Missing men in family planning: understanding the socio-spatial differentials in male sterilization and male spacing methods of contraception in India

Male involvement in family planning results in improved reproductive health and gender outcomes for women. In India, the use of family planning methods remains largely female-dominated. Recent media reports have indicated a rapid decline in male sterilization use in the past few years. This study aimed to assess the trends in, patterns of and factors associated with the use of male sterilization and male spacing methods in India using data from four rounds of the National Family Health Survey, conducted from 1992 to 2016. Bivariate analysis was done to see the trends in, and patterns of, male sterilization and spacing methods, while multinomial logistic regression was used to understand the factors associated with male spacing methods and sterilization. The results show a marked decline in the prevalence of male sterilization from 1992–93 (3.5%) to 2015–16 (0.3%) in India. Of the 640 districts, only 21 had a more than 2% prevalence of male sterilization. Scheduled tribe couples were two times more likely to use male sterilization than other (upper/no caste) groups. Couples from the northern region were significantly more likely to use male sterilization (aOR: 1.68, 95% CI: 1.43–1.97) compared with those from the south. There was a regional disparity in male condom use, with a very small proportion of couples in the southern (1.1%), north-eastern (2.4%) and eastern (3.3%) regions using the method compared with couples from the northern region (9.7%). Couples from the northern (aOR: 8.89, 95% CI: 8.44–9.38), north-eastern (aOR: 11.37, 95% CI: 10.62–12.18), eastern (aOR: 6.96, 95% CI: 6.60–7.34), western (aOR: 4.65, 95% CI: 4.40–4.92) and central (aOR: 10.89, 95% CI: 10.35–11.46) regions were also significantly more likely to use male spacing methods than those from southern India. Therefore, a greater focus on increasing the use of male sterilization and condoms is required in India to reduce the gender disparity in the use of family planning methods.

Effects of HIV Status and History of Pregnancy Termination on Trends of Family Planning Knowledge among Women Living in Nine Fragile Countries

Background: To decrease the proportion of women in fragile or conflict-affected situations (FCS) that need, but are not using modern contraception, the global health community must better understand family planning (FP) knowledge gaps; and elucidate which subgroups of women are, and are not, effectively being reached with FP information. This study investigated whether women with notable sexual and reproductive health histories that put them at risk for future pregnancy complications, namely HIV+ women and women with history of terminated pregnancy (HTP), would possess more complete FP knowledge and/or recall being given FP information more readily than HIV- women and women with no HTP (NHTP), respectively. Methods: Knowledge of several contraceptive methods, and the prevalence of women who recalled being given FP information at a healthcare visit, or via TV, radio, or periodical were estimated across HIV, HTP, and country subgroups. HIV+ and HTP status were major predictors in multivariate logistic regressions analyzing the odds of knowing a specified method of contraception or of recalling being given FP information via the modes considered. Results: HIV+ as opposed to HIV- women showed significantly higher odds of knowing about the pill (p=0.001), IUD (p<0.001), injectables (p=0.005), male condoms (p<0.001), female condoms (p<0.001), and implants (p<0.001); but not female or male sterilization. HIV+ women demonstrated higher odds of recalling being given FP information at a health visit (p=0.001), whereas HTP women did not. HTP women showed higher odds (p<0.001) of knowing each modern method of FP with the exception of male sterilization and of recalling TV (p=0.01) and radio (p<0.001) FP messages. Conclusions: Notable findings were the higher FP awareness among HIV+ and HTP women, and the observation that HIV+ women were seemingly provided FP information more readily at healthcare visits than were HTP women, despite their similar risk profiles concerning future pregnancies. Subsequent studies may elucidate why these patterns were observed and indicate which other diagnostic groups are effectively being reached with FP education, and which are not. Understanding trends and predictors of FP knowledge can help practitioners better target FP counseling efforts in FCS toward knowledge gaps and their causes.

