based on available literature was used Majority of the participants had received education up
as a tool to collect data. The focus group guide was devel- to the basic level with just three of the participants with
oped based on the themes that emerged from literature education up to tertiary level. In terms of occupation, all
reviewed. Subsequently, it was given to field experts for participants were drivers. Majority of the participants
validation. This helped to contextualize the use of vasec- were Christians with only two of them being Muslims,
tomy as a fertility control method. The input from the which is consistent with Ghana’s demographics. The par-
validation helped to fine-tune the FGD guide. Questions ticipants had ever been married with one wife except one
were asked in a clear and nondirective manner in order respondent who was married to five wives as his religious
not to predetermine or lead the answers. The FGD guide affiliation permitted so. Two of the participants were also
had main question areas in line with the objectives of the widowed. All the participants were middle-income earn-
study. See Appendix A for the FGD guide. ers as they earned between $1 and $16 equivalent to 70
Interviews were conducted by all authors on weekdays Ghana Cedis per day. In relation to the number of chil-
in March 2017. They typically lasted 2 hours and were dren, the maximum number of children was seven with a
held at the convenience of the drivers in the office of the minimum of three per participant.
station master. This was made possible because the Three main themes emerged from the FGDs con-
public transport system in Ghana is such that drivers ducted were as follows:
queue awaiting turns for passengers to board their vehi-
cles. Thus, interviews did not affect their productive . Knowledge assessment
work time. In addition, during the afternoons, there . Beliefs on vasectomy
are fewer passengers as this is not a peak period or . Attitudes toward vasectomy
rush hour. In all, there were five sessions. Interviews
were conducted in three Ghanaian languages specifically
Ga, Twi, and Ewe. The researchers were Ghanaians and
Participants Knowledge on Family Planning
could fluently speak these languages; therefore, transla- The data revealed three main subthemes for understand-
tors were not required. During the interview session, ing vasectomy. These were description of family planning,
when a question was asked, participants were allowed importance of vasectomy, and side effects of vasectomy.
4 SAGE Open Nursing 0(0)

In the first place, it helps to keep both partners’ strong

Description of Family Planning and healthy at all times. This is because, the woman loses
Majority of the participants identified family planning as a lot of blood during labor. It therefore helps the woman
a good means to decide the number of children one to fully recover before the next pregnancy. It also helps
wants to have and as an economic survival technique the husband and wife to work and save money. This puts
based on one’s economic standing. This can be seen in them in the position to cater for their family properly.
the following statements by some of the participants: (V1, FG 1)

It is good, because it helps you to decide on the number Another participant had this to say:
of children you can actually cater for. With family plan-
ning, you give birth to the number of children depending When you give birth to so many children, (say 10,12),
on your financial strength. (V3, FG 2) and you are not able to provide for them, you end up
producing armed robbers and pick—pockets and others
When a man gets married to a woman, they give birth.
who will not work but will always come to you every day
After that, they think of how to cater for their children
asking for money. It is therefore a bad practice to give
and their spacing so that they will not be burdened with
birth to so many children when you cannot provide for
the problem of taking care of them. You should as well
them. (V5, FG 1)
consider your work to plan for your family. In situations
where both partners earn enough from their businesses,
no problems are experienced in providing for the family.
But in situations where they do not earn so much, taking Side Effects of Family Planning
care of the family becomes a problem. (V3, FG 1)
An important subtheme that emerged out of the
knowledge on family planning was the side effects one
Concerning the family planning methods that were experiences. The men believed some of the side effects of
common to participants, different types were mentioned family planning on its users included acute abdominal
including the short-term methods such as the withdrawal pain, dizziness, nausea, painful labor, and infertility.
method, pills, injectable, and condom. Others indicated Others also claimed it makes women fat and unattract-
the long-acting contraceptive methods like the implants. ive. This is what one respondent said to buttress
This is what some participants had to say: the point.

