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A vasectomy promoter - who happens to have 15 siblings - tries to convince Hispanic men that a little procedure can have big benefits.
By SHANNON COLAVECCHIO-VAN SICKLER
© St. Petersburg Times, published February 14, 2003
RUSKIN -- Juan Gomez trolls the waiting room at Suncoast Community Health Center, searching past the young Hispanic mothers, toddlers and infants for a father who might consider his pitch:
Get a vasectomy, and be a better father. Limit the size of your brood, and you'll serve them all better. Oh, and don't worry about the cost: the county health department can help you pay for it.
It's not easy convincing any man to give up his ability to father children. Convincing a Latino man, raised within a culture that often equates virility with masculinity and worth, can be nearly impossible.
"You know, in Mexico, the farmers castrate the pigs," Gomez says. "I've seen my father do it, and some of these guys have, too. A lot of them hear 'vasectomy,' and they think of the pigs.
"Or they think it will make them homosexual, or impotent. So it scares them. In their culture, this carries so many taboos."
Gomez's job is to help these men, many of them farmworkers and construction workers with little or no formal education, understand that their children might have a better life if they're not sharing it with multiple brothers and sisters.
Gomez speaks from experience. He is one of 16 children, raised in Texas by his Mexican parents.
"My dad always worked hard, and we had food and shelter," he said. "But it was hard with so many."
His official job title is health promoter for the farmworker outreach program Pocos Hijos Darles Mas. The approximate English translation: Have fewer children so you can give them more.
Pocos Hijos is one of several programs offered by the Florida Institute for Community Studies, a nonprofit research, education and service organization that serves farmworker families throughout southeastern Hillsborough County.
The program started seven years ago at the urging of local farmworkers' wives, who told University of South Florida researchers that they understood birth control just fine. It was their husbands who needed help, they said.
A 1996 study funded by the Florida Border-USF Health Education and Training Centers found that of 106 Mexican farmworkers interviewed, none had planned their first child. Few had planned their second.
Pocos Hijos grew from those findings and today offers information on birth control options, safe sex and child rearing to dozens of families each year. The program is supported by a $60,000-a-year grant from the federal government, as part of the Title X Family Planning initiative that President Nixon established more than three decades ago.
Title X provides county health departments like Hillsborough's with tens of thousands of dollars each year so that low-income couples can get tubal ligations or vasectomies.
"We've never told people, 'Don't have children,' " said Alayne Unterberger, project director of Pocos Hijos. "It's about making sure you have the resources, and making sure you can give your child the life you want them to have."
Each year, Gomez talks to hundreds of men during weekly one-on-one meetings in clinics, and at group meetings at area missions such as the Beth-El Mission in Wimauma and Good Samaritan Mission in Balm.
At Good Samaritan recently, Gomez stood before about three dozen men, most of them farmworkers who had come seeking food baskets. Many have eight and nine children. Others, only in their mid 20s, already have three or four.
While they waited for their food, Gomez brought them into a room and talked about condoms, erections, testicular cancer, herpes.
And vasectomies.
"Cuantos ya tienen la vasectomia?" he asks. How many here already have had vasectomies?
No one raises a hand.
"La vasectomia no es castracion," he says. "Y todos los aspectos de sexo estan el mismo." A vasectomy is not castration, and sex won't change.
The men shift in their seats, some tittering nervously, others looking at each other and nodding, as if to say, "No way. Not for me."
After Gomez finishes, one man hangs back to talk more about the procedure.
Gomez persuaded eight men to get vasectomies last year. Each procedure cost the county health department $290.
One of the recruits was 29-year-old Ruskin resident Eliberto Cruz, an Apollo Beach construction worker who had his first child at age 20. When his third child, 15-month-old Shakira, was 6 months old, Cruz decided she would be the last.
"I got nervous just talking about it," he admits. "And my wife didn't want me to have it; she wanted more kids. But it's so expensive. My kids have a better chance of having a little bit more than if they were one of five or six."
On the same day that a friend got his vasectomy, Cruz went through what he calls "the little snip."
The outpatient procedure took less than half an hour.
"I'm glad I did it," Cruz says today. "No regrets."
But for every willing man, Gomez encounters dozens of wary men like Manuel Garcia.
In a tiny exam room at the Suncoast Clinic, Gomez sits across from Garcia, 25, showing him the proper way to unwrap a condom.