Effects of HIV status and history of pregnancy termination on trends of family planning knowledge among women living in nine fragile countries

Background: To decrease the proportion of women in fragile or conflict-affected situations (FCS) that need, but are not using modern contraception, the global health community must better understand family planning (FP) knowledge gaps; and elucidate which subgroups of women are, and are not, effectively being reached with FP information. This study investigated whether women with notable sexual and reproductive health histories that put them at risk for future pregnancy complications, namely HIV+ women and women with history of terminated pregnancy (HTP), would possess more complete FP knowledge and/or recall being given FP information more readily than HIV- women and women with no HTP (NHTP), respectively. Methods: Knowledge of several contraceptive methods, and the prevalence of women who recalled being given FP information at a healthcare visit, or via TV, radio, or periodical were estimated across HIV, HTP, and country subgroups. HIV+ and HTP status were major predictors in multivariate logistic regressions analyzing the odds of knowing a specified method of contraception or of recalling being given FP information via the modes considered. Results: HIV+ as opposed to HIV- women showed significantly higher odds of knowing about the pill (p=0.001), IUD (p<0.001), injectables (p=0.005), male condoms (p<0.001), female condoms (p<0.001), and implants (p<0.001); but not female or male sterilization. HIV+ women demonstrated higher odds of recalling being given FP information at a health visit (p=0.001), whereas HTP women did not. HTP women showed higher odds (p<0.001) of knowing each modern method of FP with the exception of male sterilization and of recalling TV (p=0.01) and radio (p<0.001) FP messages. Conclusions: Notable findings were the higher FP awareness among HIV+ and HTP women, and the observation that HIV+ women were seemingly provided FP information more readily at healthcare visits than were HTP women, despite their similar risk profiles concerning future pregnancies. Subsequent studies may elucidate why these patterns were observed and indicate which other diagnostic groups are effectively being reached with FP education, and which are not. Understanding trends and predictors of FP knowledge can help practitioners better target FP counseling efforts in FCS toward knowledge gaps and their causes.

Effects of HIV status and history of pregnancy termination on trends of family planning knowledge among women in nine fragile and conflict-affected countries

Background To decrease the proportion of women in fragile and conflict-affected situations (FCS) that need, but are not using modern contraception, the global health community must better understand family planning (FP) knowledge gaps; and elucidate which subgroups of women are, and are not, effectively being reached with FP information. This study investigated whether women with notable sexual and reproductive health histories that put them at risk for future pregnancy complications, namely HIV + women and women with history of terminated pregnancy (HTP), would possess more complete FP knowledge and/or recall being given FP information more readily than HIV- women and women with no HTP (NHTP), respectively. Methods Knowledge of several contraceptive methods, and the prevalence of women who recalled being given FP information at a healthcare visit, or via TV, radio, or periodical were estimated across HIV, HTP, and country subgroups. HIV + and HTP status were major predictors in multivariate logistic regressions analyzing the odds of knowing a specified method of contraception or of recalling being given FP information via the modes considered. Results HIV + as opposed to HIV- women showed significantly higher odds of knowing about the pill (p = 0.001), IUD (p < 0.001), injectables (p = 0.005), male condoms (p < 0.001), female condoms (p < 0.001), and implants (p < 0.001); but not female or male sterilization. HIV + women demonstrated higher odds of recalling being given FP information at a health visit (p = 0.001), whereas HTP women did not. HTP women showed higher odds (p < 0.001) of knowing each modern method of FP with the exception of male sterilization and of recalling TV (p = 0.01) and radio (p < 0.001) FP messages. Conclusions Notable findings were the higher FP awareness among HIV + and HTP women, and the observation that HIV + women were seemingly provided FP information more readily at healthcare visits than were HTP women, despite their similar risk profiles concerning future pregnancies. Subsequent studies may elucidate why these patterns were observed and indicate which other diagnostic groups are effectively being reached with FP education, and which are not. Understanding trends and predictors of FP knowledge can help practitioners better target FP counseling efforts in FCS toward knowledge gaps and their causes.

Fertility Outcome of Surgical Recanalization of Vas Deferens in Individuals with Non Scalpel Vasectomy (NSV)

Background: Non Scalpel Vasectomy (NSV) is being widely used by Family Planning Sector of Bangladesh for male sterilization. But when young persons with NSV needs reversal of the procedure (recanalization), they become frustrated hugely affecting the family harmony. Aims and Objectives: To see the efficacy of recanalization of Vas Deferens of Non Scalpel Vasectomy (NSV) Individuals. To establish confidence on national NSV program by assuring the scope of future reversal if needed. Materials and methods: During the period of January 2017 to November 2019, we have analyzed the outcome of recanalization surgery of all cases of NSV individual which were referred to our urology team at Rangpur of Bangladesh. We excised the involved segment of Vas Deferens and stented it internally by No-1 prolene (Ethicon). Then end-to-end anastomoses were done by 7/0 vicryl (Ethicon). We collected articles from Hinari, Pubmed and Banglajol with extensive searches. We have compared our findings to the previously published articles. Result- We found 91.9% success rate in this study with positive semen production. Pregnancies were achieved in wives of 72.9% of recanalized individuals. The most common causes of unsuccessful recanalizations are more than 7 years of NSV, knot in close proximity to epididymis, two or more knots and cord like Vas Deferens. One patient had significant hematoma leading to a failed outcome, otherwise there was no mentionable complication in this series. Conclusion- Recanalization of Vas Deferens of NSV individuals can be done with high success rate and other centers of Bangladesh may take steps for further evaluation. J Bangladesh Coll Phys Surg 2021; 39(3): 167-170

