Family completion is when one decides you have enough kids & decided to stop having kids permanently. In PNG family completion has been mainly done in woman (tubal ligation) while the man still goes around impregnating other woman (this is an over generalization).

I would like to get the general public's opinion about family completion in man (vasectomy). I think it makes more sense because:

1. it is the man's responsibility to care for the kids he reproduce
2. the surgical procedure is simpler than that done in woman
3. sterilization in man really completes the family rather than "side"
families being created by the man later on.
4. women have suffered enough from the 'toture' of childbirth

As I have heard from rumors some of our national, prominent Drs have had 'vasectomy' done on themselves.

Any other views on this sensitive topic?

WNM

Thank you WNM,

Before I can go ahead with my thoughts on the Issue, if you could please, as background infor to the non-medical as to why there a great need for family completion?

I had a believe that family completion is done when there is health risk for the mothers to conceive more babies.

Just saying enough kids for males sterilization and stop impragnating other women around town is not a very strong argument.

On the otherhand, promiscuity may increase.

Family completion is usually decided by oneself if you think you have had enough kids. Are few are absolutely, indicated for (a must) if having a kid or more kids posses a medical risk to the mother.

It is a very sensitive issue. But personally, in my opinion, I have pointed out some advantages earlier on. I believe a wise man who truly loves his wife & family would undergoe vasectomy.

The point of going around impregnating other woman is quiet true in PNG. Well, we know one should use a condom but there many who ignores this & the consequences are:

1. STI (sexually transmitted diseases including HIV)
2. Economic burden of having more kids & families to care for
3. Very sad to say, but increase in the number of kids with HIV despite so many campaigns.

At least vasectomy is a sure way of removing some of the above problems in man who decided to take the risk.

Thanks!

WNM

A wise man who truely loves his wife, would be wise enough to manage the affairs of the family, be faitfull and have a healthy vibrant life.

I definitely agree on the point of reducing economic burden on the family. Family planning is better, i donnot know if it is a reversible procedure or for that matter economically viable for the average PNGean.

Personally the solution for reducing economic burden is not for the health sectors alone, Doctors alone cannot combat aids, its needs wide sectoral approach, just cutting tubes here and there for the sake of an extra 1kg trukai rice for an extra day is not the way.

Guys,
I just want to add a bit onto what everyone has contributed so far.
Vasectomy is the ultimate option left to man if all else fail. Well, I think men should be willing and take the lead to go through the process instead of their wives because every other family planning method like injection and taking the pills is done by the women, except for condoms, well, there are now female condoms available for family planning too.

I really think it is up to the individuals to plan for how many children they want to have and have it within their means and not be careless about it. As long as each individual think they can support and care for their kids, why not, go for it.

On the other hand vasectomy and tubal ligation is available and have been done, mostly on woman but the sad truth is that PNG does not have the technology at the moment to reverse it. It can be done overseas but before any of you decide to run and get this proceedure done and over with, find out about what you are trying to put yourself through and see if it is worth the risk.

What if you'd like to have one more kid later on when the current ones have grown up? think about it.

As for being promiscuous coz the tubes have been tied, I do not think a man that love his wife would do that. As for impragnating other woman, you are only creating more problems for yourself, so if you are a wise man, put your foot where it belongs.

Very true, man who truly loves his wife should not do such a thing but the reality is different. Compared to tubal ligation in woman it is easier to do & very cheap (almost done free in any hospitals or even clinics around the country).

The reversal procedure needs only a microscope which already available in PNG. However, the success rate depends mainly on the surgeons skills.

The AIDS problem is very complex, there is no one solution. I think the main problem would be that many man would refuse to have it done on themselves.

I think we need to do a campeign on this & promote it. Why should the woman go on suffering.

Finally, a man who truly loves his wife would understand (or at least try to) understand the tremendous pain of childbirth & all these little surgical procedures. Its about time real man should give their woman a break!

Thanks!

WNM

I think real man will love their wife children and have a decent living. If men truly love their wife and be faithful. Maybe women will endure the pain and see it as the ultimate act of Love to bear a child from the Love of the husband.

Having said that, major awesness should be done on family planning, funding for professional welfare office and guidance officers.

If I lost the thread somewhere, what has AIDS got to do with family completion?

