Gender disparities in contraceptive use and sterilisation

Why in the News

The World Health Organization (WHO) has issued guidelines that, for the first time, set benchmarks for reversible male contraceptives. The timing matters for India, which has met its fertility goals while leaving contraception almost wholly to women.

What do the new WHO guidelines change?

1. What they are: The guidelines widen contraceptive options. They set benchmarks that reversible male methods, ones a man can stop to regain fertility, must meet, like a product standard for developers.
2. Why now: WHO research has challenged the assumption that men would not use new contraceptives.
3. Choice as equality: WHO’s director for sexual and reproductive health called choice a gender equality issue.
4. Imbalance in India: Women increasingly carry the burden of both temporary and permanent contraception, so falling fertility has not shifted any of it to men.
5. The takeaway: Better male methods give India a practical way to share contraceptive responsibility.

What does NFHS-6 show on contraceptive use?

1. Unmet need: Fertility is below replacement level. The National Family Health Survey (NFHS-6) for 2023-24 finds unmet need, married women who want to avoid pregnancy but use no method, down one percentage point.
2. More use overall: Married women using any method rose from 66.7% to 69.1% since NFHS-5.
3. Modern methods decline: Modern methods, such as pills, intrauterine devices, condoms and sterilisation, fell from 56.4% to 52.7%.
4. Traditional methods rise: Rhythm and withdrawal rose 6 percentage points, the largest rise of any method. Possible factors are fear of side-effects, privacy, partner preference and access.

How lopsided is sterilisation?

1. Female sterilisation: Its use eased from 37.9% to 36.5%, after climbing quickly between NFHS-1 and NFHS-3.
2. Male sterilisation: Only 0.5% reported it in NFHS-6, down from 3.4% in NFHS-1.
3. State pattern: Male sterilisation rose in 22 States, but only Telangana gained over one percentage point. States that reached a low Total Fertility Rate (TFR) early were no exception.

Why has vasectomy become marginal, and why does it matter?

1. From visible to marginal: As India reached replacement fertility, vasectomy shrank from a visible method to a marginal one, so the goal was met through women.
2. Simpler procedure for men: Female sterilisation is not unsafe, but ending fertility is less invasive for men and needs only local anaesthesia.

Challenges

1. Social norms: Contraception is seen as a woman’s task, and fears about masculinity keep men from vasectomy.
2. Programmes built around women: Family planning has long relied on female sterilisation camps. Eg. The 2014 Bilaspur camp deaths, Chhattisgarh.
3. Few male options: Men have only condoms and vasectomy, since reversible male methods are still in development.

Way Forward

1. Adopt WHO benchmarks: India should use the WHO guidelines to address the gender imbalance, with the Central Drugs Standard Control Organisation aligning approval rules for male methods.
2. Counsel men: Train Accredited Social Health Activists (ASHAs) to counsel men on vasectomy.
3. Address side-effect fears: Counsel women on modern methods so they do not drift to less reliable ones.

Conclusion

India has reached its fertility goal without sharing the burden of contraception between women and men. What to watch is whether family planning programmes adopt WHO’s benchmarks for male methods.

Key numbers

1. Male sterilisation, NFHS-5: 0.3% (2019-21).
2. Female sterilisation since NFHS-3: about 36 to 38%.

Back2Basics: Total Fertility Rate

1. What it is: TFR is the average number of children a woman would bear in her lifetime at current age-specific birth rates.
2. Replacement level: About 2.1, above 2 because some children die young and slightly more boys are born.

Matching Previous Year Question

“[2026, GS1, 15 marks] Critically examine the challenges of demographic transition in contemporary India.”