Female sterilization is the most accepted contraceptive among couples. One out of 10 men uses condoms according to the National Family Health Survey-5.
Rama Belgavi, (38) of Harohalli in Bengaluru’s rural area, was dressed in a faded blue saree with her head covered by her pallu and spoke hesitantly, “After my second child during the lockdown doctor consulted me for sterilization. Even though the doctor counseled my husband and me but my husband said I should go for sterilization.”
“Neither of our families is aware that I underwent this surgery, and my husband has never considered sterilisation as a valid alternative. If something happens to him, who will look after the family?” she worried, her face strained.
In Bengaluru, Savitha Sanadi (35) married Vikas Sanadi in March 2019 and gave birth to her first child in January 2020. After exactly one year, she conceived and gave birth to a second child in Sept. 2021, after which point the doctor suggested sterilization. “I guess family planning responsibility falls solely on women. Women are entitled to such tasks and very few care to educate or acknowledge men for such procedures,” she replied.
According to the latest National Family Health Survey-5 Karnataka, female sterilisation is one of the most widely accepted Family Planning Methods among couples (2019-20). In Karnataka, 48.6 percent of married women aged 15–49 years were sterilised in 2015-16, increasing to 57.4 percent in 2019-20. (according to the latest report).
Dr. Nayana Kumari S Kadamba, Obstetrician-Gynecologist at SPARSH hospital said, “Male sterilization is a less complicated procedure, but men avoid it. Families put more pressure on women to sterilize than on men. The majority of them believe that because the woman bears the kid, she is the sole receiver of this surgery.”
“In my career, I have never come across any man who is willing to undergo this procedure,” she added.
Dr. T. V. Sekher Professor and Head, Dept. of Population Policies and Programs (IIPS) in Mumbai said, “Worldwide, less than 35 percent of married women in the age group of 15 to 49 years rely on vasectomy or male sterilization. In developing countries, the overall acceptance of vasectomy is 2.5 percent only. There is a huge gender difference in sterilization acceptors in India. National Family Health Survey -5 (2019-21) says, female sterilization accounts for 37.9 percent whereas male sterilization accounts for 0.3 percent. The most common reason for the non-involvement of men is misinformation about vasectomy. Research indicates that there is widespread belief among both men and women that vasectomy makes men physically weak, impotent, and unable to enjoy sex.”
The NFHS-5 phase II report states that female sterilization (currently married women aged 15–49 years) in India is 37.9 percent whereas male sterilization remained stagnant at 0.3 percent from 2015 to 2021.
NFHS-5 was conducted in two phases. NFHS-5 Phase-I survey was conducted in 2019-20 and included 22 states/UTs. Whereas, the NFHS-5 Phase-II survey was conducted in 2019-21 and included 14 states/UTs.
Acceptance of sterilization among men remains relatively low as compared to females. It’s not just in Karnataka, but all over India.
What’s the fear?
In Karnataka, according to the Family Planning Indemnity Scheme 2018-19, there were 11 deaths, 7 complications, and 197 sterilisation failures. Furthermore, family programmes run by the government are mostly aimed towards women. Even as the world advances, many people believe that sterilisation is exclusive to women and that male sterilisation is rarely acknowledged.
Raja, a businessman with four children in Bangalore said with furrowed eyebrows and an angry tone that his religion doesn’t permit such a thing (sterilization). It’s a sin in their religion.
Vikas Sanadi husband of Savitha Sanadi said in a hesitant tone, “If something happens to me, what will happen to my family?”
A health site report states that males think that male sterilization will lower their masculinity.
The societal barrier is the primary cause of male sterilization’s poor acceptance. The Indian Journal of Public Health published a survey on the barriers to non-scalpel vasectomy acceptance in Uttar Pradesh, India’s most populous state. 89.2 percent of research participants reported socio-cultural barriers while 0.6 percent cited service delivery constraints. Procedure-related difficulties, on the other hand, were cited by 14 percent of the participants as the major reason for refusing NSV.
Dr. BR Chandrika, Deputy Director of the Family Planning Programme substantiated the fact by saying, “The scheme does focus on women but at the same time, it also tries to spread awareness of male sterilization.”
Sayantani Chatterjee, Ph.D. in Population studies and a former consultant at International Institute for Population Sciences in Mumbai said, “About three-fourths of the contraceptive users in India are protected by female sterilization. The acceptance of female sterilization is mostly higher among the rural, poor, lesser educated, working women and among those having at least one son.”
