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According to the 2002 Maternal-Child Health Survey 34.4% of women married or living in consensual unions between 15 and 49 years of age use a modern contraceptive method in Guatemala. Of these slightly more than one half used female sterilization. Despite the fact that vasectomy is just as effective is less expensive for the provider and the user and presents fewer risks for the user less than one percent of women reported using it with their partners. The Ministry of Health of Guatemala (MOH) -the main provider of contraceptive methods in the country-delivered their method of choice to 40% of modern contraceptive users and 30% of female sterilization users but to only 1.2% of vasectomy users. According to their information system between 2001 and 2003 the MOH performed only 43 vasectomies despite the fact that in 2001 four surgeons in three hospitals were trained in vasectomy procedures. The traditional model for introducing vasectomy services consists of sending a doctor to a health unit where a high number of procedures is performed. During their training they observe operations and perform between five and 10 vasectomies under an instructors supervision. When they return to their service delivery units they are expected to begin delivering the service unsupervised. However it has been frequently noted that when they return to their work sites surgeons do not use their recently acquired skills due to limited demand for the method and a lack of confidence in their skills. In this project we tested the effectiveness of a systemic model for introducing vasectomy in service delivery units of the MOH which has four basic components: a) the self-selection of health units according to their response to an invitation to participate in the project; b) the development of a counseling and information model for potential clients; c) training and sensitizing of health teams; and d) on-site training of surgeons. (excerpt)

Expanding access to vasectomy services in the Ministry of Health of Guatemala