Background: Studies on voluntary medical male circumcision (VMMC) have provided convincing evidence on its efficacy to provide partial protection against female-to-male HIV transmission in circumcised men. Following this evidence the WHO and UNAIDS formulated recommendations for VMMC implementation settings with generalised HIV epidemics and low circumcision prevalence. The recommendations stipulate an implementation that ensures VMMC services to all infants up to 2 months old (neonatal medical male circumcision/NMMC) and at least 80% of male adolescents.
We explored the acceptability of NMMC amongst pregnant women who are candidates for granting of consents for NMMC procedures in order to inform the guidelines for NMMC implementation and its possible integration with other Maternal, Child and Women''s Health (MCWH) programmes.
Methods: Nurses and counsellors at two public health facilities were trained to provide NMMC counselling and offer NMMC to pregnant women who presented for ante-natal care (ANC) services. The counselling included the benefits of NMMC in HIV prevention later in life, the surgical procedures, risks and the benefits of the procedure. Data on NMMC acceptance, refusals and reasons for refusals were recorded in the registers and subsequently captured onto an SPSS database. Data was analysed to establish the acceptability of the procedure and the feasibility of integration NMMC with MCWH programming. Qualitative thematic analysis was used to analyse the reasons for NMMC.
Results: The NMMC acceptance was high (82.9%) among the 1778 women who participated. There was no significant age difference between women accepting and those refusing NMMC (p=0.089). Most refusals were due to the women requiring consultations with partners and / or family prior to consenting (41.3%), fear of the procedure (23.8%), cultural reasons (15.9%) and no reasons given (15.3%).
Conclusions: Findings provide evidence of the possible high uptake of NMMC at public health institutions and the feasibility of its integration with other MCWH programmes. However the presence of socio-cultural issues mainly related to support for traditional circumcision and the need for further consultation with family members appear to influence women''s decisions on the granting of consents for NMMC.