Fabi was desperate when he chose to have his vasectomy; he wanted to prevent the conception of his 27th child. He lives in Haiti, the Caribbean country ranked as the poorest nation of the Americas.
Mark Shuttleworth, entrepreneur and South Africa's first astronaut, had a vasectomy before fathering any children. He told me his decision was based on a "combination of two things. One a personal lifestyle choice and the other a sense of the impeding tidal shifts that are going to create very significant issues for humanity and the planet" – the environmental impacts of population growth.
Although Mark's and Fabi's family sizes, finances and reasons for undertaking their sterilisations are different, in the end they both wanted the same thing: by having vasectomies, they elected to prevent unintended pregnancies. Tomorrow is the first World Vasectomy Day. Events on every continent will raise awareness about the environmental impact of our rising population and ask why so few men shoulder their share of the responsibility for family planning.
The launch of World Vasectomy Day was, in part, inspired by Oscar-nominated director Jonathan Stack's new documentary The Vasectomist. The film follows Florida urologist Dr Doug Stein on his mission to save the planet, one vasectomy at a time. Doug says: "You can recycle everything you can get your hands on for the rest of your life, every newspaper, magazine, beer can, coke bottle but you can’t possibly recycle as much as another unintended human will consume."
Stein believes his purpose is to help slow population growth, by limiting unintended pregnancies. Having performed 30 000 vasectomies he's clocked up more procedures than anyone else. Stein's quest starts in the US then moves to poorer nations.
About 1 000 men, in 25 countries, will tomorrow dedicate their vasectomies to Planet Earth and undergo the procedure as part of the world's first "vasectomy-athon". At the Royal Institution of Australia, urologists will be performing vasectomies in front of a studio audience, some live-streamed online. In the US, Dr Sarah Miller will launch New York's first ever pop-up vasectomy clinic. From Canada to Rwanda and China to Columbia urologists, and their patients, are taking part. Public debates, talks and screenings of The Vasectomist are being hosted in cities worldwide, including Joburg.
Africa's patriarchal societal structures, high HIV prevalence and
recognition of polygamous marriages are some of the reasons a South
African audience might react differently to audiences in Australia,
Europe and North America.
On the other hand, the deprivation in the slums of the Philippines and Haiti look frighteningly familiar. There, patients like Fabi are paid $20 (about R200) as a vasectomy incentive, "we cover their transportation costs, we cover their time lost from work," Stein says. Offering such incentives would be unlawful in South Africa.
Contraception plays a key role in women's reproductive health by preventing pregnancies which are too early, too close, too late or too many. It reduces maternal morbidity and mortality. For these and other reasons many women chose to be sterilised by a procedure called tubal ligation.
Durban urologist, Dr Aslam Bhorat, says female sterilisation is "major surgery requiring general anaesthesia and the patient is at risk of significant complications. By comparison, a vasectomy is a much less serious procedure".
makes more sense than tubal ligation for committed couples. Yet South
African women are 20 times more likely to have been sterilised than
South African men.
Forecasts suggest the South African population will increase by over 12 million between 2000 and 2050. That's around the same number of people as the current population of Gauteng. Such a large population increase will make the resolution of the housing crisis and other service delivery issues more difficult, and increase the challenge of preserving the country's biodiversity.
Shuttleworth told me: "Having seen the earth from a distance, I'm very mindful there isn't very much buffer space left" – and he's right.