One they call ‘‘pull out’’ which I know is against the It makes the woman grow fat and she becomes unattract-
teachings of the bible. I also know of the calendar ive. This sometimes leads to divorce. She is also not able
method, condoms as well as the foam method. (V1, FG 1) to perform her sexual responsibilities as she is always
complaining of being tired. Apart from that, some of
Another member in the group described the methods them are rendered infertile making them barren for the
like this: rest of their lives. (V1, FG 1)

I know of the chart method, condoms, and injectable for In the quest to promoting family planning, participants
3 months, 6 months and 1 year. I also know of the believed public education is the most potent means to
implants. (V3, FG 2) make people appreciate family planning, as illustrated
in the following statement:
It can be seen that participants were familiar with the
different types of family planning methods that are used. . . . I think nurses and doctors can also promote it by
talking to their patients about it. Teachers should also
educate their students on the benefits of family planning
Importance of Family Planning
so that it becomes part of them even before they start
In assessing the knowledge of participants on family their own families. (V1, FG 1)
planning, a subtheme that emerged was on the import-
ance. Participants understood family planning as a tech-
nique that would help one achieve the aim of raising
good children as well as providing good education.
Beliefs on Vasectomy Among Men
Again, family planning is helpful in terms of financing Making decisions concerning vasectomy depends largely
a home and maintaining maternal health. This is evident on the individual’s belief. The subthemes emerged under
in the following statement made by a respondent this include family planning control method, reversible
Appiah et al. 5

family planning method, and vasectomy adverse . . . I suppose you cannot ejaculate when you have sex after
health effects. the procedure. How then will you be satisfied? Why would
you do something like this to yourself? (V5, FG2)
Family Planning Control Method
Participants indicated that vasectomy is a type of family
Attitude of Men Toward Vasectomy
planning control method and described in different terms
what it is and how it is known in the community. The Attitude was also seen as an important factor to one’s
men expressed different beliefs on vasectomy but referred choice where vasectomy is concerned. Whether one
to it as ‘‘castration.’’ A participant typically referred to would choose vasectomy or advice someone else to do
vasectomy as ‘‘belt method’’ as this is how it is known so depends on the person’s attitude. The subthemes
and called in most Ghanaian cultures. This is evident in emerged under this were strong dislike of vasectomy
the following statements: and discourage other men.

I know of some men [who] use the ‘‘belt method’’ . . .

Strong Dislike for Vasectomy
(V7, FG2)
The analysis showed that participants had negative attitude
A participant did not actually understand the mechanism toward vasectomy by showing strong dislike for it. They
behind vasectomy so expressed himself as follows: also expressed their dislike by saying that in as much as
they would not do vasectomy, they would advise other men
I heard that after the procedure, when you have sex with not to go for it. However, in the Ghanaian context this is
a woman, she will never take seed. (V3, FG 2) not entirely surprising, as most Ghanaian men fear losing
their erection. More so, the word for the procedure is syn-
onymous to castration of animals in which case the animals
are unable to develop functioning adult sex organs.
Reversible Family Planning Method In eagerness to express his dislike for vasectomy, one
This theme was about the nature of vasectomy. All the participant said this:
participants were misinformed that vasectomy was a
reversible family planning method, which involved I will rather give birth to vagabonds than go for vasec-
tying and blocking sperm flow. A participant describes tomy as a method of family planning. I will also not
this in the following statement: encourage any man to go in for vasectomy. (V1, FG1)

I know they tie the veins so that you are no longer able to The others expressed their dislike in the following
release sperms. When you decide to give birth, you go statements:
back to untie it. (V3, FG1)
No, I don’t need it and I will never go for it. (V3, FG2)
Another participant had this to say, I don’t like it and will never consider it. (V3, FG1)

I also heard they tie something but don’t really know

what it is they tie. (V3, FG2)
Discourage Other Men
The men in this study showed strong dislike for vasec-
tomy. The focus group with men aged between 45 and 60
Vasectomy Has Adverse Health Effects years vehemently detested to anyone willing to undergo
Another major belief was the health effects of vasectomy vasectomy. The following statement by a respondent
on men. It could lead to prostate cancer and inability to emphasizes this point
ejaculate. This has been expressed in the following
statements: If a friend wants to go for vasectomy, I will only ask him
if he is crazy. (V2, FG1)
. . . if these veins have been cut and tied, and it’s these I will discourage him by telling him that it will have adverse
same veins that causes erection, it no longer becomes effects such as hernia and prostate cancer. (V1, FG1)
functional and blood no longer runs through them.
They have been destroyed and can lead to such problems However, the focus group with older men aged over 60
as prostate cancer. (V1, FG1) years had no much problem with opting for vasectomy.
6 SAGE Open Nursing 0(0)

