**8. Permanent methods: Female sterilization**

Globally, millions of couples of childbearing age in developing countries used voluntary surgical contraceptive (VSC), making it a popular method of family planning in the world [74]. But data for sub-Saharan African countries are scarce; however, based on world fertility survey results for Kenya, Lesotho and Sudan, female and male sterilization appears to be rare [75]. In another report, the use of vasectomy was under 1% [52]. This method of family planning is not too popular in SSA for a number of reasons. The method requires skilled personnel that are not available at the primary healthcare (PHC) level used by majority, and services are only available in urban areas. On the conservative side, in situations where the marriage has failed or death of partner occurred, the woman by cultural and religious norm is encouraged to remarry, and in order to "secure" her marriage, position and respect in the family and the society, she will be desirous to have at least a child to the new husband.
