Less than one in 10 men use condoms in India, while nearly four in 10 women undergo sterilisation to avoid pregnancy, according to the latest National Family Health Survey-5 (2019-2021), which also shows that female sterilisation continues to be on the rise including in urban India.
Only 9.5% men used condoms but 37.9% of women underwent sterilisation, according to the NFHS. Though condom use in urban India is better than rural parts, the overall trend is vastly similar — 7.6% men in rural India and 13.6% men in urban India use condoms, while 38.7% women in rural India and 36.3% in urban India underwent sterilisation.
Female sterilisation has gone up for the entire country from 36% in NFHS-4 (2015-2016) to 37.9% in NFHS-5. In 19 of the 36 States/UTs, female sterilisation increased in NFHS-5 compared to NFHS-4. The rise was more than 5% points in 11 States and UTs. The States with the highest increase in female sterilisation were Bihar (14.1% points to 34.8%), Goa (13.6% points to 29.9%) and Madhya Pradesh (9.7% points to 51.9%) .
In 23 of the 36 States/UTs for which data were available, condom use was less than 10%. The State with the highest condom use was Uttarakhand (25.6%) and the Union Territory Chandigarh (31.1%). The silver lining, however, is that use of condoms has gone up between the two surveys — from 5.6% to 9.5%.
But the refusal to use condoms is not due to lack of awareness — NFHS 5 data shows that 82% men were aware that consistent use of condoms can reduce the chance of getting HIV/AIDS. Studies, however, show that promotion of condoms for protection from HIV/AIDS creates confusion in their acceptance among married couples.
“Condom usage is also low because family planning is considered the responsibility of women. For men, sex stands purely for pleasure. For women, it is often either about procreation, or involves the fear of getting pregnant. Men also believe that condoms reduce pleasure. According to NFHS-4 data, 40% of men think it is a woman’s responsibility to avoid getting pregnant,” says Poonam Muttreja, Executive Director, Population Foundation of India.
“A reason for high prevalence of female sterilisation is widespread misinformation on male sterilisation. Male sterilisation’s share in family planning methods has always been extremely low, despite the fact that it’s safer, quicker and easier. People believe that it can affect their virility and weaken them physically, rendering them unfit to work. These are myths and misconceptions that need to be addressed,” she says.
Other barriers include lack of privacy in stores while buying condoms, perceived ineffectiveness, less comfort, lack of sexual satisfaction with condoms and husband’s alcohol use, according to a study published in the Indian Journal of Medical Research in 2014 and authored by Balaiah Donta.
Female sterilisation is also the preferred choice of contraception than other reversible methods such as pills (5.1%), injectables (0.6%) and intra-uterine devices (2.1%).
“Most women tend to think of family planning not for delaying and spacing but for completing the family size, though the trend is changing,” Vinod Manning, CEO, Ipas Development Foundation and CAG member for Pratigya Campaign.
“We need to change behaviours and social norms. Mass media campaigns are needed to promote a greater involvement of men in family planning. Social and behaviour change communication should not only promote condoms but also break gender stereotypes and position men as responsible partners. Values such as spousal communication and shared decision making should be inculcated. We should also try to reach people when they are young and when it’s easier to change mindsets,” says Ms Muttreja.