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Sterilization:
What Doctors Don't Know
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.
– Radha Rastogi
April 7, 2002
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By arrangement with
Womens Feature Service
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