Note: The views and opinions expressed are those of the author and do not reflect position of any other entity or individual. These views are subject to change
India, usually does not fare well on the annual Global Gender Gap Index released by the World Economic Forum. Recently, we slipped 28 places and ranked 140 out of the 156 participatory countries. While gender gap in areas such as employment rate, political empowerment and education gap is prominent, the gap is not very noticeable or not highlighted enough in other areas.
While going through the National Family Health Survey Reports released by the Ministry of Health and Family Welfare, I couldn’t help but notice the sizeable difference between the female (36%) and male (0.3%) sterilisation rates in the country. Let’s look at some data to get a sense of the issue at hand.
Out of the total female contraceptive users who are currently married, only 0.5% uses male sterilisation as a method of birth control as against female sterilisation, which accounts for 67% of the cases.
Why is female sterilisation preferred over male sterilisation? Why do our initiatives and campaigns focus on family planning only target females? Why is birth control or sterilisation considered a female problem? Let’s rewind to the history to get our answers.
India was the first country to announce the National Family Programme in 1952 — it started with the aim of slowing down the population growth and lower the fertility rate. It was initially seen as a measure to improve maternity health, but soon, with realisation of the rapidly increasing population and pressure from countries across the globe, it became a maniac scheme to sterilise men.
In 1970s, the Indian government ran a massive campaign to sterilise men — more than 6 million men underwent vasectomies within a period of one year. Men in earlier times (or maybe even now?) were seen as sources of information and communication, they were seen as decision makers and initiators of family planning. And therefore, they were an obvious target for the government.
Various techniques were used to increase the numbers — such as luring the population with small plots of land in exchange for getting sterilised or threatening government job holders about their job security if they fail to comply with government instructions.
Doctors/nurses/dais working at the grassroots were given incentives for each person they would sterilise. But due to the obvious misalignment of the incentive scheme, the health workers forced the population to get sterilised instead of sensitising them.
The entire campaign faced a severe backlash from the community and the government was forced to put a pause on the ongoing campaign very soon. The campaign was relaunched in the 1980s, however, this time, the target population for family planning was females. The government was waiting for the political climate to get better and then make the scheme more inclusive, but unfortunately, it was never done.
Women were an easy target, and especially at the time when the scheme was re-branded. Women felt it was their responsibility to get sterilised. They believed that since they give birth, they are also responsible for all the reproductive burden that comes with it; some also did it to not lose their daily wages due to pregnancy/menstruation.
In our male dominated society, people carry a misconception that vasectomies impact men’s virility or manliness. The situation has worsened so much that now about 37.3% men believe that family planning and contraceptives usage is a ‘woman’s business’, while 20.2% strangely believe that women who use contraceptive become promiscuous.
Are the females made aware of what they’re getting into?
Sadly, not enough. The National Family Health Survey-4 highlights that 58% of the women opting for sterilisation were not told about its side effects. Further, 52% of the said population were not even sensitised about other methods that they can utilise for birth control. The statistics get worse in states such as Andhra Pradesh, wherein 75% women were not told about the side effects of sterilisation and 65% did not know about other methods that they can utilise.
The government has increased the amount of monetary compensation for those getting vasectomies versus tubectomies. For example: vasectomy acceptors get Rs 1,100, while tubectomy acceptors get Rs 600. However, even with such a wide difference, the uptake for male sterilisation is abysmal.
It is also important to note here that ASHA workers in villages (Accredited Social Health Activists aka ASHA workers are community health workers deployed at the village level to support the population with various health services) are mostly females and therefore more comfortable in speaking with females.
India has a very small percentage of male nurses in the country. This may have had an impact on the skewed percentage that we are witnessing today. An article published in the Gaon Connection also highlights that health experts supports this theory and suggest that reproductive health care would improve for both men and women if more male workers were employed in community healthcare.
It is clear that the problem is deep-rooted in how our society thinks, the misconceptions that have been carried forward from the past, the undue advantage that we often give to males and our inability to question long standing traditions. It is imperative for the government to change the narrative around family planning. There is an urgent need to make it more inclusive that should be reflected in our policy decisions and our public statements.
Note: The article was originally published here.