They only had issues with its side effects. This is evident developing countries. This is because inadequate know-
as follows: ledge exists on vasectomy in Ghana. There is, therefore,
the need to improve dissemination of accurate informa-
No, I won’t stop him. I will not discourage him but will tion on vasectomy to families and community members
advise him to consider the implication of his actions. through the print and electronic media, churches, mos-
I mean he can get impotent in future (V3, FG2) ques, and other public meeting places, which can then
serve as a leading source of information for vasectomy.
Upon further probing, the participants had no wish of From our findings, it is evident that as reported else-
undergoing vasectomy, not even under the influence of a where, men have inadequate knowledge, which subse-
friend, as stated in the following statement: quently leads to negative perceptions about vasectomy.
Negatively, vasectomy was equated to castration with
Personally, I prefer not to go through any surgical pro- negative effects such as sexual weakness and impotence
cedure and therefore will never be influenced by a friend (Temach, Fekadu, & Achamyeleh, 2017). This term ‘‘cas-
who has undergone vasectomy. (V6, FG2) tration’’ has many negative connotations in our
Ghanaian community. Castration is a practice linked to
the male animal; hence, a man who is vasectomized is
likely to be seen as such. The findings described earlier
Discussion were similar to the findings from Adongo et al. (2014) and
The study revealed that some participants were aware of the ACQUIRE Project (2008), which indicated that com-
vasectomy but were not able to give detailed information munities understood male sterilization to be castration of
about vasectomy which have been consistently reported men. We discern that this false impression is a threat to
in previous studies by Pile (2008), Onasoga et al. (2013), the sustainability of vasectomy in Ghana. The partici-
Babalola and John (2012) in which majority of the par- pants also feared the future uncertainty of vasectomy.
ticipants had limited knowledge. Participants had mis- Some believed that vasectomy could have adverse effects
conceptions and lacked correct information on on their health such as prostate cancer. Obviously, people
vasectomy as this was clear in their responses. The low will not embrace that which is synonymous with castra-
patronage of vasectomy is not completely due to the tion if they consider it a procedure that will put an end to
resistance from men to the method, but also the inability their sexual life (Nishtar et al., 2012). Sexual prowess is
of health workers to make information available, attract- highly valued in the Ghanaian community whereby men
ive, and accessible to the public (Ebeigbe et al., 2011). go to long lengths to purchase creams, powders, and con-
If health worker attitudes remain unchanged, vasectomy coctions that will make them perform better in bed
will be totally relegated to the background despite its (Danquah, Koffour, Anto, & Nimako, 2011). As such,
high graded effectiveness. many Ghanaian men might not even consider a proced-
It is indeed true that knowledge played an important ure with ‘future consequences’. Recently, a Ghanaian
role in the uptake of vasectomy, but the study has study examining vasectomy from a female perspective
revealed that the actual decision for acceptance of vas- unearthed that in a religiosociocultural society like
ectomy was the sole responsibility of the man and not by Ghana, childbirth is a prestigious enterprise and for this
the couple. This is largely attributable to cultural influ- reason and more, women disapprove of vasectomy espe-
ences and also stems from the fact that in most African cially when they perceive the masculinity of their partners
societies the man is regarded as the head of the family to be challenged (Asare et al., 2017). This translates to a
and usually dominates in decision-making (Onasoga myriad of misbeliefs working in tandem. Vasectomy has
et al., 2013). There is the need to change this mindset been rendered unattractive because of some of these nega-
and to involve women in the final decision on vasectomy tive perceptions and these eventually have cluttered the
as a choice of family planning. minds of men and the public in general. It is not surpris-
The study also revealed that participants had inad- ing, therefore, that the uptake of vasectomy in a low
equate knowledge not only on vasectomy but also on resource setting like Ghana is poor.
other modern family planning methods. This was similar We also found out that men displayed a strong dislike
to the findings of studies conducted by Jangu (2013) on the toward vasectomy. They expressed their dislike by saying
attitude and willingness of men toward the use of modern that they would not go for vasectomy and would advise
family planning method and another by Akpamu, Nwoke, other men not to do so and this has been previously
Osifo, Igbinovia, and Adisa (2010) on knowledge and documented (Akpamu et al., 2010). According to
acceptance on vasectomy as a method of contraception Adongo et al. (2014), some participants felt that once
among literate men in Ekpoma, Nigeria. they had vasectomy done they would lose their power
Vasectomy seems to have gained acceptance and and control over their wives. Participants feared that of
popularity in developed countries but certainly not in losing their manhood particularly with the mentality of
Appiah et al. 7

