Gender disparities in contraceptive use and sterilisation

1. At a Glance

• In India, women carry almost all of the contraceptive burden. In NFHS-6 (2023-24), 36.5% of women reported sterilisation, against only 0.5% of men reporting male sterilisation [2].
• Total fertility has fallen below replacement level, but that demographic gain has not changed the gender imbalance. Women increasingly take up both temporary and permanent methods [2].
• The topic links population policy, women's reproductive autonomy, the health system and gender norms. It is core material for GS-I (society/women) and GS-II (health, welfare schemes).

2. Why in the News

• The World Health Organization (WHO) issued new guidelines on expanding contraceptive options. For the first time, it set benchmarks for a new generation of reversible male contraceptives [2].
• NFHS-6 (2023-24) data showed the gender skew in sterilisation persisting and a sharp rise in traditional methods. The Hindu analysed this on 29 September 2026 (Chennai edition, p. 9) [2].

3. Background & Evolution

• 1952: India launches the National Family Planning Programme, among the first in the world [GK – verify].
• 1975-77 (Emergency): coercive mass sterilisation drives, many targeting men. The backlash moved policy from "family planning" to "family welfare", and male sterilisation largely collapsed afterwards [GK – verify].
• 1994: the ICPD (Cairo) moves the global approach from targets to reproductive rights [GK – verify].
• 1996: India adopts the Target-Free Approach (Community Needs Assessment Approach) [GK – verify].
• 2000: the National Population Policy sets TFR 2.1 as a medium-term goal [GK – verify].
• Ongoing: an annual "Vasectomy Fortnight" is held in November in all States to promote male participation. Providers are trained in No Scalpel Vasectomy (NSV) [1].
• NFHS-5 (2019-21) → NFHS-6 (2023-24): unmet need falls, overall use rises, but the method mix becomes more skewed towards women [2].

4. Core Static Facts

Indicator (currently married women 15-49)	NFHS-5 (2019-21)	NFHS-6 (2023-24)	Source
Any contraceptive method	66.7%	69.1%	[2]
Modern methods	56.4%	52.7% (fell)	[2]
Traditional methods (rhythm/fertility-awareness, withdrawal)	—	+6 percentage points, the largest rise of any method	[2]
Unmet need for family planning	—	Down 1 percentage point	[2]
Female sterilisation	—	36.5%	[2]
Male sterilisation	—	0.5%	[2]

• Replacement-level fertility is a TFR of about 2.1. India's fertility is now below it [S2; the 2.1 figure is GK – verify].
• Unmet need means women who want to delay or stop childbearing but use no contraception [GK – verify definition].
• Modern methods: sterilisation (male/female), IUCD, pills, condoms, injectables. Traditional methods: rhythm, withdrawal [S2 for the traditional ones].
• Nodal ministry: Ministry of Health & Family Welfare (MoHFW). The Vasectomy Fortnight and NSV training come under its family planning programme [1].
• NFHS is conducted by MoHFW, with IIPS, Mumbai as nodal agency [GK – verify].

5. Multi-Dimensional Analysis

Social / Gender

• The ratio of female to male sterilisation is about 73:1 (36.5% vs 0.5%) [2]. Norms that treat contraception as "women's responsibility" are entrenched.
• Male reluctance is driven by myths about vasectomy (loss of virility or strength) and by the historical stigma left by the Emergency-era coercion [GK – verify].
• Women carry the surgical risk, recovery burden and complication risk, often under limited decision-making power.

Health / Scientific

• Vasectomy (NSV) is simpler, quicker and safer than tubectomy, yet it is barely used [S1 for NSV; comparative safety GK – verify].
• Modern-method use fell (56.4% → 52.7%) while traditional methods rose 6 pp [2]. Traditional methods fail more often, so unintended pregnancies could rise.
• WHO's benchmarks for reversible male contraceptives could widen men's choices beyond condoms and vasectomy [2].

Governance / Administrative

• Programme delivery leans on female sterilisation camps and ASHA/ANM networks that mainly reach women.
• Male-engagement efforts such as the Vasectomy Fortnight have made little difference to outcomes (0.5% in NFHS-6) [S1, S2].
• A "target-free" regime can still produce de facto sterilisation targets at district level [GK – verify].

Ethical / Rights-based

• Reproductive autonomy and informed consent sit at the centre. A shared-responsibility model matches the rights-based ICPD framework.
• Past sterilisation-camp tragedies raised concerns about the quality of care [GK – verify].

