Health workers in West Bengal are counselling and motivating men to undergo vasectomies, while also addressing the social determinants of health like gender dynamics and the conditions of living.
Five women in India die every hour due to complications at childbirth. Tupen Sarkar, too, had lost his first wife due to childbirth complications. When Sarkar took his second wife, Basanti, to the ASHA workers (frontline health workers) in their village for sterilisation after she had borne two children, she was operated on and the surgery deemed a success. But after three and a half years, she conceived once again.
Although India’s maternal mortality rate has declined over time, the onus of birth control lies on women, and uninformed and improper sterilisation for women has often led to deaths. When Basanti was taken to the health sub-centre again, Shefali Chakraborty, a frontline health worker, motivated Tupen to undergo a vasectomy instead, debunking the myths around the procedure and its after-effects.
“Initially, I was sceptical about undergoing the procedure, but I realised that I must keep my family small or I won’t be able to provide for them,” says Sarkar, adding that he is happy with his decision.
Jahanara Bibi, the community correspondent who documented the Sarkars’ case, spoke to auxiliary nurse-midwives (ANMs) and ASHA workers in South Dinajpur to understand why men are reluctant to undergo vasectomies.
ASHA workers like Shefali Chakraborty are recruited and trained under the National Rural Health Mission (NRHM). They function as frontline health workers in rural areas. Apart from providing basic physical healthcare services, they are also responsible for creating awareness about and addressing issues like the conditions of living, social exclusion and gender equality – all of which affect health and illness.
“Many men are afraid of vasectomies because they believe that it will weaken their physical strength. It is very difficult to motivate them,” says Kakoli Chandra, an ANM. The loss of physical strength is not the only myth around vasectomy; the risk of getting prostate cancer is another such myth, which has now been proven to be untrue. But, the root cause of all this is still patriarchy – and the resultant social stigma inflicted on men undergoing the procedure, which equates it with a loss of ‘manhood’ and virility.
While ASHA workers and ANMs perform a crucial role in helping people make informed decisions pertaining to family planning, a woman’s ability to exercise agency is still determined by the families and communities. Charkraborty also tells Jahanara that in case a contraceptive procedure fails and a woman conceives, she can carry on with the pregnancy only if she wishes to. If she does not, the health sub-centre will help her get an abortion. Contrary to Chakraborty’s sensitive approach to such a situation, hundreds of women face severe stigma at abortion clinics.
Basanti Sarkar was lucky to not undergo another sterilisation surgery because of the counseling and support that she and her spouse got from the health workers. The government, too, is pushing for vasectomies as a family planning method. Starting November 21, 2017, the health ministry has been observing Vasectomy Fortnight, in line with World Vasectomy Day, which is observed on November 20. The government also offers a higher cash incentive (₹1100) to men as opposed to the ₹600 offered to women for undergoing sterilisation. Currently, however, only 0.3% men undergo sterilisation as compared to the 36% women undergoing the same procedure, according to the National Family Health Survey. Evidently, the reluctance to undergo vasectomy remains.
Globally, there have been initiatives to promote vasectomies and to debunk the myths around it. But these efforts often fail to address the underlying patriarchy. In the United States, men undergoing vasectomies can now treat themselves to steak, some liquor and a game on a big-screen television after the procedure. The Wall Street Journal termed these as ‘brosectomies’. Incentives of the sort may increase the number of vasectomies, but they also reinforce a culture of machismo.
Programmes for sterilising women are unlikely to offer such incentives. It is assumed that a woman must unquestioningly undergo the procedure. Community health workers like Chakraborty and Chandra are trying to change this through their counselling and care-giving.
Video by community correspondent Jahanara Bibi.
Article by Alankrita Anand, a member of the Video Volunteers editorial team.
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