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American Journal of Men's Health logoLink to American Journal of Men's Health
. 2015 Dec 3;11(3):531–541. doi: 10.1177/1557988315620275

Opinions and Attitudes About Vasectomy of Married Couples Living in Turkey

Sezer Kısa 1, Esen Savaş 2, Simge Zeyneloğlu 2,✉, Sevgül Dönmez 2
PMCID: PMC5675235  PMID: 26634860

Abstract

This study was conducted as a descriptive study, designed to determine the opinions and attitudes of married couples living in Turkey about vasectomy. The sample consisted of 350 women. Researchers used a questionnaire to collect data. Descriptive statistics and chi-square analysis were used. The results showed that 14% of women and 43.0% of men were of the opinion that undergoing a vasectomy procedure was a sin. Chi-square analysis determined statistically significant differences between the male and female groups (p < .05). More than 88.0% of the men were not willing to have vasectomy and 35.4% thought that vasectomy had a negative effect on marriage and sexual health. In addition, 58.9% thought that vasectomy had a negative effect on men’s health. Women were more likely than men to see vasectomy as merely a cultural taboo instead of a sin. Sociocultural factors, such as ideas that contraception is the woman’s responsibility, that sterilized men lose status in society, or that sterilized men lose authority in the family, as well as misconceptions about vasectomy such as concerns about sexual functioning, psychological effects, and effects on physical strength, were determined to be the main barriers for vasectomy use in Turkish culture. The study recommends determining strategies for overcoming sociocultural barriers by raising awareness and increasing the utilization of vasectomy. Couple-specific family planning programs can make an important contribution toward improving awareness of the benefits of vasectomy.

Keywords: culture, family planning, men, vasectomy use, women

Introduction

The 1994 Conference on Population and Development in Cairo highlighted the need for men’s involvement in sexual and reproductive health issues (de Irala, Osorio, Carlos, & Lopez-del Burgo, 2011). One of the most important indicators of reproductive health is effective family planning (FP). Most FP methods often focus exclusively on women, with the objectives of preventing frequent births and reducing maternal and fetal death. Women have had a more prevalent role in FP services, specifically with regard to research and information campaigns related to contraception (Onasoga, Edoni, & Ekanem, 2013). Men also play a very important role in deciding the number of children couples have and how to use FP methods most effectively (de Irala et al., 2011). International health organizations in recent years have suggested emphasizing the importance of men’s participation in the promotion and use of contraceptive methods (Murdoch & Goldberg, 2014; UNFPA, 2012). In developing countries like Turkey, the rate of men’s participation in FP is still too low (de Irala et al., 2011; Ijadunola et al., 2010; Tuloro, Deressa, Ali, & Davey, 2006). Statistically, in Turkey, the withdrawal method (26.0%) is most common among men with condom use in second place (15.8%; Turkey’s Demographic and Health Survey [TDHS], 2013).

One of the most important ways to encourage men to use FP is to provide couples with more male-oriented contraceptive choices, such as vasectomy (Bunce et al., 2007). Although vasectomy is a simple process with a high success rate (>99%) and minimal complications (such as swelling and pain), it is still underutilized around the world, especially in developing countries (Cook, Van Vliet, Lopez, Pun, & Gallo, 2014; Mohamad Al-Ali et al., 2014; Rayala & Viera, 2013; Shang et al., 2015). The worldwide rate of vasectomy use is reported at 3%, with a rate of 2% in developed countries (United States Agency for International Development [USAID], 2013). Canada (22%), China (21%), the United Kingdom (21%), South Korea (16.8%), the United States (12.7%), and Australia (9.3%) have the highest usage rates. Developing countries such as India (0.1%), the Philippines (0.1%), Ghana (0.0%), and Cuba (0.1) have a very low rate of vasectomy use (Ezegwui & Enwereji, 2009; Scott, Alam, & Raman, 2011; United Nations, 2011; USAID, 2013). Although the rate of vasectomy use is low in most developing countries, it is especially low in Turkey, where it rarely exceeds 0.1%, and in the last 20 years no increase was observed (TDHS, 2013). Especially in male-dominated societies, like Turkey, culture and community aspects influence the ability and willingness of men to use vasectomy as a contraceptive method. The use of vasectomy is thought to be discouraged by fears of castration, loss of erectile function, loss of libido, and by sociocultural factors such as the risk of sexual disability after vasectomy and a sense of degradation (Ezegwui & Enwereji, 2009; İzol, Değer, & Arıdoğan, 2013; Mohamad Al-Ali et al., 2014; Owusu-Asubonteng, Dassah, Odoi, Frimpong, & Ankobea, 2012).

