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Above: Sahu with his wife and two sons. (Photos courtesy of Saurav Kumar/Jhpiego.)

A New Generation of Indian Men Take Up Family Planning

Posted June 10, 2019

Chhattisgarh, India — Manoj Kumar Sahu is proud of a very personal decision, one that typically wouldn’t be discussed openly in India. He wants his friends and family to know: he recently chose to undergo a no-scalpel vasectomy (NSV) for permanent male contraception.

 MCSP-trained counselor talks to Sahu about NSV at the community health center.
Above: An MCSP-trained counselor talks to Sahu about NSV at the community health center.

“Bigger family leads to bigger expenses,” said the 35-year-old father of two. “With a small family, the children would be better looked after.”

He hopes that sharing this decision, made together with his wife, will inspire more men to opt for the procedure. When talking to family and friends, he stresses that NSV carries less complications than permanent contraception methods for women, and was done quickly — in about 10 minutes. Two months later, he still has not experienced any side effects, he tells them.

Sahu’s active participation in family planning (FP) is not the norm for men in India, where social conventions put the onus of FP on women. Female permanent FP methods continue to be the most popular forms of modern contraception in the country, accounting for more than 75% of methods used. Male permanent FP methods, on the other hand, remain a dismal 0.62% despite being safer, quicker and easier.

MCSP is working to change this. In Chhattisgarh state, the Program is strengthening male permanent FP services by employing the Fixed Day Service (FDS) approach, which ensures routine provision of permanent FP services at health facilities by trained providers on fixed days throughout the year. The approach – which MCSP used successfully to improve the provision of female permanent FP services in Chhattisgarh – was replicated to strengthen NSV services in the state, as well.

Dr. Chandrakar

Dr. Naval
Drs. Chandrakar and Naval, who provide NSV at MCSP-supported facilities

This proved easier said than done. When the Program’s efforts began, only one facility each from Raipur and Dhamtari districts were providing NSV. As a result, men who arrived for services were often denied or experienced long waiting periods, leaving them discouraged.

To resolve this, MCSP adopted a health systems strengthening approach, and supported participating facilities to establish FDS calendars and rosters of trained providers for NSV services. This – along with Program efforts to implement innovative quality improvement and quality assurance tools – helped to standardize the provision of permanent male FP services.

“A calendar for male permanent FP services was very helpful, as facility staff were aware that on that particular day services will be provided and all FDS conducted were planned accordingly as per guideline,” said Dr. G. P. Chandrakar, a provider at an MCSP-supported facility.

As a result of these efforts, regular services of both male and female permanent FP methods are now available at six program facilities in Raipur and Dhamtari districts in the state.

Those providing NSV are encouraged by this success, but know it will take more than their skills to make India a more gender equitable FP environment. It will take a new generation of men – like Sahu – taking responsibility for FP and chipping away at the social stigma by sharing their choice with their communities.

Dr. Sanjay Naval, who provides NSV at an MCSP-supported facility, believes it’s critical to dispel myths about male permanent FP to increase its acceptance. Because men are usually the sole-earning member in the family, he said, misconceptions such as the belief that NSV can affect a patient’s stamina are particularly dangerous.

“Better counseling and follow-up by field workers will promote the uptake of NSV,” he said.

Dr. Naval’s instincts are correct: involving frontline workers (FLWs) in health programs has been identified as one of the key successful strategies to strengthen health systems. With this in mind, MCSP worked with FLWs to strengthen their FP messaging for couples, and to teach them how to pre-register men and women interested in permanent FP services.

The Program has trained ~ 32,000 FLWs to improve provision of services and client satisfaction, and a cadre of counselors to share correct messages on all modern FP methods.

Men who have undergone NSV at an MCSP-supported facility proudly show their paperwork.
Above: Men who have undergone NSV at an MCSP-supported facility proudly show their paperwork.

These efforts are not only ensuring the provision of regular, high-quality permanent male FP services in India, they are promoting male engagement in FP and supporting a gender transformative health strategy.

Maternal and Child Survival Program