Eighteen years ago, Kunta Kumari had her first child. She was 22. Recently, she delivered her sixth. At 40, Kunta, a resident of Mohiuddinpur village in UP’s Meerut district, says she is done bearing children. However, her husband Satish is not on the same page.
A daily wager who earns Rs 9,000 per month painting buildings, the 41-year-old is against any sterilisation. “My job requires physical labour, I can’t get sterilised,” he says, sitting in the crumbling rented house in which the family of eight, with children in the ages of 18, 15, 10, 5, 4, and the infant, sleeps together in one room. Kunta’s last three deliveries were through Caesarean section. She is anaemic and doctors have said she isn’t fit for a tubal ligation surgery — one of the most common female sterilisation methods in the country.
Admits Kunta, “None of my children goes to school, and on most days we skip meals. If I conceive again, we will have to beg.” Yet she nods in agreement as Satish says sterilisation is out of the question. “Apart from losing physical strength, I have heard the sterilisation procedure will make me dizzy. I paint high rises, what if I fall down?” While he says he doesn’t want more children, Satish is unsure what contraception to adopt. “The ASHA worker has told us about the pill, but I know it does not work completely,” he says. He does not use a condom.
At 20.42 crore, 16.4 per cent of the country’s population lives in UP, making it the country’s most populous state. As many as 57 of its 75 districts are designated ‘high population’ for having a total fertility rate (TFR) between 3 and 4. In March 2015, the state government told the Assembly that UP’s population would double in 20-25 years. Meerut is among the problem districts with a TFR of 3.1. It is also one of the 40 districts in UP — of the 146 across the country, spread over six other states — where the Mission Parivar Vikas, launched last year, is seeking to “stabilise” population growth.
Of the measures available, the non-invasive procedure that men like Satish can undergo is the easiest. But in a story repeated across the country, if 17.4 per cent of the married women MPV is targeting for family planning in Meerut have got sterilised, the number of men stands at 0.1 per cent. As part of its measures to encourage more men to share the burden of family planning, the UP government has set up four No-Scalpel Vasectomy (NSV) satellite centres, in Meerut, Kanpur, Allahabad and Lucknow. The Meerut programme lags behind. In 2017-18, it saw 184 procedures, against an unofficial target of 1,000 to 1,200. In the same period, the Allahabad centre registered 469 male sterilisation.
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On a Thursday morning, an NSV team has arrived at a labour chowk in Meerut city for a “chauraha (public) meeting”.
As they put up a banner and start handing out pamphlets, several men present flee, nudging others to do the same. Others hurl accusations at Akhilesh Kumar, the ‘innovation coordinator’ at the Meerut NSV centre: “Gandhari ke bhi tau ek sau ek bacche the (Even Gandhari in Mahabharat had 101 children)”; “Why don’t you go to the rich?”; “During Indira Gandhi’s time, people got plots to get sterilised. Why only Rs 4,000 now?”
Undeterred, Akhilesh begins a practised speech and hands over pamphlets that the men crumple and throw away. The few who pay attention crack up at words such as “veerya (semen)” and “yaun sambandh (sexual intercourse)”. One of the men asks him why he “isn’t going to the Muslim slums”. “You want to make this Pakistan?” “Modi-Yogi ko fax karo ki ye nahin hoga (Fax PM Narendra Modi and UP CM Adityanath that we won’t let this happen),” says Pappu Singh, 45, who has six children.
Later, as some of the men settle down, Sumit Verma, a 35-year-old daily wager, confesses, “I have been married eight years and have four children. We have never used any contraception. Everyone around me says you lose all your energy with sterilisation. Once when some workers came to our slum, my wife threatened to consume poison if I got it done,” he says in hushed tones.
Poor labourers like him, “with no education, no other jobs”, can only count on their physical strength, says Anil Singh, 40. “What sir (the NSV team) says may be true, but even if there is the slightest chance of me becoming physically incapable, I do not want it. I have five children to look after. Anyway, my wife is old now, she has not conceived in two years,” he says, adding he has never used contraception. While the NSV team is still handing out pamphlets, soon there are only a handful of men left, including Saryu Narayan, 48. A father of five, he says he understands the need for sterilisation and family planning, but it’s a question of “family honour”. “Five years ago, when I had my last child, the issue came up but my mother and wife stopped me. They said if the word gets out, they would be humiliated,” says Narayan, who has been working as a labourer for 20 years.
Like Narayan, most men in the group cite possible incapacitation and fear of being mocked as primary reasons for avoiding sterilisation. Pappu Singh, who has returned to the meeting after walking away earlier, asserts: “The women should do it. They bear the children, it will be easier for them.” As he wraps up for the day, Akhilesh says, “We tell the men about other family planning measures as well, such as condoms etc, but most men do not make it a part of their everyday family life. Sterilisation is the most effective measure. There has been a lot of focus on NSV to ensure that the responsibility of family planning is shared equally.”