10Q

Previously, we were discussing about the problems of promiscuity. Apart from the spread of HIV/AIDS, there is this added problem of having 'side' families as well as kids with HIV/AIDS. Atleast, family completion in man may prevent such problems.

So this is where AIDS came into the discussion.

WNM

Basically, I feel that the argument for the prevention of Aids is not significant for family completion. However, I do agree that for health reasons, males and females should undertake family completion. For economic reasons, contraceptives should be encouraged to space birth out.

For promiscuity reasons, realistically, prostitution should be legalised and family values strenghtened.

Yes! family completion to prevent kids being born with HIV/AIDS is not a very strong point. My initial discussion was family completion & not family planning (spacing kids).

In PNG, having too many kids is very common & it is a huge medical risk to the mother in the subsequent pregnancies as well as economic later on. Drs, especially Prof. Glen Mola usually emphasizes family completion to these at risk mothers in the labour ward. Once they agree or sign the family completion consent form and If they have complications & undergo caesarian section (opening up the uterus surgically to deliever the baby) then Tubal Ligation (family completion in females) is usually done at the same time during that operation. However, if they undergo normal delievery then they had to undergo another painful episode of Tubal Ligation, when they are about take a rest from after the painful labour process. Complications are quiet common because they just delievered a baby (post-partum) or in other words complications of post-partum would be blamed on the TL operation, creating a negative public image about TL.

That is why I was saying, once a couple decides for family completion then I think it is better for the man to have the procedure (vasectomy) done on him rather than the woman. As for reversal, I don't know which is easy & has good success rate. Is it in the male or the female? It seems in PNG, no one decides "automatically", for family completion but only after so much emphasis from the Dr.

I know that it would be difficult for png man to take up this choice. However, my reason for bringing up this topic was to find out every man's opinion on this, wether he will decide for vasectomy or not and if not what are the reasons.

Guys! please let me know your opinion.

Thanks!

WNM

I don't support family completion at all.

A choice must still be available for couples to have another baby. Allow the natural process of family completion take place.

I agree with others with the exception to health risks, its unnecessary for women or men to have family completion.

Rather, the question should be, If your wife is at a health risk to having another baby, would you, as a man, get a vasectomy?

My answer ultimately will be yes, but all factor considered, such as would the health risk reduce, would medical advances minimise health risk. If she decided to have another baby, would my process be reversal. And finally, the ultimate question, If i take the process, would my longterm psychology and hence the family be stable??


kas

Thanks! Kas for the opinion. I totally agree with you. It is really a personal choice. However, the maternal mortality rate is quiet high in PNG. This means death secondary to complications during child birth. The sad truth is that having too many kids is the main risk factor.

Typical PNG man thinks the woman is a 'kid making factory'. I'm not saying one shouldn't have too many kids. The point is the mothers' health should be considered first. We as educated ones understand our choices, but the majority do not.I'm speaking on behalf of the majority of PNG women who die each year because of the complications of child birth.

Family completion operation; tubal ligation & vasectomy, never kills anyone & there is hardly any major complications. The process of childbirth, ofcourse is natural but is associated with life threatening complications especially in multiparous (mother who has more than 1 kid) & mothers who have anemia, malaria & other medical conditions common in PNG. Even for a first time mother it is also risky, especially because they can have pre-eclampsia (condition of high blood pressure associated with pregnancy) leading to eclampsia (life-threatening complications resulting from the high blood pressure if not managed properly).

I guess it's about time we guys consider the health of our woman too!

WNM

Whilst the discussion here was basically about family completion at an individual level I would like to add a few thoughts about what it means at a national level. I think most people do not realise the potential dangers of not limiting family sizes.

A population policy is urgently needed to reduce our population growth, which is one of the worlds fastest at around 3 %. This means the population will double every 20 years. In another decade PNG population will be 9 million if left unchecked.

With half (48%) of the population under 15 years enormous strain is being put on resources and this will worsen as only half of the population are adults who care for the other half. In a decade or so AIDS/HIV is set to decimate that economically viable half of the population so that the demography of dependence is going to be further unbalanced. We are going to be in enormous trouble.

