Field Placement: The Population Council - Frontiers Program
Location: Guatemala City, Guatemala
Preceptor: Dr. Jorge Solorzano and Licencia Oralia Rodas
Student Name: Leah Maddock
Year: 2004

AMPLIANDO EL ACCESO A LA VASECTOMÍA EN GUATEMALA:
Increasing access to vasectomy in Guatemala

The Population Council is an international, non profit organization that conducts research on three fronts: biomedical, social science, and public health. Their mission is “to improve the well-being and reproductive health of current and future generations and to help achieve a humane, equitable and sustainable balance between people and their resources.” Population Council has offices in 19 countries and does research in an additional 51 countries. The Frontiers program is funded by the U.S. Agency for International Development (USAID) and led by the Population Council in collaboration with Family Health International (FHI). Frontiers conducts research aimed at improving the delivery of family planning and reproductive health services in developing countries.

I worked with Dr. Jorge Solorzano and Licencia Oralia Rodas to initiate a Population Council / Frontiers program designed to increase access to vasectomies in Guatemala. Guatemala’s high birth rates and poor education system have lead to a dearth of information about many highly effective contraceptives, including vasectomy. The project objectives: to inform Guatemalan couples about the availability and characteristics of vasectomy; and to make vasectomies more accessible in Guatemala.

There are three target populations: 1) men aged 30 to 45; 2) women in their third trimester, in the hospital to give birth, and attending postnatal visits; 3) providers and staff at the four study sites and 22 referring clinics.

Of the four sites (two hospitals and two clinics), three are in the immediate area of Guatemala City and one (hospital) is located approximately 125 miles from the city, the latter having a great area of influence in Western Guatemala. All had maternity wards, a high number of prenatal visits, postnatal visits, births, and tubal ligations. One hospital and one clinic already offered vasectomy services on demand, and the other hospital and clinic will begin offering services within the next year.

During my internship I created media material, pre- and posttests, an SPSS database, questionnaires to validate the media material, and assisted with preparations for the half-day provider training sessions. The training sessions taught providers and site staff about vasectomies and promotion techniques.

Media material included creating a flyer (half page), sign (11” x 17”), and pamphlet to hand out to patients. The flyer and pamphlets, titled “Family Planning is something for men too,” will be given to women and men. The pamphlet provided a brief description of vasectomies and tubal ligations, listed their benefits, offered hints on initiating a discussion with your partner about such subjects and how to decide which method is best for you (as a pair). The signs will be placed in the study sites as well as referring clinics. They include bullet points of information about vasectomy; where to obtain additional information and free cost of the procedure.

I created pre- and posttest for providers to complete immediately before and after the half day training sessions. The tests include demographic questions (age, occupation, years at this job); if the provider had ever performed / assisted in a vasectomy or referred a patient to vasectomy services and used Likert 5-point scale (always to never) to assess how often providers speak to their male and female patients about vasectomy. There are 10 true and false questions about vasectomy including common rumors and misinformation about the operation. Additionally a mix-match set of 5 questions asks providers to match one of five methods of birth control with its proper definition. There are two Likert 3-point scales (a lot, some, nothing) about how much providers knew about vasectomy and family planning. The posttest did not include the demographic questions, but did include three questions assessing helpfulness, content and length of the training. Pre and posttests were matched by date of birth, coded and entered into SPSS.

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