According to research, factors affecting vasectomy use include the number of children in the family (Altay & Gonener, 2009; Anderson et al., 2010; Dahal, Padmadas, & Hinde, 2008; Eisenberg, Henderson, Amory, Smith, & Walsh, 2009; Shrestha, Kayastha, Manandhar, & Chawla, 2014), age, duration of marriage (Eisenberg et al., 2009), partner’s choice (Bunce et al., 2007), medical reasons (Anish, Sreelakshmi, Akhila, Anandu, & Afsar, 2013), economic status (Bunce et al., 2007; Dassow & Bennett, 2006; Shrestha et al., 2014), region, ethnicity (Anderson et al., 2010; Anderson et al., 2012; Bunce et al., 2007; Dassow & Bennett, 2006; Eisenberg et al., 2009; Whitea & Potterb, 2014), reputation and availability of providers, religious and cultural beliefs, future uncertainty, fear, false and incomplete information (Anish et al., 2013; Bunce et al., 2007; Christiana, Sonachi, & Chinomso, 2014; Ebeigbe, Igberase, & Eigbefoh, 2011; Mohamad Al-Ali et al., 2014; Nian, Xiaozhang, Xiaofang, Qing, & Minxiang, 2010; Scott et al., 2011; Sood & Pahwa, 2014), dissatisfaction with and failure of other contraceptive methods (Anderson et al., 2010), education level (Anderson et al., 2010; Chang et al., 2015; Shrestha et al., 2014), and psychological reasons (Ebeigbe et al., 2011).

According to TDHS, the overall fertility rate in Turkey is 2.26 children per woman. This rate is highest in the eastern region (3.41 children per woman; TDHS, 2013). Married women at reproductive age who have children in particular want to restrict their number of children by using FP methods. However, significant differences in the prevalence of methods of contraception resulting from demographic considerations, such as the education level of women and cultural differences stemming from geography, region, and settlement type, have led to ineffective use or wrong selection of the FP methods.

Although vasectomy is effective, simple, permanent, and has a low risk of complications, its low utilization rate has led researchers to examine the sociocultural factors that may be influencing the decision not to use vasectomy. According to Hosseini and Abdi (2012), experiences and sociocultural consequences inform the social beliefs and opinions of individuals; therefore, providers should strive to understand the feelings and needs of vasectomized clients to encourage vasectomy use in society. Turkey has a limited number of studies on the use of vasectomy, and they are focused on men rather than couples. This study aimed to identify factors affecting the decision among couples in Turkey to undergo vasectomy and presents evidence that understanding the influence of sociocultural factors on the use of vasectomy will be effective in guiding the FP efforts of medical staff and policy makers.

Method

Descriptive statistics were used to determine the opinions and attitudes of married couples living in Turkey about vasectomy and barriers to vasectomy use. Respondents were drawn from a convenient sample of 350 married couples recruited from the postpartum clinic of a women’s hospital in Gaziantep, Turkey. The data were collected between May and December 2014. The hospital is the region’s largest women’s hospital, with 188 beds. It delivers a full range of secondary care services (inpatient and outpatient). Most of the hospital’s services focus on women and infants. The inpatient postpartum clinic accepts 40 to 60 women per day. The inclusion criteria for the study were as follows: couples, voluntary participants, literate, fertile or not menopausal, and having at least one child. Infertile or menopausal couples were not included in this study. The study was conducted at random time intervals on weekdays. The study’s findings include all responses recorded during the research period from couples who were eligible for the study.

