Vasectomy in Uttar Pradesh, India: Participatory qualitative research insights related to role of women

Objectives: To analyze women's role in acceptance of no-scalpel vasectomy (NSV) in Uttar Pradesh.

Background: Vasectomy use has significantly declined in India since the 1970s. While the national government has renewed its focus on vasectomy, acceptance in Uttar Pradesh remains low, at one-fourth of the national average.

Methods: Thirteen women and 10 men were recruited from villages and trained to carry out in-depth discussions with their friends and neighbors about family planning (FP) and NSV using an ethnographic research approach. During data collection, the peer researchers recorded detailed notes of each discussion, which were then discussed at an analysis workshop.

Results: FP decision-making was complex indicating a large difference in “ideal” versus “actual” practices. Both men and women reported the wife to be the primary initiator of FP use, without discussion with their husband or any other family members. This was attributed to the fact that she will face the physical and social inconveniences of obtaining an abortion when an unplanned pregnancy occurs. However, women feared both the impact of NSV on their husband's sexual performance and a loss of status in the community if people found out. The result is resistance to NSV as an FP option.

Conclusions: NSV acceptance may be improved by advocacy among women.

Implications: State governments need to redesign existing NSV-related messages and materials to reach women—the primary drivers of FP acceptance.