The fact that mere awareness of family planning methods is not tantamount to accurate knowledge has once again been proven by a study conducted by the Centre for Operations Research and Training, Mumbai. This study looks at attitudes towards male and female sterilization in the states of Uttar Pradesh and Uttaranchal.
This study, which collected both quantitative and qualitative data at the micro level in the districts of Gorakhpur in Uttar Pradesh and Almora in Uttaranchal, also reveals that there are significant misconceptions in the minds of both the community and health service providers - including doctors - when it comes to sterilization.
For starters, both men and women mistakenly believe that female sterilization is easier to perform than male sterilization, with fewer chances of complications and failure. This is bolstered by their highly gendered belief that vasectomy causes weakness and loss of virility.
The findings, however, do dispel one popular belief -- that men oppose vasectomy. On the contrary, in both Gorakhpur and Almora it was found that it is the women who are averse to exposing their men-folk to surgical travails. Interestingly, 81 per cent of the men in a random sample in both districts favored vasectomy, while only 43 per cent women favored it.
At another level, the findings of the study reveal that there is greater awareness about the newer methods of sterilization in Almora as compared to Gorakhpur. While awareness of traditional methods like vasectomy, tubectomy, condom, pill and foam tablets is roughly the same in both these areas, newer methods like No-Scalpel Vasectomy (NSV) and mini-laparascopy are better known in Almora. The reasons for these are easy to find. Almora, even though relatively isolated because of the hilly terrain, has been more open to outside influences as compared to Gorakhpur which still remains backward both in terms of the information available and traditional mindsets.
The men in Almora also have a greater knowledge about female contraception than their counterparts in Gorakhpur, who by and large dismiss family planning as 'women's business'. Consequently, the men in Almora are more involved in choosing the right contraceptive method.
The study, however, found that only a quarter of the couples in both the districts were aware of all the methods of sterilization. On the basis of this finding, experts maintain that there is still tremendous scope to increase awareness about contraception in both the districts. This in turn will lead to knowledge about the methods, which will consequently enable informed choice.
Unfortunately achieving this is not going to be an easy task since many health providers themselves are still bogged down with preconceived views that do not always reflect ground realities. For years they have opposed using male doctors for female sterilization and obstetric care on grounds of cultural unacceptability. While this is basically true, the ground reality is that this preference is not total: obviously in a crisis, or if no female doctor is available, both men and women are amenable to male doctors.
Despite the fact that a majority of the doctors and paramedics have been trained in family planning methods over the last two years, knowledge of newer methods like NSV was found to be abysmally low amongst them. Though the doctors and paramedics had heard of this method, not one in seven doctors was able to describe the procedure correctly, or to identify areas for incision correctly. Obviously then, they cannot promote a method of which they are ignorant themselves.
Grassroots paramedics advising people on sterilization and contraceptive choices also tend to choose the easy way out. "It is easier to counsel women," says one Auxiliary Nurse Midwife (ANM) in Gorakhpur. "They are more likely to listen than men." Adds another from Almora: "Even if we counsel men on sterilization, they will not go in for it. In the bargain the couple will not opt for sterilization at all. It is in the woman's interest -- and ours -- that some sterilization is adopted, so we advise female sterilization."
This means that in practice, tubectomy is being promoted at the cost of vasectomy because it is the path of least resistance. This also means that male sterilization, which requires more persuasion and attitudinal change, continues to remain on the backburner.
One thing made clear by the study, which only aims at presenting its findings without drawing any conclusions or analyzing the findings, is that working with the community on sensitive issues like family planning is a complex and complicated exercise. At the same time, the study also highlights the attitudinal weaknesses of the health functionaries who, despite being trained, cannot work effectively according to individual needs based on local specificities.
According to experts, the data collected during this study, which was conducted last year, could provide adequate basis on which to draw broad generalizations. It also raises some very relevant local specificities and comparison points, which could be invaluable in future local and policy planning.