The data were collected using a questionnaire that had been prepared in accordance with information collected from literature in the field (Altay & Gonener, 2009; Anderson et al., 2010; Dahal et al., 2008; Eisenberg et al., 2009; Odu, Jadunola, & Parakoyi, 2005; TDHS, 2013; Tuloro et al., 2006). The questionnaire consisted of 48 questions related to socioeconomic and demographic information (age, educational level, marital status, employment status, income status, etc.), fertility information, and the couple’s FP history (number of living children, couple’s respective ages at the time of marriage, marriage duration, number of children, children’s genders, number of male children, practice of FP methods, reasons for not using male methods, information about FP, sources of information, methods used, whose decision it was to use the methods in question, etc.). In addition, the vasectomy questionnaire included 16 propositions, which the couples were asked to respond to, such as the following: “Birth control method (vasectomy) is imposed by Western countries and is not suitable for Turkish men”; “Vasectomy results in loss of societal status for men”; “If a married couple does not want to have more children, it is the responsibility of men to use protection”; “Vasectomy has a negative psychological effect on men”; “Men with vasectomy lose their authority in the family”; “Use of vasectomy as a method of FP is not a correct practice”; “Having many children gives a man status in society”; and so on.

Five faculty members from nursing, sociology, and anthropology developed the questionnaires, reviewed them for content validity, made subsequent adjustments, and provided final approval. The final questionnaire was pilot tested with 15 couples who were not included in the main study. Based on the results, the researchers modified the questionnaire for comprehensibility and usability.

Couples who met the criteria and agreed to participate in the study met with researchers for 15 to 20 minutes in the postpartum inpatient clinic room of the sampled hospital. Prior to beginning the research, the institutional review board obtained approval from the hospital. Approval was also obtained from the provincial health authority before the data were gathered. Before conducting the research, the researchers explained to the subjects their rights as study participants and the purpose of the study. To protect the confidentiality of the subjects during the study, researchers asked the couples if they wanted to be part of the study and told participants that they had the right to terminate and withdraw from the study at any time. Researchers obtained verbal and written consent from all participants. Participation was completely voluntary and anonymous.

Statistical Analysis

The data were coded and entered into a database. Researchers used printed frequencies to check for outliers and to clean up the data. Then the data were exported to a software program, Statistical Package for the Social Sciences (SPSS), version 17.0, for analysis. The data were analyzed to calculate the frequency distribution of dependent and independent variables. Researchers employed the chi-square test to assess associations between the two dependent variables and the independent variables. The authors compared responses about the factors affecting the decision to use vasectomy, identifying the resulting p value of .05 as the significant level.

Results

A sociodemographic description of respondents was established, and 52.9% of the women and 46.0% of the men who participated in this study were between 30 and 39 years of age. Sixteen percent of the women and 35.2% of the men were high school graduates. Slightly higher than 24% of the men and 8.9% of the women reported having a sufficient income. The average number of children per couple was 2.51 ± 1.27. Eighty-three percent of the participants stated they had had their children willingly. Approximately 60% did not want to have children again. Sixty percent of respondents stated that three children is the ideal number for a family. Chi-square analysis determined a statistically significant difference based on sociodemographic variables and gender (p < .05; see Table 1).

Table 1.

Distribution of Participants’ Sociodemographic Variables According to Gender (N = 700; Gaziantep, Turkey, 2013).

Gender
 p
Women
 Men
 Total
Variables n % n % n % χ2
Age group (years)
 19-29 165 47.1 103 29.4 268 38.3 1.020 .000*
 30-39 185a 52.9 161 46.0 346 49.4
 40 and older 0.0 0.0 86 24.6 86 12.3
Educational level
 Illiterate 19 5.4 11 3.1 30 4.3 103.314 .000*
 Literate 43 12.3 8 2.3 51 7.3
 Elementary 212a 60.6 133 38.0 345 49.3
 High school 59 16.9 123 35.2 182 26.0
 University or higher 17 4.8 75 21.4 92 13.1
Occupation
 Not working 261a 74.6 9 2.6 270 38.6 405.195 .000*
 Government worker 63 18.0 135 38.6 198 28.3
 Employee 26 7.4 145 41.4 171 24.4
 Self-employed 0.0 0.0 61 17.4 61 8.7
Duration of marriage
 1-5 years 124a 35.4 95 27.1 219 31.3 22.290 .000*
 6-10 years 47 13.4 85 24.3 132 18.9
 11-15 years 110 31.4 80 22.9 190 27.1
 16 years or more 69 19.7 90 25.7 159 22.7
Perception of income level
 Sufficient 31 8.9 86 24.6 117 16.7 38.132 .000*
 Partially sufficient 108 30.9 118 33.7 226 32.3
 Not sufficient 211a 60.3 146 41.7 357 51.0
Living region
 Province 271a 77.4 236 67.4 507 72.4 16.134 .000*
 Town 65 18.6 73 20.9 138 19.7
 Village 14 4.0 41 11.7 55 7.9
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a

Group forming the difference.