Demographic / Economic

• The fall below replacement fertility shifts the policy question from "how many" to "who bears the cost" and to quality of choice [2].
• Lower unmet need (−1 pp) signals progress, but it hides a worse method mix [2].

6. Recent Developments (last 12-18 months)

• NFHS-6 (2023-24) findings published: contraceptive prevalence 69.1%, modern-method share 52.7%, female sterilisation 36.5%, male sterilisation 0.5% [2].
• WHO guidelines on expanding contraceptive options, including the first-ever benchmarks for new reversible male contraceptives [2].
• The Hindu data analysis, 29 Sep 2026: "Gender disparities in contraceptive use and sterilisation" by Bindu Shajan Perappadan and Nitika Francis [2].

7. Prelims Hooks

• NFHS-6 reference period: 2023-24. NFHS-5: 2019-21 [2].
• NFHS-6 female sterilisation: 36.5%. Male sterilisation: 0.5% [2].
• Contraceptive use among currently married women aged 15-49 rose from 66.7% (NFHS-5) to 69.1% (NFHS-6) [2].
• Modern-method use fell from 56.4% to 52.7% [2].
• Traditional methods (rhythm, withdrawal) rose 6 percentage points, the largest change of any method [2].
• Unmet need for family planning fell by 1 percentage point from NFHS-5 [2].
• WHO has, for the first time, set benchmarks for reversible male contraceptives [2].
• Vasectomy Fortnight is observed every November in all States [1].
• No Scalpel Vasectomy (NSV) is the male sterilisation technique promoted under the national programme [1].
• India's fertility is now below replacement level [2].
• India started the world's first national family planning programme in 1952 [GK – verify].
• The Target-Free Approach was adopted in 1996 [GK – verify].

8. More People Use Contraception, but Fewer Use Reliable Methods

• All of the rise in use, and more, came from traditional methods
• Overall use rose by 2.4 percentage points (66.7% → 69.1%) [2].
• Modern-method use fell by 3.7 points (56.4% → 52.7%) [2].
• So the gap between the two grew from about 10 points to about 16 points. This matches the 6-point jump in traditional methods (rhythm, withdrawal) [2].

• In short, the headline rise does not mean more people moved to reliable methods. More people moved to methods that fail more often.

• The fall in unmet need partly comes from how it is counted

• Unmet need (women who want to delay or stop having children but use no method) counts only women using nothing.
• A woman who switches to withdrawal leaves the 'unmet' group, even though her protection is weak.

• So a 1-point fall in unmet need [2] can happen while real protection gets worse.

• How to read the numbers in an answer

• Quote contraceptive use, modern-method use and method mix (the share of each method in total use) together, never one alone.
• The quality question is simple: are people moving towards methods that work, or away from them?

9. Why Government Efforts for Men Have Not Moved the 0.5%

• The tools deal with supply and money, but the barrier is belief
• MoHFW's efforts for men are a yearly Vasectomy Fortnight, NSV training for providers, a '360 degree' media campaign and compensation for lost wages [1].
• Male sterilisation still stands at 0.5% [2].

• Wage compensation helps only a man who is willing but cannot afford a day off. It does nothing for a man who fears losing his strength or who sees family planning as 'women's work'.

• Two weeks a year cannot match a system built around women

• The male push is concentrated in one fortnight in November [1].
• Services for women run all year through the health workers who visit them.

• When a couple decides, the person who has been counselled and has an easy path to a service is almost always the woman.

• More trained providers does not mean more demand

• Training more doctors in NSV (No Scalpel Vasectomy, a quick method with no cut, done through a tiny puncture) [1] means more doctors can do it.
• It does not bring in more men who want it. A 36.5% vs 0.5% gap [2] shows the problem is not a shortage of doctors.

10. Who Carries the Risk When Something Goes Wrong

• The safety net pays after harm happens. It does not prevent the harm.
• The National Family Planning Indemnity Scheme (NFPIS) insures people against death, complications and failure after sterilisation [1].
• It also protects doctors and accredited hospitals from court cases in those situations [1].

• Since sterilisations are about 73 women for every man [2], almost all the surgical risk this scheme covers falls on women.

• Protecting providers is a trade-off

• Indemnity (protection from being held liable) keeps doctors willing to run sterilisation services.

• But when a provider knows the insurer will pay, a legal case pushes less on quality of care. The woman gets money, not accountability.

• Unintended pregnancies from failed methods also fall on women

• Traditional methods rose by 6 points [2]. When they fail, it is the woman who carries the pregnancy and its health risks.