It’s not just in Karnataka but also in other states in India. Isha Bose, (30) a housewife in Kolkata said, “My husband never considered that he could also go for sterilisation. I guess females are entitled to perform this task.”
Arthi Reddy, (35) a housewife in Bengaluru urban said, “We didn’t receive any counseling from the doctors. During my second child, my husband and I decided to under sterilization. Since I had a cesarean baby, so my husband and I decided that I will go sterilization. When I’m having a cesarean baby, so it’s better that I should go for this sterilization. Why bother my partner when I’m already having one operation, and why not have the same person have another operation at the same time?”
According to the Indian standards for female and male sterilization services, both males and females must be counseled about this procedure in the language they understand.
Human Rights Watch in their report stated that Anganwadi workers and Accredited Social Health Activists (ASHA) said that it’s easier to convince women for family planning programs rather than men.
Arthi Reddy’s husband said that he was aware of male sterilization. And it was their mutual decision that Arthi would go for the procedure.
Dr. Nayana Kumari S Kadamba said, “The male partner never comes forward because they think they will lose their sex drive or sterilization will make them impotent. Not just that patriarchial mindset has been the main reason behind low acceptance of male sterilization.”
She added, “Most women with cesarean babies opt for sterilization. Females between the ages of 26 and 36 are candidates for this procedure.” Sparsh Hospital had nine female sterilization surgeries at the beginning of 2020 because after that the country was in Lockdown at various levels. Whereas only three so far in 2021. “During the pandemic, most women missed their sterilization surgeries due to fear of Covid.”
Dr. Sudeshna Ray Obstetrician-Gynecologist said, “Females generally don’t allow men to go for male sterilization. It’s the patriarchal mindset and that’s the reason the number of female sterilization is high compared to male sterilisation.”
“I counsel all my patients and very few gems come forward for male sterilization,” added Dr. Sudeshna.
“The surge in female sterilization is not a very recent phenomenon. As per the NFHS reports, female sterilization remained at about 34-36 percent in the last twenty years and male sterilization was less than 2 percent all this while. One cannot really pinpoint a single cause behind the factors affecting men’s preference for male sterilization,” said Sayantani.
Female sterilization (currently married women aged 15–49 years) cases in Bengaluru Urban increased from 38.7 percent in 2015-16 to 55.2 percent in 2019-20. However, according to the NFHS-5 report, male sterilization remained zero in 2019-20. Family Planning Centre in Bangalore said that they conducted just 12 male sterilizations in 2021.
“The general perception of the use of contraceptive methods is largely conceived as a woman’s affair. It has largely to do with the definition of muscularity in our society as many men think that male sterilization will make them lesser men. Also, many men are not well aware of the process of male sterilization and they are afraid of the side effects (which are often not correct). Many don’t prefer to use a permanent method also,” added Sayantani.
The population would be impacted if sterilisation rates were to rise. The fertility rate in Karnataka has already dropped from 2.5 in 1999 to 1.7 in 2020. If there is a lack of understanding, the burden of sterilisation on women will be increased. Female sterilisation is a more difficult, costly, and time-consuming procedure than male sterilisation.
Sayanatani pointed out the fact that the provision of free female sterilisation at public health institutions, as well as compensation for acceptors, is possibly one of the major public health initiatives made by India’s national and state governments. Furthermore, due to the growing use of contraceptive technologies in the previous two decades, the fertility rate has declined dramatically. Female sterilisation alone cannot be said to have made a considerable impact on the country’s demographic condition, but given that it is the most widely utilised method, it undoubtedly has. Female sterilisation has direct and indirect effects on the country’s demographic and socioeconomic situations.
Dr. BR Chandrika said, “Yes, every year we organize No-Scalpel Vasectomy (NSV) Fortnight programme in November. In the first week, we spread awareness on No-Scalpel Vasectomy (NSV) Fortnight, and in the second week, we operate. The department has organizes different literature, banners, and posters for the fortnight. Infact the male patients who underwent this NSV share their experiences to encourage others.”
The initiatives undertaken by the Government to promote male sterilization in the country are the training of service providers in No-Scalpel Vasectomy (NSV) to enhance the pool of service providers. A 360-degree media campaign underlining the role of men in family planning has been rolled out to encourage men to adopt family planning methods.
“The government is trying hard to spread awareness on male vasectomy. Infact if a male opts for male sterilization he gets Rs. 1100 whereas female sterilized patient receives Rs. 600,” Dr. Chandrika said.
