India’s family planning efforts show a stark gender disparity, with women bearing nearly all contraceptive responsibility. Male sterilisation rates remain abysmally low due to societal norms, misconceptions, and poor awareness.
Contraception and its types
Contraception refers to methods or devices used to prevent pregnancy as a result of sexual intercourse.
- It includes a variety of options such as barrier methods (e.g., condoms), hormonal methods (e.g., pills, implants), intrauterine devices (IUDs), sterilisation procedures (e.g., vasectomy, tubectomy), and natural methods (e.g., fertility awareness).
- Vasectomy is a surgical procedure for men in which the vas deferens (the tubes that carry sperm from the testicles) are cut or sealed, preventing sperm from being released during ejaculation.
- Non-scalpel vasectomy (NSV) is a minimally invasive male sterilisation method that uses a small puncture instead of incisions or stitches, offering quicker recovery and fewer complications compared to traditional vasectomy.
- Tubectomy is a surgical procedure for women where the fallopian tubes are either cut, tied, or blocked to prevent eggs from reaching the uterus and being fertilised by sperm.
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Sterilisation in India After Independence
- After gaining independence in 1947, India focused on controlling its rapidly growing population.
- In 1952, India launched its first national family planning program.
- Initially, the focus was more on improving maternal and child health, but it soon shifted to stabilising the population and included sterilisation as a key method.
Trends in Contraception in India
- Decline in Male Sterilisation:
- During 1966-70, 80.5% of sterilisation procedures were vasectomies.
- This figure has sharply declined, stabilising at a mere 0.3% as per NFHS-4 (2015-16) and NFHS-5.
- Gender Disparity:
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- Female sterilization rates are significantly higher at 37.9%.
- This imbalance contradicts Section 4.8 of the National Health Policy 2017, which aims to increase male sterilization rates to 30%, a target that is still far from being achieved.
- As a result, SDG Goal 5, which calls for gender equality and the empowerment of women by 2030, would be compromised.
Challenges in Promoting Male Sterilisation
- Social and Cultural Barriers:
- Societal norms and misconceptions about masculinity lead many men to view sterilisation as unnecessary.
- Concerns about its impact on daily wages further discourage participation.
- A 2024 survey in rural Maharashtra revealed women often see sterilisation as their sole responsibility, while men resist due to ego and traditional gender roles.
- Lack of Awareness:
- Misconceptions, fears, and illiteracy hinder men’s participation in sterilisation.
- Awareness about safe methods like no-scalpel vasectomies is low among both men and health workers.
- Government cash incentives to offset wage losses remain underutilised due to inadequate information dissemination.
- Infrastructure Challenges:
- Rural areas lack skilled healthcare providers to perform vasectomy procedures effectively.
- Weak health systems and inadequate resources exacerbate the issue, preventing reliable access to the procedure, especially in remote locations.
Proposed Solutions for Promoting Male Sterilisation
- Awareness and Sensitisation:
- School Programs: Introduce sensitisation programs in schools during early adolescence, alongside peer group discussions, to instil shared contraceptive responsibility from an early age.
- Behaviour Change Campaigns: Conduct sustained communication initiatives to debunk myths about vasectomies, such as the misconception that it diminishes manhood.
- International Example: Brazil’s success in increasing vasectomy uptake from 0.8% in the 1980s to 5% in the last decade, through mass media campaigns, demonstrates the effectiveness of such awareness efforts.
- Incentives and Accessibility:
- Cash Incentives: Increase conditional cash incentives for vasectomies to encourage male participation.
- Regional Success: For example, Madhya Pradesh’s 2022 policy raised incentives by 50%, and Maharashtra’s 2019 initiative saw higher participation in rural tribal areas.
- Strengthening Health Infrastructure:
- Training Healthcare Professionals: Train more healthcare professionals in vasectomy procedures, especially in rural areas, to ensure quality and accessibility.
- Non-scalpel Vasectomy: Promote non-scalpel vasectomy methods to make the procedure safer, simpler, and less invasive, thus encouraging more men to opt for it.
- Learning from International Models:
- South Korea: High vasectomy prevalence due to progressive norms and gender equality.
- Bhutan: Successfully promoted vasectomy through social acceptance, quality services, and government-run camps.
- Brazil: Increased vasectomy uptake through targeted public awareness campaigns.
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Conclusion
The responsibility of family planning must be shared equally between men and women. By addressing cultural barriers, increasing awareness, and providing incentives, India can achieve gender equality in contraceptive responsibility and ensure better family planning outcomes.
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