The fear of not being able to support his family on his modest salary as a salesman took over him and he vented his anger on his wife who had had to get her intrauterine device (IUD) removed after she experienced excruciating pain and heavy bleeding during her periods.[break]
“How could she let this happen to our family? I lived in a constant stage of outrage until she decided to have an abortion,” says Parajuli.
The notion that reproduction is primarily a woman-related issue is still largely prevalent in our society and that men have zero responsibility for birth control and hence women’s reproductive health and family planning as well..
To add to that, there are only a few male-oriented contraceptives available as compared to the large number of methods for females. In a culture that is male-dominated, women end up bearing the brunt of birth control, whether their health permits them or not.
Vasectomy, condoms, abstinence, or withdrawal – the choice for men is limited but it is without notable side effects; even then, the rate of prevalence of male contraception is low.
“This is mainly due to lack of awareness and opposition from husbands,” says Dr Aruna Karki, Head of Department at the Gynecology Ward at Kathmandu Model Hospital, Bag Bazaar.
In a society where men still make most of the decisions where family is concerned, women like Parajuli’s wife have little say in matters like birth control. Parajuli chose not to even use a condom and relied on his wife to take the necessary precautions despite her health issues.
His wife, on the other hand, had suffered from nausea and headache when she was using contraceptive pills and had an IUD inserted which also had to be removed due to complications. She had requested Parajuli to opt for sterilization but he had been vehemently opposed to such an idea.
“What could I have done? I had tried all the methods of contraception but they never worked for me and gave me health scares instead,” says Parajuli’s wife who now resorts to emergency contraception after every intercourse.
Even emergency contraception has its toll on her and she suffers from dysmenorrhea and irregular periods.
Female-based contraceptives like pills, injectables, norplant and IUDs come with a fair share of side effects which also differ from woman to woman. But the most common side effects are nausea, headache, irregular bleeding, weight gain and breast tenderness.
These methods also provide no protection against sexually transmitted diseases which is why couples are advised to use condoms even if they are using other contraceptive methods, as condoms protect both users and their partners against most STDs.
Many men, however, complain of irritation and less satisfaction and choose to do without it.
In some cases, the preference of a son is also one of the causes for certain couples not using any contraceptive methods. Sudha Poudel, program officer at Family Planning Association of Nepal (FPAN), narrates the case of a highly educated couple in Battis Putali, Kathmandu, where even after four daughters they were still not using any method of birth control – all in the hope for a son.
“I’ve seen that a son is a necessity mostly for men and low use of contraceptive methods due to this is generally the husband’s decision,” shares Poudel.
According to the United Nations, only 3% of married couples rely on male sterilization and only 3% use condoms in developing nations. Even worldwide, four times as many female sterilizations are performed as vasectomies.
In the context of Nepal, however, according to Karki, families opt for female sterilization most of the times; and even in cases where the husband is willing to undergo vasectomy, it is the wives who oppose the idea.
“They are worried that vasectomies will make their men weak and unable to work and hence incapable to support the family,” Karki adds.
Vasectomy is simpler, safer and requires half the time needed for female sterilization. It is also relatively free of side effects, and even if there are some minor side effects, they disappear within one or two weeks without any treatment.
Oftentimes, men don’t volunteer for vasectomy due to the fear of castration or loss of masculinity. But vasectomy does not affect the production of male hormones, so there is no change in their physical traits. Most men are, however, unaware of this.
Resistance from men is not the only cause for popularity of female sterilization, compared to vasectomy. In Nepal, it is also due to less focus on men in birth control by the government and family planning services.
Poudel points out that in a male-dominated society like Nepal, there is a lack of awareness among men about their role in birth control. Men are hesitant to go for surgery when there are options available that require no effort from their side.
This usually means that females are the ones showing interest in taking precautions because they either don’t want to get pregnant early into a marriage or don’t want more children.
“This is the reason why birth control in Nepal is women-centric. It’s the woman who faces the stigma of unwanted pregnancy in the society, not the man. So it’s mostly women who take matters like birth control seriously,” says Poudel who also mentions that though this is the scenario in Nepal, FPAN makes sure they focus equally on men and women while advocating family planning.
Dr Shilu Aryal, Senior Consultant of OB/GYN at Family Health Division at the Ministry of Health and Population wholeheartedly agrees with Poudel’s statement and adds that it is because women are more pregnancy conscious that birth control measure is sought after more by them than their male counterparts.
Nepal has the highest maternal mortality rate, and the practice of unsafe abortions is still ongoing as women choose to visit abortion ‘providers’ rather than clinics that have highly trained professionals due to the stigma attached to abortions.
Before the legalization of abortion in 2002, unsafe abortion was the leading cause of mortality in pregnant women. Today, even after a decade, the case is very much the same as many women are still unaware of safe abortion procedures.
With most men choosing not to use even the simplest method of contraception such as condoms and relying on their wives for birth control, the rate of unwanted pregnancy is still high.
Since this is the case, there is a great need for birth control and family planning to reduce the risks of unwanted pregnancy and subsequent abortion.
Karki feels that men need to be motivated and counseled to take up birth control. “If a well-run vasectomy service is easily accessible, then men can be convinced to opt for sterilization after a couple has had the desired number of children,” adds Karki.
“This would reduce the number of unwanted pregnancy and abortion and the state of the country’s reproductive health will enhance.”
Men need to understand that their participation in family planning is as necessary and important as a woman’s contribution and not just think of family planning as a woman’s domain. Only then will the situation of women’s reproductive health show any signs of improving.
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