Women remain the sole acceptors for surgical birth control in India

New Delhi: The promise of more money and even the fact that the procedure involves almost no discomfort do not seem to have persuaded the Indian man to volunteer for vasectomy.

The Indian family planning programme’s near-total dependence on women is evident from the fact that the male versus female ratio for sterilization in 2016-17 stood at staggering 1:52, as per latest data with the ministry of health and family welfare. Additionally, around 1,000 women have died following sterilization surgeries in the past five years.

The findings from the recently released National Family Health Survey-4 (NFHS) by the health ministry also supported the fact that in India women appear to be solely bearing the onus of family planning.

“Female sterilization remains the most popular modern contraceptive method. Among currently married women age 15-49, 36% use female sterilization, followed by male condoms (6%) and pills (4%). Among sexually active unmarried women, female sterilization is the most commonly used method (19%), followed by male condoms (12%). More than eight in 10 (82%) women who got sterilized underwent the procedure in a public health sector facility, mostly a government or municipal hospital or a Community Health Centre (CHC) or a rural hospital,” the NFHS-4 report stated.

While permanent methods of contraception have traditionally found more acceptance in India, most acceptors are women, although a vasectomy is easier than female sterilization.

“Vasectomy is a simpler and safer procedure in comparison to tubectomy. In fact, in non scalpel vasectomy there are no stitches. Also, the reversal of vasectomy is considered better and effective than tubectomy. We have always seen that women are pushed to undergo the procedure but males should also participate in permanent family planning methods,” said Suneeta Mittal, director, obstetrics and gynaecology, Fortis hospital in Gurgaon. Mittal is also a consultant to Union Health Ministry in reproductive programs.

India is home to almost 17.3% of the world’s protected couples and 20% of its eligible couples with unmet needs.

The Union Health Ministry has already identified 11 high focus states for unmet need for family planning—Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, Chhattisgarh, Jharkhand, Odhisha, Haryana, Gujarat, Uttarakhand and Assam. Since sterilization services are voluntary, the compensation in high focus states is Rs2,000 for vasectomy and Rs1,400 for tubectomy (for women). Efforts to persuade men to undergo vasectomy, such as marking 21 to 27 November as world vasectomy week, and awareness campaigns all seem to be in vain in India.

“Historically, the emphasis has largely been on contraceptive methods for women and there has been little effort to involve men in family planning. Myths and misconceptions about male sterilization are rampant like the loss of virility and strength of the man, further exacerbated after the forced sterilizations of the 70s,” said Poonam Muttreja, executive director, Population Foundation of India, a non-governmental organization working on policy advocacy and research on population issues.

“Patriarchal mind-sets make men think that family planning is primarily a woman’s responsibility. We need to emphasize that this is equally a men’s issue and an issue of society at large. Family planning programmes need to focus on encouraging male engagement through better behaviour change communication strategies that smash deep-rooted myths, misconceptions and patriarchy,” she said.