*

p < .05.

Statistical analysis was used to determine gender-based differences in respondents’ views regarding FP and contraception generally. Regarding FP methods generally, 39.1% of women and 40.3% of men reported using FP methods, 60% of women and 28.2% of men stated that use of FP is a sin, and 14.3% of women and 43.0% of men reported their opinion that use of vasectomy is a sin. Finally, 24.0% of women and 51.4% of men reported receiving information about FP, but of those, only 16.7% of women and 39.4% of men reported receiving information from health care providers. Chi-square analysis determined a statistically significant difference between the groups (p < .05; see Table 2).

Table 2.

Distribution of Participants’ Opinions About Family Planning According to Gender (N = 700; Gaziantep, Turkey, 2013).

Gender
 p
Women
 Men
 Total
Variables n % n % n % χ2
Currently using contraception?
 Yes 137 39.1 141 40.3 278 39.7 0.095 .817
 No 213 60.9 209 59.7 422 60.3
Use of family planning is a sin
 Yes 212a 60.6 99 28.2 311 44.4 78.462 .000*
 No 91 26.0 192 54.9 283 40.4
 Some methods 47 13.4 59 16.9 106 15.1
Family planning methods viewed as a sin (n = 417)b
 Tubal ligation 222a 85.7 90 57.0 312 74.8 78.462 .000*
 Vasectomy 37 14.3 68 43.0 105 25.2
Receiving information related to family planning
 Yes 84 24.0 180 51.4 264 37.7 56.047 .000*
 No 266a 76.0 170 48.6 436 62.5
Source of information (n = 264)b
 Health care provider 14 16.7 71 39.4 85 32.2 24.318 .000*
 Friend/family 70 83.3 109a 60.6 179 67.8
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a

Group forming the difference. bColumn totals vary by number of responses.

*

p < .05.

Participants’ responses to questions about their knowledge of vasectomy generally revealed that 39.4% of women and 45.1% of men had heard of vasectomy before the survey; 49.4% of men did not know whether vasectomy was a safe contraceptive method or not; 28.3% of women and 19.6% of men viewed vasectomy as a difficult process; 84.1% of women and 44.9% of men stated that their negative views toward vasectomy were affected by environment; 10.1% of women and 35.4% of men believed vasectomy had a negative effect on marriage; and 3.6% of women and 35.4% of men believed vasectomy could negatively affect sexual health. The analysis also reveals that the education level of male participants has an impact on the status of having vasectomy. The male participants who had high school (39.9% or 63 men) and university education (37.3 or 59 men) were more aware of vasectomy and vasectomy-related issues compared with the participants who had less than high school education (22.8% or 36 men). Finally, 88.6% of the men were not willing to have vasectomy as an FP method. Chi-square analysis of reported opinions about vasectomy generally according to gender identified a statistically significant difference (p < .05; see Table 3).

Table 3.

Distribution of Participants’ Opinions About Vasectomy Use According to Gender (N = 296a; Gaziantep, Turkey, 2013).

