Journal of Medical Society

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 34  |  Issue : 3  |  Page : 139--143

A community-based study to assess the perceptions and barriers in utilization of no-scalpel vasectomy among married men in a rural area of South India


Prateek Saurabh Shrivastava1, Saurabh RamBihariLal Shrivastava2,  
1 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Tiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603 108, Tamil Nadu
India

Abstract

Background: India is the second most populous country in the world after China. In 1992, the government introduced an innovative technique “no-scalpel vasectomy” (NSV), a simpler, safer, and cheaper method aimed at increasing male participation in family planning. Despite the many advantages over female sterilization techniques, NSV still accounts for <1% of all the family planning methods used in India. Hence, this study was conducted among married men in a rural area to assess their knowledge and perceptions regarding NSV and identify various barriers in utilization of NSV. Materials and Methods: A community-based cross-sectional descriptive study was carried out for 6 months in the rural field practice area of a tertiary care hospital in Chengalpet district among a total of 170 married men in the age group of 21–60 years. Systematic random sampling was used to identify the study participants, and all the eligible participants were interviewed using a pretested semi-structured schedule. Data entry was done in Microsoft Excel, and analysis was done using the Statistical Package for the Social Sciences, version 23. Results: Good knowledge level about NSV was found in only 21 (12.4%) participants. Among the 170 study participants, only 2 (1.2%) had undergone vasectomy. The most common barriers to utilization of NSV were found to be availability of alternative methods of contraception by 136 (80%) participants followed by misconceptions about the procedure of NSV in 134 (78.8%) participants. Conclusion: The study highlights the urgent need to overcome the misconceptions and sociocultural concerns not only regarding NSV but also about the importance of male involvement in family welfare by targeted interventions in order to boost the acceptance of this simpler terminal contraception method.



How to cite this article:
Shrivastava PS, Shrivastava SR. A community-based study to assess the perceptions and barriers in utilization of no-scalpel vasectomy among married men in a rural area of South India.J Med Soc 2020;34:139-143


How to cite this URL:
Shrivastava PS, Shrivastava SR. A community-based study to assess the perceptions and barriers in utilization of no-scalpel vasectomy among married men in a rural area of South India. J Med Soc [serial online] 2020 [cited 2021 Jun 21 ];34:139-143
Available from: https://www.jmedsoc.org/text.asp?2020/34/3/139/315099


Full Text



 Introduction



India is the second most populous country in the world after China, and despite occupying only 2.4% of world land area, India supports over 17.31% of the world population. It is also projected that India will be the world's most populous country by the year 2022.[1] In order to tackle this population explosion, the Government of India launched the National Family Welfare Program in 1952. Under the program, male and female sterilization techniques are one of the most reliable and safest methods of family planning. In 1992, the government introduced an innovative technique “no-scalpel vasectomy (NSV),” a simpler, safer, and cheaper method aimed at increasing male participation in family planning.[2]

NSV is a new sterilization technique that is a safe, convenient, and sophisticated technique which requires no incision, no stitches but only a small puncture. The NSV is less expensive than tubectomy in terms of equipment needed, duration of hospitalization, and doctors' training. Postoperative complications (viz. bleeding, hematomas, and infection) are fewer with NSV compared to the traditional incision method. Further, the vasectomized men can resume sexual activity more quickly.[3],[4]

According to the 2005–2006 National Family Health Survey-3 (NFHS-3), the acceptance of NSV in India reduced from about 2% in NFHS-2 to <1% in NFHS-3 in both urban and rural areas.[5] Furthermore, NFHS-4 report for the state of Tamil Nadu states that the current usage of male sterilization is very minimal.[6]

Despite having so many advantages over female sterilization techniques and monetary incentives being provided by the government, NSV still accounts for <1% of all the family planning methods used in India. Various sociocultural factors (viz. myths and misconceptions about vasectomy, lack of adequate contraceptive knowledge, and regressive thinking that family planning is only women's perspective) play an important role in decision-making regarding family welfare.[7] Hence, this study was conducted among married men in a rural area to assess their perceptions regarding NSV and identify various barriers in utilization of NSV as a contraceptive measure among them.