11. The Case for 'Leave It to Choice' — and Where It Falls Short

• The strongest counter-argument
• India moved away from targets on purpose, to respect reproductive choice.
• If couples choose tubectomy, the State should not push men. Pushing men brings back memories of Emergency-era coercion.

• On this view, 36.5% vs 0.5% [2] is simply what couples chose.

• What is right about it

• Coercion is a real risk. Any male sterilisation target would repeat an old mistake.

• The answer cannot be quotas for vasectomy.

• Why it still does not hold up

• A choice is only free if real options exist. For men, the only modern options today are condoms and vasectomy. WHO's benchmarks for reversible male methods are only a first step towards more [2].
• The health system reaches women far more easily than men. Norms say contraception is her job. A choice shaped by both is not a neutral choice.
• So the fix is more options and a system that reaches men — not targets.

12. What Should Change, and Who Should Do It

• MoHFW: run the male push all year, not just for two weeks
• Today, male engagement is mostly the November Vasectomy Fortnight and a media campaign [1].

• Build vasectomy counselling into routine visits for couples, so the husband hears it too, not only the wife.

• MoHFW: address the rise in traditional methods directly

• Modern-method use fell while withdrawal and rhythm rose 6 points [2].

• Frontline counselling should explain how often these methods fail, and offer spacing methods (methods that delay the next child, like pills, IUCD or injectables) in their place.

• MoHFW: get ready now for new male methods

• WHO has set, for the first time, benchmarks for reversible male contraceptives [2].

• India should plan how such products would be tested, approved and delivered, so they reach men quickly once they exist.

• MoHFW: publish NFPIS claims by sex and by type of harm

• NFPIS already records deaths, complications and failures [1].
• Making this data public would show the true cost women carry, and where the quality of care is poor.

13. Anchors for Answers

• Data: Female sterilisation 36.5% vs male 0.5% among currently married women, NFHS-6 (2023-24) — about 73:1 [2]
• Data: Contraceptive use rose 66.7% → 69.1%, but modern-method use fell 56.4% → 52.7%; traditional methods rose 6 points [2]
• Report/Committee: WHO guidelines on expanding contraceptive options (2026) — first benchmarks for reversible male contraceptives [2]
• Scheme: National Family Planning Indemnity Scheme — insures clients against death, complications and failure after sterilisation, and protects providers from court cases [1]
• Scheme: Vasectomy Fortnight (every November), NSV training, compensation for lost wages — India's male-engagement tools, with male sterilisation still at 0.5% [1][2]

14. Mains Relevance

• GS-I: Role of women and women's organisations; population and associated issues; social empowerment.
• GS-II: Issues relating to development and management of social sector/services relating to health; welfare schemes for vulnerable sections.
• GS-IV (case-study angle): informed consent, coercion, autonomy.
• Question stems: 1. 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. (GS-I, 15 marks) 2. The decline in modern contraceptive use alongside rising traditional methods in NFHS-6 raises concerns about quality of family planning services. Discuss. (GS-II, 10 marks) 3. Critically evaluate the shift of India's family planning programme from a target-driven to a rights-based approach in the light of persisting gender disparities in sterilisation. (GS-II, 15 marks)

15. Related Topics to Study Next

• NFHS-5 vs NFHS-6 key indicators: the baseline for all trend questions (TFR, anaemia, stunting).
• National Population Policy 2000 and ICPD 1994: the policy frameworks behind the rights-based approach.
• Mission Parivar Vikas: the targeted family planning push in high-TFR districts [GK – verify].
• Demographic dividend and population ageing: consequences of below-replacement fertility.
• Emergency (1975-77) and forced sterilisation: the historical root of male aversion to sterilisation.
• Women's reproductive rights and SC judgments (e.g., Devika Biswas v. UoI, 2016, on sterilisation camps) [GK – verify].
• SDG 3.7 and SDG 5.6: universal access to sexual and reproductive health [GK – verify].
• Maternal health schemes (JSY, PMSMA): the linked reproductive health delivery system.

16. Common Errors / Trap Areas

• Mixing up NFHS rounds and years: NFHS-5 = 2019-21, NFHS-6 = 2023-24 [2].
• Assuming higher contraceptive prevalence means better quality: overall use rose, but modern methods fell [2].
• Misclassifying methods: rhythm and withdrawal are traditional, not modern [2].
• Attributing the Vasectomy Fortnight to the wrong month: it is November [1] (World Population Day is 11 July [GK – verify]).
• Confusing WHO's new male-contraceptive benchmarks with an approved product: they are benchmarks for future reversible methods, not a launched drug [2].