Why impressive Kerala is lagging in male sterilisation

Declining rate of population growth is a key factor in achieving the goal of poverty eradication. One Indian state that has consistently scored high in bringing down population growth over the last few decades is Kerala.

However, data shows that the declining rate of population growth has been achieved at the cost of women. And the latest National Family Health Survey (NFHS) just corroborates this argument.

The rate of female sterilisation in Kerala is above the national average at 46.6 per cent. The national average of the same is 37.9 per cent. On the other hand, the rate of male sterilisation is embarrassingly low in Kerala despite the state having impressive scores in many other indicators of standard of living and social development.

Only 0.1 per cent of men are getting sterilised in Kerala, which apparently shows that the burden of family planning falls on the shoulders of women.

NFHS data also shows that men in Kerala are highly reluctant to use condoms despite being fully aware that regular use of condoms prevents HIV/AIDS. Only 3.4 per cent of men use condoms – which puts the state far below the national average (9.5 per cent). In contrast, 84.5 per cent of Kerala men know that the regular use of condoms will reduce the risk of HIV/AIDS.

Kerala is a good example for those who want to understand the paradoxes of women empowerment. According to NFHS, 94.1 per cent of Kerala women have participation in household decisions and 86.6 per cent have their own mobile phone.

In all other indicators such as literacy, higher education, maternal mortality, prenatal and postnatal care, etc. Kerala scores high. But family planning is clearly the sole responsibility of women, as the data shows.

“Unfortunately, indicators such as high female literacy and higher education have nothing to do with decisions related to family planning. Childbearing is conceived entirely as a woman’s business in Kerala. Hence, most of the women voluntarily go for tubectomy after the second child. Many of them don’t even know that they have a right to ask their husbands to go for vasectomy,” says Dr Niramala Sudhakaran, retired superintendent of the women and child hospital at Thiruvananthapuram Medical College.

Dr Nirmala, who has decades of experience in gynaecology, argues that the entire blame cannot be put on men because there is a systemic error that does not promote vasectomy.

“We do not have proper and sufficient vasectomy clinics, though we have gone far ahead in family planning. There are misconceptions related to vasectomy. People need counselling and privacy. Unfortunately, we do not have sufficient number of vasectomy clinics providing a conducive atmosphere,” says Dr Nirmala.

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Not only Dr Nirmala, but many other doctors The Federal talked to agree that the fundamental problem lies with the absence of a policy.

“The government does not have a policy to promote vasectomy. There are lot of men who do not even know that this is only a simple procedure which does not induce pain. In my experience, many husbands change their mind when we explain to them that tubectomy is more painful compared to vasectomy. They do not want their wives to go through the additional pain (after delivery),” says a senior gynaecologist with a government medical college in Kerala.

The absence of proper counselling also makes men reluctant to go for sterilisation. According to doctors, there are men who think that a vasectomy would weaken their sexual health.

“I wanted to start a vasectomy clinic in my hospital and submitted a proposal to the government, but another doctor wanted that space to begin a paediatric clinic and negotiated for the same. My request was rejected and his was approved,” a gynaecologist who does not want to disclose her identity shared her experience with The Federal.

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There are also doctors who are culturally conditioned to think that birth control is a woman’s business. Dr Sheela Sadasivan, a gynaecologist retired from Government Medical College in Thiruvananthapuram, admits that even healthcare professionals need education on the matter. She also expressed the concern that Kerala does not have a policy to promote male sterilisation, which is the result of a cultural impediment.

“I had frustrating experiences when I tried to promote vasectomy. Bureaucrats turn their backs on efforts to run camps for vasectomy. At the same time, I know from my experience that there are lot of men who are ready to do it if we give them proper counselling,” says Dr Sheela.

She also told The Federal that the number of doctors who are specialised in NSV (Non-Scalpel Vasectomy) is very low. “It is a bloodless, painless, walk-in and walk-out procedure. Compared to tubectomy, it is less dangerous too,” she adds.

“Usually, mothers of pregnant women insist that we do permanent sterilisation for their daughters after the second delivery. In our cultural practice, all labour related to pregnancy and delivery falls on the shoulders of the mother and grandmother. Women in their middle-age are too tired to take care of their grandchildren,” says Dr Nirmala.

The data is only a reflection of how deeply conservative Kerala is towards its women. Childbearing and the burden of birth control would continue to be a woman’s business unless there is a policy push and focused intervention.

The NFHS data also gives an indication that Kerala men are becoming more regressive while women are slowly shedding patriarchal values. For example, the percentage of women who justified husbands beating wives was 69 in 2015/16. This has reduced to 52 in the latest survey.

On the contrary, 58 per cent of men justified beating wives in 2015/16. This is increased to 63 per cent in 2019/20. Another interesting revelation that came out in the survey is that 16 per cent of men think that contraception is entirely a woman’s business. At the same time, 44 per cent of them believe that women using contraception may become promiscuous.