Around 1 p.m. on Thursday, many women had gathered at a community health center (CHC) in Mahoba district, Uttar Pradesh. They were all waiting their turn to undergo permanent contraception, sterilization or sealing of the fallopian tubes. Thursdays at public health facilities in Uttar Pradesh are set aside for sterilization surgeries and vasectomies for men, which block sperm – two methods of contraception.
There were men who had accompanied women, but there were no men awaiting their own surgery when IndiaSpend visited Jaitpur CHC in Mahoba.
Why did Rajesh Kumar (38), a resident of Barkheda village, not opt for vasectomy, and why was his wife, Gudiya, undergoing sterilization? A few women seated behind him giggled at the question. After a long pause, Rajesh said, “I’m scared.”
Between 2019 and 2021, nearly 38% of women surveyed nationwide for the Fifth National Family Health Survey had undergone sterilization, compared to just 0.3% of men who had undergone a vasectomy. In comparison, 17% of women surveyed in Uttar Pradesh had undergone sterilization compared to 0.1% of men.
Why Men Are Afraid of Vasectomies
“We perform 30 family planning procedures in one day, and all the patients are women,” said PK Singh, medical superintendent of Jaitpur CHC. “A lot of money is spent on raising awareness about family planning, but men are still hesitant. In 2020, while 545 women came to see us, only three men opted for a vasectomy.”
In 2020, the number of men opting for family planning procedures in Jaitpur, at three, was the highest of any CHC in the district, Singh said.
When Accredited Social Health Activists, or ASHAs, visit homes to encourage men and women to adopt contraception, they find that the men are reluctant. “We encourage the men too, but they tell us very harshly that it is the women who will have to undergo the procedure,” said Ram Sati, an ASHA worker from Lamora village in Mahoba. “Even the women say they will opt for it because they don’t want to bother the men.”
One reason is the myths behind the procedure. “There is a general perception that men are getting weak after family planning procedures. We tell them it’s a simple procedure and they wouldn’t even need stitches, they’re still reluctant,” said said Omvati, an ASHA worker, who lives in Akona Village. . “Even the wives feel that their husbands will become weak if they go for it.”
When we spoke to men who accompanied their wives for family planning procedures, they echoed Omvati’s words. “I don’t know a single man who has opted for this, that’s why I’m scared. Since it’s mostly women who undergo this procedure, I asked my wife to go for it,” Manoj said. , 42 years old. . “I heard that men get weaker after this operation. When asked where he got this information, he replied, “Everyone says so.”
To encourage men to opt for the family planning procedure, the government organizes a nasbandi pakhwada (a vasectomy awareness program) every year. Men are advised on these walks, but there is no change in the numbers.
Bad facilities for women
On a cold winter night in December 2021, several women lay on thin mattresses on the floor of Mehrauni CHC in Lalitpur district, Uttar Pradesh. Some family members carried women on their backs after the operation because there were not enough stretchers for everyone who came.
“There is not enough space at the CHC. I don’t have enough beds, so we are giving mattresses to the patients,” said MP Singh, the CHC’s medical superintendent. “We advise them to go home after the procedure and call them from time to time for checks.”
Women are not getting the kind of care they should be getting after undergoing family planning procedures. At Birgha CHC in Lalitpur, women were lying on the floor on mattresses after their surgery. CHC Medical Director Chatrapal Singh said: “We are doing 30 procedures a day. We have 10 to 12 beds as well as mattresses.”
When asked if women should stay in CHCs for a few days after the procedure, he replied, “There is a standard that they should be kept under observation for at least one day/night, but we don’t “We don’t have enough beds. Moreover, they themselves are not very comfortable staying at the CHC and are choosing to return home.”
Low knowledge of family planning among men
India’s family planning campaigns, spearheaded by both its public health systems and civil society programs, are almost entirely focused on women, according to a study by the International Center for Research on Women (ICRW). Moreover, it is the men who decide how many children a couple should have and when, as we reported in September 2020.
Up to 54% of men said their wives could not use contraception without their permission and a fifth thought it was the woman’s responsibility to avoid pregnancy – 31% of women agreed – according to a study on masculinity conducted by the ICRW and the United Nations Population Fund in 2014.
“There are two reasons why fewer men are opting for family planning procedures. First, there are not many male health workers in the villages. The main focus of ASHA workers and ANMs [Auxiliary Nurse Midwives] are women. Men are often overlooked. Second, health officials/authorities are not held accountable for fewer vasectomies,” said Amulya Nidhi, national co-host of Jan Swasthya Abhiyan, a network of civil society organizations working for rights to health “It is written in our Constitution that there should be no discrimination between men and women. However, no one bothers to find solutions where such discrimination occurs.”
The village sub-centres need 157,000 male health workers. However, only 82,857 posts had been approved, of which 59,348 were filled and 29,421 vacant, according to a response from the Lok Sabha on February 5, 2021.
By contrast, there are more female health workers in the field than needed: there were 205,000 female health workers hired, while the need was 157,000 and the sanctioned positions were 183,936.