• India has a long history of family planning initiatives, beginning in 1952 with a national program aimed at improving maternal and child health and stabilizing population growth.
• Over the years, the program has evolved, but one striking trend has emerged: a stark gender disparity in the adoption of permanent contraceptive methods.
• This disparity underscores systemic challenges to achieving gender equality, particularly in the context of Sustainable Development Goal 5: empowering all women and girls by 2030.

The Decline of Male Sterilisation

• During the late 1960s, vasectomies were the dominant sterilisation method in India, constituting over 80% of such procedures.
• However, policy shifts, misconceptions, and societal attitudes have led to a steep decline.
• The five rounds of the National Family Health Survey (NFHS) reveal a consistent drop in male sterilisation rates, with the most recent surveys, NFHS-4 (2015-16) and NFHS-5, showing no progress.
• This stands in contrast to the National Health Policy of 2017, which set a target of increasing male sterilisation rates to 30%.

Reasons Behind Disparity between Male and Female Sterilisation Rates in India

• Societal Expectations and Responsibility
• In many Indian communities, family planning is perceived primarily as a woman''s responsibility.
• This notion is perpetuated by cultural expectations that women are the primary caregivers and thus must manage reproductive health.
• Men, on the other hand, are often considered exempt from these responsibilities due to their roles as breadwinners.
• These ingrained attitudes perpetuate the idea that women must endure the physical and emotional costs of sterilisation, while men remain uninvolved.
• Myths and Misconceptions About Vasectomies
• Misconceptions about vasectomies play a significant role in their low uptake.
• Many men fear that the procedure will affect their masculinity, libido, or physical strength, despite medical evidence to the contrary.
• This fear is compounded by a lack of reliable information and widespread myths, such as vasectomy leading to impotence or being a form of emasculation.
• Such unfounded beliefs discourage men from considering the procedure, even when it is a safer and less invasive alternative to female sterilisation.
• Economic and Practical Barriers
• Economic considerations further discourage men from undergoing vasectomies.
• Many families rely heavily on male income, and the prospect of missing work for even a day can seem untenable for those living on daily wages.
• Despite government cash incentives designed to compensate for lost wages, awareness of these programs remains low.
• Women interviewed in a 2024 field study in Chhatrapati Sambhaji Nagar, Maharashtra, expressed concerns that vasectomies would impose additional financial burdens on their families.
• This highlights a critical gap in communication about government support systems.
• Patriarchal Resistance and Female Reluctance
• Interestingly, the resistance to male sterilisation is not confined to men because many women also view vasectomy as inappropriate or unnecessary for their husbands.
• In patriarchal households, women may internalise societal norms that assign reproductive responsibilities to them alone.
• Some women interviewed in rural areas believed that asking their husbands to undergo a vasectomy would be disrespectful or could lead to marital discord.
• This further entrenches gender imbalances and perpetuates the cycle of female burden in family planning.
• Lack of Skilled Healthcare Providers and Awareness
• In rural areas, limited access to skilled healthcare providers exacerbates the problem.
• Even when men are willing to undergo vasectomies, the unavailability of trained professionals poses a significant barrier.
• Additionally, community health workers, often the primary source of medical information in rural regions, are themselves poorly informed about vasectomy options, particularly modern techniques like no-scalpel vasectomies.
• This lack of awareness reduces the visibility of male sterilisation as a viable option, perpetuating reliance on female sterilisation.

Implications for Gender Equality

• This gendered disparity undermines broader efforts to achieve gender equality and women’s empowerment.
• When women bear the brunt of sterilisation, they face higher health risks and potential disruptions to their daily lives and livelihoods.
• Moreover, the societal narrative that places the burden solely on women reinforces harmful gender stereotypes and limits the potential for shared responsibilities in marital and familial dynamics.
• Addressing these disparities requires not only increased awareness about the safety and simplicity of vasectomy procedures but also a societal shift in how reproductive responsibilities are viewed.
• Until men are encouraged to take an active role in family planning, achieving gender equality in India will remain an elusive goal.

Strategies for Promoting Vasectomy Adoption

• Early Education, Awareness, Social and Behavioural Change Initiatives
  • Sensitisation about shared family planning responsibilities should begin in schools.
  • Early exposure to concepts of gender equality and reproductive health through peer-group discussions and structured awareness programs can challenge existing stereotypes and destigmatise vasectomies.
  • Sustained efforts in debunking myths surrounding vasectomies are crucial.
  • Campaigns must focus on the procedure''s safety and simplicity compared to tubectomy, the corresponding surgical method for women.
• Enhanced Incentives and Learning from International Successes
  • Conditional cash incentives can play a vital role in increasing male participation.
  • For instance, a 2019 study in Maharashtra revealed that financial incentives encouraged more men in rural tribal areas to opt for vasectomies.
  • Madhya Pradesh''s 2022 decision to raise these incentives by 50% demonstrates a promising policy direction.
  • Countries like South Korea, Bhutan, and Brazil offer valuable lessons.
  • South Korea''s high vasectomy prevalence is linked to progressive gender norms, while Bhutan''s government-run camps and Brazil''s mass media campaigns have effectively increased male sterilisation rates.
  • These examples show that normalising vasectomies and offering high-quality services can drive acceptance.
• Strengthening Health Systems
  • The Indian government must align its health infrastructure with policy goals by training more professionals to perform vasectomies and promoting technical advancements like non-scalpel techniques.
  • Investments in awareness and accessibility are essential for creating an environment where male sterilisation is a viable option.

The disproportionate reliance on women for sterilisation highlights deep-seated gender inequalities in India''s family planning efforts. Bridging this gap requires more than policy intentions; it demands actionable steps that integrate education, incentives, and systemic reform. By normalising vasectomies and addressing societal misconceptions, India can promote shared responsibility in family planning, paving the way for gender equality and improved reproductive health outcomes.