Indian birth-control effort finds mostly women in line

Faced with the prospect of India's 684 millions doubling themselves within 31 years, Indian officials are searching out ways to get the country's lagging family-planning program back on the tracks.

Among their concerns is how to get Indian men, who have deserted the program in droves since India's bitter experience with forced sterilizations in the mid- 1970s, to accept the idea of vasectomies again.

Although the Indian government offers a full, free array of birth-control services, sterilizations are considered the only ultimately effective means of halting the population explosion in a nation of mass poverty and illiteracy.

But the volume and pattern of sterilizations here have shifted dramatically since the heyday of Prime Minister Indira Gandhi's authoritarian "emergency" rule of 1975-77, when men were the chief victims of local officials' zeal to meet and exceed sterilization targets.

Not only has the number of sterilizations plunged by three-quarters since the 1976-77 emergency peak of 8 million a year, but also the sex ratio has done a near-total turnaround.

Male sterilizations, or vasectomies, then accounted for 80 percent of the total. Now, 77 percent of Indians undergoing voluntary sterilization are women.

The turnaround has prompted concern that Indian men have abandoned family-planning responsibilities to their womenfolk, even though experts agree that vasectomies are safer, cheaper, easier, and more effective than any form of female sterilization.

"Men have the notion that they will become impotent and that they will not have the strength to do heavy work," explains an Indian physician. "It's a wrong notion but it's there."

The relative dearth of vasectomies has sparked proposals, such as the one offered by 200 Indian state and national legislators recently that men should get much higher incentive payments for undergoing sterilizations that women do.

And among India's small feminist community, the phenomenon has touched off some controversy and much soul-searching.

There is anger that Indian men are seemingly off the family-planning hook, mixed with pride that women have kept the family- planning effort alive through the doldrums of the last four years by coming forward for birth-control services.

There is relief that new techniques such as laparoscopy have made female sterilizations quicker and easier, and a sense of resignation that, for at least a few more generations, women will have to shoulder the burden of birth-control responsibilities in India's maledominated society.

"My feminism is becoming mellowed," confesses Rami Chhabra, a program director for the privately funded Family Planning Foundation and prolific writer on birth control and population problems in India, the world's second most populous nation.

"I've come to realize you cannot impose what seem to be strong feminist principles on a society that is not ready for them," Mrs. Chhabra declares.

"It would take generations for women here to reach a point where they say, 'No, it's not going to be me who goes in for a sterilization.'"

What's more important, she argues, is that women who want sterilization or any other form of birth control get it -- complete with quality service, courteous treatment, and adequate medical follow-up.

"The burden of family planning should be a shared one and not fall on women alone," says Mrs. Gandhi, who last week said it was time for India to revitalize its family-planning efforts "while in a state of shock." The shock came from provisional 1981 census results that showed unchecked population growth over the past decade despite massive expenditures for family planning.

Some states are already trying higher financial incentives for male sterilizations -- with little success. In Rajasthan, for example, a male undergoing vasectomy gets $17 -- a generous incentive exceeding a month's pay for a farm laborer.

A woman gets only $13 for sterilization by laparoscopy, an outpatient procedure, or $15 for a tubectomy involving several days' hospital stay.

Rajasthan is a state known for its zeal during the era of compulsory sterilization -- a reputation dramatically illustrated by official state figures. During the peak emergency year of 1976-77, vasectomies soared sixfold to 323,484.

The following year, after Indian voters had turned Mrs. Gandhi's government out of office, Rajasthan's vasectomies plummeted to only 1,948.

In the aftermath, Rajasthani men continue to avoid sterilization. Last year only 6,563 volunteered for vasectomies -- less than one- third of pre-emergency levels. At the same time they sent their wives for sterilizations in increasing numbers -- nearly 94,000 last year compared to 36,318 the year before. A woman must have her husband's consent for the operation. Men need no such assent from their wives.

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