castration meant that their wives may find lovers to sat- implemented in order to change the mindset of men in
isfy their sexual demands and thus may no longer be Ghana toward vasectomy. Relevant information must be
respected in their homes. Upon further probing, the par- provided in order to remove the negative impression that
ticipants had no wish of undergoing vasectomy not even has obscured the benefits of vasectomy.
under the influence of a friend.
Interestingly enough, the findings of a study con-
ducted by Dayanand et al. (2014) to assess the level of
Appendix A: FGD Guide
knowledge and attitude toward vasectomy in adult males
from Pokhara, Western Nepal revealed that majority of Background information of respondents
the participants were in support and showed positive
attitude toward vasectomy which was in absolute con- 1. Tell me all about yourself
trast to the findings of this study. Vasectomy, as men-
tioned earlier, seems to be very popular in developed Probes:
nations but certainly not in Africa. It is evident that
these men in developing countries have, over the years, . Age
showed negative attitude toward vasectomy because of . Marital status
the rather poor knowledge they have on vasectomy. . Years of marriage
Therefore, to improve on the uptake of vasectomy, the . Educational background
basic reason, which is inadequate knowledge, must be . Occupation
tackled and this will eventually reflect in its uptake. . Religion
From the study, it was appreciated that the partici- . Number of children
pants had good knowledge on the short-term methods
but knew only few long-term methods. The participants Knowledge assessment
knew vasectomy as a reversible family planning method
with adverse health effects such as prostate cancer and 1. Tell me all you know about family planning
inability to ejaculate. The men in this study showed nega-
tive attitude and perceptions toward vasectomy. Probes:

. Definition
Strengths and Limitations
. Types of family planning for both men and women
The unique nature stems from the fact that it is the first of . Advantages of family planning
its kind examining vasectomy as a family planning option . Factors that promote usage of family planning
from a standpoint of married men in a developing coun- . Side effects
try. The findings from this study will enable policy makers
to have insight into factors that militate against vasectomy 2. Emphasis on vasectomy
in order to design appropriate policies and strategies to
reach out to men. In addition, the qualitative descriptive Probes:
nature of the study allowed for in-depth exploration of
information from participants. One limitation centers on . What is vasectomy? What are the advantages? What
the study findings which may not be applicable to all are some of the disadvantages?
urban communities in Ghana. This is because there are . When will you decide to go for vasectomy?
varying characteristics of men in the urban communities. . Where can one go for vasectomy?
The researchers are cognizant of the cultural underpin- . How much will it cost one to go for vasectomy?
nings of the Ghanaian society that might have inadvert-
ently influenced participant responses. However, this 3. Are you aware of anyone who has undergone
limitation also illuminates the need for future studies vasectomy?
examining the cultural influences on vasectomy.
Beliefs
Conclusion 1. Can you tell me who makes decisions concerning the
Vasectomy is poorly patronized in Ghana. From the following in your family?
study findings, the researchers can conclude that this is
in part due to several misbeliefs and negative attitudes Probes:
concerning vasectomy. There is an urgent need for
behavioral change strategies and programs to be -Yourself or Wife
8 SAGE Open Nursing 0(0)

-What about in-laws 8. What will you do if your friend informs you that he is
-Religious leaders going for vasectomy?

. Having children in the family (pregnancy and Probe:

childbirth)
. Not having children . Will you stop him?
. Number of children . Will you encourage him?
. Minimum duration between each successive child . Will inform the wife?
birth . What will be your attitude towards one who has
undergone vasectomy?
2. Why do people give birth to children?
9. Tell me all about someone who has undergone
Probes: What are some of the reasons people give for vasectomy
having?
Probe:
. More children
. Few children . The person’s experiences
. Can the person motivate you to go for vasectomy?
3. In your opinion, which of the family planning methods
are most effective for use? 10. What else would you like to be clarified?

Probe: those by females or males Probe: allow respondents to ask questions and make
other contributions
. Female condoms, pills, injections, tubal ligation,
IUD, norplant, calendar method, and so forth. Authors’ Contributions
. Vasectomy, condoms S. A., A. M., J. K. A., and I. G. conceptualized the study; S. A.,
I. G., A. M., & J. K. A. collected the data. J. K. A. and S. A.
4. Do you think vasectomy could lead to any of the analyzed the data. S. A., I. G., and A. M. drafted the manu-
following: script and all authors edited and approved the content.

. Inability to ejaculate? Declaration of Conflicting Interests

. Halt in sperm production? The author(s) declared no potential conflicts of interest with respect
. Prostate cancer? to the research, authorship, and/or publication of this article.

5. Do you think this procedure can be reversed? Funding

The author(s) received no financial support for the research,
Attitude
authorship, and/or publication of this article.

