Female sterilisation at 36.5%, vasectomy at just 0.5%: Why India’s family planning burden still falls on women

The latest findings from the sixth National Family Health Survey (NFHS-6) have once again thrown light on an underlying imbalance in India’s approach to family planning. 

According to the survey, India’s Total Fertility Rate (TFR) has remained at 2.0 children per woman, below the replacement level of 2.1, while access to family planning services has improved, with the contraceptive prevalence rate increasing from 66.7% in NFHS-5 to 69.1% in NFHS-6.

However, the responsibility of contraception continues to be borne overwhelmingly by women. Sterilisation remains one of the most widely used methods of contraception in the country, but the disparity between male and female participation is striking. The survey reveals female sterilisation or tubectomy accounts for 36.5% of contraceptive use, whereas male sterilisation or vasectomy stands at just 0.5%, only marginally higher than the 0.3% recorded in NFHS-5.

The figures once again raise a persistent question: despite being a relatively simple and safe procedure, why does vasectomy continue to remain one of the least accepted family planning methods in India?

Why does male sterilisation continue to remain so low in India?

The low acceptance of vasectomy is not a recent phenomenon. In fact, studies suggest that male participation in family planning has been steadily declining over the past three decades, even as overall contraceptive use has increased.

A 2021 study examining four rounds of the National Family Health Survey between 1992 and 2016 found a marked decline in male sterilisation in India, from 3.5% in 1992-93 to just 0.3% in 2015-16. The researchers noted that family planning in India remains largely female-dominated, despite evidence that greater male involvement improves reproductive health and gender outcomes for women.

The study observed significant regional differences in the use of male sterilisation. Of the 640 districts analysed, only 21 recorded a prevalence of more than 2% for male sterilisation. Scheduled Tribe couples were found to be nearly twice as likely to adopt vasectomy compared with upper-caste groups. Couples from northern India were also significantly more likely to opt for male sterilisation compared with those from southern states.

The authors wrote, “Male involvement in family planning results in improved reproductive health and gender outcomes for women. In India, the use of family planning methods remains largely female-dominated.”

The study concluded that “a greater focus on increasing the use of male sterilisation and condoms is required in India to reduce the gender disparity in the use of family planning methods.”

Researchers suggest that the declining uptake of vasectomy cannot be viewed merely as an individual choice. Rather, it reflects deeper social norms that continue to place the burden of contraception on women.

This unequal burden was further highlighted by a 2022 study that explored covert contraceptive use among women. Analysing data from NFHS-3 and NFHS-4, the study found that the prevalence of covert contraceptive use rose from 15% in 2005-06 to 27% in 2015-16. Oral contraceptive pills emerged as the most commonly used covert method, followed by intrauterine devices (IUDs).

Researchers noted that a husband's attitude towards gender equality plays an important role in determining how openly couples discuss contraception and fertility preferences. Women whose husbands displayed low or moderately egalitarian attitudes were significantly more likely to hide contraceptive use compared with women whose husbands had highly egalitarian views.

The authors concluded, “The study reveals that husband’s low egalitarian gender attitude can be a potential barrier between spouses, preventing them from opening up about their fertility preferences and contraceptive needs to each other. A couple-oriented approach to family planning is needed so that both members of a couple can satisfy their fertility desires and preferences eventually.”

The findings point to a broader issue - that decisions around family planning are often shaped not just by access to services but also by gender norms, communication within marriages and prevailing social attitudes.

A more recent systematic review published in 2025 sheds further light on the reasons behind the poor acceptance of vasectomy in India. The review analysed 24 studies conducted across the country and identified five broad categories of barriers: fear, social issues, cultural issues, lack of knowledge and health-system-related factors.

The researchers noted that many men fear undergoing a surgical procedure and continue to associate vasectomy with loss of masculinity, sexual weakness and inability to work. Misconceptions regarding loss of libido and physical strength, particularly among daily wage earners and men involved in physically demanding occupations, were found to be common.

The review stated that men often “presumed the procedure would lead to loss of libido, physical weakness leading to income loss, and social stigma from community members.”

The researchers also pointed to inadequate awareness and poor counselling services as barriers to acceptance. According to the review, health education and financial incentives could help improve acceptance of vasectomy among Indian men.

Why does the burden of family planning continue to fall on women? 

