This past month we spoke with current leaders of the Ministry of Health’s family planning movement in Mexico, Dr. Karla Berdichevsky Felman, head of National Center of Gender Equity and Reproductive Health (CNEGSR) their National Director for Family Planning, Act. Yolanda Chavez Varela and lead Vasectomy Trainer, Dr. Jose Antonio Castro Garduño.
Since our first trip in 2016, the government’s uninterrupted support has turned Mexico into leaders of World Vasectomy Day’ s global movement for enhanced male engagement in family planning. In 2017, along with our partners at the Ministry of Health’s National Center of Gender Equity and Reproductive Health, Mexico hosted WORLD VASECTOMY DAY’s 5th annual celebration. As well as this article, we are including links to the three interviews in their entirety (just click on their names to see them in full)
In early 2016, WVD received a Skype message from Dr. Jose Antonio Castro, the CNEGSR’s lead vasectomy trainer. Eager to showcase Mexico’s vasectomy program, Dr. Castro offered to join our global campaign. “I was doing research and saw a piece about WVD. There was nothing about Mexico in it, so I tracked down Jonathan Stack and invited him and his colleagues to come to a meeting we were organizing for our vasectomy providers.” Vasectomy has a long history in Mexico, but the non scalpel technique that the government now utilizes did not arrive until 1993. Dr. Castro was one of the early adopters and his job was to build the program from the ground up. A man with a passion for male engagement in family planning, Dr. Castro immediately set up educational events at the local police and fire departments and started traveling throughout the country.
Until then the numbers of procedures were between 500-600 annually, but given the ease of the NSV technique and the support of the government, numbers skyrocketed to over 5,000 within a year.
Today the training program continues and has expanded to each of Mexico’s 32 states. “I have trained over 350 doctors in Mexico. It is a rigorous process that requires each candidate to complete 50 procedures before he or she can qualify to be fully certified. In 2015, the year before WVD began supporting el Centro’s work, the numbers had risen to 16,000 yearly.”
As important as it is to have well trained doctors, for a vasectomy program to scale up to its full potential, it needs substantial investment from the public sector. Leading this effort since 2014, is Actuaria Yolanda Varela Chavez, “We have made a commitment to promote men’s participation in family planning and in the use of contraceptives. Our program promotes male co-responsibility in the regulation of fertility, and in turn contributes to responsible and chosen parenthood, as well as combating sexual and gender-based violence and promoting healthier and more egalitarian decisions.”
From our first encounter at the doctor training program in Cuernavaca in 2016, Act. Varela Chavez, Director of Family Planning, has been a stalwart and consistent supporter of WVD in Mexico.
Under her guidance, the numbers of vasectomies performed, both at the Centro de Salud and at other government health institutions has grown steadily. From about 750 following our first conversation with Dr. Castro in 2015, to 2,599 procedures in 2016 to 6,477 in 2017, these numbers were achieved with 350 doctors and program directors in all 32 states. Even more impressive, in the years after serving as WVD headquarters, numbers continued to grow, reaching close to 9000 in 2019. And the growth wasn’t limited just to the few days in November when World Vasectomy Day is celebrated, but to the entire year. In 2019, over 53,000 vasectomies were done throughout the public health system. The fact that the procedures are free, contributes greatly to their appeal.
Another unique component of the Centro’s program is its emphasis on gender equity. This focus has been strongly highlighted by their Executive Director, Dra. Karla Berdichevsky who has been the leader over the past 3 years. Working with her team, they have set a five year plan, 2020-2024, that recognizes the importance of male participation, “The current Action Program incorporates the transversal axis of gender equality, which in the matter of contraception includes vasectomy services as a substantive action to promote shared responsibility in the regulation of fertility.”
Despite stereotypes about Mexican machismo, the growth in numbers of men choosing a vasectomy reflects a shift in consciousness among younger generations.
According to Act. Varela, “The culture of the Mexican population has changed in recent decades and there is increasing participation of women in various fields of productive life, which has contributed to the fact that men in the country also exercise different types of roles in relationships as a couple. We are changing and promoting new masculinities in the country.
As with all matters in public health, starting in March of 2020, Mexico’s vasectomy program was severely impacted by Covid and protecting the health of its providers was a priority. “Of the team of more than 350 doctors who perform vasectomies in the country at the beginning of 2020, about 40 percent had to take shelter at home, because due to their age or their health condition they had risk factors for contagion of COVID-19, and unfortunately there were some deaths from this disease among our doctors.”
The number of vasectomies through CNEGSR fell to 20,461 in 2020, which represented a decrease of 37.6% compared to the productivity registered in 2019 (32,807). While not surprising, it is worth noting that although dozens of clinics were converted to offer exclusive care to patients with Covid, the number of vasectomies performed in the Ministry of Health in 2020, was still slightly higher than the 16,000 reached in 2016.
As in the rest of the world, it has been a tough 18 months in Mexico and the challenges continue, but with men and women committed to choosing the family size they believe is right for them, the numbers are already starting to rise. In the first quarter of 2021 el Centro has registered a 63% increase as compared to the same time frame in 2020. For Mexico and their Ministry of Health, family planning services, for both men and women, remains an essential service.
As Dr. Castro says, “We have learned that the best promoter for a vasectomy is a man who has had a successful and positive experience. And the key to a successful experience is a well trained doctor in a positive and clean environment.”
With their commitment to excellence in both communication and service intact, Mexico’s vasectomy program has a bright future ahead and that bodes well for its people and their future.