By Dr. Manoj Pal, Team Leader, with contributions from Reeta Saxena, Senior Project Officer, MOMENTUM Safe Surgery in Family Planning and Obstetrics

Ankit and Varsha Varke, both 32, live in a small village in the district of Balaghat, Madhya Pradesh, India. The couple has two daughters who are nine and three, both delivered at a public health hospital. Ankit is a part-time farmer and engaged in low-wage jobs such as part-time mason and laborer, while Varsha is a homemaker.

Varsha did not want to have more children so the couple could focus on providing food, education, and clothing for their existing family, but she was hesitant to talk to her husband about this. She gathered her courage one day and proudly recalls, “I had to initiate the conversation, it was a matter of our children and our aspirations for them.”

To her surprise, Ankit was also worried about how he would afford his daughters’ education, saying, “I want my children to go to the best schools and receive the best education. How can I afford it?” Both wanted a family planning method that would give them a one-time, permanent solution. When an Accredited Social Health Activist (ASHA) from her village visited Varsha, she discussed all possible contraceptive options. “My obvious choice was operation (female sterilization), everyone I know of is accepting it,” Varsha said.

During the consultation, the ASHA also spoke about no-scalpel vasectomy (NSV) as an option, but the couple never gave serious thought to it. This is typical in India, where female sterilization is commonly performed. Nearly 1 in 5 couples (38 percent) opt for female sterilization compared to just 0.3% opting for male sterilization.

To help clients across the state considering NSV, MOMENTUM Safe Surgery in Family Planning and Obstetrics is supporting the Government of Madhya Pradesh to improve availability of quality NSV services in the state. This targeted effort aims to expand long-term contraceptive options, which is especially important for couples like Ankit and Varsha.

When Varsha went to the health facility for her procedure, she was found ineligible for female sterilization by the healthcare provider. “I was quite upset when I learnt I was not eligible for the procedure due to my health issues,” Varsha said. “I learnt that I was anemic…I felt anxious, I did not know what to do now.”

She went home and told her husband. They discussed the alternative options, and Varsha suggested that Ankit go for NSV. However, Ankit had heard rumors about NSV side effects and was hesitant. “I have heard that men become weak after NSV,” he said. “What if I am not able to do my daily work, who would look after my family?”

Varsha suggested meeting the ASHA and learning more, but Ankit was hesitant to talk to a woman from the same village about family planning. He asked Varsha to talk to her, ask the questions, and then explain it to him. After their doubts were assuaged with facts about the procedure, the couple finally decided to go for NSV.

MOMENTUM’s work in Madhya Pradesh includes orienting cadres of ASHA supervisors on strategies to increase male involvement in family planning. The goal is increased acceptability of and access to quality NSV surgeries, which is also a priority of the state government.

Even after their decision to pursue NSV, the couple encountered barriers: When Ankit and Varsha told their family members about their decision, Ankit’s mother protested, repeating some of the same rumors that concerned Ankit. This was a blow to the couple’s confidence and created doubts. When the ASHA visited their home, they told her they had once again shifted their plans and would not pursue vasectomy.

By chance Ankit shared this discussion with his brother-in-law, Varsha’s brother. To his surprise, his brother-in-law had gone through NSV and was able to share his experience. He informed Ankit that two neighbors had also undergone NSV. “I did not know that so many people in the village had gone through the procedure. Nobody talked of it until I asked them. This was a confidence booster,” Ankit said.

The couple then discussed the issue with their mother-in-law again and convinced her of the necessity of their choice to obtain the NSV.

Today Varsha and Ankit are content with the decision they made and happy to share their story with others as the availability of non-surgical vasectomies increases and as misconceptions about the procedure are dispelled.

In addition to its support for ASHA workers, MOMENTUM is training two trainers per district across Madhya Pradesh on how to perform NSV. These individuals will cascade their training to new providers using government mechanisms, to address the dearth of providers who can provide quality NSV services. With its two-pronged approach to increase both the quality and client knowledge of NSV, MOMENTUM hopes to engage more couples in decision making around contraceptive choice.