About six years into their marriage, Rajesh Raman (identify modified), a Mumbai-based finance skilled and his spouse Meera (identify modified), a medical skilled, started to significantly ponder the thought of not having kids in any respect. After deliberating on the matter for 2 years, they determined that Rajesh would get a vasectomy executed. (Representational Picture above courtesy Shutterstock/Floor Image)
“We’re in all probability among the many few {couples} on this nation who determined to take this step with out having kids. About six years into our marriage, we began discussing that possibly having kids is just not part of our life targets. In addition to my company job, I additionally work as a life coach in a startup I run with my spouse. I work with greater than 2,000 folks on varied points like abuse, relationship administration, career-life steadiness, and many others,” says Rajesh, chatting with The Higher India.
“To help our collective imaginative and prescient of making a wider influence in society, we felt that possibly having our organic baby is just not part of our plan. After deliberating on the matter, I acquired a vasectomy executed in 2020,” provides the 37-year-old based mostly in Mumbai.
Elaborating on their choice to not have kids, Rajesh notes, “We consider that having a toddler is at the very least a 21-year funding of your time. As mother and father, you want to have the ability to dedicate a whole lot of your time and power. As a mother or father, it’s your high precedence to boost a toddler to be the most effective that they are often. It’s an amazing duty and it’s essential to do justice to it.”
However earlier than arriving at this choice to not have kids, Rajesh and Meera spoke to many individuals from lecturers to spiritualists who helped them perceive that there are myriad methods of fulfilling the obligations of a caregiver aside from turning into a organic mother or father.
“There are a lot of methods to fulfil the obligation of a caregiver apart from being mother and father to a toddler. So, it’s not that we’re working away from the duty [of becoming parents]. It’s simply that we search to commit our duty and time to a wider set of individuals,” says Rajesh.
However with regards to methods to ‘seal the deal’ on their choice to not have kids, Rajesh and Meera spoke to docs and explored the assorted contraceptive choices earlier than them.
“There are some momentary and everlasting choices out there. Funnily, the vast majority of the contraception choices are diverted in the direction of females like copper IUDs, oral contraceptives, and many others. In the event that they’re wanting long run, ladies need to bear tubal ligation, which is a cumbersome medical process, adopted by a four-week common restoration time,” notes Rajesh.
“Vasectomy, nonetheless, is a less complicated process with a quicker restoration course of. We did a whole lot of analysis and watched many testimonials on-line. We additionally spoke to some docs who’ve carried out vasectomies and individuals who have undergone it. Considering their inputs, we felt {that a} vasectomy is the most secure, most everlasting and least difficult process with little to no unwanted side effects. This was additionally a medical choice apart from a private one,” he provides.
How did their mother and father and family react to this choice to get a vasectomy?
Over these two years [before getting a vasectomy], Rajesh and Meera had very open and clear discussions with their respective households in regards to the choice to not have kids. Fortunately, their mother and father have been utterly aligned with Rajesh and Meera’s choice.
Nevertheless, what shocked them was the angle of the docs. “After we went to some docs [urologists] who carry out vasectomies, we have been turned away,” explains Rajesh.
“First, they weren’t positive that we have been a pair and requested us to furnish our marriage certificates as a result of they’d by no means heard of a younger couple choosing a everlasting sterilisation process with out having kids. Some docs have been of the view that we have been making an attempt to be ‘naughty’ right here. We argued that this choice got here after a lot deliberation and thought. After an prolonged search, we lastly discovered a physician who was able to do the process,” he provides.
Rajesh’s expertise with the vasectomy process
Talking to The Higher India, Rajesh describes his expertise of getting a vasectomy.
“A easy vasectomy requires chopping off and sealing the vas deferens, that are the 2 tubes that carry the sperm from the testicles to the urethra, thus making it a everlasting type of male contraception. The complete process will be executed both on common or native anaesthesia. For my [with scalpel] vasectomy, I went with native anaesthesia. The process took about quarter-hour. It was very fast. I felt little or no ache in the course of the process,” provides Rajesh.
Rajesh had Meera, a physician, witness the process since she knew the urologist.
“In the course of the process, chances are you’ll know when the physician cuts your vas deferens since you really feel a sensation. Equally, once they’re sealing it off, you’ll once more really feel a sure sensation and never any type of intense ache since you’re underneath anaesthesia. You’re then shortly stitched up after which placed on a course of painkillers for the subsequent 4 or 5 days,” he recollects, including that post-procedure, he felt slight discomfort whereas sitting for a few days.
“I’d suggest getting the process executed on a Friday so that you just get your weekend off. You’ll be able to earn a living from home on Monday, and on Tuesday, you’re nearly again to regular,” Rajesh says.
