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• Experts list ignorance, family, societal, religious pressures, other factors
• ‘What if I remarry and need more kids? God forbid!’
By Ngozi Nwoke
When Mrs. Francisca Adewale, a mother of three boys and one girl, walked out of the family planning clinic after her third Depo-Provera injection, she was limping and nauseous.
The nurse told her to expect headaches and mood swings. Nobody told her she would bleed for weeks.
She thought the bleeding would stop after Day Three, like the leaflet said. Instead, it stretched into Day Nine, then Day 14, until it became alarming.
Her sleep pattern became distorted. She woke up tired, irritable, and with a dull ache behind her eyes that Paracetamol could barely cure. The mood swings came harder than she expected. Small things provoked her.
“I was snapping at people and then crying an hour later. I didn’t recognise myself. My appetite shifted too. I craved salty and sugary foods, and gained 4kg in two months.
“I went back to the clinic twice. The first time, a nurse told me to have patience, that my body was adjusting to the injections.
“The second time, I was given iron tablets for the bleeding and was advised to drink more water. No one asked about my blood pressure, the migraine, or whether I had a support system at home to manage the side effects of the injections.”
Adewale is a secondary school teacher, so standing for hours while bleeding, nauseous, and light-headed became untenable.
Her experience reflects a pattern up to 85 per cent of Nigerian women, and she describes family planning counselling that focuses on effectiveness and uptake but leaves out the lived, day-to-day impact. Bleeding patterns, weight changes, libido shifts, and emotional swings are often minimised as “minor” or “temporary.”
For women with existing anaemia, fibroids, or high stress jobs, those “minor” effects can derail work, marriage, and mental health as a result of the contraception, pills, implants, IUDs, and injections.
In all of these hassles, one option that is barely or never considered is vasectomy – a 15-to-30-minute outpatient procedure that blocks sperm from leaving the body. No hormones. No daily pill.
Yet in Nigeria, the number of men who have undergone vasectomy is extremely low because family planning is coded as “women’s responsibility.” Meanwhile, male methods are limited with condoms, withdrawal, or abstinence.
The United Nations and Demographic and Health Survey records that 99 per cent of Nigerian men have not had a vasectomy.
Gynaecologists pointed out that the side effects of birth control vary, but for many women, they include irregular bleeding, mood changes, breast tenderness, and, in some cases, hypertension or clotting risks, depending on the method and medical history.
Professor. Franca Attoh, a sociologist from the Department of Sociology, University of Lagos, said that cultural norms are a major barrier to male involvement in family planning in Nigeria.
According to Attoh, African culture is highly patriarchal and frowns at the suggestion of vasectomy.
She noted that only women are expected to be involved in family planning. Even among the educated and elite, she said, many men will not accept vasectomy because of the belief that a real man is virile and should be capable of impregnating a woman, no matter his age.
“A man who undergoes vasectomy is not considered a complete man anymore, according to our culture,” Attoh stated.
She explained that this perception makes family planning difficult because the decision is often left to the woman alone. Even then, some men do not accept their spouse being involved in family planning.
The sociologist stressed that much needs to be done to create awareness and understanding about family planning, especially among men. “Otherwise, there will be little or no development in this regard,” she said.
Similarly, Tunde Oladele, a sociologist at a Lagos-based research institute noted that the lack of male participation in birth control is caused by the lack of awareness, which leaves men out of the dialogue entirely.
“Vasectomy is rarely discussed at the community level. Lots of men are not aware of what vasectomy is. When you say family planning for men, they think of only condoms and withdrawal. That lack of awareness is a major barrier before we even get to culture or fear.
“The lack of awareness runs deeper than most people realise. In motor parks, barbershops, and even in hospital waiting rooms, many men have never heard the word vasectomy spoken out loud, or if they have, they confuse it with castration.
“Health talks, radio jingles, and clinic posters overwhelmingly target women, so male-focused information is scarce. Without clear, accessible explanations from doctors, community leaders, or peers, most men fill the gap with myths, and by the time family planning is discussed at home, vasectomy has already been ruled out by default.”
Oladele stated that when men consider their wife’s health, the conversation around vasectomy shifts from fear to responsibility.
He noted that many men only begin to listen when the procedure is framed not as a loss of masculinity, but as a deliberate act of protecting their partner from repeated hormonal side effects, risky pregnancies, and clinic fatigue.
According to him, couples are more likely to accept vasectomy when they see it as shared decision-making rather than a woman’s burden alone.
