- Per NFHS 5, though the exposure to family planning messages is slightly higher for men than women, 35% of men in India think contraception is women’s business.
- Gender inequality, rooted in cultural norms, and lack of male engagement continues to cause poor family planning practices nationwide.
- The use of male contraceptive methods is surrounded by myths: vasectomy is a safer, quicker and easier, but Indian men remain averse to the procedure.
- Male participation is about respecting equality rather than only decision-making, and should extend to their role as enablers and beneficiaries in ensuring women’s dignity.
- Male participation should not mean that women’s decision-making powers are encumbered, and women are forced to accept men’s choices.
In India, female sterilisation has remained the mainstay of the national family planning programme for decades.
The recently released fifth National Family Health Survey (NFHS 5) data has once again highlighted the limited male engagement in family planning in the country in 2019-2021. The uptake of male sterilisation (vasectomy) is exceptionally low in India at 0.53%, despite being a safer and easier method and the use of condoms constitutes 17% against the 67% uptake of female sterilisation in the overall modern contraceptive prevalence rate.
States such as Andhra Pradesh, Telangana, Kerala and Karnataka reported the highest weightage (equal or more than 84%) of female sterilisation in overall use of modern contraceptives in 2019-21.
India’s family planning programme has traditionally focused on women, with little emphasis on engaging men as beneficiaries and enablers. Often women are not seen as equal partners, yet the responsibility of family planning lies with them. Also, men are often the decision-makers, yet they are not usually targeted for family planning services and information.
According to NFHS 5, though the exposure to family planning messages is slightly higher for men (78%) than women (75%), 35% of men in India think that contraception is women’s business.
Gender inequality, rooted in cultural norms, and lack of male engagement continues to cause poor family planning practices nationwide. Factors such as lack of awareness of sexual and reproductive health and rights, lack of knowledge about appropriate contraceptive methods, myths and misconceptions, lack of access to services, information, and counselling on available methods of contraception, their benefits and side effects and their management determine the skewed contraceptive uptake in the community.
The use of male contraceptive methods, in particular, is surrounded by myths and misconceptions. Though vasectomy is a safer, quicker and easier option, several studies have suggested that Indian men do not undergo the procedure as they’re concerned about losing their virility. Many men resist vasectomies due to myths that the procedure causes physical weakness or impotence and reduces a man’s capability to provide for his household.
The fact remains that, unlike other contraceptive methods, male sterilisation does not require management of side effects, if done under hygienic conditions and with due compliance with prescribed guidelines for family planning.
While there is a need for systematic and sustained engagement of men in health and family planning, the discourse on the engagement of men as partners in accessing family planning and health services should go beyond contraceptive use. Male participation is about being responsible and respecting equality rather than only decision-making. It should extend to the role of men as enablers and beneficiaries in ensuring women’s dignity, equal voice and reproductive rights. Male participation should not mean that women’s decision-making powers are encumbered, and women are forced to accept men’s choices.
There is a need to invest in men early on, starting with young adolescents by opening and sustaining channels for sharing and learning for adolescents. The right investments in education, nutrition, skilling and reproductive health will ensure young people finish school, gain financial independence, adopt healthy behavioural practices and participate in decisions related to delaying childbearing, timing and spacing of pregnancies and deciding the number of children they will have.
The public health system, family planning programmes and communication strategies should be designed to encourage male engagement in family planning. Frontline health workers, including ASHA workers and auxiliary nurse midwives, need to be strengthened and male health workers added to supplement the existing women health workers. The government has the opportunity to increase male engagement by actively involving the cadre of multi-purpose workers (male) at the Ayushman Bharat Health & Wellness Centres.
There should be an emphasis on changing mindsets and stereotypes through social and behaviour change communication strategies to empower women to make decisions regarding their health and increase spousal communication.
Advocating for men to accept vasectomy as a family planning method is necessary. The Population Foundation of India addressed this through a popular transmedia serial called ‘Main Kuch Bhi Kar Sakti Hoon’1 (MKBKSH). (Editor’s note: The author is affiliated with the Population Foundation of India.)
An end-line evaluation, which an independent agency conducted, showed that after watching the serial, women had become more confident in communicating with their husbands on contraception and accessing family planning services.
A group of men from Chhatarpur, Madhya Pradesh, pledged to adopt contraception after watching MKBKSH. They advocate for adopting vasectomy – called ‘mastbandi’ (a modification of nasbandi, which is Hindi for tubal ligation) in the serial and move from village to village in the region and sing ballads to motivate other men.
Systematic and sustained engagement of men in health and family planning, not just as clients but as responsible partners to women, can improve access and use of family planning services and bridge the gap of the unmet need for contraception. We need to draw out more men, especially from local communities and Panchayati Raj Institutions, as family planning champions, create role models and normalise conversations on male engagement in family planning.
Social acknowledgment of men who adopt male sterilisation and reducing taboos around the subject is critical to bring about attitudinal, social, and behaviour change, in addition to dispelling myths.
Male engagement in family planning is a powerful tool for improving both men’s and women’s reproductive health, promoting gender equality and an equitable role for both partners in planning their families. Therefore, strategies for promoting male engagement are essential in India’s family planning programme nationally and at the community level.
Alok Vajpeyi is lead, knowledge management and core grants at Population Foundation of India.
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