Gender
 p
Women
 Men
 Total
Opinions n % n % n % χ2
Participant has heard about vasectomy (n = 700)
 Yes 138 39.4 158 45.1 296 42.3 2.341 .146
 No 212 60.6 192 54.9 404 57.7
Participant sees vasectomy as a safe contraceptive method
 Yes 113b 81.9 73 46.2 186 62.8 95.813 .000*
 No 25 18.1 7 4.4 32 10.8
 Do not know 0 0.0 78 49.4 78 26.4
Participant sees vasectomy as a difficult procedure
 Easy 41 29.7 33 20.9 74 25.0 8.995 .000*
 Difficult 39 28.3 31 19.6 70 23.6
 Do not know 58 42.0 94b 59.5 152 51.4
Current environment includes people who have adverse reaction toward vasectomy
 Yes 82b 59.4 65 41.1 147 49.7 22.208 .000*
 No 0 0.0 19 12.0 19 6.4
 Do not know 56 40.6 74 46.9 130 43.9
Participants’ views affected by environment that is adverse to vasectomy
 Yes 116b 84.1 71 44.9 187 63.2 48.460 .000*
 No 22 15.9 87 55.1 109 36.8
Willing to have vasectomy/tubal ligation
 Yes 29 21.0 18 11.4 47 15.9 5.106 .000*
 No 109 79.0 140b 88.6 249 84.1
Number of children required before considering vasectomy/tubal ligation (n = 71)c
 3 children 17 37.0 14 56.0 31 43.7 18.652 .000*
 4 children 29b 63.0 5 20.0 34 47.9
 5 children and more 0 0.0 6 24.0 6 8.4
Vasectomy’s effect on men’s health
 Does not affect 100b 72.5 65 41.1 165 55.7 33.808 .000*
 Affects negatively 38 27.5 93 58.9 131 44.3
Vasectomy’s effect on marriage
 Does not affect 124b 89.9 96 60.8 220 74.3 33.566 .000*
 Affects positively 0 0.0 6 3.8 6 2.0
 Affects negatively 14 10.1 56 35.4 70 23.7
Reasons given for views about negative effects (n = 70)c
 Environmental 14 100.0 35b 62.5 49 70.0 7.500 .006*
 Sexuality 0.0 0.0 21 37.5 21 30.0
Vasectomy’s effect on sexual health
 Does not affect 133b 96.4 98 62.0 231 78.0 50.823 .000*
 Affects positively 0 0.0 4 2.5 4 1.4
 Affects negatively 5 3.6 56 35.4 61 20.6
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a

Responses of participants who had heard vasectomy. bGroup forming the difference. cColumn totals vary by number of responses.

*

p < .05.

Finally, participants’ responses to sociocultural propositions about vasectomy revealed that 100% of women and 29.7% of men agreed that vasectomy as a birth control method is imposed by Western countries and is not suitable for Turkish men. In addition, 100% of women and 35.4% of men agreed that vasectomy results in the loss of a man’s status in society. All the participant women and 54.4% of men agreed that vasectomy as a method of FP is not a correct practice, and 100% of women and 18.4% of men agreed that vasectomy is a cultural taboo. Chi-square analysis of these figures revealed a statistically significant difference between the two groups (p < .05; see Table 4).

Table 4.

Distribution of Participants’ Responses to Propositions About Vasectomy According to Gender (N = 296a; Gaziantep, Turkey, 2013).

Gender
 p
Women
 Men
 Total
Propositions n % n % n % χ2
Vasectomy is imposed by Western countries and is not suitable for Turkish
 Agree 138b 100.0 47 29.7 185 62.5 1.551 .000*
 No opinion 0.0 0.0 16 10.1 16 5.4
 Disagree 0.0 0.0 95 60.1 95 32.1
Vasectomy results in loss of a man’s status in society
 Agree 138b 100.0 56 35.4 194 65.5 1.359 .000*
 No opinion 0.0 0.0 14 8.9 14 4.7
 Disagree 0.0 0.0 88 55.7 88 29.7
If a married couple does not want to have more children, men should be responsible for contraception
 Agree 0.0 0.0 17 10.8 17 5.7 20.758 .000*
 No opinion 0.0 0.0 5 3.2 5 1.7
 Disagree 138b 100.0 136 86.1 274 92.6
Vasectomy has a psychologically negative effect on men
 Agree 138b 100.0 86 37.8 224 75.7 83.099 .000*
 No opinion 0.0 0.0 23 100.0 23 7.7
 Disagree 0.0 0.0 49 100.0 49 16.6
Men with a vasectomy lose their authority in the family
 Agree 0.0 0.0 50 31.6 50 16.9 86.177 .000*
 No opinion 0.0 0.0 24 15.2 24 8.1
 Disagree 138b 100.0 84 53.2 222 75.0
Use of vasectomy as a method of family planning is not a correct practice
 Agree 138b 100.0 86 54.4 224 75.7 83.099 .000*
 No opinion 0.0 0.0 24 15.2 24 8.1
 Disagree 0.0 0.0 48 30.4 48 75.0
Vasectomy is important for the health of the family
 Agree 0.0 0.0 43 27.2 43 14.5 72.742 .000*
 No opinion 0.0 0.0 22 13.9 22 7.5
 Disagree 138b 100.0 93 58.9 231 78.0
Vasectomy is suitable for poor people
 Agree 0.0 0.0 14 8.9 14 4.7 12.835 .000*
 Disagree 138b 100.0 144 91.1 282 95.3
Having many children gives a man status in society
 Agree 95 68.8 43 27.2 138 41.6 1.591 .000*
 No opinion 43 31.2 5 3.2 48 16.2
 Disagree 0.0 0.0 110b 69.6 110 37.2
Vasectomy is a cultural taboo
 Agree 138b 100.0 29 18.4 167 56.4 1.997 .000*
 No opinion 0.0 0.0 36 21.5 34 11.5
 Disagree 0.0 0.0 95 60.2 95 32.1
Having a large number of children is important for elder care
 Agree 138b 100.0 48 20.4 186 62.8 1.529 .000*
 No opinion 0.0 0.0 18 11.4 18 6.7
 Disagree 0.0 0.0 92 58.2 92 31.1
Tubal ligation for women is easier than vasectomy
 Agree 138b 100.0 41 15.9 179 60.5 1.690 .000*
 No opinion 0.0 0.0 83 52.5 83 28.0
 Disagree 0.0 0.0 34 21.5 34 11.5
Men lose their sexuality after vasectomy
 Agree 124b 89.9 21 13.3 145 49.0 1.766 .000*
 No opinion 14 10.1 73 46.2 87 29.4
 Disagree 0.0 0.0 64 40.5 64 21.6
Men do not get pleasure from sexual intercourse after vasectomy
 Agree 95b 68.8 19 12.0 114 38.5 1.205 .000*
 No opinion 43 31.2 79 50.0 122 41.2
 Disagree 0.0 0.0 60 38.0 60 20.3
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a