This will be the one single most important problem the government and people of PNG have to deal with in the next decade. Imagine what a growth rate of nearly 3 % means. There will be socio-economic chaos within our lifetime. In 20 years we need twice the numbers of schools, aid posts, hospitals, jobs and so on let alone improving on the poor facilities we already have. A recent report mentioned population growth outstripping our domestic food production so that at some stage we will have to be faced with the unlikely spectre of hunger among our people.

The increase in population has also outstripped the growth of the PNG economy. Already in the highlands there is significant land shortage with once large areas of unpopulated fertile areas such as the Whagi valley so crowded most fights are due to land disputes. Soon a significant proportion of the highlands population will be without land to live off.

On a personal basis uncontrolled population growth has detrimental effects on maternal as well as child health as the family resources become increasingly inadequate and mothers put under severe strain with poor recovery from preceding births. With several children in an increasing user pay society services such as education, which were once taken for granted are now expensive and cannot be afforded by the average family. Children with potential to be educated to tertiary level will miss out as parents carry out a juggling act to see which of their children should go the whole distance in education while the rest miss out.

The decision to tackle the population problem needs to come from the political leaders and most effectively needs to be a separate body adequately funded and staffed by a multidisciplinary group of specialists who can be given a defined time period to present viable programs. Population control is a very difficult task and only one country, China, seems to have been able to have any measure of success. That however should not discourage us; even keeping the growth rate steady or marginally slowing it is a desirable goal in itself.

Most people are conversant with many of the individual family planning measures that are available via the health system. However, most people may not realise that a possible effective measure is the education and empowerment of women.

What is also highly significant is that maternal education is the single most important determinant of health of children in numerous studies (at least 24 studies) in third world nations. In Pakistan and Indonesia infant mortality rate in children whose mothers had only 4 years of primary schooling was half that of mothers with no schooling at all. In South America the influence of maternal education was stronger than the level of household income on the infant mortality rate. (Infant mortality rate is the number of children under the age of one year who die out of a 1000 children being born every year. This is generally a good measure of health status in a given society).

Educated mothers are more knowledgeable about hygiene, nutrition and accept immunisations and other interventions more readily. Empowering and educating women will allow them to marry and have children later, be able to determine their family sizes and space them better. A recent study has shown that the average woman in PNG would like to have 3 children but in the current cultural contexts those decisions are not hers to make. This has broader implications not only for better health but also population control and ultimately better socio-economic status at the family level.

Introduction of compulsory education for girls (as well as boys) in for instance the state of Kerala in India (Cuba is an even better example) not only resulted in a significant improvements to health indicators and literacy rates. There was a significant decrease in population growth. It is not difficult to see why this should be so; as girls stay longer in school and go on to tertiary education they marry and have their first children later. They are also empowered by being educated so they are able to influence choice of family sizes and in choosing active methods of birth control.

On a general note compulsory but free education of all children in this country up to grade 12 would have far reaching consequences not only in health indicators alone but economically as well as providing a literate electorate that can fully participate in the democratic political process. Recent fears expressed by about increased unemployment expectations from too many high school graduates seems to me a very short-sighted argument when in my view a literate population would be a panacea for so many of our society’s shortcomings.

My aim was to stimulate such responses. Thanks for the facts on the benefits of limiting family size & educating women. So it is very obvious that tubal ligation is very beneficial in the broad aspect & in the long run. I urge a 'smart' government to address this real issue urgently. In fact, having a big family of which one can't really care for & discipline is the root problem of almost all social problems we see in our country. Not to mention the rising crime problems, especially in Lae city now. The message is simple 'sapos yu no inap long lukatim gut na disiplinim alrait noken karim'. If you can't afford to care & discipline them then don't bother having those kids. It's not just a matter of having kids & leaving them all to the mother. The kids need alot of attention from both the mum & dad.

If every man is responsible for his own kid, I don't think we'll have all these social problems we have now. If our government is really smart & is concerned for its people then it would only have 2 policies:

1. Limit family size
2. Educate all woman

Any other opinion?

WNM

I would rather government cameup with more job opportunities whilst promoting gender equality

More Jobs
1. People occupied and busy
2. More financial support for family

In this way, only those ladies who face health complications could undergoe family completion.

For the government to provide more jobs may be difficult. Currently, the number of elementary & high schools have been increased but the number of Unis are constant. However, more students are squeezed into them. With jobs we are not industrialized, as you would realize from the slowly increasing number of 'brain drains' each year. Could any one give us some figures on the number of unemployed Uni graduates, including the 'brain drains'?

