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Unequal Contraceptive Responsibility
Context:
In 1952, India became a pioneer in launching a national family planning program, which initially focused on improving maternal and child health but later shifted its focus to population stabilisation. As the program evolved, so did the adoption of permanent methods of contraception.
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- Between 1966 and 1970, vasectomies accounted for approximately 80.5% of all sterilisation procedures in India.
- However, this figure has declined over the years due to changing policies and other factors that de-emphasised male sterilisation.
- Data from the five rounds of the National Family Health Survey (NFHS) reveal a steady decline in male sterilisation over the last three decades across all states.
- In NFHS-4 (2015-16) and NFHS-5, the percentage of vasectomies remained stagnant at a mere 0.3%.
Gender Disparity in Sterilisation:
- This trend stands in stark contrast to Section 4.8 of the National Health Policy 2017, which aimed to raise male sterilisations to at least 30%. Currently, India falls significantly short of this target.
- Official statistics highlight a glaring disparity between female and male sterilisation rates—37.9% versus 0.3%, respectively—underscoring the disproportionate burden borne by women.
- This imbalance poses a significant barrier to achieving Sustainable Development Goal 5: achieving gender equality and empowering all women and girls by 2030.
- To address this disparity, the third Friday of November is observed as Vasectomy Day globally (this year on November 15).
- India also initiated a “Vasectomy Fortnight” in 2017 to raise awareness, dispel myths, and encourage men to consider vasectomy as a viable contraceptive option.
- Despite these efforts, policy gaps and ground realities have kept male sterilisation rates low.
Challenges and Ground Realities:
- For instance, a recent survey conducted in March 2024 in a village in Chhatrapati Sambhaji Nagar, Maharashtra, revealed that women viewed sterilisation as their sole responsibility.
- They believed that men should not bear this “burden” because of their role as primary breadwinners.
- Additionally, many women were unaware of the government’s cash incentives to offset wage losses for men undergoing vasectomy.
- Misconceptions about vasectomy—such as its impact on libido—male egos, illiteracy, and family opposition further hinder its acceptance.
- The unavailability of skilled medical providers, particularly in rural areas, exacerbates the problem.
- Compounding this issue, many trained community health workers lack adequate knowledge about no-scalpel vasectomies.
Solutions:
- Early Sensitisation: Awareness programs and peer-group discussions in schools can instil the idea of shared responsibility in family planning from an early age.
- Sustained social and behaviour change communication campaigns are essential to debunk myths and destigmatise vasectomy.
- Notably, vasectomy is a safer and simpler procedure compared to tubectomy, which involves operating on women’s fallopian tubes.
- Enhanced Incentives: Financial incentives can significantly increase male participation.
- A 2019 study in Maharashtra found higher vasectomy uptake among men in rural tribal areas when conditional cash incentives were offered.
- Similarly, Madhya Pradesh’s 2022 decision to increase incentives by 50% is a commendable step in this direction.
- International Lessons: India can learn from countries like South Korea, Bhutan, and Brazil.
- South Korea’s high vasectomy prevalence is attributed to progressive societal norms and gender equality.
- Bhutan normalised vasectomies through high-quality services and government-run camps, while Brazil leveraged mass media campaigns to raise awareness, increasing vasectomy prevalence from 0.8% in the 1980s to 5% in the past decade.
- Strengthening the Health System: The government must align its national health system with policy objectives by investing in training more healthcare providers, promoting non-scalpel vasectomy techniques, and ensuring high-quality services.