Responses of participants who had heard vasectomy. bGroup forming the difference.

*

p < .05.

Discussion

This study was conducted to examine the opinions and attitudes of married couples living in Turkey about vasectomy and barriers to vasectomy use. Although there are many studies on the use of FP in Turkey, thus far they have focused mostly on married women and men separately. This study about barriers to vasectomy use was conducted using couples in Turkey, and it is thought that the findings will fill the information gap in this regard.

Sociocultural factors influencing views about contraception were considered in this study. According to the results, 6 out of 10 participants stated not using any contraceptive method. More than 60% of women and more than 28% of men reported their opinion that FP is a sin, particularly the methods of tubal ligation and vasectomy; 43% of men thought having vasectomy is sin. More than half of the participating women stated that women are responsible for making decisions about contraceptive methods. These results are consistent with other studies. In the literature, fertility and use of FP methods are associated with religion, education level, and societal practices. Especially in Muslim countries, religious belief is one of the most important factors influencing FP practices. In addition, the irreversibility of tubal ligation and vasectomy further affects the availability of both methods and, combined with uncertainty about the future, represents a major barrier to more widespread use of vasectomy (Frajzyngier, Bunce, Lusiola, Searing, & Riwa, 2006). A study from Nigeria indicated that no respondent with Islamic beliefs agrees to any degree of vasectomy use (Akpamu, Nwoke, Osifo, Igbinovia, & Adisa, 2010). Although Islam does not prohibit the use of contraception, some interpretations still appear to influence the overall use of contraception (Mahat, Pacheun, & Taechaboonsermsak, 2010). Orji, Ojofeitimi, and Olanrewaju (2007) reported that religion influenced the attitude of married Nigerian men toward FP. Another study reported that one of the reasons for not using any FP methods was religious belief (Onwuhafua, Kantiok, Olafimihan, & Shittu, 2005). A study on the usage of FP among Turkish married men indicated that two out of three men viewed FP as a sin in their religion (Kısa, Zeyneloğlu, & Delibaş, 2013).

