Although it is easier for men to be sterilised, the women end up bearing the burden of contraception. The Government and civil society must work to popularise vasectomies
The burden of family planning in a patriarchal society is borne primarily by women. In the age of woman empowerment, it is high time that the menfolk realise that their women suffer much more and are at a greater heath risk if they have to perform the duty of family planning all by themselves. It is the woman who delivers a child, undergoes labour pains in the process and then toils in bringing up the children. In addition, if she has to take the necessary precaution to ensure adequate spacing between children and then also sterilise herself after the family is complete, that is patently unfair.
According to Dr Alpana Aggarwal, a Mathura-based gynecologist, as far as spacing between children is concerned, there are not many choices for men besides using a condom. However, this method of contraception has been rendered unsuccessful due to non-compliance by men. There is a lot of research work going on in the developed world to develop a female contraceptive but so far without result.
For women, however, there are many choices in contraception wherein the side effects outweigh the benefits. Popular temporary methods include the intra-uterine device. The IUD has no systemic side effects except that it can cause some local discomfort. Birth-control pills are also commonly used, especially in the West. These pills have few, if not negligible side effects, but can cause damage if used for long period of time.
Also, what happens when the family is completeIJ Sterilisation remains the only permanent option. In case of women, tubectomy is a full-scale operative procedure, requiring sedation and post-operative care. In contrast, a vasectomy for men is a local procedure, requiring no hospital admission. The No-Scalpel Vasectomy procedure takes just five minutes and has no side effects at all.
Dr Aggarwal says that in her experience even among the economically and socially backward groups, women come for sterilisation after their family is complete as they realise the benefits of a small family. But often they have to be turned away due to low haemoglobin, anaemia or other such medical conditions. In such situations, it is much more convenient for the men to get a vasectomy but few turn up. Consequently, the woman suffers unwanted pregnancies.
There are social prejudices associated with male sterilisation such as the supposed loss of manhood. Moreover, men generally have a cavalier attitude towards the health of women. In some cases, there are religious biases against family planning as well, which need to be discouraged.
There has reportedly been a 75 per cent rise in the number of tubectomies between 2010 and 2013 in Delhi, as against the number of vasectomies which has fallen by 40 per cent. Clearly, men are not sharing the responsibility of family planning.
However, it is not the job of healthcare providers to motivate men to get themselves a vasectomy. That has to be done by social activists, woman and child welfare groups and the Government. But, this public awareness exercise is lacking.
The country’s growing population is a ticking bomb. As per the 2011 census, India is the second-most crowded country in the world after China. But while China has curtailed its growth rate to 5.4 per cent, India is growing at about 17 per cent. That means by 2030, India will overtake China as the most populous country.
Vasectomy, because of its merit over tubectomy, is the answer to India’s population crisis. Government hospitals are already paying Rs 1,200 to each person who undergoes a vasectomy, but much more needs to be done.
Poverty alleviation programmes have to be synchronised with the family planning schemes. Those responsible for disbursement of subsidies should work in tandem with family welfare counsellors who must educate the poor about the merits of NSV. A bigger pool of doctors and paramedics is also needed. These personnel can be sent to remote areas to ferry ‘acceptors’ to the nearest medical facility where they can get the NSV done, and then the acceptors can be dropped home. Travel and communication remain a major problem for the poor.
Similarly, daily wage earners, both in the private and the public sect or, should get their salaries for the day that they take off for the purpose. Private hospitals, set up on cheap land from the Government, should also do their part by conducting free tubectomies and vasectomies.