Family planning in India: Women brave health risks to opt for sterilisation, as men shrug off responsibility

A dozen women are sitting on the floor. Some of them are teenage mothers with young ones on their laps. Others are matriarchs of their families who will make decisions on behalf of their young daughters-in-law. They are all in a two-room village at a health sub-centre in the Rama Kheda Kalan village in southern Madhya Pradesh. 5,000 people rely on this sub-centre for basic healthcare in this tribal area of Burhanpur district. There is no doctor or a nurse. There is one Accredited Social Health Activist (ASHA) worker who is responsible for delivering healthcare schemes of the government. Today she is advising the women about the benefits of the ‘operation.’ “It can be done this Monday if you agree. You will get money from the government too,” she informs them. “It is not just important to give birth to the children but one also has to give them a good quality of life,” she counsels. Many heads nod. [caption id=“attachment_5169761” align=“alignnone” width=“825”]  Representational image. Reuters/Adnan Abidi[/caption] According to the National Family Health Survey (NFHS) data, close to half of the married women in rural Burhanpur in the age group of 15-49 have undergone female sterilisation. The percentage for men: zero. Across the country, one in three married women between 15 and 49 years of age will undergo a sterilisation while only 0.3 percent of men will undergo a vasectomy. When gone wrong, female sterilisation is an operation that can lead to complications like ectopic pregnancy (fertilisation outside the uterus) and in some cases, even death. It needs a sterilised environment and competent health workers – both of which tribal areas like that of Burhanpur lack. In fact, India has one of the highest rates of female sterilisations in the world according to a United Nations report published in 2015. The report adds that while as a trend it is not something to be worried about if women are substituting more effective methods for lesser ones, it is important that they get information about the different options depending on their needs. “Women also suffer due to the poor quality of care­ during the procedure. It is not just about mortality post the procedure but many also see a rise in morbidity. They could have life-long gynecological problems or even mental health issues emerging from the experience,” explains Alok Vajpeyi, head of knowledge management at Population Foundation of India, an NGO that works to address issues like family planning, maternal and child health, among others. “Women normally get a tubectomy done following a delivery, especially when the desire for the male child has been met,” explained Kavya P, SBI Youth for India fellow working in tribal Burhanpur on maternal health. Post the operation though, women go back to rigorous household work or working in the fields. “They lose weight, complain of headaches and are constantly tired,” she said. Low hemoglobin is another common complaint. What about the men’s role in family planning? Only 4 percent of married women in the 15-49 age group turns to pills for family planning and 5.6 percent turn to condom, apart from the 36 percent who opt for female sterilisation. Over half the population does not use any modern method of contraception. What’s more, a vasectomy procedure costs less, can be done under local anesthesia and almost never causes death. “We ran a campaign to push the number of vasectomies up in the region but we did not get any response for it,” said Sachin Lad, block programme manager for Khaknar area of Burhanpur. The officials acknowledge that it is not fair to the women but in tribal areas, they point out, if the women keep getting pregnant it is worse for their health. Annually, of every 1,00,000 live births, 173 women will die in Madhya Pradesh. The average maternal mortality for India stands at 130, an improvement from 254 a decade back. And so, despite the risks, sterilisation is pushed because men would not come forward to get a vasectomy done – a much simpler, almost risk-free procedure. The cash incentive for women and men differ too. While women get Rs 3,000 for a tubectomy, the men will be given Rs 2,000 post a vasectomy procedure. India has been at the receiving end of criticism for running a family planning programme that interacts very little with men. This despite the fact that men often decide when to have sex and the family size, something international human rights organisation Human Rights Watch has been drawing attention to for years. “There is not much contribution as far as the male engagement concerned. It is always women who have to be bothered about family planning in the country,” added Vajpeyi.