A bloodless revolution

In India, it is only in the last two years that non-scalpel vasectomies have been taken up in a concerted campaign. Starting with promotions at health camps and melas, as more doctors receive training in the procedure it is fast becoming available in hospitals and health centres in different parts of the country.

So what is the NSV and how is it different from the conventional vasectomy?The NSV involves a surgical technique where after a local anaesthetic injection in the scrotum, a trained surgeon uses what is known as the 8220;three-finger technique8221; to palpate the skin and locate the vas deferens or the tube carrying the sperm. A tiny puncture is made to deliver the vas deferens outside the body, where it is ligated and a two centimetre section of the tube removed. Since the sheath of blood vessels surrounding the vas is cast aside, there is virtually no bleeding during the procedure.

The puncture is so small that it disappears soon after the procedure and the patient is able to return to his desk job within a couple of hours. For those doing manual or heavy labour, they can resume their routine after two days.

8220;It is a safe and simple procedure. There is no cut made, so there are no stitches. Bleeding is minimal and the chances of picking up an infection, almost negligible. And the patient walks out after the procedure,8221; says B. Kishore, Assistant Commissioner, Family Planning, Ministry of Health and Family Welfare, and one of the prime movers of the NSV campaign being spearheaded by the Ministry.

In the last two years alone, according to official statistics some 45,000 NSVs have been performed, mostly at training camps and health melas. Of these over 38,000 NSVs have been conducted in Andhra Pradesh alone, the maximum number being in the state8217;s Karimnagar district, where NSVs have outpassed the number of tubectomies done on women.

However, the actual number of NSVs carried out so far may be far higher, in the range of 75,000 since many doctors who have been trained are carrying out the procedure, the figures of which are not being tabulated.

The response has been equally good in Orissa, where all the districts have been covered by the NSV campaign. So far the Department of Family Welfare has covered over 175 districts in 20 states in the country. The response has been more than enthusiastic as word spreads of the ease with which the procedure is conducted. 8220;It8217;s had a snowballing effect. Word has spread and people are turning up to get information about the NSV8221;, says Michael Vlassof of the UNFPA, one of the supporters of the project.

Its not just the public that is enthusiastic about the NSV. The medical fraternity sees the non-scalpel procedure making a difference in bringing down the overwhelmingly large numbers of tubectomies that are conducted on women in India. Nearly 97 per cent of sterilisations carried out in the country are on women, primarily because women have little or no control over their reproductive lives. A woman may agree to a major surgical procedure like a tubectomy if it means deliverance from the unending cycle of child-bearing.

quot;If we were to look at it in legal terms, a tubectomy is a grievous injury where the woman8217;s abdomen is cut open making it a major surgery. Compared to this the conventional vasectomy is a minor injury. And the NSV is an even minor procedurequot;, says Ramachandra Kaza, project advisor on NSV to the Government of India and to the UNFPA.

The governmental push for the NSV and its growing popularity also ties in with the newly-unveiled National Population Policy 2000 which seeks to emphasise the role of males in family planning.

quot;There has been considerable gender bias in the availability and focus of family welfare programmes on women. The focus will now increasingly be on making males aware of their role and responsibility in family planningquot;, says Meenaskshi Dutta-Ghosh of the Department of Family Welfare.

Describing the preparations that are made in a district where the NSV is introduced, Kishore says the ground is prepared with an intensive IEC information, education and communication campaign. Handbills are distributed and health officers are on hand to explain the procedure to the curious.

According to Kishore, a surgeon by training who has undergone the procedure himself, the usual reaction once people hear about the hassle-free answer to contraception needs, is to enquire about the nearest clinic or hospital where the facility is available.

In Delhi, some of the major hospitals like LNJP, Deen Dayal Upadhyaya and Guru Teg Bahadur, are already offering the facility. Indeed, in a sign of things to come, the LNJP hospital has a separate male-only family planning clinic, where nearly 6,000 non-scalpel vasectomies have been done.

Medical practitioners working in family planning clinics point out that with the enthusiastic response to the NSV initiative, the ghosts of the enforced sterilisation drives carried out during the Emergency have finally been laid to rest.

The evidence is in the numbers. Male sterilisation figures have gone up from 1.9 per cent of the total sterilisations conducted in 1997 to 2.45 per cent in 1999. 8220;This may not seem like much, but in a one-billion strong country, it is a positive dent. And the trend is clearly upwards,8221; says Kaza, a master trainer, who has trained hundreds of doctors in the technique.