India’s Family Planning Programme focuses almost entirely on female sterilisation. In November last year, 18 women died in sterilisation camps at Bilaspur, Chhattisgarh. Apart of the abysmal conditions at such camps, the deaths also highlighted how women bear all the burden when it comes to family planning.

In September this year, the Supreme Court ordered the government to end sterilisation camps in three years. In that order, the court also noted that the centre should place more emphasis on the safer method of vasectomy, “for gender equity”.

Vasectomy involves surgically cutting or blocking the vas deferens – the tubes that transport sperm from the testicles to the penis. The procedure lasts about 20 minutes and is considered to be a safe and easy surgery.

On World Vasectomy Day, speaks to Poonam Muttreja, executive director of the non-profit organisation Population Foundation of India on the challenges in making vasectomy a more popular method of family planning.

Poonam Muttreja, executive director of Population Foundation of India.

How many men as compared to women opt for family planning measures?
On an average, vasectomy covers only 1% of the total number of modern contraceptive methods used by people in this country. Condom use is about 5%. Of the total, 48.5% of the total use of modern contraceptive use about 6% if used by men.

The numbers of vasectomy varies from state to state. Some north eastern states such as Assam have some of the highest rates of vasectomy – that is 10% and then it comes down drastically in Uttar Pradesh and Bihar, which is less than 1% of the total use of modern contraceptives. If you look at the graph it is a steep decline from one state to another.

Why is vasectomy not a popular method?
I think Emergency (in 1975) has affected the way we think about vasectomy (there were many allegations of forced vasectomies). It has got a very bad name, especially in UP and Bihar. There was more focus on those two states at the time.

Since then, no politician has wanted to work too much on promoting this procedure. In Bihar, Chief Minister Nitish Kumar had pushed for vasectomy a lot. But we need our frontline healthworkers such as Auxilliary Nurse and Midwife or ANM to push this technique more.

The government has also not done anything to blow the myth that men get weak after the procedure. This myth reaches women also. No woman wants her husband to become weak. Women are totally against men getting a vasectomy procedure. Most women, 63% as per our surveys, say that is legitimate for them to be beaten. Patriarchy is instilled in women as much as men.

So, it is a very complex issue involving myths, politics, and patriarchy.

Do you think the government is serious about pushing for vasectomy? Are there enough campaigns targeting men as opposed to women?
The Supreme Court has asked them to. They have to now. From November 21, they have decided to celebrate two weeks of vasectomy, and will have camps for the same. They do not have a choice.

There is also a huge shortage in many states for skilled doctors who can conduct non-scalpel vasectomy. As per the Family Welfare Statistics in India 2011, where a total of 709 primary health centres were surveyed, only 6.2% of the health centres had a skilled medical officer trained in performing vasectomy procedure. Where there is no person to perform the surgery, there will be neither demand nor supply.

But the government is now recognising the need to train more people. Earlier, all the training for doctors in family planning was conducted for tubectomy, not vasectomy.

What has the experience of men who underwent vasectomy been? Or under what circumstances do men accept to undergo vasectomy?
In general, the experience of vasectomy across caste and class is that it is not accepted. People who opt for it realise that there are no side effects. And that is is easier for men as opposed to women to undergo a sterilisation procedure.

A man usually opts for this procedure only after good counselling. We need ANMs who will go out of their way to counsel men to undergo this procedure. They have to tell men that it is a procedure that is simpler than tubectomy.

I feel that an uneducated health worker is not good enough. We need doctors and trained personnel to counsel men. Also we need key opinion leaders, and champions to push for advocating vasectomy. It cannot be a simple message by health workers.

Even giving incentives to men undergoing vasectomies has not helped much.
The government gives Rs 1,400 to a man undergoing vasectomy as compared to Rs 600 to a woman undergoing tubectomy. But men will not sell their virility, which they believe will be lost after the procedure. Even Rs 2,000 to Rs 5,000 won’t help. I would think a person who is desperate for money like say a drug addict will undergo this procedure. For very few people will Rs 1,400 be an incentive.

We do not believe in incentives for any method. It is so much better to spend money on counseling and providing good quality services. Incentives are totally useless. The failure of the use of incentives in vasectomy proves the argument that incentives do not work.

What has been the experience in other parts of the world? Are they better at promoting vasectomy?
Even in some of our neighbouring countries, such as Nepal have much higher rates of vasectomy. In Nepal, vasectomy contributes to 8% of the modern contraception use in the country.

This does have quite a bit to do with emergency. We just stopped giving services and did not train doctors to conduct vasectomy.