Male infertility affects up to 12% of the world’s male population and is linked to various environmental and medical conditions. Manual microscope-based testing and computer-assisted semen analysis (CASA) are the current standard methods to diagnose male infertility; however, these methods are labor-intensive, expensive, and laboratory-based. Cultural and socially dominated stigma against male infertility testing hinders a large number of men from getting tested for infertility, especially in resource-limited African countries. We describe the development and clinical testing of an automated smartphone-based semen analyzer designed for quantitative measurement of sperm concentration and motility for point-of-care male infertility screening. Using a total of 350 clinical semen specimens at a fertility clinic, we have shown that our assay can analyze an unwashed, unprocessed liquefied semen sample with

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An automated smartphone-based diagnostic assay for point-of-care semen analysis

Objective Ghana, like the rest of West Africa, has very low contraceptive prevalence and is one of a few nations that reports declines in contraceptive use over time based on two of the most recent national surveys. Fear of side effects is a leading cause of non-use of contraception, based on national surveys. The objective of this study was to gain a more holistic understanding of why Ghanaian women are not using contraception. Methods We used focus groups with vignettes to elicit normative beliefs about contraception. We recruited 91 women from three different clinics within Legon Hospital in Accra, Ghana: the antenatal clinic, the student clinic and the child welfare clinic. Focus groups were homogeneous with regard to age group and union status. Results We found that women were most concerned with the menstrual irregularities caused by hormonal methods. In addition, women believed strongly that the hospital was the best place to get contraception as blood tests were needed to match women with the appropriate method. Knowledge of how methods worked and of basic reproductive biology was low. Conclusions Poor knowledge of how to use modern methods combined with myths and misinformation should be the targets of programmes to increase modern contraceptive prevalence in Ghana.

https://srh.bmj.com/content/familyplanning/40/1/30.full.pdf

Misperceptions, misinformation and myths about modern contraceptive use in Ghana

Pervasive gendered inequities and norms regarding the subordination of women give Ghanaian men disproportionately more power than women, particularly in relation to sex. We hypothesize that lack of sexual empowerment may pose an important barrier to reproductive health and adoption of family planning methods. Using the 2008 Ghana Demographic Health Survey, we examine the association between women's sexual empowerment and contraceptive use in Ghana among nonpregnant married and partnered women not desiring to conceive in the next three months. Increasing levels of sexual empowerment are found to be associated with use of contraceptives, even after adjusting for demographic predictors of contraceptive use. This association is moderated by wealth. Formal education, increasing wealth, and being in an unmarried partnership are associated with contraceptive use, whereas women who identify as being Muslim are less likely to use contraceptives than those who identify as being Christian. These findings suggest that to achieve universal access to reproductive health services, gendered disparities in sexual empowerment, particularly among economically disadvantaged women, need to be better addressed.

/pdf/women-s-sexual-empowerment-and-contraceptive-use-in-ghana-213vkrw44c.pdf

Women's Sexual Empowerment and Contraceptive Use in Ghana

Meeting the need for modern contraception: Effective solutions to a pressing global challenge

Evolutionary models of human reproduction argue that variation in fertility can be understood as the local optimization of a life-history trade-off between offspring quantity and ‘quality’. Child survival is a fundamental dimension of quality in these models as early-life mortality represents a crucial selective bottleneck in human evolution. This perspective is well-rehearsed, but current literature presents mixed evidence for a trade-off between fertility and child survival, and little empirical ground to evaluate how socioecological and individual characteristics influence the benefits of fertility limitation. By compiling demographic survey data, we demonstrate robust negative relationships between fertility and child survival across 27 sub-Saharan African countries. Our analyses suggest this relationship is primarily accounted for by offspring competition for parental investment, rather than by reverse causal mechanisms. We also find that the trade-off increases in relative magnitude as national mortality declines and maternal somatic (height) and extrasomatic (education) capital increase. This supports the idea that socioeconomic development, and associated reductions in extrinsic child mortality, favour reduced fertility by increasing the relative returns to parental investment. Observed fertility, however, falls considerably short of predicted optima for maximizing total offspring survivorship, strongly suggesting that additional unmeasured costs of reproduction ultimately constrain the evolution of human family size.

https://royalsocietypublishing.org/doi/pdf/10.1098/rspb.2012.1635

The life-history trade-off between fertility and child survival

Demographics of vasectomy--USA and international.

Many family planning (FP) programs in sub-Saharan Africa are fragile; recent performance has fallen off and future performance is challenged Yet robust and wellfunctioning FP programs are still urgently needed if countries are to meet their health, equity, poverty-alleviation, and economic development goals In support of these observations, we present data on FP parameters in subSaharan Africa overall and in eight of its countries, including Nigeria, the most populous African country; Kenya, a long-time leader in FP in the region; and Uganda, with fertility among the highest in Africa and a population projected to more than triple in the next 40 years to become sub-Saharan Africa’s fourth-most-populous country We also draw upon findings of individual case studies of the contraceptive programs of Ghana (Solo et al 2005c), Malawi (Solo et al 2005a), Senegal (Wickstrom et al 2006), Tanzania (Pile and Simbakalia 2006), and Zambia (Solo et al 2005b), as well as a synthesis of some of these case studies (ACQUIRE Project 2005) 1 All eight of these countries, which together comprise 40 percent of the population of sub-Saharan Africa, are facing the same difficult dynamics in terms of threat and need

Fragile, threatened, and still urgently needed: family planning programs in sub-Saharan Africa.

Background
Simple ligation of the vas with suture material and excision of a small vas segment is believed to be the most common vasectomy occlusion technique performed in low-resource settings. Ligation and excision (LE) is associated with a risk of occlusion and contraceptive failure which can be reduced by performing fascial interposition (FI) along with LE. Combining FI with intra luminal thermal cautery could be even more effective. The objective of this study was to determine the surgical vasectomy techniques currently used in five Asian countries and to evaluate the facilitating and limiting factors to introduction and assessment of FI and thermal cautery in these countries.

/pdf/vasectomy-surgical-techniques-in-south-and-south-east-asia-4w9by4z6y8.pdf

Vasectomy surgical techniques in South and South East Asia.

The Ghana vasectomy initiative: Facilitating client–provider communication on no-scalpel vasectomy

Although the need for family planning remains widespread and its health and economic rationales remain valid, family planning has been neglected in the face of competing health and development priorities. Given the need for “repositioning family planning” (i.e., for raising the priority of and resources for family planning), vasectomy services in particular need more attention and support. Vasectomy, the only highly effective male method of contraception, is safe, simple to perform, and economical—yet in most countries it is the family planning method that is the least known, understood, or used.

http://www.engenderhealth.org/files/pubs/acquire-digital-archive/2.0_invest_in_fp_and_lapms/2.2_resources/2.2.2_working_papers/vasectomy_unfinished-agenda-final_updated.pdf

John M. Pile

Papers

Demographics of vasectomy--USA and international.

Fragile, threatened, and still urgently needed: family planning programs in sub-Saharan Africa.

Vasectomy surgical techniques in South and South East Asia.

The Ghana vasectomy initiative: Facilitating client–provider communication on no-scalpel vasectomy

Vasectomy: The Unfinished Agenda