Men and Family Planning : A Population Day Reimagination

The 11^th Common Review Mission report of the National Health Mission released recently, reiterated what is common knowledge in India, that women bear the brunt of family planning responsibilities in this country. Since the days of the Emergency, when men had been taken forcibly from the streets and sterilized, the family planning programme has been squarely directed at women. Following the success of the male sterilization camps from Kerala and Tamil Nadu in the 1970’s, the female sterilization programme also adopted the camp approach, even though the female sterilization operation is a completely different proposition in terms of technical quality and competencies required. The introduction of the laparoscope made the tubal ligation operation appear to be the most simple among surgical techniques, and doctors in India went on record breaking sprees before failures, complications and deaths brought issues of quality to the fore. It has required the Supreme Court to make orders in two cases, Ramakant Rai anr vs UOI ( 2003) and Devika Biswas anr UOI ( 2015)  and the quality of the programme is still not fully assured. Considering the levels of gender inequality, it is possible that till women remain the targets of the programme, the quality will remain suspect.

The relationship between family planning and development is a long one. The initial participation of men in India’s family planning programme was part of the post-Independence national building thrust. I have met many older men in rural India the 1980’s and 90’s who had mentioned this with pride. Clearly they were not the ones who had faced the wrath of Sanjay Gandhi’s misplaced enthusiasm. Much later when the government realized that the family planning programme had become completely lopsided, and when gender issues became more commonly discussed after the International Conference on Population and Development ( Cairo 1994) and Fourth World Conference on Women (Beijing 1995), men were difficult to attract to the programme. A common myth has been that operations weaken men, but more common is the fact that women are concerned with failure. If the woman’s operation fails and she becomes pregnant, she does not face any social stigma but has to go through one more pregnancy. However if the man’s operation fails, and isolated reports indicate we do have very high failure rates for sterilization in India, the woman stands to be blamed possibly for having sex with someone else, because the husband is assumed sterile. This can have disastrous consequences for women in a country where male honour is closely related with women’s virginity and faithfulness.

Once men were freed from the ‘nation building’ prerogative, the business of family planning has become completely a women’s affair, and has nothing to do with the circle of men’s concern. If you look at family relationships and reproduction in India, especially in those states where Total Fertility Rates (TFR), or the number of children each woman has, is high, it is clear that men and women often inhabit different worlds. The men are in the public domain, while the women are either inside the house or behind long veils. Men are not even expected to play any childcare roles, other than toughen boys to become men. Daughters are isolated from their fathers, with little scope for any parental intimacy. The main concern of the father remains the daughter’s virginity which is closely associated with the man’s honour, and the consequence is early marriage. In the marital home the daughter-in-law is a domestic worker, a role she is prepared from early on in her natal home, and a successful breeder. Success being related to her ability to bear ‘sons’. It is not surprising therefore that early childbearing is a key marker of a successful daughter-in-law among all classes in India, because marriage is essentially an arrangement for carrying on the family line within strict ‘caste’ parameters. Marriage being essentially a family affair in large parts of rural and even urban India, the young couple hardly has time to develop close interpersonal intimacies. Children also belong to the family, women do the reproduction so the arrangement through which women manage their contraceptive needs falls into this overall pattern.  When children are born, the world they inhabit includes mothers, aunts, grandmothers and grandaunts, and the father even if interested has to be in very peripheral roles. The main role of the men is to remain on hand to take economic decisions regarding costs of care during pregnancy, child birth or the post-partum period and to ensure that the women can be taken to the hospital if and when the need arises. With men increasingly migrating out of villages, the father is often absent when his child is born.

The image of the family as a closely knit unit of people with blood and marital ties and deep interpersonal and intimate relationships is not one which is true for much of India’s rural families. Yes there are blood and marital ties, which creates kinship relationships and these have high value especially for men. Men and women have clear and complementary roles to perform and boys and girls are socialized to perform these roles. The levels of intimacy that is assumed in the middle class colonially influenced imagination do not usually exist in these spaces, especially in the joint and extended families. On a somewhat different note it is not surprising where interpersonal intimacies are so limited, levels of domestic violence and forced sex in marriage are as high as they are in India.

To create a male interest in family planning in India will require creating an interest within the existing framework of hegemonic masculinities which men inhabit or restructure social relationships at the family level to create new levels of male engagement within the family. The rhetoric of nationalism or superior race or religion as the imperative for contraceptive use or ‘selective breeding’ creates an ethos for male engagement which is clearly within a framework of hegemonic masculinities and has been done in the past. Shades of this argument do come up in the framing of population policies even in states in India from time to time. But this can never be a logic for promoting male participation. The current state policies within the ‘Mission Parivar Vikas’ continue to be driven by the logic of financial incentives without creating a clear vision of the man or father within an intimate family space.

The Centre for Health and Social Justice (CHSJ) has over the last ten years and more been working with men on issues of gender justice and one of the areas which has shown clear signs of promise is men’s engagement within the family. With the larger socio-economic changes which are upon us, older social tropes are giving way. With increasing women’s literacy and empowerment the stress on relations between women and men who are less adapted to change are high leading to greater contests and to violence inside and outside the household. CHSJ has worked with men in hundreds of villages in the states of UP, MP, Rajasthan, Maharashtra and Jharkhand, and in all these places men and women count on improved and more intimate relationships in the family as a key dimension of change. This leads to greater involvement of men as fathers and spouse, participating in household work, childcare as well as taking contraceptive responsibility.  Even though there is still some hesitation in adopting vasectomy, which is the most important concern for the state, men are being more consistent in their use of condoms as well as supporting women in their use of contraceptives. The most important change that we have seen is that spacing among children has increased, and couples are using contraceptive even before the first child has been born. This is extremely important as breaks down the imperative that women face in proving that they are fertile as soon as possible after marriage. An important by product of this male involvement has been women reporting better sex, a rare consideration for a family planning programme!