Currently, population growth is out numbering economic growth rate which means more unemployment is expected.

Limiting family size simply means self reliance & not depending too much on the government. Atleast, that's what I think.

Thanks!

WNM

Actually, recent BPNG figures indicate that economic growth in terms of GDP growth rate is over 1% above population growth rate.

Which makes for a very SLOW growing economy. only about 1% is nothing.

I believe, the current GDP figures even if it's higher (as you said) than the pop growth rate, does not represent the reality. Another obvious point is that the gap between the rich & the poor is widening. GDP do not mean much when it comes to how one manage your kids as a family unit. In the modern times, I believe that smaller families means better quality of life, for the family & not high GDP, definitely in the case of PNG.

Thanks!

WNM

In 10years, with relative to this year, it would mean that the economy grew by 10%, isn't that something?

That would translate to about K20b worth of growth.

How will the gap between the have & have not be like then? Will the lives of rural people be transformed by that time? How will the crime rate be like then? How will the quality of life (QOL) be like for an average PNGean. Well, these are some things to think about too. I firmly believe in small families, high quality of living & less social problems.

Thanks!

WNM

WNM,
THose are problems we need to be concerned about now.
There are several problems with interpreting the increase in GDP.

1. The GDP will rise and fall. Population growth does not fall, nor does it remain static. It grows relentlessly and we need to deal with it now.

2. GDP and GNP are economic indices that are calculated on an average basis for the population. Indeed various reports from surveys by UNDP and UNICEF in the last decade have shown that despite growth in GDP and GNP there has been no real increase in average household income; in real terms average household income has actually fallen. (Factor in the falling kina value and inflation).

3. Ownership of wealth is disproportionate in this world. Often a tiny proportion of the population owns a huge segment of the nation’s wealth. One often wonders about the amount of liquid wealth that is actually transferred offshore in these situations.

Whilst the individual wishes of people must be respected; they must also be educated on the disadvantages of a large family; both for the family and the country as a whole. They must be offered the choices of safe and cheap family planning methods.

I wish to point out again that in several surveys women have expressed the opinion that the average number of children they would like to have is 3. Men should be informed and aware of what their partner’s wishes are. Women are acutely aware of the unfairness in selecting out one child to receive a full education and keep the others at home because the family cannot afford to educate all of them.

What seems inevitable is the fact that because of poverty, large families and costly education the gap between the haves and the have-nots will widen and there will develop a permanent underclass who will find it difficult to break out of that groove. The once level playing field that most of us entered into will no longer be level. There will be increasing crime and lawlessness and those of us who are in the working and the middle class will be seen to be enemies along with the wealthy classes and we will need to hide behind ever high walls.

Look at every stable liberal democracy that enjoys a reasonable life style today. They are characterised by large middle classes (small wealthy and small very poor with a good safety net for the poor), high literacy rates, low population growth with small sized families. Strong democratic institutions are also a feature but are probably a result of many prerequisites; many of which include the above.

Corrupt governments and systems such as which is prevalent in PNG today occurs because there are the “bigmen” with a multitude of disadvantaged small men who rely on the bigmen for what ever cast off can be handed down. It is much harder in a society where everymen is equally literate and economically self-sufficient; only then can allegiance to a state or an ideal supersede allegiance to a corrupt mortal.

All these problems have their roots in poverty, illiteracy and ignorance which is aggravated by uncontrolled population growth. Any chance of a given generation to make up any ground is lost by the subsequent generation where there are too many off-spring for these small gains to be of any advantage. A very small number will break out of this but the majority will be hopelessly enmeshed in that underclass.

In order to prevent this from happening the two things that need to happen is to control population growth and have education freely available (or at minimal cost) which is compulsory. Whilst waiting for the government to act (we obviously must engage in the political process to do so) we should in our personal lives campaign for limiting families and push for our less fortunate relatives to have the means to receive an education.

In many ways I am oversimplifying what is in many ways is a complex sociological quagmire but I believe this is a justifiable encapsulation of the problem.
Ta

Thanks! that's a great summary of a complex topic. I fully agree with you.

