Even as the Health Ministry announced plans on Friday for a targeted population control programme in 145 high fertility districts, data from 2013 shows that nothing has changed since the deaths of 19 women in a sterilisation camp in Bilaspur in 2014.
Women continue to constitute 98 per cent of the sterilised population; this despite the fact that the procedure is less complicated for men.
Of the total 41,41,502 sterilisations done in India in 2015-16 under government programmes, 40,61,462 were tubectomies. In 2014-15, out of a total 40,30,409 sterilisations, 39,52,043 were tubectomies and, in 2013-14, the corresponding numbers were 43,03,568 and 42,13,172.
The lack of male health workers is the primary reason why the age-old myth about men becoming “weak” — a euphemism for the loss of sexual prowess — has remained unaddressed, thus transferring the entire burden of population control on to women in a country where the use of contraceptives is still not common in the rural areas.
Statewise data reveal the lack of emphasis on vasectomy, a procedure in which the vas deferens is sealed off to prevent sperm from entering the seminal stream.
In 2013-14, Mizoram did zero vasectomies, Arunachal Pradesh did 2, and Meghalaya and Nagaland 14 and 15 respectively. Among the states that are now the focus of the new “Mission Parivar Vikas”, Uttar Pradesh did 8,375 vasectomies and 2,62,758 tubectomies in 2013-14; 9,798 vasectomies and 2,28,198 tubectomies in 2014-15; and 6,042 vasectomies and 2,25,616 tubectomies in 2015-16.
In tubectomy, the woman’s fallopian tubes are sealed off so that the egg can no longer reach the uterus where post fertilisation it is implanted and grows into a baby.
Madhya Pradesh in 2013-14 did 6,396 vasectomies and 3,54,932 tubectomies; in 2014-15 and 2015-16, these numbers were 5,980 and 3,67,604, and 9,726 and 3,96,216, respectively. For Rajasthan, the vasectomy figures from 2013-14 onward were 3,770, 4,302 and 4,706; while those for tubectomy, 2,99,868, 2,99,134 and 2,80,513 respectively. In Assam, yearly vasectomy figures from 2013-14 onward were 4,137, 4,276 and 4,237; those for tubectomy were 49,860, 40,537 and 45,121.
Poonam Muttreja of the Population Foundation of India said, “There is this huge myth that men become ‘weak’ after sterilisation. Little has been done to dispel that myth. The entire public health system is such that men are not even addressed; where are the multipurpose male health workers to talk to the men? Since 2000, India has done away with the practice of setting population control targets, yet there is something called the expected level of achievement (ELA) at the district level, which really are targets. Here also the ELAs for female sterilisation are much more.”
Muttreja said a recent study had found that only 1.5 per cent of funds were being used to promote spacing methods, while 85 per cent were being spent on female sterilisation. For 77 per cent sterilised women, sterilisation was the first attempt at any sort of family planning, she said, to make the point that India was not doing enough to promote non-surgical contraceptive methods.
According to the Rural Health Statistics, 2015, out of a total requirement of 1,53,655 male health workers in the country, only 55,657 were in position. In case of female health workers/ANMs, the figures were 1,78,963 and 2,12,185 respectively.
The 145 high-fertility districts spread across seven high focus, high TFR states of UP, Bihar, Rajasthan, Madhya Pradesh, Chhattisgarh, Jharkhand and Assam, that constitute 44 per cent of the country’s population, where the new mission will be launched, were selected, among other things, on their sterilisation performance.
The key strategic focus of this initiative will be on improving access to contraceptives through delivering assured services, dovetailing with new promotional schemes, ensuring commodity security, building capacity (service providers), creating an enabling environment along with close monitoring and implementation, according to a statement from the Ministry of Health.