The health department of Karnataka achieved half of its mandated targets of sterilization, condom distribution in 2018-2019.
For me, family planning is about the ideal family: parents and two children, said Latika Chaudhury (40), a senior coordinator and homemaker from Electronic City. “(Family) planning is required not only for planning the number of children, but to plan for giving a good education, good character, and values through their lives. Planning depends on people’s capabilities,” she said.
She accepted that decisions regarding family planning are mostly dominated by the male voice in the family. “It’s a male dominant society, right?” she said giggling while trying to hide her awkwardness on the subject. Doctors tend to ask mothers after childbirth if they want to be sterilized, but nobody asks men to get sterilized, she added.
Resham, another homemaker from the city hesitantly said that men dominate women. “Men think that the way I want it, things should be done that way.” While agreeing that men push women to get sterilized, “maybe sometimes forcefully also,” she added. The National Family Health Survey (NFHS) Five proves her point. Released in December 2020, it noted that no men went through vasectomies in Bangalore Urban.
“I have worked for 18 years as a gynecologist, and initially, we used to give the option of vasectomy but it was so unacceptable to men that we have stopped giving that option,” said Dr. Shashi Agarwal, a gynecologist based in Domlur Layout. Dr. Agarwal said that she sees approximately 10 women a month who come for sterilization; however, in her career, she only saw two cases where a man underwent a vasectomy.
In comparison to this, Dr. Shriharsh Ajjur, a Urologist from BTM Layout sees about 2 to 3 patients every month. “Condoms and vasectomies are the two common ways for men to participate in family planning,” he said. The NFHS – 5 reported that about only nine percent of the people surveyed used condoms.
Awareness and side effects
Men usually don’t come forward for this vasectomy procedure, you know? They have myths that they won’t be able to have any sex later. And that is one of the reasons why they do not want to undergo this procedure. Usually, the ladies undergo sterilization after two children. They also go for abortion, many times. Nobody wants to take these pills also.”Shalini MK, a gynecologist from Indranagar, Bangalore
An official from the Family and Welfare Department, Karnataka mentioned that the department has awareness programs scheduled for World Population Day in July. Similarly, for NSV fortnight, they have several banners, articles, and posters planned.
Dr. Ajjur said, “Firstly, there is no awareness; it’s a social problem. Nobody thinks that males can also go for sterilization. We have to generate awareness in the public. We see a lot of advertisements about Tubectomies, Copper Ts. We never see those frequent advertisements for vasectomies.”
“A lot of people have myths that this will cut down their sex life. So once they go through vasectomies they can’t have a normal sex life. And also we need to create awareness that this is just an Outpatient Department (OPD) procedure, like any other injections it’s a small injection,” he added.
Dr. Shashi Agarwal said that if a contraceptive is chosen properly and the procedure is done in an efficient manner and place then one does not see any side effects. However, she added regarding CopperTs and IUCDs, “I get many people with complications like excessive bleeding, expulsion, and migration beyond the uterus all those things and they need to remove that. Injections are easier, but it causes bleeding and sometimes loss of periods completely so they don’t know whether they are pregnant or it is the medicine effect.”
In 2017-2018, the Department of Health and Family Welfare Karnataka recorded nine deaths and 127 failures under the Family Planning Indemnity Scheme.
Do government programs focus more on women?
Dr. Shalini agreed that government programs are women-oriented as compared to being neutral.
“I mean this is because having children and all are thought to be a women’s responsibility no? So she should look after that. They have this mental attitude. I don’t know whether they are brought up like that, these men. And some believe that they are superior and this family planning and this childbearing and all are women’s responsibility no and hence the sterilization is also her responsibility,” she said.
“Probably because of the cultural ideas, the government does not encourage it so much. Even in government hospitals, they also just have female sterilization camps,” said Dr. Agarwal.
Deputy Director of Family Planning, Government of Karnataka Dr. BR Chandrika said that even though the government creates so much awareness, the male partners’ acceptance (of sterilization) is very poor.
She added that the department publishes videos, jingles, posters to increase awareness about sterilization operations. For males, the department gives more importance to No-Scalpel Vasectomy (NSV) Fortnight, which is held in November annually. “The first one week, we give complete awareness regarding the (sterilization) camps and program services. In the second week, we do the operations,” she said.
Apart from this, she said that the department shares videos of their doctors, program officers, and village-level leaders who share their experiences about getting an NSV operation.
“Now, we have planned that to motivate those husbands whose wives have risky pregnancies since these women cannot opt for any sterilization; so the men can go for sterilization,” she said.