“Docs ask you to not interact in sexual exercise for a few weeks. The primary time you ejaculate after the process, you would possibly discover a little bit of blood however that’s no purpose to get freaked out. It’s a really regular factor. After 60 days, you’ll need to do a sperm depend check/semen evaluation the place the consequence needs to be zero. Docs additionally do a biopsy of the piece of vas deferens that has been lower to make sure that they’ve acquired the process proper,” says Rajesh.
Whereas receiving the outcomes of his sperm depend check, Rajesh recollects a humorous incident.
“Often the report comes 4 hours after the check. So, I referred to as the lab asking for the outcomes and a girl on the opposite line of the telephone stated that my report had come out incorrect and was unwilling to get into the specifics. Then my spouse referred to as and pressed her on the outcomes. She was like, ‘Oh my god, I’m very sorry to say your husband’s sperm depend is zero.’ That woman didn’t know that this was excellent news to us and she or he was relieved after my spouse defined {that a} vasectomy had been executed. We nonetheless get a pleasant snort out of recalling this incident,” he recollects.
Getting males on board for contraception
One of many largest issues with India’s household programme initiatives is that males are hesitant or unwilling to bear a vasectomy, and as a substitute, they put their wives/companions by means of longer, tougher and extra painful procedures that require an extended restoration interval.
Poonam Muttreja, the manager director of the Inhabitants Basis of India, says, “Household planning is a shared duty between companions. Involving males in household planning programmes can foster higher spousal communication, promote gender-equitable attitudes, and improve the uptake of household planning strategies. Regardless of this, India’s household planning programme exhibits a major hole in male involvement. At the moment, the general public well being system gives solely two male-specific contraceptive choices: condoms and male sterilisation (vasectomy).”
“Though the Nationwide Household Well being Survey (NFHS) 5 (2019-21) knowledge confirmed a major improve in uptake of condoms (from 5.6% in 2015-16 to 9.5% in 2019-21), condoms and male sterilisation contributed solely 17% and 1% respectively within the methodology combine. Though male sterilisation is a less complicated process in comparison with feminine sterilisation, feminine sterilisation stays the preferred fashionable contraceptive methodology. The weightage of feminine sterilisation in whole use of contemporary contraceptives for household planning was 67% in 2019-21,” she provides.
However why do Indian males stay hesitant or unwilling to bear procedures like vasectomy?
As Poonam explains, “In lots of elements of South Asia, males don’t take part in discussions and knowledgeable decision-making about household planning, and the onus is on ladies to make use of contraceptives. NFHS 5 knowledge reveals that greater than one-third (35%) of males consider that contraception is ladies’s enterprise. This mindset has resulted in restricted male involvement in household planning efforts.”
She provides, “Different contributing components embody restricted consciousness of sexual and reproductive well being, inadequate data about efficient contraceptive strategies, and the persistence of myths and misconceptions. Gender inequality, deeply embedded in cultural norms, continues to hinder efficient male engagement in household planning.”
So, how can we overcome a few of these boundaries and get extra males concerned in contraception?
Shattering myths surrounding male contraception and vasectomies
In India, main myths and misconceptions surrounding male contraception, notably vasectomy, contribute to its low acceptance.
“One prevalent false impression is that vasectomy results in a lack of virility, libido, and many others, regardless of medical proof displaying no influence on sexual operate. One other fantasy is that the process is irreversible, whereas vasectomies are sometimes reversible, with the success charges relying on timing and method,” explains Poonam.
“Moreover, there’s a widespread perception that household planning is solely a lady’s duty, bolstered by conventional gender roles. This has led to male sterilisation accounting for only one%, in comparison with 67% feminine sterilisation within the methodology combine as per Nationwide Household Well being Survey (NFHS-5) knowledge, highlighting the stark gender disparity in contraceptive duty,” she provides.
In a 2019 dialog with The Higher India, a gynaecologist and infertility specialist working for a personal hospital in Bengaluru, stated, “Practically, the complete burden of the household planning programme is carried by ladies. That is due to social mindset, doubtful claims that vasectomy reduces a person’s virility and skill to work, and an absence of different choices.”
Talking to The Higher India, a Delhi-based urologist who needs to stay nameless says that males have the choice of getting a conventional (with scalpel) and no-scalpel vasectomy. Whereas each choices are secure, he argues that no-scalpel vasectomy is the popular selection.
“One of many most secure, most painless, cold, and best modes of household planning is no-scalpel vasectomy for males. This process has no antagonistic influence in your intercourse life. You get the identical enjoyment out of intercourse as you probably did earlier. If a surgical procedure which takes a couple of minutes permits you and your loved ones to safe themselves towards undesirable pregnancies, a no-scalpel vasectomy is a superb possibility. Additionally, a no-scalpel vasectomy is reversible. For some purpose, should you and your accomplice need a baby, a physician can undertake a process to reverse its results,” says the urologist.