 Materials and Methods



Study settings and sample size

A community-based cross-sectional descriptive study was carried out for 6 months in the rural field practice area of a tertiary care hospital in Chengalpet district among all married men in the age group of 21–60 years. Currently married men having at least 1 child and those who are willing to give informed consent were included as study participants. The sample size was calculated using the formula, N = [INLINE:1] (Where in P = 45.6 on the basis of the result of a study done in West Bengal, India, which showed knowledge about NSV among married men as 45.6%, Q = 54.4, L [allowable error] = 8).[8] Thus, the sample size was calculated as 155, and assuming a 10% nonresponse rate, the final sample size was approximated to 170.

Study collection tool

A semi-structured schedule comprising the following parts (viz. sociodemographic parameters, knowledge about NSV, perception about NSV, and barriers in utilization of NSV) was prepared in English in order to meet the study objectives and subsequently translated into the local language (Tamil). This schedule was then pretested on 20 individuals to check for validity and understanding of the participants and suitably modified based on the results of a pilot study.

Data collection

Sembakkam village in the rural field practice area of a tertiary care institute comprises approximately 380 households. Using systematic random sampling, every second household was visited starting from the street across the Rural Health Training Centre. Every street of the entire Sembakkam village was covered systematically. Study participants were selected from the households based on the inclusion criteria. The selected study participant was the interviewed face to face using the pretested schedule after obtaining their written informed consent. Utmost care was taken to maintain privacy and confidentiality.

Study variables

The following parameters were assessed: sociodemographic parameters (viz. age, education, occupation, income, type of family, and number of children); parameters related to knowledge and perceptions about NSV (viz. awareness about NSV, source of information, awareness about cash incentive and insurance for complications, and advantages of NSV); and barriers in utilization of NSV (viz. lack of awareness, misconceptions, and family pressure).

Scoring system

The participants' knowledge and perceptions about NSV were scored using an arbitrary scoring system. Each correct response under knowledge and perception attracted one point, whereas any wrong or don't know answer attracted no point. Overall, a total score of six points was designed for assessing the knowledge and perception of the study participants. The participants were thus categorized as having poor knowledge (0–2 points), fair knowledge (3–4 points), and good knowledge (>4 points). Furthermore, for the assessment of the perception, the participants with >3 points and those with ≤3 points were categorized as having positive and negative perception about NSV. Socioeconomic class of the families was ascertained using Modified BG Prasad's classification.

Ethical considerations

Ethical clearance was obtained from the institutional ethics committee prior to the start of the study. Written informed consent was obtained from the study participants before obtaining any information from them.

Statistical analysis

Data entry was done in Microsoft Excel, and statistical analysis was done using the IBM Statistical Package for the Social Sciences Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. Frequency distributions were calculated for all the variables.

 Results and Observations



A total of 170 males were enrolled in the study. Out of these, the majority, i.e., 51 (30%), belonged to the age group of 40–49 years. The mean age of the study participants was 42.5. Majority of the participants, 144 (84.7%), were Hindu by religion, belonged to lower socioeconomic class, 89 (52.3%), and were engaged in semi-skilled occupation, 87 (51.1%) [Table 1].{Table 1}

Knowledge about NSV was assessed using an arbitrary scoring system. Good knowledge level was found in 21 (12.4%) followed by fair knowledge in 67 (39.4%) and poor knowledge level in 82 (48.2%). It was observed that 132 (78.9%) participants had knowledge about vasectomy, but only 51 (30%) participants were aware about NSV. Among the 170 study participants, only 2 (1.2%) had undergone vasectomy. It was evident that awareness with regard to monetary incentive and provision for insurance if pregnancy or any other complication occurs after vasectomy was very poor and found in only 11 (6.5%) and 7 (4.1%), respectively [Table 2].{Table 2}

Participants' perception about NSV was also assessed using an arbitrary scoring system. Positive perception was found among 69 (40.6%) followed by the negative perception among 101 (59.4%). Although 37 (21.8%) participants perceived that NSV was a simpler and cheaper procedure compared to tubectomy, the majority of the participants, 76 (44.7%), believed that it leads to loss of libido. In addition, only 24 (14.1) participants showed willingness to undergo NSV in the future [Table 3].{Table 3}