How should we start now to do our part as individuals-I mean the family planning awareness campaigns. It is an individual choice but we as educated ones, have a duty in educating the average PNGean to understand the importance of limiting family size.

Currently, I think the 'noise' on HIV/AIDS is louder than this topic. However, it should be considered too.

Thanks!

WNM

By coincidence it seems there is an article in todays post courier about population matters in the same vein which is Sir Peter Barters address to Parliament. Do read it if you can.

Population growth, HIV, global warming, careful interaction with our natural environment etc are all interlinked issues that each and everyone of us as individuals should take responsibility for.

If any of you haven't read Jared Diamonds book "Collapse" do try to read it (JD of Guns, germs and steel fame). It outlines how several societies have failed in history becasue they did not consider the harmful effects of environmental change, use of natural resources and population control. It is horrifying but an island called Tikopia in the Solomons inhabited by Polynesians had a limited land area and only survived by taking harsh decisions communally such as practicing infanticide and allowing only first borns to have children. At one point in time in history they decided to kill off all pigs (who consumed the food humans could have had). Other such instances point to the fact that when man does not live within certain limits provided by his environment that society collapses and JD is providing an allegory for the whole world community which may collapse if we are not careful.

We cannot afford to be complacent in PNG anymore!

Ta

That's right! Jared Diamond also tried to explain how & why the Western societies are now more advanced that other societies & first started set sail to explore the world.

Although, some people said, the Chinese were the first to sail the world.

The examples you gave are very clear examples of why we should start controlling our population now. Look at China, now. They are already taking drastic measures. They are forcing their citizens to have 1 kid. Infact, they are 'punishing' (pay a fine) them for having more than 1 kid. Papua New Guinea should start now, so we don't take drastic measures later.

WNM

Wantoks, thank you for this very enlighting discussions. I vividly recall a documentary I watched about the destruction of a small island nation called Easter Island. The calamity a direct consequence of lack of resource management due, in no less significant part, to uncontrolled population growth with subsquent strain on the environment, food, and finally land space. These precursors led to a vicious confrontation between families to gain control of the scarce resources, which lead to the ultimate demise of the Island nation.

I imagine PNG will not reach that state, however, I do whole heartly agree that man must take the lead in family completion where the health of the spouse is at risk.

wantok.

Yes! wantok, family completion has both short term benefits for the family & long term benefits for the country as a whole. By the way, to clarify abit; Family planning usually refers to spacing out your kids (the years between each kid) & family completion means having a surgical procedure to permanently stop having kids (although, reversal could be successful in a few cases).

Thanks!

WNM

To Wantok, that documentary on what happened on Easter Island is described in Jared Diamonds book “Collapse”. An extract is available on this link www.hartford-hwp.com/archives/24/042.html. (WNM, JD also describes how the Tokugawa shogunate in the 17th century realised the effects of deforestation and put in place measures to conserve forests and decrease cutting down of trees).

Diamond lists 8 factors which have historically contributed to the collapse of past societies: deforestation and destruction of natural habitat, overuse of soil and its poor management’ poor management of water resources, overhunting’ overfishing, introduction of new species, human population growth and increased per capita impact of people.

I would venture to suggest that in fact whilst the other factors could happen independently, uncontrolled human population growth alone can result in all those other problems.

The recurring theme of failed societies such as the Mayans is the fact that the ruling elites were insulated from the effects of their civilisation on the common people; hence bad decisions were made.

Do we the middle class tertiary educated nationals really know how life is like in the lower strata of society? Do we know how a family in a settlement such as in horsecamp survive on 1 meal a day (rice without meat) and some of these kids suffer from nutritional diseases such as Vitamin A deficiency on a scale not seen 20 years ago. Do we know how a family in Jimi in the Western Highlands is finding arable land scarce and realise the only way out is for three of the four boys to be educated and working. However the local school is without teachers for many days of the week as they walk the two days to Banz (road completely gone now) chasing their pay in Hagen. That the school fees to educate all these boys would be several grand but the coffee harvest though good cannot be sold as without roads there can not be any buyers.

How can we be complacent and think population growth is still not a problem yet when we go to Tabari place and meet lots of street beggars who are kids brought into this world by parents who did not plan to care for them and educate them? When Port Moresby General Hospital is now way too small to cater for a population that is growing at breakneck speed? When patients are dying in hospital because we do not have enough space, enough workers, enough resources etc.