Speaking about his personal expertise, Rajesh states unequivocally that vasectomy doesn’t have an effect on his sexual exercise. He says, “You don’t must spend on condoms once more. And also you don’t must plan when you may have intercourse. Getting a vasectomy has zero influence in your intercourse life.”
“In reality, I’d say that getting a vasectomy has improved my sexual efficiency as a result of I’m in a greater [mind] house. There isn’t a discount within the quantity of enjoyment I can get from intercourse. You don’t really feel any adjustments physiologically, and it’s 100% secure,” he provides.
Getting extra males concerned in contraception and household planning
So, how can we get extra males concerned in contraception and household planning?
Up to now, the Union Ministry of Well being and Household Welfare has taken some steps to mainstream males’s function in household planning.
Based on Poonam, these embody, “Vasectomy fortnight (each November), set up of condom bins in any respect ranges of well being care services, IIC/BCC campaigns to advertise male contraceptives, counselling of males on contraceptives by involvement of ASHAs, distribution of Nayi Pehel equipment containing condoms for newlyweds, and organisation of the Saas Bahu Pati Sammelan to advertise male engagement underneath Mission Parivar Vikas programme.”
These initiatives have elevated consciousness and demand for household planning. However there may be way more to be achieved to understand gender fairness totally and shared duty in household planning.
“Addressing stereotypes and inspiring males to view household planning as a shared duty requires a complete method. Public well being programs, household planning programmes, and communication methods have to be tailor-made to advertise male involvement actively. By partaking males as equal companions in household planning, we could unlock a essential pathway to driving significant change within the nation,” argues Poonam.
“A sustained effort in behaviour change communication, mixed with energetic on-ground engagement with males, is crucial whereas selling ladies’s rights and decision-making autonomy. The main target needs to be on shifting mindsets and addressing stereotypes to empower ladies in making knowledgeable well being choices, whereas additionally fostering open communication between spouses. It’s essential to provoke these efforts early by partaking adolescents in discussions about sexual and reproductive well being and rights. Moreover, strategic engagement is required to encourage males to think about vasectomy as a viable household planning possibility,” she provides.
How can we get there?
Poonam notes, “It is very important perceive that male engagement intervention wants a multi-sectoral method. Schooling, age at marriage, health-seeking behaviour, and socio-cultural norms should be addressed concurrently and concurrently.”
Listed below are two steps she recommends:
- Frontline well being employees (ASHAs, ANMs) have to be supported and male well being employees have to be added to complement the prevailing workforce.
- Given the Authorities’s current emphasis on strengthening counselling at hospitals, an elevated thrust on {couples} counselling and follow-ups is more likely to bear fruit.
“The Authorities’s effort to interact male peer educators as a part of the RKSK (Rashtriya Kishor Swasthya Karyakram) programme is a transfer in the precise course,” she says.
“Lastly, the involvement of different stakeholders, together with civil society organisations and personal companions, to contain males on this course of must be underlined. Modern methods to make sure this underneath current PPP (public-private partnership) and social franchising fashions will positively influence well being and household planning on the group degree,” she provides.
Why is male participation essential in household planning?
Rajesh believes that if you have already got a toddler and also you don’t intend to have one other, getting a vasectomy is a should with the intention to transfer on in life.
“You probably have determined to not have kids in any respect, my suggestion is to take 18 months as a pair to debate this in trustworthy element, do the analysis, discuss to specialists, perceive what it’s to be a mother or father and have these delicate conversations with your loved ones. As soon as you’re clear about this choice, get the process executed and transfer on forward,” he argues.
Having stated that, Poonam notes that the discourse on the engagement of males as companions in accessing household planning and well being companies must transcend contraceptive use.
“Male participation is about being accountable and respecting equality somewhat than simply about decision-making. It ought to prolong to the function of males as enablers and beneficiaries within the technique of making certain dignity, equal voice, and reproductive rights for ladies. Male participation shouldn’t imply that girls’s decision-making powers are encumbered, and ladies are compelled to just accept males’s selections,” she argues.
“Research reveal that males typically management contraception decision-making and choice of contraception of feminine companions, notably within the context of the prevalence of intimate accomplice violence, which may impede contraceptive use in addition to improve the danger for contraceptive failure. Male engagement in household planning ought to enhance males’s and ladies’s reproductive well being and promote gender equality and ladies’s empowerment,” she provides.
(Edited by Pranita Bhat; Pictures courtesy Shutterstock)
