We're worried about population explosion. So let's talk brass tacks

A simple indicator of Indian men's involvement in family planning is male sterilisation numbers. What explains the abysmal numbers?

More than half a century ago, male sterilization was the dominant method of sterilization in India. As many as 80.5% of the sterilizations conducted during 1966-1970 were vasectomies, indicating a strong cultural acceptance and an absence of apprehensions surrounding this method. This also showed that while women bore children, men took responsibility for family planning in a big way. And then, the Emergency struck in 1975. What was once voluntary was forced on the people.

The decline in male sterilization or vasectomy, subsequently, was dramatic and, as it has been so far the case, irreversible.(Shutterstock)

The decline in male sterilization or vasectomy, subsequently, was dramatic and, as it has been so far the case, irreversible. It dropped from 65.1% in 1971-1975 to 14.8% in 1981-1985 (GoI data). The downtrend has continued. As documented in the fifth National Family Household Survey (NFHS-5, 2019-21), male participation dropped to 0.3% of all family planning methods, while the total contribution of men to family planning remains at an abysmal 10%. The introduction of no-scalpel vasectomy, which is less invasive than conventional vasectomy, has not helped in arresting the trend. Recent data from the Brihanmumbai Municipal Corporation indicate that although in percentage terms, there has been an increase in the number of vasectomies in the capital city of Maharashtra: 480 men underwent sterilization operations in 2022-2023, compared to 43 men the previous year, in absolute terms, this number is very low.

Data from the Ministry of Health and Family Welfare’s Health Management Information System (HMIS) reveals a stark disparity between male and female sterilization statistics. In 2019-20, only 55,324 male sterilizations were conducted compared to 3,402,458 female sterilizations. The latest HMIS 2021-22 analytical report states that in the year 2021-22, male sterilization figures were recorded at 33,635, improving by 27% from 2020-21 (26,424) but declining by 38% when compared to 2019-20 (54,239). While it may appear that Emergency struck the death blow to male sterilization, India must reverse the trend in favour of greater male participation in family planning.

India presents a varied picture regarding vasectomy acceptance, a culmination of centuries-old patriarchal norms and unequal power relations between men and women. In most parts of the country, women are still expected to get married early and have children, preferably sons. Despite lacking the agency to decide if, when, and how many children to have, women shoulder the primary responsibility of planning their families, as is evident from the low uptake of male contraceptives in the country.

Data from NFHS 5 reveals that the uptake of male contraceptives varies across India, with some regions experiencing extremely low adoption rates. For example, in Haryana, men as contraceptive users, share 60% of the family planning responsibility (in total use of modern contraceptives), Uttarakhand (46%), Punjab (45%), Uttar Pradesh (43%), and Himachal Pradesh (36%) are ahead of states such as Karnataka (6%) and Andhra Pradesh (1%) which have achieved lower fertility rates than several north Indian states. This disparity highlights the existing gender imbalance in the responsibility for family planning and underscores the need for transformative change.

Male involvement in a gender equal society

 

Male engagement in family planning is crucial for several reasons. First and foremost, it promotes gender equality by empowering men to play an active role in family planning decisions, ensuring that the responsibility does not disproportionately burden women. It also enables couples to make informed choices together, fostering mutual respect and strengthening relationships. Furthermore, male engagement in family planning allows families to plan and achieve their desired family size, leading to better health outcomes for both individuals and communities.

Data from several countries in Asia and the world shows much higher participation by men in family planning. For instance, according to a UN report, Japanese men’s share of family planning methods is 35%, with China and Hong Kong at 32%. Many other countries of the world show a sizable contribution by men to family planning.

It may be argued that more family planning methods are available for women than men, resulting in more women becoming users of these methods. Science and technology have invented more methods for women such as oral contraceptive pills, intra-uterine devices, injectables, and implants, among others, while fewer methods are available for men. However, several methods available to women are more invasive or have more side effects than male methods, namely condoms and no-scalpel vasectomy (NSV). NSV is minimally invasive with almost-immediate recovery while tubectomy or female sterilization is highly invasive and requires a long recovery period.

It is possible that post-Emergency, the demand for vasectomy dropped so dramatically that programme managers decided to focus on female sterilization at the cost of promoting other methods. It is important that India makes an effort to reverse the trend by strengthening the men’s sterilization programme while promoting temporary methods such as condoms.

A series of initiatives, such as running age-appropriate sex education programs that emphasize the importance of shared responsibility and informed decision-making will help mould the minds of young men. At the same time, men’s access to a wide range of affordable male contraceptive options through public health programs should be ensured. The information gap needs to be bridged through awareness campaigns so that male contraceptive use can be destigmatized and cultural taboos and misinformation surrounding the topic are addressed. Collaborating with religious and community leaders, religious institutions, and men's groups to encourage male participation in family planning will be useful.

It may be difficult, initially, to reverse the trend, but once the gains appear, these will be worth the effort.

 

Sanghamitra Singh is chief of programmes at Population Foundation of India