How can we be complacent and think population growth is still not a problem when you go to the highlands and see the whagi valley overcrowded with no more fallow land available for cultivation? When the Cateret Islanders are refused resettlement in Buka (to whom they are ethnically related) because there is not enough land on Buka itself which has seen an unprecedented population explosion.

If we wait another 10 years it may be far too late. The time to act is now. It is time to consider not only population growth but to consider how we do not destroy our environments and how we can manage our natural resources.

We can all do things in a small way in first starting with ourselves and then with our relatives and friends. If all of us were to be involved there would be a critical mass. And from reading the forum and seeing what some things that are happening in POM many young people are motivated to do something at an individual level.

Ta (Sori long mauswara tumas)

I think its about POPULATION CONTROL as well, but also how many men out there have babies to five different women, get that under control can only be a good thing.

That's what I mean when I say Family completion by doing vasectomy in man. It makes more sense than Tubal ligation for woman.

Thanks!

WNM

Come on, men. I have not seen any good response to the original post by WNM. Looks like no one is willing to undergo vasectomy for the sake of their woman's health being at risk. If there are some I have overlooked, correct me on that.

WNM, maybe most men will seriously consider vasectomy if our country has a policy similar to the one child policy in China or the men have not said any straight answers coz going through the operation will take away their ability to reproduce which in turn affects them psychologically or simply makes them less a man.

Which one is it?

Cynthia, there have been alot of good responses so far to the original topic, ofcourse, including your responses.

To control the overal population growth, It could be possible to have milder policies like;if a couple have only 1 kid, the government will fully subsidise school fees & if 2 kids than partly, if more than 2 than none (no school fees paid). This is just an idea that needs to be expanded.

Vasectomy is a personal choice for men. There is a cultural component so it will be really hard to emphasize it. However, all men should be aware that surgically it is very easy to do & comfortable for the man, with almost no complications (the non-scapel method) compared to tubal ligation in women. Furthermore, I'm not sure wether it is the right time or place to bring this point up, but, personally I'm thinking of introducing a new, much simpler & faster vasectomy technique than the 'non-scapel technique. After approval from PNG medical board, sometimes in the future, I would like to do it for free to only selected individuals (man). With that don't want to discuss any further about this new technique.

Finally, in Manus I was surprised to see several man come to the hospital, voluntarily for vasectomy. There we did the 'non-scapel technique'.

WNM

I think vasectomy is taking on among men in PNG and as you say it will be accepted gradually. However there are programs going on and whilst I do not have the actual figures (but will try and get them); the EHP seems to be at the forefront with a HEO trained to lead and many other health workers have been trained so far and it is anticipated that many more will be trained. (These programs are being supported extensively by AusAid and UNFPA).

It seems that there is a tussle going on in Family Health services where some doctors do not think HEOs etc should be allowed to train to do this whilst others believe that it should be the way to go.

I hear that educated PNG males are however surprisingly the least likely to take up the challenge (but this is anecdotal).

Ta

Thanks for this positive contribution. Currently, with limited Drs, HEO & nurses are doing alot. As long as HEOs are trainned well to do vasectomy, I see no reason stopping them. As PNGeans become more educated, they have the freedom of choice to go to whoever they want, for any kind of medical service, as long as they can pay. If one can't pay then one has no choice but to end up at the public health care system (althought, there's a little fee).

WNM

Thank you "Ta" for the wonderful summary of the whole situation regarding population control and sustainability few postings back. Challenging and motivating words to read.

WNM, I'm quite optimistic about your vision to put more emphasis on men to undergo family completion when there is a pregnancy risk face by the partner. I would advocate it to be introduced as a standard practice after the 2nd or 3rd child is born into the family and the risk of further pregnancy increases.

I think the key to the success of the program has to be awareness. The discussion of sexual function before and after the operation are major concerns to the average man. There are many myths that must be addressed with traditional men and their outlook of "manliness".