6. What will you do if you do not want to have any more

children? ORCID iD
James Kwaku Agyen http://orcid.org/0000-0002-7270-9655
Probes: Isabella Garti http://orcid.org/0000-0002-7230-5351

. Will you opt for vasectomy? References

. Will you ask asking your partner to take up any form ACQUIRE Project. (2008). Counseling for effective use of
of family planning method? family planning. Participant handbook. New York, NY:
Engender Health/The ACQUIRE Project. Retrieved from
7. What will do if you decide to go for vasectomy as a http://www.acquireproject.org/
Adongo, P. B., Tapsoba, P., Phillips, J. F., Tabong, P. T.-N.,
family planning method?
Stone, A., Kuffour, E., . . . ;Akweongo, P. (2014). ‘‘If you do
vasectomy and come back here weak, I will divorce you’’: A
Probe: qualitative study of community perceptions about vasec-
tomy in Southern Ghana. BMC International Health and
. Will you inform your partner? Human Rights, 14(1), 16. doi:10.1186/1472-698X-14-16
. Will you refuse to inform your partner? Akpamu, U., Nwoke, E. O., Osifo, U. C., Igbinovia, E. N. S.,
. What about your parents, religious leader, friends . . .? & Adisa, A. W. (2010). Knowledge and acceptance of
Appiah et al. 9