“The male sterilization level has remained static; it is not going up or coming down. It has remained between 700 – 1000 operations yearly. Only this year, it has dropped down like anything by about 50 percent. We could only achieve something like 500 operations this year, (due to COVID-19),” she commented.
Anjali Singh Kulkarni said, “ Not just the camps which are just one aspect, but, if you look at the type of contraceptives whether we look at Mala-N, the oral pill whether we talk about injectables or copper Ts or IUCDs, the variety of options that are available for women. For men it’s either condoms or sterilization operations, that’s it.
She explained why government planning programs have to focus on women to a certain extent.
“One was that they were easy targets, second was in the name of women empowerment because let’s think of this scenario in some rural area where women don’t have much say, they are not the decision-makers, they cannot take a stand. Even when she decided that she does not want to have a baby in the next year. Even if she decides that, maybe, the family environment is going to force her. So the mother in law, father in law, the society, the neighbors, everyone is asking questions: ‘When are going to have a baby?’”
“Those forcing situations will not permit her, to know, take a stand and say I don’t want to have a child now she cannot tell her husband that but if she is taking the pill without telling anyone she is confident that she doesn’t want to have it now she’s not going to have it till the time she stops taking it.”
“So because of the context we live in the Indian scenario promoting contraceptives in women was required, it was important. But we cannot continue that forever. Certainly women empowerment, so it is important to promote contraceptives for women but at the same time, understanding and engaging men are also important. So know what is needed where and act accordingly.”
Population law, need of the hour?
While India’s fertility rate is decreasing, it is still the second most populated country in the world and is projected to overtake China in the next three years. A 2019 research paper reported that the population in India has already crossed the optimum limit and has become a liability. The problem of population explosion in India has proved to be a big hindrance in the success of economic planning and development, the paper noted.
Prof. C.M. Lakshmana, from the Population Research Centre, Institute of Social and Economic Change (ISEC), Bangalore said, “Our resources are shrinking due to this migrating population and also increasing population. So it is going to be very difficult and in the future, it is going to affect our clean environment.”
“You see Bangalore, basically there’s lots of greenery and all those things. Nowadays due to the increasing population, the green belts are becoming residential areas. This is going to affect our biodiversity and environment. For example, the government has created various layouts, Vishweshwaraiah layout, Kempegowda layout, and a huge chunk of agricultural land has been converted. Lack of greenery also affects flora and fauna,” he added.
He agreed that this then means that since our limited resources are going to be used by a larger number of people, the competition amongst us all is going to increase.
The Population Regulation Bill, 2019 was introduced in the Rajya Sabha by Bharatiya Janata Party (BJP) Member of Parliament (MP) Rakesh Sinha. The bill aims to put stringent measures against those who procreate more than two children. These measures range from denial of benefits from the Public Distribution System (PDS) to any financial assistance from the government.
“A population law would 100 percent help…See, however much campaign you and all, the only thing (needed). Once it comes down as a law, definitely people will obey. I always feel that a law is best,” said Dr. Shalini.
Prof. Lakshmana, however, held a different view. He explained that while the government family planning program has done a good job in bringing the overall fertility rate down, one needs to look at the individual region’s population rather than look at the country as a whole.
Pointing out that rural populations tend to have a higher fertility rate he said, “…Uttar Pradesh, Uttarakhand, and Bihar have more rural areas, the population is high in these states and there itself we need to control.” Similarly, factors like migration to urban areas, the prevalence of child marriage, few communities (like scheduled tribes) having their social norms all affect population growth.
“So rather than a law, you should plan effectively so that you can accommodate everyone,” he said.
Anjali Singh Kulkarni too believes that a population law would not help in the promotion of contraceptives or sterilization operations.
“People don’t go and discuss with people should I have four or three children or what number of children. This is something very individual choice and when such individual choices are there a law would not be very effective.
“So, therefore, this area of health program is one where a lot of support, counseling availability accessibility and affordability of services is critical rather than having laws. As when we have laws it generally tantamount to some kind of punishment if people do not abide by the law.
“If there is a law that is related to the promotion of contraceptives or usage of contraceptives it’s very difficult to make sure whether people are using or not,” she said.
Dr. Mukharjee said that education holds the key through which necessary change can be brought about since it has a multifaceted approach to family planning. “Our school curriculums are not addressing these issues. A girl is not aware of her bodily rights so she learns from her house that menstruation is bad, that it is a negative thing,” she said. Given how hierarchical and diverse our society is, one cannot expect families to teach these things. But there can be certain universal topics that can be addressed via curriculums, which both boys and girls have equal access to. She added, “You cannot expect overnight changes; these are very slow sustainable processes. So, we need a whole generation to change an entire perspective. This can only come through the right kind of education.”