Outside the Urban Primary Health Centre (UPHC) in Saidapet, Chennai, a poster advocates no-scalpel vasectomies (NSV) and reads that in comparison to female sterilisation, they are easier, safer, do not entail sutures or scars, and are outpatient procedures. It further reads that an incentive of Rs 1,100 will be awarded for those who undergo the procedure and if a motivator (a person who motivates a man to undergo a vasectomy) is involved, they will be awarded Rs 200. The poster is displayed prominently next to the entry to the health centre, but despite this, Chandra, the urban health nurse at the centre tells TNM that there have not been any takers for vasectomy from this ward over the past year.
Much like the Saidapet ward, wards from across the city have reported meagre figures despite the NSV fortnight that is observed every year by the government between November 21 and December 4, 2022. Gandhimadhi, another urban health nurse from Vadapalani says, “Last year, only one man who was referred for NSV from this ward went through with the procedure. We have been motivating them this year, but not a single man has followed through yet. In contrast, many women who we suggested sterilisation to, have undergone surgery and are coming here for regular post-surgery check-ups.”
City Medical Officer (CMO) Dr Hemalatha, reveals that only 47 cases of NSVs have been registered for Chennai between April and December 4, 2022, against 4,469 female sterilisations. Specifically, out of the 47 procedures, 20 were performed during the NSV fortnight.
At the end of the 14-day drive on December 4, Ambattur registered six cases followed by two cases each in Tondiarpet, Royapuram, Anna Nagar, Teynampet, and Adyar. Thiruvotriyur, Manali, Valasaravakkam, Alandur and Thiru Vi Ka Nagar reported zero takers while the other zones registered one case each.
Pointing to this trend Dr Hemalatha says, “Female sterilisations are taking place throughout the year. But among men, this frequency is lacking. Men are only coming forward during such awareness drives. So we have extended this drive till December 18.”
She says that increased numbers during the campaign cannot be interpreted entirely from a positive standpoint as the majority of men undergoing the procedure do so because the spouses are unfit for surgery. “If a woman has hypertension or diabetes or any other serious medical problems such as cardiac complications or a history of epilepsy, she is not fit for sterilisation,” she added. Thus far, the corporation has spent around Rs 35 lakh whereas the incentives offered to the beneficiaries alone have amounted to roughly Rs 34 lakh.
Chennai is not the only city to struggle to increase the number of NSVs. According to the National Family and Health Survey-5 (NFHS-5), female sterilisation is the most sought-after family planning method in Tamil Nadu. The survey’s key highlights show that out of the 68.6% of the state’s population who use contraception methods, women form a staggering 57.8% of those opting for sterilisation procedures, while men formed a measly 0.1%.
While awareness drives are being conducted every year to improve the percentage of male sterilisation, they have not covered the city well, resulting in lack of awareness. Thirty-four-year-old Rajeswari is a diabetic and she is now pregnant. Unaware that she is medically unfit for a sterilisation procedure, she says, “When my husband and I spoke about family planning, he just asked me to get it done. So, after giving birth to this child, I have decided that I will undergo surgery.” Rajeswari admits that the idea of her husband undergoing the procedure never occurred to her as she was not aware it was even possible.
In the postpartum room of the Government Maternity Hospital in Vadapalani, Suganya (28), a new mother is waiting to undergo puerperal sterilisation (performed within a week of childbirth). It was not really a choice for her. She says, “I know that there is surgery for men and I asked my husband if he is willing to undergo that. But he did not respond to me. Mostly we only hear of women getting sterilised, not men.”
Across Suganya’s bed, 29-year-old Rani (name changed) is also waiting to undergo puerperal surgery. She decided to undergo the surgery after her husband argued that vasectomy would affect his “manliness.” She says, “My husband told me that he will lose his manliness if he has to undergo the surgery. I have decided to undergo surgery without his knowledge because there is no need for the spouse to sign a consent form.” She further explains that her husband is concerned that the surgery will affect his libido.
Dr. Hemalatha says that these misconceptions about sterilisation causing low libido have been expressed by a lot of women. “It is not true. NSV does not affect men’s libido and does not mandate anything such as complete bed rest. Men can walk in, get the procedure done and walk out. But awareness on these aspects can only be achieved when NSV fortnights are conducted often. This will help in providing frequent reminders, and repetitively feeding them with correct information will only create a lasting impact,” she says.