Is permanent contraception acceptable in sub-Saharan Africa? 
Some authors contend that the low use of family planning in sub-Saharan Africa is due to a low demand for fertility regulation among African men and women.  The present authors' experience in Africa has been that it is not the demand for family planning services, but the way services are delivered that accounts for low numbers of acceptors in Africa.  The specific case of Kenya is mentioned, where improvements in the quality of sterilization services and increases in the number of institutions that can provide minilaparotomy under local anesthesia have led to an increase in the acceptance of sterilization.  The authors maintain that the demand for all family planning methods does exist, and it is up to the donor agencies and family planning service providers to try to meet that demand by providing services that are efficient to providers while oriented to the clients' needs.  In the case of voluntary surgical contraception, that means providing minilaparotomy under local anesthesia.