"A man once asked me, 'Why would I, a healthy man, who has made two kids, undergo this surgery? That would make me less of a man,'" says urologist Dr Suvit Jumde, describing a typical conversation with a patient to whom he advised vasectomy.
The Tamil Nadu Family Welfare and Health Department devised campaigning strategies in 2022 to bust myths about male sterilisation – vasectomy – but data shows that there has been very little improvement in the numbers.
The state performed 507 operations in 2018-19, which rose to 951 in 2019-2020. However, the numbers dropped to 863 in 2021-2022.
FIT spoke to urologists, gynaecologists, surgeons, and medical officers to understand why Tamil Nadu, a state with one of the best healthcare systems in the country, has not had much success when it comes to men taking the responsibility for family planning.
99.6% of Sterilisations Performed Were for Women
Outside every Urban Primary Health Centre (UPHC) and government hospital in the state, a poster advocating no-scalpel vasectomies (NSV) can be spotted.
A vasectomy is a surgical procedure to make a man sterile. During the procedure, the doctor cuts or blocks the tubes called the vas deferens, which carry the sperm from the testes to the penis. Since the 1980s, the traditional procedure that requires a scalpel to make two small incisions in the scrotum has been replaced by a no-scalpel surgery.
Notably, a vasectomy can be reversed at any time the man desires to have children.
The poster reads that in comparison to female sterilisation, the surgery is easier and safer, does not entail sutures or scars, and is an outpatient procedure. Also, the man who undergoes the procedure will receive an incentive of Rs 1,100 and anyone who motivates a man to undergo a vasectomy will be awarded Rs 200.
Dr Hemalatha, Chennai City Medical Officer (CMO), said they have been providing this incentive for over five years and have even raised the amount this year. However, they still haven't found many takers.
According to the National Family and Health Survey-5, female sterilisation is the most sought-after family planning method in Tamil Nadu.
The survey shows that out of the 68.6 percent of the state's population who use contraception methods, women form a staggering 57.8 percent of those opting for sterilisation procedures, while men formed a meagre 0.1 percent.
Data from the Health and Family Welfare Department of the state shows that in 2020-21, of the 225,834 sterilisations performed in government hospitals in Chennai, only 0.3 percent (689) were male sterilisation procedures, including conventional vasectomy. The remaining 99.6 percent (225,145) were female sterilisations.
Dr Hemalatha revealed that only 47 cases of NSVs were registered in Chennai between April and November 2022, against 4,469 female sterilisations.
She explained that a majority of men who undergo the surgery do so because their spouses are unfit for surgery.
If a woman has hypertension, diabetes, or any other serious medical problems, then the sterilisation procedure becomes very risky. It is only then that the man really steps up, she added.
Fear of Losing Libido, Unsatisfactory Sex
FIT spoke to medical officers in Chennai, Thoothukudi, Trichy, Vellore, Puducherry, and Salem, and they said that in most cases, it is, in fact, the women who don't allow men to undergo NSV. This is because they believe the latter cannot carry out hard work after the procedure.
"It is the mother and the wife who are the main reasons for the failure of many such campaigns," said Dr Meena, Director of the Institute of Obstetrics and Gynaecology and the Government Hospital for Women and Children in Egmore, Chennai.
"Another myth is they think their partner cannot satisfy them during sexual activity – and the man might lose his libido," said Dr Meena.
"After the procedure, men can go back to work immediately. But for women, we need to cut open the abdomen. We always refer the parents to Rajiv Gandhi Government Hospital for counselling with the urologists and even depute a health worker to accompany them; but in a majority of cases, the parents fail to go. And if we do manage to take them in and fix a date for the surgery, they fail to turn up for the procedure."Dr Meena, Director of the Institute of Obstetrics and Gynaecology and the Government Hospital for Women and Children in Egmore, Chennai
Dr Kala, retired director of Government Hospital for Women & Children in Egmore, who also headed family planning campaigns for over five years in the state capital, said:
"If I've done 300 sterilisation procedures for women in a year, it is unlikely that I would have done even 30 for men. We have realised that it is not the paramedical staff who can motivate the men. Just like how an alcohol addict who has gone through rehabilitation is best suited to convince other addicts, we need men who've undergone the procedure to give confidence to others."Dr Kala, Retired Director, Government Hospital for Women & Children in Egmore
In a bid to get more male volunteers, a few years ago, the state introduced a method wherein health workers were given sterilisation targets every month. "But this didn't work. Because, just to show numbers, men who were over the age of 70 or those who've already been sterilised were brought to the table. However, this method was a success when it came to female sterilisation," she added.
Dr Jumde said that in the past four years of working at the Mahatma Gandhi Medical College and Research Institute, Puducherry, he has not performed even a single vasectomy.
"Most Indians do not want to undergo an operation unless it is life-threatening. Only when men come for a hernia operation do they agree to get this procedure done. Also, many a times, when you go to a government hospital, you are given a date that is several months away. This is enough to dampen their enthusiasm," he added.
'A Basket of Contraceptive Options'
Several senior doctors said that while it has been a long struggle to convince men, they ensure that every couple is briefed about the various methods of contraception for safe sex.
Dr Hemalatha pointed out that ever since the pandemic, a majority of couples are registering their desire to have only one child.
"Due to the pandemic, many avoided hospitals for surgeries that weren't absolutely necessary. So, this exposed people to other methods, starting with simple condoms. Many don't want to go for a permanent method of sterilisation, and instead, are opting for temporary methods of contraception," she added.
She said that most couples are using 'Chhaya' or Centchroman, which is a non-hormonal contraceptive pill that needs to be taken twice a week for the first three months and once a week thereafter.
It is a safe and effective method that can be consumed by women even during breastfeeding. Another popular method is injectables, which are intramuscular hormonal contraceptives for women that provide three months' protection with a single dose.
Dr Meena pointed out that while there is a "basket of choices of contraception," it really is burdening the woman, rather than making family planning a shared responsibility.