- Gita Bandi
- BBC News – Delhi
3 hours ago
Only a few men in India participate in family planning programmes
When Ranjani Sharma told her husband that she was considering permanent sterilization as a foolproof method of contraception and to avoid having more children, he first tried to dissuade her from carrying out the idea.
Ranjani is a 27-year-old mother of three and lives in a suburb of Lucknow, northern India.
Rangani explained to me over the phone that her husband had concerns about the effects of the operation on her health. “He said it could negatively affect your health,” she says.
However, Ranjani felt she could not take it any longer. The couple decided they didn’t want any more children, and were using condoms to avoid pregnancy.
But this method proved to be not a “guaranteed method” of contraception, and Ranjani became pregnant twice and had to take over-the-counter abortion pills.
“I had severe bleeding, my head was spinning, then I fainted, my energy was completely lost, and I was tired all the time. So I told my husband that sterilization would be the best solution than taking these spoiled pills,” she says.
The spouses were considering the situation, and whether the husband should undergo sterilization procedures, but not the wife. However, Ranjani felt she had to be chosen.
“But I told him no,” Ranjani explains. “He is the breadwinner of the family, and sterilization will make him weak, and he will not be able to do heavy loads.”
Dr S Shanta Kumari, president of the Federation of Obstetrics and Gynecological Societies of India, says that “common myths and misconceptions” such as that male sterilization or vasectomy will affect virility is what prevents men from participating in the responsibility for family planning programmes. Thus, the burden of dealing with contraceptives is left entirely to women.
“And the family planning campaigns in India, which are run by the government and NGOs, are completely focused on women. I believe that it should be a joint responsibility of both men and women, and they are partners in this decision. But the responsibility is always the preserve of on women.”
The results of the latest national survey on reproductive health and the family in India confirm what Dr. Shanta Kumari said. It is the most comprehensive household survey with regard to health and social indicators, conducted by the government between 2019 and 2021.
This survey revealed that more than 99 percent of married men and women between the ages of 15 and 49 had knowledge of at least one modern contraceptive method.
These methods include male and female sterilization, condoms, pills, injections, and the intrauterine device, and the survey showed that their use increased from 47.8 percent during 2015-2016 to 56.5 percent during the period between 2019 and 2021.
But these numbers, which may call for optimism, do not show the whole truth.
photo released, Getty Images
India launched family planning and birth control awareness programs several years ago
The survey revealed that the proportion of men who use condoms is 9.5 percent, or less than one man in ten men, and that female sterilization is the most common method of contraception, and the resort to this method has increased during the past five years from 36 percent to 37.9 percent.
In contrast, the male sterilization rate remained constant at 0.3 percent despite being safer and easier.
Permanent sterilization of males is done by cutting the spermatic duct, or also called the vas deferens, or by closing it, which is also called closing the vas deferens, which are the ducts that connect the testicles to the prostate gland, and this prevents the sperm produced in the testicles from entering the semen.
This operation can be performed in the clinic and under local anesthesia, and it eliminates the fertility of the man, but it does not affect ejaculation and does not detract from his manhood or strength.
As for permanent sterilization in women, it is usually done by what is known as ligation of the ovaries or ligation of the fallopian tubes. The fallopian tubes are the two tubes through which eggs travel from the ovaries to the uterus, and fertilization takes place in them.
The operation can be done by cutting the two channels, tying them, blocking them or closing them with a medical clip, which is more complicated, and is carried out in two ways, one requires an incision in the abdomen and general anesthesia, and the second is an endoscopy through a tube inserted through the vagina and does not require general anesthesia, but its effectiveness begins after three months of making it.
Another method for permanent sterilization of women is hysterectomy.
photo released, Getty Images
Women waiting their turn for contraceptive advice
The survey also revealed that 50 per cent of men in the states of Uttar Pradesh, Bihar and Telangana consider that “contraception is a woman’s business and a man should not worry about it”.
The views of 45 percent of men in Karnataka were similar, as did one in three men in the states of Andhra Pradesh, Madhya Pradesh and West Bengal.
In order for real change to occur, the attitude adopted by men must first change, according to Abinav Pandey, who led a research project on the unequal responsibility for family planning and women’s burden, which ran from 2017 to 2019 and covered five states, Uttar Pradesh and Bihar. , Madhya Pradesh, Chhattisgarh, and Rajasthan.
“In all states, we found that male participation in family planning programs was very low, mainly due to a lack of awareness,” says Pandey.
“There are a lot of misconceptions about sterilization, as men feel that they will lose their masculinity and will not be able to do hard work.”
“Using condoms is more acceptable, but many men tell us that they do not like them, because they were uncomfortable, and using them reduces their enjoyment of sex.”
The government distributes free condoms in villages and poor areas of cities, as part of a family planning program, in addition to another goal of protecting against sexually transmitted diseases.
But Akansha Yadav of the JP Pant Institute for Rural Development Studies, which organizes workshops to train health workers in rural areas and members of village councils in safe abortion methods, says many women get pregnant because of a defective condom, not using it properly, or because their husbands They may come home at night after drinking alcohol and refuse to use a condom.
In these cases, it becomes a woman’s problem alone. With only a few women realizing that abortions are legal in India, Akansha says, women often resort to over-the-counter abortion pills, or to permanent sterilization, as Ranjani Sharma has done.
photo released, Getty Images
Many men aren’t comfortable using condoms, say family planning campaigners
Dr Shanta Kumari says she is primarily advocating for long-acting contraceptives that can be stopped, not permanent sterilization.
“Once the couple had two children, I told them they should use temporary, but long-term contraception, and after a few years, they could decide whether to do permanent sterilization,” she says.
For women, she says, long-acting contraceptives come in the form of intrauterine devices (such as an IUD) or pills, but nothing similar is available for men.
“There is research underway around the world to find long-term male contraceptives, but they are not permanent, but this has not been achieved so far.”
Until that happens, Abinav Pandey argues, family planning programs will have to find ways to reach men and persuade them to participate, but we should not expect a miracle, he warns, because change will be slow.
He says, “Men are not comfortable talking about sex in open forums. In rural areas, almost all government health workers are female, and they distribute condoms to homes, but do not have the opportunity to communicate with men. So we suggested that the government recruit Male volunteers persuade men to increase their participation in family planning.
In 2016, Pandey says, a pilot project was launched in 148 districts across India, and mother-in-law as well as daughter-in-laws were invited to participate and talk about family planning.
In Rajasthan, 2019 they also started inviting spouses to participate in these meetings, and a year later Uttar Pradesh adopted the same move.
“It helped improve male participation to some extent. We saw that some men started accompanying their wives to counseling sessions, but they were still reluctant to use contraceptives,” says Pandey.
photo released, Getty Images
A volunteer distributes condoms to men in a village
Dr. Kumari believes that changing this requires concerted efforts and cooperation between the government, doctors and the media in order to carry out campaigns that convince young people that vasectomy is a safe and simple procedure, and does not affect manhood.
Until that happens, she says, men will continue to shirk responsibility for family planning, and contraception will remain a burden for women alone.