International bodies have pushed for shared responsibility in family planning. The United Nations Population Fund, (UNFPA), has repeatedly stated that male involvement is critical to achieving reproductive health goals, noting that vasectomy is one of the safest and most effective permanent contraceptive methods for men who have completed their families.
The United Nations International Children’s Emergency Funds (UNICEF), in its broader reproductive health guidance, emphasises that family planning decisions should not rest on women alone and that men’s engagement improves outcomes for couples and children. Both agencies list vasectomy alongside female sterilisation as a voluntary, permanent option where appropriate counselling is provided.
To understand the procedure, Abayomi Ogunbekun, a Lagos-based medical doctor clarified how vasectomy works, its recovery timeline, and what men should consider before and after the procedure.
According to him, a vasectomy cuts or seals the vas deferens, so sperm can’t enter semen. The surgery takes about 15-30 minutes under local anaesthesia. However, men are not sterile right away. He said other contraception is still needed until 1-2 semen tests about 2-3 months later confirm zero sperm.
On side effects, the doctor noted that in the short term, men can expect pain, swelling, bruising, and tenderness. Less common issues include infection, bleeding or hematoma, and sperm granuloma. In the long term, a small percentage of men may experience chronic scrotal pain. He added that the procedure does not affect testosterone, libido, or erections.
Addressing reversal, he explained that it is microsurgery to reconnect the vas deferens. Sperm return to semen in over 90 per cent of cases if it’s been less than three years, and around 70 per cent after 10 or more years. Pregnancy rates are usually between 30 per cent and 75 per cent.
He said the main factors are how much time has passed since the vasectomy, whether there’s blockage or sperm antibodies, and the surgeon’s experience.
Chinedu Okoro, a consultant urologist at a private hospital in Ikeja, also enlightened that vasectomy does not affect testosterone, erection, or ejaculation, adding that men can still produce semen, but just without sperm.
Questioning if vasectomy can be reversed to enable the man impregnate a woman, he disclosed that its success depends on the time since the vasectomy was performed, the technique used originally, and whether blockages have formed.
He said: “Many Nigerian men still hesitate because vasectomy is wrongly tied to masculinity and patriarchy. There is a belief that cutting or tying anything near the testicles means you are no longer a man, or that your wife will start misbehaving because you can not impregnate another woman. There is also fear of community gossip. In extended families, a man’s ability to father children is his pride. Choosing a permanent method feels like surrendering his male authority.”
He addded that religion and lineage pressure also compound the consideration of vasectomy, revealing that many families expect their sons to keep producing children until there is a male heir, or until the elders are satisfied.
Okoro said the procedure is underutilised because it is under-discussed. “We do thousands of hernias, but maybe a few dozen vasectomies a year. Men come for erectile dysfunction, prostate issues, but not for family planning. We need male-friendly counselling spaces, not only women’s clinics.”
To get the reaction of men on if they would opt for a vasectomy, Saturday Sun spoke to married men in Lagos with different family sizes and beliefs.
Their answers showed the same divide seen across many communities: openness from some who want to share the burden of contraception, and strong hesitation from others who are held back by fear, stigma, and misinformation.
Cyril Eze, a father of five said, “My wife suffered a lot with pills and an implant. If someone explained vasectomy properly, I would consider it. But honestly, I was scared before today. I thought it would affect my bedroom performance as a man. If a doctor assures me it won’t, and my wife supports me, I can do it. Society will laugh at me, but my wife won’t be the only one to do the birth control.”
James Tolo, a father of three simply said, “No, I cannot do it. What if my wife dies and I want to marry again? God forbid. I need to be able to have more children whenever I want. Men in my area will call me incomplete. It is not worth the shame. Condoms are enough for me.”
For Theresa Lawrence, mother of two girls and a boy, there would be willingness when a man is well informed about vasectomy and supported by his wife.
When asked if she supports her husband to undergo the surgery, she said. “After my second CS, the doctor said I should not have more children soon. I did an implant and it gave me headaches. If my husband said he would do vasectomy so I can rest, I would accept. I would even go with him to the hospital. Marriage is partnership. Why must my body take all the damage?”
She added: “But many women will not say this openly because mothers-in-law will ask, ‘So your husband cannot produce a baby again?’ We need more education in churches, mosques and work places, not just clinics.”
Experts have raised the alarm that until awareness rises, the issue of birth control will still be regarded as a woman’s responsibility alone, and until men see vasectomy as a safe, deliberate act of partnership rather than a loss of manhood, Nigeria’s family planning story will remain half-told.