In 2021 only 900 male sterilizations were performed in Karnataka. “Our programme is for both women and men. Male sterilization is an easier and simpler process. But in rural areas, males aren’t allowed to go for it because it’s a patriarchal society. They think that what if the sterilization process makes the man disabled for life or something that would happen to then it would affect the whole family. And who will take care of the family in the future,” she further added.
Since 1951, India has used sterilisation as a form of population control in order to keep its population growth rate under control. Because of the patriarchal worldview, male sterilisation is low. During the 1975 Emergency poor men were sterilized. Almost 6.2 million Indian men were sterilised as a result of the sterilisation programme. Between 2009 and 2012, less than 100,000 vasectomies were performed on men, with more than 700 men dying as a result of botched surgery. And many men experienced issues as a result of the procedure. This fear persists in men, which is one of the reasons why male sterilisation rates are lower than female sterilisation rates.
Other family planning methods:
In India, only 9.5 percent of men use a condom. In rural areas, just 7.6 percent of men use condoms, compared to 13.6 percent of men in urban areas. According to a study published in the Indian Journal of Medical Research, men’s low condom acceptability is due to the most significant barriers, such as lack of privacy in stores and social stigma associated with condom use. Not being accepted by a sexual partner, perceived ineffectiveness, reduced comfort, loss of sexual satisfaction with condoms, husband’s alcohol usage, depression, anxiety, and not being accessible at that moment are all stated concerns associated with not using condoms.
“I feel that using condoms lowers sexual pleasure,” Ravi Kumar, a working professional in Bangalore, said. With a shy expression on his face, he said. “Whenever my girlfriend and I think there’s a chance of getting pregnant, my partner takes birth control tablets.” It works 99.9 percent of the time.”
A study showed that acceptability depends on awareness, knowledge, and a positive attitude towards condoms. Various strategies had been adopted to create awareness and spread correct knowledge of condoms. Condom use for avoiding unplanned pregnancies is somewhat curtailed by condom use for HIV/AIDS prevention. This causes some ambiguity in terms of acceptable behaviour among married couples.
Sayanti said, “Additionally, the trends in the current contraceptive use suggest a shift in the uptake of more spacing methods such as the use of condoms, IUDs, etc. one can argue that males accepting male sterilization are more gender-neutral and they believe that the burden of contraceptive use or female sterilization does not only lie with the women of the society. Fertility is already declining and has almost reached the below replacement level in India and a decent amount of people are contraceptive users.”
There hasn’t been any significant increase in the usage of contraceptive pills by women in Karnataka. It jumped by just 1.7 percent from 2015-16 to 2019-21. Well IUD/PPIUCD is 2.9 percent and injectables are 0.5 percent.
Expert’s take on this:
Dr. Sekhar said, “In fact, vasectomy offers clients an easier and cheaper alternative to female sterilization. Sustained promotion and IEC campaigns can overcome rumors and raise the demand for vasectomy. Government of India has taken many initiatives to promote male sterilization including Vasectomy fortnight in the month of November every year, training of service providers in No-scalpel Vasectomy (NSV), and an increase in cash incentives provided, media campaigns, etc. In Telangana state, in two districts- Warangal and Karim Nagar- where male sterilization has been prevailing at a significant rate for nearly 30 years. In the Warangal district, 8 percent of male sterilization was reported as per NFHS-4. This is remarkable when we consider other parts of the country.”
“Many private providers and NGO trusts under the public-private partnership programs offer compensation to sterilized families. Also, I believe that male sterilization is not the only way out Couples together should be advocated on the different available contraceptive methods (which can be both temporary and permanent methods) by concerned persons at health facilities/ASHA workers/NGO people,” suggested Sayantani.
“Furthermore, the mass vasectomy programmes in the 70s in India also proved to be a major downside. Lack of proper knowledge on male sterilization is indeed a problem. Creating awareness and guiding people with correct information through IEC are the easiest ways. Campaigns through mass medias-tv, radio, mobile, newspaper/posters/hoardings/banners/leaflets can be effective. Governments can partner with NGO bodies working on reproductive and child health (RCH) for the same. One has to remember that unless Social and Behavior Change Communication (SBCC) is targeted; there will be no positive outcomes from these campaigns,” added Sayantani.
Expert says that the patriarchal mindset is responsible for this. Government must take more initiatives to spread awareness of male sterilization. Women shouldn’t be responsible for everything starting from giving birth to a child to family planning.