Fournier's gangrene complicating vasectomy.

Quality of care of services provided to family planning clients is a source of major concern in reproductive health care, especially in resource-poor settings. It may be measured in terms of safety of the method or service provided and may be influenced by the knowledge, skills and experience of the service providers, the environment in which the services are provided and the care thereafter. As a result of various efforts by the government and other stake-holders there have been tremendous developments in the family planning programme in Malawi in the past ten or so years. The contraceptive prevalence rate (CPR) more than doubled between 1992 and 2000. Secondly there has been expansion of facilities providing contraceptive services and the method mix such as introduction of voluntary surgical contraception (VSC) for both females and males. The increased demand for contraceptive services has outstripped the available services and as a result led to lapses in the quality of care. These have resulted in some apparently healthy individuals either dying in the course of or following service provision or suffering serious morbidities. This paper presents two cases of Fournier's gangrene following vasectomy in previously healthy male adults in Malawi. It discusses their diverse management and results thereof, and explores the potential impact on the programme in Malawi, in the context of adverse publicity on contraceptives. The possible operational factors for the complications are explored and preventive strategies proposed to ensure sustenance of the already registered gains in fertility control in Malawi.