India has reached below-replacement fertility, yet the burden of contraception remains overwhelmingly on women. Examine the causes and suggest measures for greater male participation.

India's fertility has fallen below replacement level, but the gain has not shifted the gender burden. NFHS-6 (2023-24) shows that 36.5% of currently married women rely on female sterilisation, against just 0.5% for male sterilisation. That is roughly 73 women for every man [1].

Causes of the Skew

• Social norms: contraception is treated as "women's work", yet women have limited say in the couple's decision.
• Myths and historical stigma: men fear losing virility, and the memory of Emergency-era coercion still keeps them away from vasectomy.
• Programme design: services reach women all year through ASHA/ANM networks. The push for men is mostly one Vasectomy Fortnight each November [2].
• Supply-side tools for a demand-side problem: No Scalpel Vasectomy (NSV) training and enhanced compensation deal with access and cost [2]. They do not change beliefs, so male sterilisation stays at 0.5% [1].
• Narrow male method basket: men have only condoms and vasectomy. WHO has only now set its first benchmarks for reversible male contraceptives [1].
• Falling method quality: modern-method use fell from 56.4% to 52.7%, while traditional methods rose about 6 points [1]. When these methods fail, women carry the pregnancy.

Measures for Greater Male Participation

• Year-round couple counselling: build vasectomy counselling into routine frontline visits, so husbands hear it and not only wives.
• Male champions and myth-busting: use men who have had NSV, and male health workers, to present it as a quick procedure without a scalpel [2].
• Widen male options: prepare testing, approval and delivery pathways for reversible male contraceptives, in line with WHO benchmarks [1].
• Privacy-based access: expand condom boxes in health facilities and home delivery of contraceptives [2].
• Behaviour change communication: use schools, workplaces and male-dominated spaces to present family planning as a shared responsibility.
• Choice, not targets: male participation must rest on informed consent, never quotas, so that past coercion is not repeated.

The skew comes less from a shortage of services than from social norms, myths and a delivery system built around women. Shifting the focus from supply to demand can make contraception a truly shared responsibility. That means counselling couples, widening male options and rebuilding trust. This would fulfil the rights-based vision of reproductive autonomy and the gender-equality goal of SDG 5.