“Why are Indian men not open to vasectomy?”

To this question on Quora, a question-and-answer website, the answers suggest women think it has more to do with social stigma, while men think it will raise doubts about their ‘manhood’:

• “Most Indian decisions are based on ‘Log Kya Kahenge’ or what will people say?”
• “Men think if they’re not capable of producing children, why are they even alive?”
• “Marriages don’t work out and people don’t want to take a permanent decision.”
• “It makes them feel less of a man.”

These are some of the common reasons that contribute to the fact that vasectomy as a method of birth control is yet to catch on in India.

Vasectomy, the surgical procedure designed to make a man sterile by cutting or blocking both the right and the left vas deferens — the tubes through which sperm pass — is a quick and, in most cases, a painless procedure, especially when compared to the female equivalent. Tubectomies, in which women’s Fallopian tubes are clamped, blocked or sealed to prevent eggs from reaching the uterus for fertilization and implantation, are invasive, lengthier, require general anesthesia and hospitalization, and are more likely to cause a considerable amount of pain.

Yet, a study by the Indian Council of Medical Research, the apex body in India for the formulation and promotion of biomedical research, found that the prevalence and acceptance of vasectomy in India had fallen from 74.2% in 1970 to just 4.2% in 1992.

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Between 2017 and 2018, 93.1% of sterilization procedures performed in India were on women. Only 6.8% were men who underwent vasectomy, stated another report by the National Health Mission, a family planning initiative by the government of India.

“Historically, the emphasis has largely been on contraceptive methods for women, and there has been little effort to involve men in family planning,” Poonam Muttreja, the executive director of Population Foundation of India, an NGO dedicated to population issues, had earlier told Livemint. “Myths and misconceptions about male sterilization are rampant, like the loss of virility and strength of the man, further exacerbated after the forced sterilizations of the 70s.”

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In the 70s, during the Indian Emergency, forced sterilization programs, in which 6.2 million men — bachelors and fathers among them — were dragged to surgery by government health workers with police assistance, caused national outrage.

“It ended up instilling a deep suspicion in the minds of Indian men,” says Deepanshu Chadha, director of Planning Families, a family planning NGO based out of New Delhi. “Vasectomies continue to be disregarded mainly because of these forced sterilizations, followed by how little people know about the procedure and assumptions about it that aren’t true.”

Dr Himanshu Shah, a urologist at Mumbai’s RG Stone Hospital, says that vasectomies are “quick, mostly painless and non-invasive. It’s a minor 15-minute surgery that is conducted under local anesthesia.” He adds, “Over the years, technology and innovation have also simplified the procedure.”

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Dr Shah said men can now also opt for a No Scalpel Vasectomy (NSV) in which the vas deferens is brought out through a tiny puncture in the skin, cut or clamped and inserted back into its position without a single stitch.

“But more than the technicalities of the procedure, it’s the myths related to a man’s virility that stops them from going ahead with the procedure and often, women support them in promoting these myths,” adds Dr Shah.

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Many men and women think that vasectomies will lead to an end in sex drive or cause problems in erection or ejaculation. Dr Shruti Sanchi, who is a Mumbai-based sexologist and has counselled many men wanting to undergo the procedure, says, “These assumptions are not true. The only thing vasectomies does, is that it ends the ability to have children because there will be no sperm in the ejaculate. You can have and enjoy sex just like you did before the procedure,” she says. “There will also be no difference in the way or amount you ejaculate.” And most importantly, “It will not have any impact on erections,” she adds.

Psychologist Dr Adnan Mir says that some people also think that a vasectomy will affect a man’s mannerisms, strength, gait, voice or anything that is identified with ‘manhood,’ but, “vasectomies cause or bring about no such change in a man’s body or his manhood.”

As Habeeb, a Kerala resident wrote about his own experience with vasectomy on Facebook last year: “Vasectomy is a simple procedure. It will not affect ejection, ejaculation or orgasm. It is a relatively painless surgical procedure with a shorter recovery period. There are no restrictions as such, and sexual relationship can be resumed very soon.”

He added, “The doc said that there should be no need for any extra precautions except for not doing things like raising something very heavy for a week. I came home and started eating and drinking. The next morning, I walked in the usual way.”

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He went on to add, “So, dear women, at a time when both men and women have equal options to partake in family planning, when there’s a much easier operation than the one you will have to undergo, if the man is lovingly pushing you towards the surgery, you must tell him, ‘You go and undergo this procedure.’ Anyway, it’s not as challenging/demanding as giving birth to a child.”

Since being shared last year in April, his post has received 2000+ reactions with more than 500 comments, many along the lines of: “Let your message be an eye opener to the ignorant. You are really great. Proved yourself to be a good husband and a confident male.”

Another comment reads, “We all know these procedures. But your perception is really inspiring to all….God Bless….”

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The only risk associated with vasectomies is that they may not always be reversible, says Dr Shah. Any attempt to undo a vasectomy “will require the surgeon to reroute the vas deferens to restore the internal passage for sperm to pass through. It lasts two to three hours and although it often works, reversing a vasectomy is not a sure thing. It depends on each case.”

He adds that the longer the span of time since the vasectomy, the more complicated it may be to reverse.

While this could be a downside for some, for others, the finality of a vasectomy might be appealing. For the latter, vasectomies today represent an opportunity to equally divide the burden of family planning, given that tubectomies are far more expensive, invasive and in most cases, also irreversible.

As Muttreja said to Livemint, “Patriarchal mind-sets make men think that family planning is primarily a woman’s responsibility. We need to emphasize that this is equally a men’s issue and an issue of society at large. Family planning programs need to focus on encouraging male engagement through better behavior change communication strategies that smash deep-rooted myths, misconceptions and patriarchy.”