The views of women concerning the use of vasectomy were particularly interesting. Almost 40% of the women reported having heard of vasectomy before the survey. Of those, more than 81% of women stated that vasectomy is a safe contraceptive method, but 79% of women did not approve of vasectomy as a FP method. These results are compatible with other studies. One of the most important barriers to vasectomy use is the negative opinions of women toward vasectomy. According to Bunce et al. (2007), wives have a strong influence on the outcome of decisions about vasectomy as a contraceptive method. A cross-sectional questionnaire-based study from Nigeria, which aimed to assess the influence of the spouse on the man’s decision to accept or reject vasectomy, reported that only 13.5% of women accepted vasectomy compared with 26% of men. Furthermore, 92% of the men who would agree to vasectomy stated that they will only do so if their spouses agree (Tijani, Ojewola, Yahya, Oluwole, & Odusanya, 2013). Most of the women stated that vasectomy does not have an adverse effect on men’s health, on sexual health, or on married life. Only 10.1% of women had an opinion that vasectomy has a negative effect on marriage. Studies in recent years continue to support the idea that the use of vasectomy has no negative affect on the sexual lives of individuals. A study about the sex lives of nine women living with vasectomized partners determined that vasectomy proved to be a good method to enjoy and increase the frequency of sexual relations and sexual satisfaction among couples who could stop worrying about unwanted pregnancies (Cordoba, Mercado, & Sapién, 2010). In contrast, a study from India reported that fear of physical weakness resulting from the procedure would limit a man’s ability to provide for his family. This belief was common among both men and women, and was one of the main barriers to acceptance of vasectomy use (Scott et al., 2011). A Chinese study revealed the increasingly popular views that vasectomy reduces sexual potency, causes impotence, or makes men physically weak, all of which were cited as reasons for why the widespread use of vasectomy before 1990 in China began to decline after 1990 (Nian et al., 2010). The reason given for views about negative effects of vasectomy on marriage is the influence of society’s perspective.

Regarding responses to sociocultural propositions about vasectomy, more women reported negative views about vasectomy. All the participating women in this study reported their opinion that vasectomy as a birth control method is imposed by Western countries and is not suitable for Turkish men, that having a vasectomy is not a correct FP practice, that vasectomy has a psychologically negative effect on men, that vasectomy is a cultural taboo, and that vasectomy results in loss of a man’s status in society. More than half of the women stated that vasectomized men will not experience pleasure from sexual intercourse. A study from India reported that a perceived reduction in men’s sexual performance served as another barrier to the use of vasectomy. This concern was more frequently expressed by women (Scott et al. 2011). In the Philippines, vasectomy use is not widely accepted partly due to fears of loss of sexual performance and a possible change in sexual orientation (Clark, Flavier, Jimenez, Lee, & Solomon, 2007). Some of the opinions, such as that vasectomy as a birth control method is imposed by Western countries, are more widespread and persistent in southeastern Turkey, where the majority of people come from minority populations. There is a big difference between men and women on the opinion of “vasectomy is a cultural taboo.” Although the study participants came from the same culture, more women than men see vasectomy as a cultural taboo. These views are thought to arise from the roles society imposes on women and men. Turkish society is a patriarchal society. In traditional societies, like in Turkey, birth control is a responsibility given to women, and one of the determinants of women’s social status is the number of children they have. Thus, societal status is considered to be the reason they are opposed to vasectomy. Women in southeastern Turkey have low levels of education, and most do not work outside of the house. In this region, the fertility rate is high compared with that of other parts of the country. The overall fertility rate in Turkey is 2.26 children per family, but in eastern and southeastern Anatolia, it is higher than 3.41 children per family (TDHS, 2013). Couples who do not have any children or who have not had any male children are excluded from society. Other results of this study support this idea. Seventy-two percent of women said that the responsible partner for decisions about FP was the woman. In addition, the majority of women stated that use of vasectomy as a method of FP is not a correct practice. Furthermore, all the women stated that tubal ligation is easier than vasectomy. These results indicate that the implementation and success of FP methods are a responsibility given to women.