I read an interesting case of universal polio vaccination in China. As we all know, there is also a policy of 1 child per couple. All children had to be registered for universal polio vaccination to be successful. The logistics involved was dependent on recorded registry data. Sometimes after polio vaccination was administered, there was an outbreak of polio in central and northern west parts china. It was found that many of these areas had more than 1 child. They had 3 children, as such the number of vaccine fell short; well one of the reasons was these areas were mostly agricultural communities. They needed extra hands to assist in farming.

Well my point is that, it maybe interesting to see the demographic distribution of population growth and areas where there is a boom in population. We may need to target these areas and at the sometime dispel concerns of having larger families and at the same time present alternatives. In the highlands, tribal war may stimulate population boom. In hinterlands and plains of Markham, not forgetting the Oil Palm Plantation of New Guinea Islands, need for extra hands on the farm or the sea may be a catalyst.

I also have some concerns, I do agree that a vasectomy is also a way to combat unwanted pregnancy due to promiscuous behavior but how would we give that news to the spouse? It maybe quite difficult to tell the wife we had to give your husband a vasectomy because he is potentially promiscuous and likely to trigger an explosion in the population. It may be an extreme case but a law could be in place to do just that. Would that make him more or less promiscuous is another matter.

With regard to AIDS and other STI, I can only imagine what it may do with the psychology of careless man. My question would be, how those emphasis on vasectomy impact on the collective sexual behavior of men, would HIV, STI cases increase? The Manus case is an interesting one, if you have time please tell us more surrounding the case.

All in all, if my wife was at health risk, and all methods of contraceptive and family planning failed, with her consultation, I may take that approach.

Cheers
kolwan

Kolwan Thanks,

I think you have succinctly expressed what many of my reservations about an all out family planning policy pushed from the top; often in my years as a junior doctor I felt embarrassed when a family would be brow beaten by colleagues to agree to have a tubal ligation etc. People have their rights and those should be respected but somehow at the same time they need to be made aware that they can make choices.

As I pointed out above in many surveys women have spoken their minds; they would like an average of 3 children. On the other hand we do not know what their men-folk want. We also do not know what factors determine how many children a couple want; if in the first place they do have any choice.

I would suspect that our people would have exactly the same response as the chinese if we tried a forcible one child policy. But on the other hand if the couple were aware of their own limitations in educating all their kids and if they were aware that several options were available to plan space or limit their number of children they could make different choices.

It would therefore seem the first logical place to start is to set up a multidisciplinary organisation whose job would be to coordinate a population plan. We would need social scientists to define what factors can influence family sizes and how we can best approach dealing with society about coming to a consensus about dealing with our population problems.

Let me reiterate that the problem is not overpopulation for PNG. With proper planning we could probably sustain double our current population easily. However the problem is the current demographics where over half the population is under 15 and the rate of population growth in relation to economic growth, availability of basic resources and the ability of families to care for children in an age that is increasingly adopting a user pay philosophy for the most basic utilities such as education and health services.

In fact in the west and some Asian countries like Japan and Singapore the population problem seems to be of a completely different nature. They face negative population growth with the prospect of half the population to be over retirement age with less than 40% of the population in the workforce with that set to even decrease further.

When it comes to individual methods like vasectomy and tubal ligation I find it difficult to make a decision as an individual. I would hate to have a permanent surgical procedure carried out on me (or by inference my partner). I’d rather opt for a simple family planning method that is not permanent. Again this is a personal fear that defies scientific reasoning and I’d probably need to be at the stage where I had enough children and found other methods of planning not feasible to be able to make a rational decision. These fears and others such as possible negative consequences on sexual function are clearly core issues that need to be dealt with before the population is able to adopt such policies freely.

The overwhelming challenge is to make the PNG population a literate one. Educated women will make educated choices about family size, utilise available methods of family planning and bring up their children utilising optimal nutritional and health practices. And if people say it is too expensive how is it possible that countries like Sri Lanka or even Fiji be able to give free education to children in the first 10 to 12 years of schooling.

Ta

Thanks again, Kolwan & Ta for these contributions.

Our society is a fast changing one. Rural-urban migration is a huge problem. People are moving away from subsistence agricultre & engaging in large scale commercial agriculture. Mines are sprouting up every where like mushrooms after the rain, thus transforming the rural life into an urban one overnight. Because of all this education is becoming a key to survival as well as for developement. However, the government cannot provide education for all & it is becoming expensive & also I do not know the balance between Uni grads every year & the availabillity of jobs. To enjoy a quality life, we've got to achieve a balance between the economic growth & population growth. At this point of time, we have alot of problems because of the imbalance. High crime rate, high iliteracy rate, health needs of all are not met etc.