Hold it from the tip, Gomez says, and don't store it in your wallet for months.
He opens a wooden suitcase that would make a teenager blush. It is filled with models and diagrams of all the birth control methods: male and female condoms, a cervical cap, an intrauterine device, pills, hormone patches.
Gomez asks Garcia how many children he wants.
Garcia looks down at his second and youngest child, 3-year-old Jesse, and says, "Uno mas." One more.
"Okay," Gomez says, "So what do you and your wife use for birth control?"
Garcia, a local construction worker, says he and his wife rely on condoms.
But pastillas, birth control pills, are always an option, Garcia adds.
"How often does your wife have to take the pills for them to work?" Gomez asks.
"Cada vez que haces sexo?" Garcia replies. Every time you have sex?
Gomez is not surprised at Garcia's misinformed answer, having had similar conversations with hundreds of Hispanic fathers in Ruskin, Wimauma, Dover and Plant City.
"In our culture, we men decide about the size of the family," Gomez says. "But it's the ladies who actually are in charge of the family planning, of the birth control and the pregnancy care. We sort of don't get involved."
Roughly half a million U.S. men receive vasectomies a year, according to Planned Parenthood Federation of America. But most of them are white.
Last year, the Hillsborough County Health Department paid for 75 vasectomies, including 22 for Hispanic men, said Carol Roberts, program manager for the sterilization program. So far this year, the program has paid for 34, including 11 for Hispanic men.
"Obviously, having some stranger rooting around in your privates is cause for anxiety," said Dr. Douglas Stein, who has performed the health department's Title X vasectomies since 1996. "For some people, or some cultures, they may look upon the ability to procreate as very essential to who they are -- more so than in other cultures."
Indeed, Manuel Garcia told Juan that he would not consider a vasectomy.
"What if something happens to me and my wife, and I marry someone else?" Garcia says. "I want to be able to have children with her."
The vasectomy is a simple 15-minute procedure, performed in a doctor's office or clinic with a local anesthetic.
It is less painful, less complicated and cheaper than a tubal ligation, which costs the county about $1,500.
"From a taxpayer's perspective, the vasectomy is better," said Dr. Stein. "You can do five guys for the price of one woman."
Title X is the only federal program devoted solely to family planning and reproductive health care. The idea is to spend money on Title X to save money for other social services agencies.
Counties receive Title X money based on how many vasectomies and tubal ligations were performed in that county during the previous budget year. This year, Hillsborough County has a budget of $184,000.
Coverage levels depend upon income and family size, and vary by county. In Hillsborough, the health department covers the full cost of the vasectomy for families with low enough incomes.
"I really see this as the promotion of responsible fatherhood," Stein said. "That's what Pocos Hijos is about. If we have responsible fathers, family planning becomes second nature."
For information on the Hillsborough County sterilization program, call 307-8000, ext. 6203; or go to www.vasectomysupport.org. Juan Gomez can be reached at 633-8988.
Roughly half a million men receive vasectomies each year in the United States. The procedure works by blocking the vas deferens, the tubes that carry sperm during ejaculation.
Traditional, scalpel vasectomy:
The vasectomy is a minor operation and usually is done in a doctor's office or clinic under local anesthesia. Patients are awake during the surgery, which usually takes between 15 and 30 minutes.
The doctor injects a local anesthetic into the skin of the scrotum to numb it. Then the doctor makes one or two small cuts in the skin of the scrotum, through which the tubes are gently lifted out. The doctor cuts the tubes. The cut ends are tied or sealed. The openings in the scrotum are closed with small stitches that dissolve or are removed after a few days. After a short rest, usually half an hour, the patient can go home.
No-scalpel vasectomy:
After the anesthetic is injected, the doctor pierces the skin of the scrotum with a sharp instrument, then gently stretches the opening so that the tubes can be reached and blocked. No stitches are needed to close the tiny wound. There is very little blood, and fewer complications than when the scalpel is used. This procedure accounts for nearly one-third of all vasectomies in the United States.
After the procedure:
The testes still make sperm, but it can no longer pass up through the vas tubes.
Complications from the operation are rare, according to the American Medical Association. Of every 1,000 men sterilized, fewer than two will cause pregnancy in the first year.
After a vasectomy, a man's hormones, beard and voice do not change. His sex drive and ability to have sex do not change.
-- Source: engenderhealth.org