Examining men’s opinions regarding vasectomy reveals that majority of the men (88.6%) did not want to have vasectomy. Similar findings were reported in other studies. A recent study reported that the most of the respondents (97.0%) were aware about vasectomy as method of sterilization in men, but only 1% was practicing (Saoji, Gumashta, Hajare, & Nayse, 2013). A study of Turkish urologists indicated that 43.6% of their participant patients did not want to have a vasectomy and none of the urologists would choose vasectomy for themselves (Asan, Ateşçi, Gündüz, Gümüş, & Lekili, 2004). A study from Nigeria indicated that only 1.6% of male participants agreed that vasectomy should be used as a method of contraception (Akpamu et al., 2010). Mahat et al. (2010) indicated that the misconceptions and beliefs based on cultural feelings had a great role in refusal by men for choosing the option of vasectomy. In the present study, one out of two men stated that he did not know whether vasectomy is a safe procedure, and more than 45% of the men had not heard of vasectomy before the study. Almost 60% of men did not know whether vasectomy was a difficult procedure or not. A majority of men did not agree with most of the propositions about vasectomy, such as that vasectomy is imposed by Western countries and is not suitable for Turkish men, that vasectomy results in a loss of a man’s status in society, and that having many children gives a man status in society, and so on. The information that they did acquire about FP was sourced mainly from family and friends that are not reliable, evidence-based sources. These results indicate that there is a lack of information about the vasectomy procedure rather than false beliefs among Turkish men. In studies, one of the factors determined to influence the use of vasectomy was lack of information (Frajzyngier et al. 2006). In one study, the low level of knowledge was cited as the cause of low levels of acceptance of vasectomy in Nigeria (Akpamu et al., 2010). A study from China indicated that the factors influencing the use of vasectomy included lack of knowledge, misconceptions, and rumors (Nian et al., 2010). In developing countries, although men agree that FP is the responsibility of both partners in a couple, men also believe women should use contraceptive methods when the need for FP arises, and thus they do not want to receive information on FP.

It seems that men have more concerns about sexuality when compared with women. More than 35% of men stated that vasectomy affects sexual health and marriage life. The second reason given for views about negative effects of vasectomy on marriage was stated to be sexuality. More than half of the men had an opinion that a vasectomy procedure has a negative effect on men’s health. These results were consistent with other studies. A study by Shih, Dubé, Sheinbein, Borrero, and Dehlendorf (2013) indicated that reasons not to choose vasectomy included negative associations with the term sterilization, loss of manhood, and permanence. Misconceptions about vasectomy included misunderstandings about the vasectomy procedure and adverse postvasectomy sexual function. Thus, availability and utilization of the various methods of contraception result in part from users’ considerations of the effects and also from restrictions of contraceptive methods on sexual intercourse and sexual satisfaction. A study by Mohamad Al-Ali et al. (2014) indicated that vasectomy has no impact on the sex life of men. A study from Saoji et al. (2013) reported that the largest number of respondents (28.5%) believed that women are best suited for surgical contraceptive methods, and 19.5% believed vasectomy would lead to general weakness and might result in reduced sexual performance. Similarly, Hosseini and Abdi. (2012) indicated that the main concerns of men regarding vasectomy were its impact on their sex life or sexual performance, the stress of infertility and early aging after the vasectomy, and the fear of surgery.

Conclusion

Three hundred fifty couples were included in this study. Sociocultural factors, such as ideas that contraception is the woman’s responsibility, that sterilized men lose status in society, or that sterilized men lose authority in the family, along with misconceptions about vasectomy, such as that it has psychologically negative effects, that it causes sexuality related issues, that it is imposed by Western countries to decrease Turkish populations, or that it is suitable for poor people, as well as a lack of information were determined to be the main barriers for vasectomy use in Turkish culture. It was determined that women have more negative opinions regarding vasectomy use than men, but that more than half of the men were opposed to vasectomy as a FP method. As a result, a twofold response is recommended: determine strategies to overcome sociocultural barriers to raise awareness and increase the utilization rate of vasectomy; and integrate training and consultancy regarding the use of vasectomy in FP services, including the design of couple-specific education programs for couples with many children. Finally, to raise awareness of vasectomy, FP services and education must be expanded and oriented toward women and men together. To decrease misconceptions, fears, and rumors, a large-scale campaign should be carried out with reliable, evidence-based sources.

Limitations

There are several limitations to this study. First, this study was a cross-sectional study with a nonrandom convenience sample. Therefore, it includes all the limitations of a cross-sectional study. However, when we think about the difficulty of finding men willing to talk about their reproductive and sexual history, this study’s large sample size adds valuable information. Second, this study is not free from recall biases. The couples’ responses to questions related to the practice of FP methods and sexual life in the past are potentially subject to recall bias. Third, there is a potential response bias. Participants may have intentionally given misleading answers to questions about sexuality. There is also a selection bias as the research was done only on the volunteers. Finally, the sample included only one hospital in Gaziantep and 350 couples, which may limit the generalizability of our findings to other populations.

Footnotes

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

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