‘‘vasectomy as a method of contraception’’amongst literate County, Jinja, Uganda. Kampala, Uganda: School of
married men in Ekpoma, Nigeria. African Journal of Public Health, Makerere University. Retrieved from
Biomedical Research, 13(2), 153–156. http://www.academia.edu/4239220/Attitude_and_willing
Alireza, D., Shahriar, S., & Abdolah, K. (2017). Nursing Staff’s ness_of_men_towards_the_use_of_modern_family_planni-
views regarding barriers to vasectomy: A cross sectional ng_methods_in_Budondo_Sub-County_Jinja_Uganda
survey. The Open Public Health Journal, 10, 57–62. Kenya National Bureau of Statistics & ORC Macro. (2010).
doi:10.2174/1874944501710010057. Kenya demographic and health survey 2008-09. Health
Asare, O., Otupiri, E., Apenkwa, J., & Odotei-Adjei, R. (2017). (San Francisco), 1–314. doi:10.3109/03014460.2013.775344
Perspectives of urban Ghanaian women on vasectomy. Kols, A., & Lande, R. (2008). Vasectomy: Reaching out to new
Reproductive Health, 14(1), 21. doi:org./10.1186/s12978- users. Population Reports. Series D: Male Sterilization,
017-0286-5 Shelter from the storm: a transformative agenda for women
Babalola, S., & John, N. (2012). Factors underlying the use of and girls in a crisis prone world (6), 1–23.
long-acting and permanent family planning methods in Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry.
Nigeria: A qualitative study. The RESPOND Project Study Newbury Park, CA: Sage Publications.
Series: Contributions to Global Knowledge –Report No. 5. Mutombo, N., Bakibinga, P., Mukiira, C., & Kamande, E.
New York: EngenderHealth/The RESPOND Project. (2014). Benefits of family planning: An assessment of
Brechin, S., & Bigrigg, A. (2006). Male and female sterilisation. women’s knowledge in rural Western Kenya. BMJ Open,
Current Obstetrics and Gynaecology, 16(1), 39–46. 4(3), e004643. doi:10.1136/bmjopen-2013-004643
Bunce, A., Guest, G., Searing, H., Frajzyngier, V., Riwa, P., Nishtar, N., Sami, N., Faruqi, A., Khowaja, S., & Ul-Hasnain,
Kanama, J., & Achwal, I. (2007). Factors Affecting F. (2013). Myths and fallacies about male contraceptive
Vasectomy Acceptability in Tanzania. International Family methods: A qualitative study amongst married youth in
Planning Perspectives, 33(1), 13–21. Retrieved from http:// slums of Karachi, Pakistan. Global Journal of Health
www.jstor.org/stable/3003918. Science, 5(2), 84–93. doi:10.5539/gjhs.v5n2p84
Chipeta, E. K., Chimwaza, W., & Kalilani-Phiri, L. (2010). Nordqvist, C. (2016). What types of contraception are there?
Contraceptive knowledge, beliefs and attitudes in rural Medical News Today. Retrieved from http://www.medical-
Malawi: Misinformation, misbeliefs and misperceptions. newstoday.com/articles/162762.php.
Malawi Medical Journal: The Journal of Medical Onasoga, O. A., Edoni, E. E., & Ekanem, J. (2013). Knowledge
Association of Malawi, 22(2), 38–41. and attitude of men towards vasectomy as a family planning
Danquah, C. A., Koffuor, G. A., Anto, B, P., & Nimako, K. A. method in Edo State Nigeria. Journal of Research in Nursing
(2011). The indiscriminate use of sex enhancing products and Midwifery, 2(1), 13–21.
among Ghanaians: Prevalence, and potential risk. Owusu-Asubonteng, G., Dassah, E. T., Odoi, A. T., Frimpong,
Advances in Applied Science Research, 2(5), 350-359. P., & Ankobea, F. K. (2012). Trend, client profile and sur-
Dayanand, M. G., Sharma, A., Ahmed, M. M., Paran, M. P., gical features of vasectomy in Ghana. The European Journal
Jyothi, M., & Rani, M. (2014). A Pubmedhouse Journal. of Contraception & Reproductive Health Care, 17(3),
Medical Science, 2(4), 164–170. 229–236. doi:10.3109/13625187.2012.661109
Ebeigbe, P., Igberase, G., & Eigbefoh, J. (2011). Vasectomy: A Pile, J. M. (2008). Vasectomy advocacy package: Safe, cost-
survey of attitudes, counseling patterns and acceptace effective, and underutilized. Advocacy Brief No, 5
among Nigerian resident gynaecologists. Ghana Medical Shih, G., Turok, D. K., & Parker, W. J. (2011). Vasectomy:
Journal, 45(3), 101–104. Retrieved from https://www.ajo- The other (better) form of sterilization. Contraception,
l.info/index.php/gmj/article/view/74308 83(4), 310–315.
Ezegwui, H. U., & Enwereji, J. O. (2009). Attitude of men in State of the World Population. (2015). Retrieved from https://
Nigeria to vasectomy. International Health, 1(2), 169–172. www.unfpa.org/swop-2015
Ghana Statistical Service (GSS) (2008). Ghana Population and Suchithra, E. T., & Sujina, C. M. (2016). Current practice and
Housing Census Report 2008. Accra, Ghana. determinants of family planning methods among married
Ghana Demographic and Health Survey (GDHS). (2015). females in the reproductive age group (15–49 yrs) in a
Retrieved from http://www.statsghana.gov.gh/docfiles/pub- rural setting, Kerala. Indian Journal of Forensic and
lications/2014%20GDHS%20%20Report.pdf Community Medicine, 3(1), 13–19.
Ghana national population council (2017). Population of Temach, A. J., Fekadu, G. A., & Achamyeleh, A. A. (2017).
Ghana: population and the economy fact sheet no. VIII Educational status as determinant of men’s knowledge
(march 2017). Retrieved from http//www.npc.gov.gh/wp about vasectomy in Dangila town administration, Amhara
content/uploads/2018/03/Factsheet-on-Population-and-the- region, Northwest Ethiopia. Reproductive Health, 14(1), 54.
Economy.pdf doi:10.1186/s12978-017-0314-5
Hardee, K., Croce-Galis, M., & Gay, J. (2017). Are men well United Nations Economic Commission for Africa. (2016). The
served by family planning programs? Reproductive health, demographic profile of African Countries—United Nations.
14(1), 14. Retrieved from https://doi.org/10.1186/s12978- Retrieved from https://www.uneca.org/publications/demo-
017-0278-5 graphic-profi%1Fle-african-countries
Jangu, W. I. (2013). Attitude and willingness of men towards the Van Lith, L. M., Yahner, M., & Bakamjian, L. (2013).
use of modern family planning methods in Budondo Sub- Women’s growing desire to limit further births in sub-
10 SAGE Open Nursing 0(0)

Saharan Africa: Meeting the challenge. Global Health: World Population Review. (2018). 2018 World population by
Science and Practice, 1, 97–107. country. Retrieved from http://worldpopulationreview.com/
World Bank. (2018). Population growth (annual %). Retrieved World Health Organization. (2018). Family planning/contracep-
from https://data.worldbank.org/indicator/SP.POP.GROW tion factsheet. Retrieved from http://www.who.int/media-
World Population Data Sheet. (2016). Population reference centre/factsheets/fs351/en
bureau. Retrieved from http://www.prb.org/Publications/
Datasheets/2017/2017-world-population-data-sheet.aspx