Japan has been enjoying a high quality of living for a long time. High literacy rate, lowest crime rate, high standard of health care etc. But now, the aged population is growing & creating economic problems.

Well, I believe life is a delicate balance between many aspects. Right now fo us PNGeans it is little out of balance. If we don't plan well now, it will get worse.

We should educate PNGeans to be self reliant & not depend too much on the government and I believe one way to do that is to educate them to be more responsible for their own family. To effectively manage one's own family & to enjoy a quality life is to limit the size. Each man should decide according to his income ('noken karim natin, nating tingim future'). I interviewed or surveyed all mothers at the labour ward in Manus for 3 months & I was surprise to find out that almost all (100%) of their current pregnancy was unplanned. Now, this is very scary. I'm asking myself, is the dad ready to care for his kid or his just enjoying sex. Sorry to put this way but this is the reality.

Those few man who underwent vasectomy in Manus, I didn't interview them so I couldn't find out what made them to take up the decision.

Family planning alone for life is ok! but it is inconvenient & also has minor side effects. Man don't understand, because it is the woman who undergoes family planning. As for condom, personally I wouldn't want to use it with my wife for life. Many of the hormones used for family planning reduces libido so I wouldn't want my wife to be out of libido & to be forced into sex everytime. Sex is a gift from God that should by enjoyed, freely by both married partners for life.

So as you can see family completion using vasectomy leaves alot of time & energy for the mum to work & care for the children & to enjoy a natural marriage relationship with the husband. Vasectomy do not reduce libido in man nor does it have any short term or long term complications. The only problem is the man's 'ego'. What is this 'ego'? is it, no sperm no man or no children in a another (second or third wife) no man. This is stupid & nonsense.

I urge all PNG man to think seriously about his family size & the livelyhood of his woman (wife). 'Noken greedy na tingim hamamas blong yu yet'.

WNM

WNM, I absolutely agree.

Why not get a vasectomy rather the go through all the hassles of contraceptives, TL or others. Obviously its the better choice. Its easy, simple, low health risk and of course promotes healty living.

kolwan

That's the way to go Kolwan. Thanks for the support!

WNM

So Kolwan can we expect to see you any time soon being first in line to set an example LOL

Snip snip

Sapos yu ting yu igat inap pikininni ok, welcome tasol!

Currently, there's no proper program for vasectomy but if you go to Prof. Sappuri's or Mola's clinic, it can be done quickly (no appointments & waiting time) but with a little fee. If you go to PMGH family planning clinic it can be done cheaply but with an appointment & waiting time.

If you are outside Pom, you can walk into any hospital & ask if the surgeons there know the 'nonscalpel method' of vasectomy. It is easy so I bet many surgeons or general practicioners would be able to do it.

In the future, I would like to start selective recruiting of man who are interested to undergoe a newer, technique of vasectomy. If you are interested to find out more or wants to be recruited then please let me know: w_mol2003@yahoo.com

Thanks for being a responsible man!

WNM

Update on vasectomy in PNG.

Under the current reproductive health program over 6,000 men have now undergone vasectomies in PNG mainly in EHP and ESP. EHP has alone accounted for 4000 of these. A local HEO in Goroka, Michael Muri is training community health workers in this procedure and according to Prof Mola who watched one done by a CHW thought technically the CHW was technically superior to how he (Prof Mola) does it.

The only hitch is that the NDoH may put a stop to this by not allowing non-doctors to perform such procedures. The O&G society is however gearing itself up to fight this in the event that this indeed takes place.

In fact the Maria Stoppes International, an NGO organisation which has recently set up in PNG and has a clinic in NCD is now employing a male doctor (they already had female doctors to carry out reproductive health care for women) and will be getting him trained to do non-scalpel vasectomy. This is due directly to the number of enquiries by men who have wanted vasectomies but do not want to front up as there are only female staff.

Ta

This is great! I wish to see this prgram expanded to other provinces so more man can receive the procedure (nonscapel vasectomy). I see no reasons why HEO shouldn't be allowed to do the procedure.

WNM