‘As a first step, sensitisation should begin during early adolescence in schools’
| Photo Credit: Getty Images/iStockphoto
In 1952, India pioneered a national programme for family planning, whose focus has since changed — from improving maternal and child health to stabilising the population. As this programme evolved, so too did permanent methods of contraception.
During 1966-70, about 80.5% of all sterilisation procedures in India were vasectomies. This percentage declined every year due to changing policies that, together with other factors, placed less and less of an emphasis on vasectomies. The five rounds of the National Family Health Survey (NHFS) also show the use of male sterilisation, especially in the last three decades, to be steadily decreasing in all States. In fact, the vasectomies percentage remained constant at around 0.3% in NFHS-4 (2015-16) and NFHS-5.
Gender and the disparity
This trend goes against Section 4.8 of the National Health Policy 2017, which aimed to increase the fraction of male sterilisations to at least 30%. Even today, India is far from meeting this target. Official data also show a large disparity between the rates of female and male sterilisation — 37.9% and 0.3%, respectively. Such huge differences indicate that women continue to bear virtually all of the burden of sterilisation, which in turn poses a challenge for India to achieve Sustainable Development Goal 5 — ‘gender equality and empowerment of all women and girls by 2030’ — among others.
In one attempt to bridge this gap, the world observes Vasectomy Day on the third Friday of November (it was on November 15 this year). In 2017, India observed a ‘vasectomy fortnight’ as well.
The initiative is to revitalise the procedure by increasing awareness, generating demand among men, and debunking misconceptions. In the end, the goal is for people already looking for contraceptives as well as those who would if they knew about safe options to consider vasectomies more favourably.
But for these concerted efforts, policies still overlook multiple issues on the ground, keeping them ineffective and allowing the gap between male and female sterilisation rates to persist.
The ground reality, solutions
For example, two of the three writers of this article surveyed a village in Chhatrapati Sambhaji Nagar, Maharashtra, in March 2024 as part of a field exercise. The women said sterilisation was their responsibility and that the men do not believe they need to have vasectomies. Most of them also expressed a belief that men should not be “burdened” by it because they already work hard to make ends meet, and that undergoing the procedure could rob the men of their day’s wages, worsening their hardship.
Editorial | The power of choice: a case for life-saving modern contraception
These women were also unaware of the Indian government’s cash incentives to those who undergo vasectomies to offset the loss of wages. In fact, many studies in India have suggested that illiteracy, male egos, misconceptions about its impact on libido, and family opposition have led to the poor acceptance of vasectomies. Many men are not aware of their role in ensuring the safe passage of reproductive years in the lives of their female partners.
The unavailability of skilled providers has aggravated the situation, especially in rural areas. To make matters worse, many trained community health workers themselves know little about no-scalpel vasectomies.
As things stand, with increasing awareness of gender equality and rights, it is certainly possible to build a society in which male sterilisation is accepted as normative through proper and timely course correction.
As a first step, sensitisation should begin during early adolescence in schools, where awareness programmes and monitored peer-group discussions can lay the foundation for accepting sterilisation as a shared responsibility. Sustained social and behaviour change communication initiatives will be instrumental in debunking myths around and destigmatising vasectomies. Vasectomy is a safe and simple procedure compared to tubectomy, the corresponding surgical procedure for women involving their fallopian tubes.
Second, these information, education and communication activities should be supplemented with greater conditional cash incentives for vasectomies with the goal to improve male participation.
A study in Maharashtra in 2019 showed that more men in rural tribal areas opted for vasectomies after being offered a conditional cash incentive. Madhya Pradesh’s move in 2022 to increase this incentive by 50% is appreciable in this light.
An international comparison
Third, India should draw from the lessons from other countries that have increased vasectomy uptake. South Korea has the highest prevalence of the procedure worldwide, and has reported that men are more likely to shoulder contraceptive responsibilities as a result of progressive societal norms and greater gender equality. Similarly, Bhutan has popularised vasectomy among its men by making the procedure socially acceptable, availing good-quality services, and organising government-run vasectomy camps. Brazil increased vasectomy uptake by running awareness campaigns on mass media. The prevalence rate has risen, from 0.8% in the 1980s to 5% in the last decade.
Greater public awareness of vasectomies allows both partners in a union to make informed family planning decisions. In tandem, the government must strengthen the national health system to align with policy objectives, invest in training more health professionals to perform the procedure, and promote technical advancements to increase the use of non-scalpel vasectomies.
The resulting policy should not have only intention. It should also lay out concrete steps to achieve its targets. The need of the hour is demand- and service-focused efforts rather than mere formulation.
Samira Rizvi is a public health student at the Tata Institute of Social Sciences (TISS), Mumbai. Thanooja N. is a public health student at the Tata Institute of Social Sciences (TISS), Mumbai. M. Sivakami is a professor at the Tata Institute of Social Sciences (TISS)
Published – November 30, 2024 12:08 am IST