The most common barriers to utilization of NSV were found to be availability of alternative methods of contraception by 136 (80%) participants followed by misconceptions about the procedure of NSV by 134 (78.8%). Some of the participants, 47 (27.6%), firmly believed that there is no role of male involvement in contraception while others were not interested in undergoing vasectomy, 43 (25.3%), as none of the friends or relatives have undergone NSV [Table 4].{Table 4}

 Discussion



The Government of India has emphasized a cafeteria approach in its National Family Welfare Program in order to improve the utilization of various contraceptive methods based on active involvement of the eligible couples. Even though many information, education and communication as well as behavior change communication (BCC) strategies have been adopted for creating awareness about male sterilization technique, i.e., vasectomy, none of them have proved to be fruitful enough to increase its utilization among the Indian population. NFHS-4 report of the state of Tamil Nadu states that the current usage of male sterilization is very minimal.[6] Similar result was obtained in the present study where the utilization rate of NSV was found to be only 1.2%. A study done in Punjab also concurs with our finding which reported the utilization rate as 2%.[7] This reiterates the fact that NSV is not utilized as a contraceptive method not only in Tamil Nadu but also in other states of India.

In our study, poor knowledge level about NSV was found in almost half of the study participants, i.e., 82 (48.2%). Similar results were obtained from other studies conducted in different parts of India.[3],[7],[8] This shows that there is in general dearth of knowledge regarding NSV in the Indian male population. In the present study, it was observed that although 37 (21.8%) participants perceived that NSV was a simpler and cheaper procedure compared to tubectomy. Similarly, in a study conducted in Punjab, India, it was observed that more than half of the males believed that tubectomy procedure was simpler and without major side effects.[7] This shows the lack of adequate knowledge among the male population regarding the male sterilization technique. It also emphasizes the fact that BCC techniques focused on the advantages of NSV over tubectomy should be conducted regularly targeting the currently married male in order to improve their awareness about NSV.

In the current study, majority of the participants, 76 (44.7%), believed that NSV leads to loss of libido and only 24 (14.1%) participants showed willingness to undergo NSV in the future whereas the study done in Punjab showed that even when almost half of the respondents approved about male sterilization as an option for contraception, only one-fifth of them were willing for it.[7] This highlights the knowledge application gap prevalent in the society which has led to reluctance to undergo a simpler procedure like NSV.

The most common barriers to utilization of NSV in this study were found to be availability of alternative methods of contraception by 136 (80%) participants followed by misconceptions about the procedure of NSV by 134 (78.8%). Some of the participants, 47 (27.6%), firmly believed that there is no role of male involvement in contraception while others were not interested in undergoing vasectomy, 43 (25.3%), as none of the friends or relatives have undergone NSV. Similarly, in a study conducted in Turkey, sociocultural factors, viz. contraception is the responsibility of females, loss of status for sterilized males in the family and society, and loss of strength, were reported to be major barriers for vasectomy.[9] In another study done in Punjab, major barriers cited were perception among men that tubectomy was a simpler procedure, fear of failure of vasectomy, and also the willingness of female partners to undergo tubectomy.[7]

Furthermore, other studies done in Uttar Pradesh and other parts of North India report sociocultural barriers as major concerns toward utilization of NSV.[8],[10] Fear of surgery and loss of wages due to prolonged bed rest were also some of the barriers reported from a study done in West Bengal, India.[11] Thus, it is clearly evident that majority of the barriers are related to sociocultural factors and misconceptions toward vasectomy which need to be bridged by means of effective advocacy communication and social mobilization activities directed to the target audience of not only married males but also their partners. The present study had its limitations with regard to the generalizability of the results as it reports the opinion of the participants only from a rural area of South India.

 Conclusion



This study identified the various perceptions among married men about NSV. It also highlighted a range of sociocultural barriers and misconceptions about NSV leading to its underutilization among men. Thus, it is high time we realize the need to overcome the myths and social concerns not only regarding NSV but also about the importance of male involvement in family welfare by targeted interventions in order to boost the acceptance of this simpler terminal contraception method.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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