Challenges in involvement of male spouse in family planning program in rural areas of Varanasi

Background: Globally, men have not shared equally with women the responsibility for fertility regulation. While family planning efforts have been directed almost toward women, the lack of male involvement may also reflect the limited options available to men. Current methods for men are condom, withdrawal, or permanent, such as vasectomy. The success of family planning depends on the involvement of couples but this hardly happen especially in rural areas. It is the belief, though erroneously among most males that the practice of family planning should be the sole responsibility of the female. The present study was a community based cross sectional study with the objective to assess challenges in involvement of male spouse in family planning program in rural areas.Methods: This is a community based and cross-sectional study was undertaken in randomly selected 4 villages of Kashi vidyapeeth block, Varanasi. Total enumeration of women from the selected villages delivered within last 3 years was done and their husbands were interviewed by using a pre-designed, pre-tested interview schedule. Chi-square test was applied to find out any association between the variables. P<0.05 was considered to be statistically significant, data was analyzed with statistical package for the social sciences (SPSS) 20 trial version.Results: These preliminary findings are part of thesis shows that out of 130 interviewed respondents, majority (89.5%) had aware about family planning and two third (66.2%) of the respondents said that either they or their wives are using family planning. More than half of the respondents were aware about male sterilization but none of them were using male sterilization. Majority (77.7%) of the respondents said that human immunodeficiency virus-acquired immune deficiency syndrome (HIV-AIDS) and 45.4% were said that sexually transmitted diseases or sexually transmitted infections (STDs/STIs) can be prevented by use of condom. More than half (53.8%) of the respondents were sole of the decision maker regarding the use of family planning.Conclusions: The present study concludes that the majority of the respondents were awareness about the family planning but practices of family planning is low in the study area. Health workers should educate the eligible couples for use of contraceptive methods. Promotion of male contraceptive usage should be done by intense awareness campaigns.

Predictors of Male Sterilization among Eligible, Modern Method of Family Planning Users in India: Evidence from a Nationwide Survey

Background: Male sterilization despite being more cost-effective compared to female sterilization is opted by very few Indian eligible couple as family planning (FP) method. Aims & Objectives: To find out attributes of male sterilization among current eligible modern family planning methods users in India. Material & Methods: It was an observational study, cross-sectional in design based on fourth round of national family health survey (NFHS-4) 2015-16 men’s datasheet. There were in total 112122 data, of which 11772 sample population who had completed their family, been using modern methods of family planning and wife in reproductive age (15-49) were selected for analysis. Results: Among the study subjects, 377(3.2%) underwent male sterilization. In multivariable model those who were residing in southern India; Hindu by religion; scheduled caste (SC)/scheduled tribe (ST) by caste; belonged to lower quintile of wealth index; covered by a health insurance scheme; perceived ≤2 children as ideal number of children; husbands not working and employed seasonally/occasionally were more likely to undergo male sterilization adjusted with the age of husband, wife, their place of residence and property ownership status. Conclusion: Male sterilization in the sample population was significantly predicted by the region, religion, ethnicity, socioeconomic status, husbands employment status etc.

Intersecting Inequalities: Education, Race/Ethnicity, and Sterilization

Despite extensive evidence that fundamental causes of health, such as socioeconomic status (SES) and race/ethnicity, often interact, the potential importance of such interactions has received limited attention in the contraceptive use literature. Even fewer studies have explicitly considered how interacting systems of power may structure contraceptive use with an intersectional framework. Drawing on the female ( N = 8,744) and male ( N = 5,826) samples of the 2006–15 National Survey of Family Growth (NSFG), this study relies on an intersectional approach to examine if education gradients in female and male sterilization vary by race/ethnicity. For non-Hispanic white respondents, results confirm the negative education gradient in female sterilization, and positive gradient in male sterilization. For non-Hispanic black and Hispanic respondents, education gradients tend to be less steep for female sterilization, but steeper for male sterilization. This indicates that different forms of oppression combine, overlap, and intersect to shape individuals’ unique social positions and experiences—including their contraceptive use.