Experts say that the gap between female and male sterilisation in India is not merely a matter of awareness but is rooted in long-standing social and cultural attitudes that place the burden of contraception on women.

Dr Prakrutha S., Consultant – Fertility and Reproductive Medicine, Aster CMI Hospital, Bengaluru,  said  that reproductive health and contraception are still viewed primarily as a woman's responsibility in many households. She noted that despite vasectomy being simpler, safer and less invasive than female sterilisation, misconceptions surrounding masculinity and sexual performance continue to discourage men from opting for the procedure.

Dr Santhosh Raj, Consultant – General & Laparoscopy Surgery, Male Infertility and Sexual Health, Motherhood Hospitals, Banashankari, Bengaluru,also agreed that the trend seen in NFHS-6 reflects broader societal norms. He observed that family planning has historically been treated as part of women's healthcare and that public health campaigns and reproductive rights initiatives have largely evolved around women's needs. Since women regularly visit healthcare facilities during pregnancy and childbirth, conversations around permanent contraception naturally tend to happen with them.

"Over time, this has created a notion that contraception is the role of females alone," he said.

What myths and fears keep men away from vasectomy? 

Both experts emphasised that some of the most persistent barriers are myths that have little scientific basis.

Dr Prakrutha explained that vasectomy only blocks the tubes that carry sperm and does not affect testosterone production, sexual desire, erectile function or a man's ability to perform physical work. She said many men wrongly believe that the procedure causes impotence, weakness or loss of masculinity.

"Another misconception is that vasectomy is a major surgery, whereas it is typically a simple, safe and minimally invasive procedure with a very high success rate as a permanent contraceptive method," she said.

Dr Prakrutha said that most men recover quickly and can resume their normal activities within a short period, making these fears largely unsupported by scientific evidence.

Echoing similar concerns, Dr Santhosh noted that vasectomy is often confused with castration, leading many men to fear that they will lose their virility or physical strength.

"These notions are entirely unfounded from a medical standpoint. Vasectomy entails sealing the tubes through which sperm travels and has nothing to do with testosterone levels, the hormone responsible for virility and strength," he said.

He added that the procedure does not affect sexual performance or endurance, yet many men continue to fear that they will be unable to perform manual work after undergoing surgery.

Awareness alone may not be enough to bridge the gap

Experts believe that lack of awareness is only one piece of the puzzle. Deeply ingrained gender norms, social stigma and mistrust surrounding sterilisation continue to influence men's decisions.

Dr Prakrutha said that family pressures and misconceptions passed down through generations often reinforce the idea that contraception is a woman's responsibility. Concerns about how relatives and society may perceive men who undergo vasectomy further discourage acceptance.

"Increasing vasectomy acceptance requires more than education alone; it requires addressing cultural beliefs, promoting shared responsibility in family planning and building confidence in healthcare systems through consistent counselling and community engagement," she said.

Dr Santhosh pointed out that fears of social judgement are often stronger than lack of information. He said some men worry that undergoing vasectomy may make them appear less masculine in the eyes of peers and family members.

He also highlighted that “memories of coercive sterilisation campaigns in earlier decades have left a lingering mistrust of family planning surgeries among certain sections of society, making men reluctant to participate despite being aware of the procedure's safety.”

What can help increase male participation in family planning?

Experts said that changing the situation will require shifting the conversation from women's health to family health.

Dr Prakrutha stressed the need for public health campaigns that actively target men and address myths related to fertility and sexual health through evidence-based information. She said counselling should involve both partners so that family planning is viewed as a shared responsibility rather than solely a woman's concern.

Community leaders, healthcare professionals and men who have themselves undergone vasectomy can play an important role in normalising discussions and reducing stigma, she added. Workplace awareness programmes and outreach initiatives could also help reach men who may otherwise have little interaction with reproductive health services.

Dr Santhosh agreed that awareness campaigns must speak directly to men and avoid judgmental messaging.

"A transformation must occur from women's health to family health. Incorporating discussions on vasectomy into regular prenatal appointments for couples and using male healthcare practitioners or satisfied clients in the community as spokespersons can help build trust in the process," he said.

Both experts agreed that long-term change will depend not only on expanding access to services but also on promoting gender equity and encouraging men to take a more active role in reproductive health decisions.

This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS