The RESPOND Project partners EngenderHealth and Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (JHU•CCP) are providing technical assistance to the Government of Uttar Pradesh (GoUP) to expand awareness of, acceptance of, and access to no-scalpel vasectomy (NSV) services. A participatory ethnographic evaluation research (PEER) study was commissioned to understand the reasons for the low prevalence of vasectomy in Uttar Pradesh and to contribute to developing an approach for increasing demand for the procedure. Specific study objectives included:
1. Identifying levels of knowledge about, attitudes toward, and perceptions of NSV by various groups
2. Identifying how men who have undergone vasectomy and their partners are perceived by other community members
3. Understanding quality of care issues in private and public facilities and the role that financial reimbursements play in influencing a client to accept NSV
4. Assessing the nature of spousal communication around the decision to use family planning, and NSV in particular
5. Providing information that will enable the project to tailor messages to promote NSV in terms of the benefits of the method and the ways in which it can improve couples’ lives
The PEER method is a qualitative anthropological approach based on the idea that trust with a community is essential for researching social life. Community members, therefore, are trained to carry out in-depth interviews with three friends and/or other peers selected by them. All questions are asked in the third person, in terms of what others like them say or do but never about themselves directly, so that respondents will feel free to speak about what they hear or know about others within their social network. The method allows for information to be collected over a short period of time and provides insights into how people understand and negotiate behaviour. The method tends to reveal contradictions between social norms and actual experiences.
The study was carried out in rural Kanpur, Uttar Pradesh, India, where 25 community members (13 women and 12 men) were trained in the PEER process. Following the training, they returned to their villages, and all 13 women and 10 of the men interviewed three of their friends (conducting 68 interviews in all), using interview guidelines developed during the training. Each peer researcher was to meet with his or her peers three times to discuss:
1. Family and family size
2. Family planning and family planning methods
3. Male sterilisation
NSV is a refined approach for isolating and delivering the vas for male sterilisation. The technique uses vasal block anesthesia and specially developed instruments to access the vas without the need for either a scalpel to incise the scrotum or sutures to close an incision. NSV results in fewer complications, causes less pain than conventional vasectomy approaches, and allows quicker return to sexual activity.