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India – The sterilisation skew #healthcare

A public awareness campaign with banners about ‘Vasectomy week’. — Photo: Special Arrangement   | Photo Credit: Special ArrangementA fortnight after the national ‘Vasectomy Fortnight’, the Telangana experience reveals the gap in India’s family planning programme

Sterilisation is simpler in men than women — recovery time and surgical risk are smaller, complications are rare and deaths rarer. Yet, as the national ‘Vasectomy Fortnight’ came to end earlier this month, the writing on the wall is clear: men are unwilling to share the burden of birth control.

The government observed ‘Vasectomy Fortnight’ between November 21 and December 4 with the hope to create awareness about male sterilisation and, more importantly, to facilitate district administrations reach sterilisation targets through campaigns. Of the 40 lakh sterilisation procedures done in 2014-15, vasectomies accounted for minuscule 1.9 per cent.

Experiments in the country’s youngest State, Telangana, reveal the sterilisation gap in India’s family planning programme. This fortnight, five men walked into the vasectomy camp in Ranga Reddy, a district adjoining Telangana’s capital Hyderabad with a 25 lakh population. The district administration managed to convince them to opt for the procedure. A second camp on December 8 found no takers and officials have renewed efforts to draw more men before the end of the financial year. With an annual target of 2,500 vasectomies this year — the district’s count stands at 5. Last year’s numbers only seem marginally better with 37 men undergoing the procedure. The State paid them Rs.1,100 each for undergoing sterilisation while the 24,000 women who underwent sterilisation were paid Rs.880 per person.

Counselling the key

Vigorous campaigning, efficient counselling and post-operative services as well as education are real differentiators,” says Renu Kapoor of the Family Planning Association of India. She pegs the lack of willingness to share the burden of contraception on a misplaced sense of masculinity.

“Men who avail vasectomies at our centres are educated and from organised work sectors. They do not require much counselling but have queries. They have heard of it from other men,” Dr. Kapoor says. She stressed the importance of counselling in understanding the strong likelihood of pregnancy for three months after the procedure. Her observations suggest most men from middle- and higher-income groups who decide to undergo vasectomy arrive with their partners for counselling and the procedure; most women who opt for sterilisation, mainly from low-income groups, seek counsel of other women.

India’s total fertility rate of 2.3 is expected to sink below 2 within the next decade. Telangana’s fertility rate reached replacement levels before the State came into being in 2014 — “replacement level fertility” is when the total fertility rate, i.e. the average number of children born per woman is the same as the dying population, implying that the population exactly replaces itself from one generation to the next. The third round of National Family Health Survey (NFHS) done a decade ago established that undivided Andhra Pradesh had recorded fertility rate of 1.8.

The latest survey in 2015 affirmed Telangana’s fertility rate stood at 1.8 births per woman. “For men, concerns of losing sexual potency and physical vigour make them unwilling to discuss vasectomy,” says Harish Chandra Reddy, health official in Ranga Reddy district. “A small number of unintended pregnancies and a few unfavourable post-vasectomy fallouts seem to have thrown it out of the reckoning.”

Experts maintain that the gap between vasectomy targets and achievements remain unchanged over the years even as country’s fertility and birth rates continue to fall, driven mainly by female sterilisation.

Tubectomies still the norm

Despite aggressive promotional campaigns over the last decade, only a small proportion of couples use State-distributed condoms (0.5 per cent in 7,786 Telangana households surveyed in 2015), oral contraceptives (0.3 per cent), intra-uterine devices (0.3 per cent) and male sterilisation to prevent birth. Of the 77,000 sterilisation procedures performed in the State’s public health sector till October 2016, only 1,287 or 1.6 per cent were vasectomies. In the two years since Telangana’s creation, vasectomies as a percentage of total sterilisations stood at 3 per cent, unchanged over the last decade. The State’s health administration, under no pressure to reach targets given that Telangana has achieved replacement level fertility, aims to perform around two lakh sterilisations this year. If last year’s numbers are any indication, one lakh more Telangana women will undergo sterilisation in the next three months.

An analysis of family health data published in 2012 reveals that up to 5 per cent women who underwent sterilisation before 2006 regret doing so, either because they feel they were too young at the time or because they opted for it without having any sons. The study noted that in States with lowest fertility rates, including undivided Andhra Pradesh, the median age of women being sterilised was around 23.

“Lack of gender equality, vulnerability of women and early marriages makes them agreeable to mass sterilisation programmes,” says women’s rights activist Rukmini Rao. “In rural India, women are against their husbands undergoing vasectomies fearing it may rob the family of its means of earnings and cast aspersions on them should pregnancy ensue after vasectomy.”

Women’s rights activists across the country had discussed and commented on the National Policy for Women when the government introduced the draft in May. Among other things, the policy envisages shifting focus of the country’s family planning programme to male sterilisations but those like Dr. Rao who participated in the discussions remain highly sceptical. She believes sterilisation should be the last option of birth control.http://www.thehindu.com/sci-tech/health/The-sterilisation-skew/article16897144.ece

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Comment (1)

  1. K SHESHU BABU

    Male hegemony is clearly reflected in family planning too! Women are forced not only to look after daily chores, but also undergo family planning operations and look after small family norms. Despite male contraception being easier, the percentage of male sterilisation is low with women being forced despite complex operation and possible infections compared to male. The deaths in Chhattisgarh of women due to negligence in operations reflect clearly the dangers of such operations. Awareness programmes describing benefits of male contraception should be carried out through the the country by health care experts and civil rights activists.

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