How Health Systems Shape Low Vasectomy Utilization: A Gender Analysis of Vasectomy Provisioning in India’s Family Planning Policies

Lack of men’s involvement in family planning burdens women with the responsibility of fertility control. Vasectomy, a safe and simple procedure, offers an opportunity for men to share the responsibility for fertility control. While India’s family welfare program has offered vasectomy services since 1952, their uptake remains significantly lower than female contraceptive methods. This chapter examines the conceptualization and implementation of vasectomy services in India’s family planning program to identify potential systemic problems contributing to the gender disparity in utilization. Data were collected from government documents, in-depth interviews with key informants and medical officers, and focus group discussions with health workers. Naila Kabeer’s Social Relations Framework and Carol Bacchi’s What Is the Problem Represented to Be (WPR) approach guided the gender analysis of policies. Conceptually, the policy fails to problematize the prevailing gender norms and their role in the gender-unequal sterilization utilization pattern. Moreover, insufficient budget allocation, inadequate training of health professionals, an undue emphasis on female methods, and a shortage of male health workers eventually contribute to the low uptake of vasectomy services. The tendency to use permanent contraceptive methods as an easier programmatic solution coupled with a vertical health system that targets women for development goals creates the context for an unclear, ambitious, and gender-blind vasectomy policy. Increasing men’s use of vasectomy will require, among other things, allocating increased financial resources and recruiting male workers who can address negative masculinities associated with the fear of vasectomy.