Introducing sustainable vasectomy services in Guatemala.

International Family Planning Perspectives In 2003, the need to improve access to vasectomy services—which the Ministry of Health had been trying to address for several years†—took on new urgency. The obstetrics and gynecology ward of the IGSS hospital in Guatemala City, which had been providing family planning and other reproductive health services to partners of insured males beyond the 40-day postpartum period (even though it had no clear mandate to do so), underwent an administrative change. The new administration terminated all reproductive health services beyond this period, including family planning. Vasectomy services were also halted, meaning that practically all vasectomies were being provided in the private sector.* In light of these developments, the Ministry of Health recognized that it would need to increase the number of health units offering this service, which would require the training of doctors and health teams. While Ministry service delivery guidelines gave detailed instructions on how no-scalpel vasectomy should be provided in their health units, the provision of materials and equipment needed for the procedure was inadequate. Furthermore, because vasectomy was the least known contraceptive method in Guatemala, potential clients would need to be informed of its availability. Earlier efforts by the Ministry of Health to introduce vasectomy services had involved sending doctors to hospitals where a relatively high number of vasectomies were being performed; there, the doctor received theoretical training and performed 5–6 operations under expert supervision. Upon returning to their health units, these newly trained providers were given access to the equipment and supplies needed to perform vasectomies, with the expectation that they would immediately begin offering this service. However, since this program did not include the promotion of vasectomies to potential clients, demand was usually low; therefore, the doctors performed few vasectomies and sometimes stopped offering them after a short period. Over time, these providers lost their initial enthusiasm, as well as the skills needed to perform the procedures safely. Hence this program proved ineffective in creating sustainable vasectomy services. In addition, it was costly: With few Guatemalan health units having sufficient caseloads, doctors often had to be sent to other countries for training, or needed to stay at the training site for extended periods of time.