Why aren’t more men stepping up? Will be the first question you’ll likely ask yourselves once you’ve had a skim of the latest National Health Mission report – and you wouldn’t be too far off.
According to the NHM’s report – quoted by Indian Express – out of the total sterilisations carried out across India in 2017-18, a whopping 93.1% of them were performed on women – with only 6.8% on men. What this essentially means, is that more tubectomies were carried out rather than vasectomies.
But what gives? Why the rush to hustle and jostle women into queues to the nearest clinic to get their tubes tied, whilst theirs continue doing their business, uncut and unhindered? A sentence quoted verbatim from the report states – “Women continue to bear an uneven burden of the terminal methods of family planning and sterilisation”.
The report chalks it down to:
- the unwillingness of male partners to use condoms and sterilise themselves,
- a general fear that the process will rob them of their virility,
- and the loftily-held belief that women are responsible for family planning, anyway.
Her Surgery, Not Mine
“The numbers couldn’t have been more accurate!” exclaims Dr Ranjana Sharma, Senior Consultant – Gynaecology at Apollo Hospitals in New Delhi. “I can certainly tell you that out of all the patients that I see, the ratio is disproportionate. The men shy away and urge and push their female partners forward.”
Acquiesces Dr Bandana Sodhi, obstetrician-gynaecologist at Moolchand Medcity in New Delhi,
"When a couple comes to visit me for a sterilisation discussion, the men are usually quick to tell me – ‘Inko operation karwani hai, mujhe nahi (She wants to get it done, not me)’. A majority of the women themselves will tell me, ‘Nahi, main karwa lungi. Inko zaroorat nahi hai. (I’ll do this, he doesn’t need to.)’ The fear amongst these couples is that the man will become impotent or lose his ‘virility’!"
These fears prevail, despite the fact that a vasectomy is a far, far less invasive and quicker process than a tubectomy.
Says Dr Sharma –
"A vasectomy is a simple surgery that involves cutting off or blocking the small tubes in your scrotum that carry the sperm. The procedure only requires local anaesthesia to the area and the patient can go home the very day. Tubectomies, however, require women to be put under general anaesthesia. She has to get all the blood-work done and then admitted to hospital. The procedure for her is laparoscopic – with an instrument that goes inside her abdomen to tie her tubes. Risk of injury to other organs near the tubes also exists." -
But then, here’s a more pressing question that we may not be asking – so what if a vasectomy is easier than a tubectomy? Even if it weren’t – why should the speediness of a procedure/an entire sex’s threshold for pain be the parameters we set for differential treatment of the sexes?
A quick Google search on vasectomy will throw up the most-oft-asked question – “Will I ever be able to orgasm after I’ve had a vasectomy?”
Both Dr Sharma and Dr Sodhi claim this is because of the codes of toxic masculinity – which hinges on a man’s ability to perform in bed.
Why the Toxic Masculinity?
This is borne out by Dr Kamna Chibber, Head of Mental Health at the Department of Department of Mental Health and Behavioural Science – Fortis La Femme, New Delhi –
"In a deeply gendered society such as ours, the idea of a man getting a vasectomy – or sometimes, even wearing a condom – is unacceptable. They believe it would make you “not man enough”. What’s sad is that the narrative of the society shapes the mentality of the man."
What Dr Chibber wishes she could stress enough is the importance of telling a man that his ‘manhood’ is not associated with his sexuality. Nor with a procedure that tells him he can’t have children.
"The fear in one’s mind is – ‘I don’t want to become a social pariah. I don’t want to be ostracised’."
Himani Bajaj, a Women’s Studies Scholar – currently pursuing a PhD on Women and Contraceptives in Urban Delhi – believes the problem is also sociological:
"Historically, post Independence, when development programmes were first launched, they were focused largely on women. But this focus wasn’t empowering. Just going to a doctor – for a rural woman who belongs to a marginalised community – is a task in itself. The decision to sterilise themselves isn’t always an informed one. They are told that it’s for their betterment – that you’re ‘developed’ if you sterilise yourself, but it’s just your body being controlled."
Bajaj draws on her own experiences of studying family planning and contraceptive methods in the villages of Madhya Pradesh, where she saw a lot of “discomfort” between men and women in talking about birth control.
"These women often quietly give in to the narrative of patriarchy – allowing the state to control their body. The Emergency has made it even worse for them, since forced sterilisations carried out on men at the time has put the fear of the scalpel in the man’s mind."An Unequal World of ‘Withdrawals’ and i-Pills
Bajaj, however, insists that this inability to negotiate their own bodies exists within the urban milieu too –
"How many times can women here negotiate condoms or contraceptives? People in metros too will have intercourse and say – ‘Oh, i-Pill toh hai, to make it all better!’"
Dr Sharma at Apollo agrees – and reiterates that a large number of her urban patient- couples say they use the ‘withdrawal method’ as a form of contraception.
Till responsibility is equally shared and distributed, women’s bodies will continue to be submitted, unquestioningly, to the anvil of population control. Can we stop counting on the woman to tie up her tubes in a tidy little bow?
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