Family planning ball in men’s court
The National Family Health Survey-5 shows India has made gains in several areas related to health and human development over the previous phase (2015–16). But it also reveals that reproduction and family planning remain solely the burden of women. According to the NFHS-5, male sterilisation as a current method of family planning has remained unchanged from NFHS-4 at 0.3%. On the other hand, female sterilisation has increased to 37.9% from 36%, although the procedures are more complicated and recovery time longer. While 56.5% of respondents (currently married women ages 15 to 49) said they were using some modern method of contraception against 47.8% in NFHS-4, condom use is only 9.5%, albeit an improvement from 5.6% earlier.
The placing of the responsibility of family planning on women, who may struggle for access to care, financial resources and even control over their own body due to patriarchal views on female sexuality, comes from a torrid history. During the Emergency, reportedly 6 million men were sterilised in one year. Indira Gandhi’s government was subsequently voted out of power. The focus of family planning switched to women even as the bugaboo of an imminent population bomb faded.
For instance, in Bihar, 34.8% of women using modern contraception opted for female sterilisation in the NFHS-5 vs 20.7% earlier while male sterilisation accounted for 0.1% compared to 0 earlier. Yet, in Kerala, a state that ranks high on social indicators, the figure was 46.6% of female sterilisation against 0.1% male. On the one hand, while ostensibly at least some of these women may be willingly exerting control over their bodies, they may be doing so while making a limited choice between the risk of unwanted pregnancies and maternal mortality, and that of serious surgery.
Recently, in Tamil Nadu, Karur district framed male vasectomy as an act of love for one’s family while offering meaningful incentives including access to bank loans and housing pattas. Twenty one men opted for it this year compared to eight last year. To draw men back into the conversation on reproduction requires gender norms and roles to be challenged and dismantled, yet interventions like the one in TN may also be needed and can show quicker results.