Context

• India has a long history of family planning initiatives, beginning in 1952 with a national program aimed at improving maternal and child health and stabilizing population growth.
• Over the years, the program has evolved, but one striking trend has emerged: a stark gender disparity in the adoption of permanent contraceptive methods.
• This disparity underscores systemic challenges to achieving gender equality, particularly in the context of Sustainable Development Goal 5: empowering all women and girls by 2030.

The Decline of Male Sterilisation

• During the late 1960s, vasectomies were the dominant sterilisation method in India, constituting over 80% of such procedures.
• However, policy shifts, misconceptions, and societal attitudes have led to a steep decline.
• The five rounds of the National Family Health Survey (NFHS) reveal a consistent drop in male sterilisation rates, with the most recent surveys, NFHS-4 (2015-16) and NFHS-5, showing no progress.
• This stands in contrast to the National Health Policy of 2017, which set a target of increasing male sterilisation rates to 30%.

Reasons Behind Disparity between Male and Female Sterilisation Rates in India

• Societal Expectations and Responsibility
  • In many Indian communities, family planning is perceived primarily as a woman's responsibility.
  • This notion is perpetuated by cultural expectations that women are the primary caregivers and thus must manage reproductive health.
  • Men, on the other hand, are often considered exempt from these responsibilities due to their roles as breadwinners.
  • These ingrained attitudes perpetuate the idea that women must endure the physical and emotional costs of sterilisation, while men remain uninvolved.
• Myths and Misconceptions About Vasectomies
  • Misconceptions about vasectomies play a significant role in their low uptake.
  • Many men fear that the procedure will affect their masculinity, libido, or physical strength, despite medical evidence to the contrary.
  • This fear is compounded by a lack of reliable information and widespread myths, such as vasectomy leading to impotence or being a form of emasculation.
  • Such unfounded beliefs discourage men from considering the procedure, even when it is a safer and less invasive alternative to female sterilisation.
• Economic and Practical Barriers
  • Economic considerations further discourage men from undergoing vasectomies.
  • Many families rely heavily on male income, and the prospect of missing work for even a day can seem untenable for those living on daily wages.
  • Despite government cash incentives designed to compensate for lost wages, awareness of these programs remains low.
  • Women interviewed in a 2024 field study in Chhatrapati Sambhaji Nagar, Maharashtra, expressed concerns that vasectomies would impose additional financial burdens on their families.
  • This highlights a critical gap in communication about government support systems.
• Patriarchal Resistance and Female Reluctance
  • Interestingly, the resistance to male sterilisation is not confined to men because many women also view vasectomy as inappropriate or unnecessary for their husbands.
  • In patriarchal households, women may internalise societal norms that assign reproductive responsibilities to them alone.
  • Some women interviewed in rural areas believed that asking their husbands to undergo a vasectomy would be disrespectful or could lead to marital discord.
  • This further entrenches gender imbalances and perpetuates the cycle of female burden in family planning.
• Lack of Skilled Healthcare Providers and Awareness
  • In rural areas, limited access to skilled healthcare providers exacerbates the problem.
  • Even when men are willing to undergo vasectomies, the unavailability of trained professionals poses a significant barrier.
  • Additionally, community health workers, often the primary source of medical information in rural regions, are themselves poorly informed about vasectomy options, particularly modern techniques like no-scalpel vasectomies.
  • This lack of awareness reduces the visibility of male sterilisation as a viable option, perpetuating reliance on female sterilisation.

Implications for Gender Equality

• This gendered disparity undermines broader efforts to achieve gender equality and women’s empowerment.
• When women bear the brunt of sterilisation, they face higher health risks and potential disruptions to their daily lives and livelihoods.
• Moreover, the societal narrative that places the burden solely on women reinforces harmful gender stereotypes and limits the potential for shared responsibilities in marital and familial dynamics.
• Addressing these disparities requires not only increased awareness about the safety and simplicity of vasectomy procedures but also a societal shift in how reproductive responsibilities are viewed.
• Until men are encouraged to take an active role in family planning, achieving gender equality in India will remain an elusive goal.

Strategies for Promoting Vasectomy Adoption

• Early Education, Awareness, Social and Behavioural Change Initiatives
  • Sensitisation about shared family planning responsibilities should begin in schools.
  • Early exposure to concepts of gender equality and reproductive health through peer-group discussions and structured awareness programs can challenge existing stereotypes and destigmatise vasectomies.
  • Sustained efforts in debunking myths surrounding vasectomies are crucial.
  • Campaigns must focus on the procedure's safety and simplicity compared to tubectomy, the corresponding surgical method for women.
• Enhanced Incentives and Learning from International Successes
  • Conditional cash incentives can play a vital role in increasing male participation.
  • For instance, a 2019 study in Maharashtra revealed that financial incentives encouraged more men in rural tribal areas to opt for vasectomies.
  • Madhya Pradesh's 2022 decision to raise these incentives by 50% demonstrates a promising policy direction.
  • Countries like South Korea, Bhutan, and Brazil offer valuable lessons.
  • South Korea's high vasectomy prevalence is linked to progressive gender norms, while Bhutan's government-run camps and Brazil's mass media campaigns have effectively increased male sterilisation rates.
  • These examples show that normalising vasectomies and offering high-quality services can drive acceptance.
• Strengthening Health Systems
  • The Indian government must align its health infrastructure with policy goals by training more professionals to perform vasectomies and promoting technical advancements like non-scalpel techniques.
  • Investments in awareness and accessibility are essential for creating an environment where male sterilisation is a viable option.

Conclusion

• The disproportionate reliance on women for sterilisation highlights deep-seated gender inequalities in India's family planning efforts.
• Bridging this gap requires more than policy intentions; it demands actionable steps that integrate education, incentives, and systemic reform.
• By normalising vasectomies and addressing societal misconceptions, India can promote shared responsibility in family planning, paving the way for gender equality and improved reproductive health outcomes.