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Switzerland

Sharing The Burden Of Contraception: Are Vasectomies The New Pill?

Ouch...
Ouch...
Caroline Stevan

GENEVA - Wife: "I’ve done my share. It’s your turn now.”

Husband: “If you leave me in the next five years, I’ll really feel like I sacrificed myself for nothing.”

What are they talking about? Working part-time to spend more time with the kids? Turning down a promotion? Giving up paragliding and cycling on weekends to take Julie to her tennis lesson and Hector to the swimming pool? No, they are talking about having a vasectomy to avoid having any more children. Ariane and Alain, 40 and 47 years old, have had two children together, and do not want any more.

“For the past 20 years, I’ve tried every contraceptive method that exists, and I am fed up,” says Ariane, a nurse from Geneva. “Taking the pill and using condoms are a real constraint, and for medical reasons, I can’t use intrauterine devices (IUDs), and copper ones are not as efficient... I really want to live my sex life without the constraint and anxiety of a potential pregnancy and I think it’s time for him to do his share.”

What about him? He seems more resigned than enthusiastic. “It’s happening I guess. There’s no denying this will make our sex life more comfortable – at the moment we are using condoms or the more primary method of withdrawal, nothing very spontaneous there – but I have to admit I am a little scared about the non-reversible character of it all. We know we won’t have any more babies together, but what if we split up, or something happens to her? A single man on the market is clearly penalized if he can’t have children, even at 47,” says the lawyer.

In reality, vasectomy is not completely irreversible. An operation called Vasovasostomy can be performed, by which partially reverses vasectomies. “The operation has a 90% success rate if the patient does it less than 15 years after the vasectomy, but the pregnancy rate then falls to 60%, which often coincides with the latest pregnancy age for the mother-to-be,” explains Dr. George-Antoine de Boccard, urologist at the Beaulieu clinic in Geneva. Nevertheless, he advises patients to consider the operation as permanent, and refuses to perform vasectomies on young patients and men who have had no children.

Since Dec. 2012, this professor has noticed an increase in the number of vasectomies performed, as well as in requests for information. On average the clinic performs around a hundred vasectomies a year. Since January, they have been performing around five a week. If it is still too early to talk about a real trend, this specialist is wondering if this is a consequence of “the wave of panic concerning oral contraceptive pills in France”.

In January, several cases of deep vein thrombosis (DVT) were diagnosed as a consequence of taking the Diane-35 pill (known as Diane, Dianette, Bella Hexal and Dixi-35 overseas). As a result, many couples started looking for a different means of contraception. At the hospital, where around 50 vasectomies are usually performed in a year, the numbers are stable. The West Leman Hospital complex has not registered any increase in 2013 either.

“I think it’s time to stop having children!”

For Zach, a 35-year-old from eastern Switzerland, the Diane-35 scandal “made things clearer.” He underwent a vasectomy two months ago, and just got confirmation of his newfound sterility thanks to a Spermogram test. “I feel relieved. Things are clear now,” says the social worker. “I am a father of three and there is a 17-year difference between the eldest and the youngest one, who was born from a second union. I already have to pay alimony; I think it’s time to stop having children! My partner is a smoker and can’t stand the side effects of oral contraceptives, so we turned to something more drastic and less chemical. She could have undergone a tubal ligation but the surgery is heavier than a vasectomy, and I wanted to share the burden of contraception with her.”

His capacity for empathy is also what convinced Wim of taking the plunge, a year ago. “I saw my wife giving birth to our two children, I thought I could take it upon myself to have this operation. It lasted 40 minutes and everything went well”. Zach admits that it is not easy “to lie there with your genitals exposed in front of all the nurses”, and that he did not really enjoy “sitting on a bag of ice for two days”, but it was an outpatient operation and he did not need to take days off from work. He also reassures those who might fear losing some of their manhood in the intervention: “It did not change anything to my erections, my ejaculations or my anatomy”.

Alain, Zach and Wim have the typical profile of vasectomy candidates. “Most men are 40 to 45 years old, their wife is the same age and they already have two or three children. They often fear complications resulting from feminine contraception, especially when the woman is overweight, has high blood pressure, or is a smoker. They often come to the consultation together, but it is not mandatory,” says professor de Broccard. “We also have to deal with very young men, aged 22 or 23, who think the world is such a bad place they shouldn’t make babies. We say no to them. And then there are the older ones, 55-60 years old, who really want to avoid having a child.”

Laurent Vaucher, urologist at the Lausanne Hospital, has observed the same trend. He adds that all segments of society are concerned. In this hospital, men under 35 are not accepted for a vasectomy, and neither are men who have not had children yet. Every year, they perform around ten Vasovasostomies. “In 80 to 90% of cases, it is for divorced men who now have a younger partner who would like to have children. Sometimes we do it for couples who have lost a child, or for men who had a vasectomy when they were younger and now regret it”, explains Vaucher.

Pierre is 49 today, he had a vasectomy when he was 30; at the time, he had already had four children. “Given my age, the doctor asked to meet my wife. She was more skeptical than I was, but I managed to convince her. After my operation, we ended up adopting a little girl, which might not have happened without the vasectomy..."

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Society

In Northern Kenya, Where Climate Change Is Measured In Starving Children

The worst drought in 40 years, which has deepened from the effects of climate change, is hitting the young the hardest around the Horn of Africa. A close-up look at the victims, and attempts to save lives and limit lasting effects on an already fragile region in Kenya.

Photo of five mothers holding their malnourished children

At feeding time, nurses and aides encourage mothers to socialize their children and stimulate them to eat.

Georgina Gustin

KAKUMA — The words "Stabilization Ward" are painted in uneven black letters above the entrance, but everyone in this massive refugee camp in Kakuma, Kenya, calls it ya maziwa: The place of milk.

Rescue workers and doctors, mothers and fathers, have carried hundreds of starving children through the doors of this one-room hospital wing, which is sometimes so crowded that babies and toddlers have to share beds. A pediatric unit is only a few steps away, but malnourished children don’t go there. They need special care, and even that doesn’t always save them.

In an office of the International Rescue Committee nearby, Vincent Opinya sits behind a desk with figures on dry-erase boards and a map of the camp on the walls around him. “We’ve lost 45 children this year due to malnutrition,” he says, juggling emergencies, phone calls, and texts. “We’re seeing a significant increase in malnutrition cases as a result of the drought — the worst we’ve faced in 40 years.”

From January to June, the ward experienced an 800 percent rise in admissions of children under 5 who needed treatment for malnourishment — a surge that aid groups blame mostly on a climate change-fueled drought that has turned the region into a parched barren.

Opinya, the nutrition manager for the IRC here, has had to rattle off these statistics many times, but the reality of the numbers is starting to crack his professional armor. “It’s a very sad situation,” he says, wearily. And he believes it will only get worse. A third year of drought is likely on the way.

More children may die. But millions will survive malnutrition and hunger only to live through a compromised future, researchers say. The longer-term health effects of this drought — weakened immune systems, developmental problems — will persist for a generation or more, with consequences that will cascade into communities and societies for decades.

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