Let men do their bit

The Pioneer, Sunday November 11, 2007

Shailaja Chandra

For 30 years, vasectomy has been a political taboo, and the entire burden of family planning has been on women. But modern vasectomy techniques are a success in the West. India needs to try them

According to the projection of the Registrar General of India, India's most populous State, Uttar Pradesh, will account for 22 per cent of India's population by 2026. Half of India's demographic growth will occur in Uttar Pradesh and Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Rajasthan - certainly a huge jump. Fertility rates here are destined to take decades to reach replacement levels. In contrast, the south (Andhra Pradesh, Karnataka, Kerala and Tamil Nadu) is forecast to jointly account for only 13 per cent of the population increase during the same period, having already achieved the target fertility rate of 2.1 optimally projected for 2010 for the country.

Currently, 42 per cent of India's population produces three or more children. Of 188 million couples requiring contraceptive coverage, only 53 per cent are using contraceptives. The percentage of women having more than three children is 57 per cent in Uttar Pradesh, 54 per cent in Bihar and 49 per cent in Madhya Pradesh. Almost half the girls there are under 18 at marriage and soon become mothers.

With half the population in the reproductive group using no contraceptives, there is urgent need to push up the age of marriage, delay the birth of the first child and widen the scope for spacing and limiting families. Vasectomy is a feasible way of enlarging services for a simple, safe and effective terminal method.

Unfortunately, any large-scale efforts to limit population are attacked by critics as an invasion of "human rights". Added to this, given the cultural ethos of the northern States, such goals are dumped as "unacceptable" and "impossible" and invariably shunned by many politicians who thrive on the continued ignorance of populations.

The Millennium Development Goals do not envision family planning strategies as the direct route to improving maternal and child health. This acts as a deterrent to do-gooder international or national organisations from getting involved overtly.

Concentration on maternal and child health services has unwittingly excluded men. Counselling on vasectomy is just not their business. In India, men have ceased to be the direct object of the family planning programme ever since eight million male sterilisations were conducted -- six times more than in a normal year -- coercively and haphazardly during the draconian Emergency.

Even now horror stories of three decades gone by give shudders to politicians, especially in the Hindi belt. With no other terminal option available, millions of women have perforce to undergo tubal ligations having already borne the brunt of unwanted pregnancies and repeated childbirths, not to speak of often dangerous induced abortions.

Against this background, the recent resurrection of the vasectomy programme comes as a welcome surprise. Madhya Pradesh has doubled vasectomies in the span of just one year from 7,000 operations in 2003-04 to over 15,000 the year after. An orthodox State like Haryana has steadily shown higher and higher performance each passing year. Its neighbour Punjab has quadrupled the number of vasectomies in a matter of one year. Likewise conservative Rajasthan has upped the vasectomy performance from just 1,700 during 2003-04 by almost five-times.

During a recent visit to Gujarat, I noted how vasectomy operations had increased six-fold in one year with 6,200 operations conducted in just two months inviting the headline, "Vasectomy with a Vengeance", from a national newspaper. On October 6, in a single district, Vadodara, nearly 900 vasectomies were performed and hundreds of men had clearly come willingly for this outpatient procedure.

At every health facility, ANMs in white saris and smart name tags, anganwadi workers and village women togged up in their best attire escorted the "acceptors" for vasectomy. Even the drivers and sweepers had jumped on the vasectomy bandwagon and motivated between five and 15 young men each. Surgeries progressed speedily and while the patients lounged on beds, waiting their turn, paranthas, enthusiastic counselling and a bag full of condoms were kept in readiness to complete the day's work.

Whether the carrot was the Rs 200 motivation money or the Rs 1,000 compensation for acceptors, an enormous response was clearly evident. But despite occasional peaks, India's annual vasectomy total remains less than a 10th of the pre-Emergency levels, despite hundreds of surgeons having acquired the Chinese non-scalpel skill taught largely by a veteran, Dr RM Kaza of Delhi's Maulana Azad Medical College.

In the United States, United Kingdom, Canada and New Zealand vasectomies are expensive and it is the more educated people who opt for the procedure, gently encouraged to do so by sophisticated advertisements. In India, as in Bangladesh, Sri Lanka, and Thailand, vasectomies are treated as the poor man's option. In some Latin American countries like Brazil, Colombia and Mexico, vasectomy has been presented as an alternative to female sterilisation, and by involving wives in decision-making the outturns improved.

What is needed is for decision-makers outside the health sector to stop worrying about resurrecting the ghost of 1975 and understand that our population growth is having a direct and detrimental effect on maternal and infant mortality, the birth of underweight children and their future growth and survival. In all fairness to women, it is time to revitalise vasectomy.