Sterilization of women (Tubectomy) is the most common contraceptive in India, and as many as six million women are sterilized annually. The average age is 25.5 years, and 77% have never tried other contraception. The method is most common among women with low education, who have more than three children and with those who have already given birth to boys.
The government of India has in recent decades focused on female sterilization to reduce population growth, but has placed little emphasis on alternative contraception and contraception for men. In the ongoing fight against population growth, the authorities are now trying to reverse this trend.
In 1950, the total fertility rate in India was 6.4 children per woman. In 2011, it had dropped to 2.6. However, the target was 2.1 children per woman by 2010, which was considered necessary to keep the population stable. Economic growth, education of women, better health services and targeted contraceptive programs are among the most important factors that have contributed to the decline in the birth rate.
Since the first family planning program in 1952, the Indian authorities have implemented a number of different measures aimed at reducing population growth. From the late 1960s, the state intensified the program and organized vasectomy camps (sterilization of men), where up to 60,000 procedures were performed per week. During the state of emergency 1975 - 1977, Indira Gandhi (1917 - 1984) launched a program that was to be a "frontal attack on the problem of population", and which included forced sterilization of men with more than three children. This was a cruel and inhumane measure.
In 1977, the country got a new prime minister, and the new program focused on motivation, education and volunteering. The latest family planning program "National Population Policy" continues to focus on information and guidance, so that the population will be able to make voluntary and informed choices.
A study shows that 16% of Indian men believe that contraceptive use in women is a sign of complete sexual promiscuity. With a very varied level of education in rural areas, moreover, women do not always have the prerequisites to understand the health information that is given to them.
Sterilization - a simple solution?
Financial compensation is given to those who are sterilized at public and approved private clinics, and to health personnel who motivate and inform or perform the procedure itself. In the so-called high-focus states with the highest fertility rate, men receive 1100 rupees (approx. 130 Norwegian kroner) for sterilization, while women receive 600 rupees (72 Norwegian kroner) to permanently prevent future pregnancies.
Private doctors who perform sterilization at public clinics also receive money for each sterilization performed. This is a measure to increase activity at public health clinics that have equipment, but lack qualified health personnel. One of the criticisms of money incentives is that they may influence the health workers' assessment. Studies have also shown that some of the poorest have used this as an income, which is explained by the fact that the compensation is much higher than the average daily wage in rural areas.
Another study shows that women would not necessarily be sterilized if they had become aware of other contraceptives. Up to 85% of those motivated for sterilization did not receive sufficient information about alternative contraceptives. The study provided detailed information on various contraceptives, and the result was that only 17% of those informed would choose sterilization, while 80% wanted reversible methods, such as birth control pills and IUDs. This is in stark contrast to the number of tubectomy procedures performed each year in India.
In India, there is now a need for better information and offers of contraceptive methods adapted to each individual, in addition to the need to make demands for increased involvement of men. When more women in India now receive an education, they will probably see a change in the use of contraceptive methods.
In India, women are often declared as "a property of her husband" - hence, choices becomes few!
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