Over at Bhurbaral, Meerut’s most populated region, Anshu Kumari, 25, has found another way around it. She and husband Rahul Kumar, 36, a tailor earning Rs 9,000 per month, have three children. After providing for 10 members of an extended family, there is little money left. For now, only their eldest son attends school. Rahul, who dismisses the fact that sterilisation is reversible, says he has “reasons” not to undergo the procedure, or let his wife do it. “If my wife dies, how will I raise a family again? I might want to remarry.”
But, unknown to Rahul, Anshu, who delivered her first child at the age of 18, went on the pill five years ago. Experts say they come across many women like her.
Dr Abhilasha Gupta, the head of department of gynaecology at Meerut’s Lala Lajpat Rai Memorial Medical College, who conducts between 6-10 female sterilisation a day, says it is “simpler” for a man to get sterilised “because there is no surgery and they do not need to get admitted to a hospital”. “But the idea of sterilisation doesn’t appeal to men. In women, the procedure involves a laparoscopic surgery and sometimes the tubes may ‘recanalise’ at a later stage, which will undo the process. Also, we do not operate on women who are anaemic,” she says.
As ‘innovation coordinator’, Akhilesh is the link between government departments, family planning workers, NGOs and people on the ground. “The compensation (Rs 4,000) in Meerut is higher than at other places as the district is part of the MPV (women, in contrast, get Rs 2,000). But there is such stigma that people run away the moment they see us,” he says. Akhilesh believes the decision to debit the compensation money directly to bank accounts since last year has also been a deterrent. “People don’t trust us.”
Deepak Kumar, the Meerut district co-ordinator for Hindustan Latex Family Planning Promotion Trust ( HLFPPT), a non-profit that provides health services in slums, says education is “the only counter”. “In both Meerut and UP, literacy and awareness levels are low. Educated people come and get sterilised on their own. It is the unlettered who we struggle with. Women are apprehensive of even using the intrauterine contraceptive device (IUCD) because they fear they will gain weight and in men the misconceptions are even bigger.”
Meerut’s higher Muslim population also makes their task difficult. Akhilesh admits there is larger resistance to the population drive in areas with large Muslim populations. “People in slums such as Zakir Nagar in Meerut don’t even let us enter. They say sterilisation is against their religion,” he says, adding that they at best put up posters. Sitara Bano of Mawana, an area with nearly 55 per cent Muslim population, 30 km from Meerut city, admits to insecurities in the community, apart from “it being against our religion”. “Many men feel targeted because of it. A lot of it also has to do with rumours that are spread,” she says.
However, Sitara adds, things are changing. “People realise they cannot feed 10 children, they are not fools. We know that sterilisation is for everyone, not just Muslims,” says the 40-year-old, who has four children herself. Her husband works at a mosque. Deepak Kumar of the HLFPPT says the only way to reach out to minority communities is through religious heads, “people the community trusts”. “Of the 10 NSV procedures we helped with last year, six were undergone by Muslim men.”
Khalid Rasheed Firangi Mahali, chairman of the Islamic Centre of India, has been associated with the UP government’s family planning programme. He agrees that religious leaders have been most effective in conveying public health messages, citing the example of the polio drive. “While Islamic law does not allow for sterilisation, I tell people there are provisions to adopt family planning measures to have a good quality of life and families agree,” he says.
The last three years have seen the implementation of over 20 schemes to control population in UP. The Principal Secretary, Medical Health and Family Welfare, Prashant Trivedi, says while sterilisation remains an important weapon, they are concentrating on “education and awareness”. “Population control is a gradual process… There are indicative targets for sterilisation but the focus is on creating awareness about family planning, ensuring quality deliveries for women and reducing infant and maternal mortality rate. Also, children are no longer viewed as ‘labour assets’ because of the laws against child labour etc,” he says.
Underlining the efforts by the government, Pankaj Kumar, Mission Director of the National Health Mission in UP, says the state’s TFR has been “falling consistently”. “On July 11, CM Yogi Adityanath will flag an awareness rally. There is a comprehensive plan,” says the officer. One of those success stories is of Sunil Kumar, 29, and wife Pushpa, 27. In January this year, when doctors refused to conduct a ligation surgery on Pushpa, who was frail after three children, delivering the eldest at the age of 16, Sunil decided to undergo sterilisation himself. “I was afraid, but with Rs 8,000 a month, I could barely provide for two children,” says the daily wager.
However, he is yet to tell his friends and family.” “Gharwale pakad kar marenge (My parents will beat me up),” he says. Pushpa says she doesn’t mind. “We will have to keep it a secret all our lives but at least we are at peace. I am thinking of taking up a job soon to put my children through a private school.”
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