Why are men missing in family planning in India?

New Delhi: Indian men continue to shy away from their responsibility when it comes to family planning, as uptake of male contraception methods remain constant and abysmally low in 10 years.

The findings are part of a recent study published in the International Journal of Community Medicine and Public Health that analysed data from the Demographic and Health Surveys (DHS) Program and National Family Healthy Survey (NFHS-4) and NFHS-3 done in 2015-16 and 2005-06 respectively.

The current contraceptive prevalence 56% in NFHS-4 has remained unchanged from NFHS-3. The contraceptive prevalence rate appears to have stagnated after 2004, highlighted the study.

“There is slight increase in awareness about modern method of contraception from 98% of women in NFHS-3 to 99.2% in NFHS-4 whereas among men 98.6% it remained unchanged in both the rounds. Intra uterine device (IUD), Condom, Pill use has increased from 1.7%, 5.2%, 3.1% to 2%, 7%, 5%, respectively. However female sterilization declined from 37.3% to 34% and male sterilization from 1% to 0.4 %,” the study said.

According to a United Nations (UN) report released last month, India is projected to overtake China as the world’s most populous country around 2027. UN department of economics and social affairs, Population division (2019), came up with the World Population Prospects 2019 stating that the largest increases in population between 2019 and 2050 will take place in-- India, Nigeria, Pakistan, the Democratic Republic of the Congo, Ethiopia, the United Republic of Tanzania, Indonesia, Egypt and the United States of America.

The IJCM study also cited that as per observation from National Population Policy (2000) document acceptance of sterilization alone will not induce a decline in fertility levels unless it is preceded by a substantial reduction in the achieved family size of couples as about 45% of population increase is contributed by births above two children per family.

“There is acute lack of male involvement in family planning. In many parts of the world including India, family planning is largely viewed as a women’s issue. As per NFHS 4, three in eight men believe that the contraception is women’s business and that men should not have to worry about it. The emphasis has been largely on methods for women historically, and there has been little effort to involve men. The low levels of men’s involvement are reflected, to an extent, in the very low use of male contraceptives,” said Poonam Muttreja, Executive Director of Population Foundation of India.

“The acceptance of male methods of contraception is marred by a number of myths and misconceptions including loss of virility. While there is a need for systematic and sustained engagement of men in health and family planning, the discourse on the engagement of men as partners in accessing family planning and health services needs to go beyond contraceptive use,” she said.

The initiatives being undertaken by the union health ministry to increase male participation in Family Planning are observation of ‘Vasectomy Fortnight’ in the month of November every year in all States of India to raise awareness on male participation and promotion of male sterilization. The government is also providing training of service providers in No Scalpel Vasectomy (NSV) to enhance the pool of service providers. Government has also done condom boxes set up in facilities to enable clients to access condoms in privacy. The ‘Home Delivery of Contraceptive Scheme’ has also been launched to deliver contraceptives including condoms to the beneficiaries. The government has also substantially increased the compensation for male sterilization under the Enhanced compensation scheme for sterilization. Union health ministry is also undertaking a 360-degree media campaign underlining the role of men in family planning to encourage men to adopt family planning methods.

According to the latest data presented in Parliament by union health ministry, the national average for current use of male family planning methods i.e. male sterilization and condom) is only 5.9 %.

“In Indian society, most of the families are traditional and use of birth control is often not supported by husbands. They are quite hostile to learning about birth control This is evident from the fact that there has been a steady and progressive decline in acceptors of vasectomy and the number of tubectomy of women has also not been encouraging,” said Anita Kant, head of the department obstetrics and gynaecology, Asian Hospital, Faridabad.

“It’s time to involve the males in family planning programs and also educate the whole family especially the in laws of the women. Sterilization or tubectomy should be done by a qualified doctor in the most hygienic way as most of these are done at family planning camps which are not only unhygienic but also performed in inhumane conditions,” she said.

Even after four decades of the inception of family planning program, India’s population continues to grow at over 2%. Government’s family planning programs have penetrated into the population and a large number of couples currently are opting them.

“However, it has taken people time to accept modern family planning methods and this is why the fertility rate has reduced slowly. Also, there is a gender skew to the adoption of family planning. Female sterilization accounts for as much as 75% of the modern family planning adopted by Indians. The origin of this skew lies on the fact that government and social programmes on family planning have focussed largely on women to adopt contraception,” said Savitha Kuttan, Founder and chief executive officer (CEO) at Omnicuris, a socio-medical enterprise working with the state governments for improving healthcare system.

Kuttan explained that lack of awareness and involvement of men in this process has created a hinderance -- men not only adopt the procedures available for them but also do not let women adopt contraception.

“It has also been observed that many men tend to have the misconception that they might lose their virility if they undergo vasectomy. This is why despite being a safer and smaller surgical procedure, its penetration remains very low,” said Kuttan.