Editorial 1: Indians need to share contraceptive responsibility
Context
With more awareness of gender equality and rights, it is possible to build a society in which male sterilisation is accepted as normative
Introduction
In 1952, India pioneered a national programme for family planning, whose focus has since changed — from improving maternal and child health to stabilising the population. As this programme evolved, so too did permanent methods of contraception.
- During 1966-70, about 80.5% of all sterilisation procedures in India were vasectomies.
- This percentage declined every year due to changing policies that, together with other factors, placed less and less of an emphasis on vasectomies.
- The five rounds of the National Family Health Survey (NHFS) also show the use of male sterilisation, especially in the last three decades, to be steadily decreasing in all States.
- In fact, the vasectomies percentage remained constant at around 0.3% in NFHS-4 (2015-16) and NFHS-5.
Gender and the disparity: Disparity in Sterilisation Trends
- Policy target:: This trend goes against Section 4.8 of the National Health Policy 2017, which aimed to increase the fraction of male sterilisations to at least 30%.
- Even today, India is far from meeting this target.
- Current statistics: Official data also show a large disparity between the rates of female and male sterilisation — 37.9% and 0.3%, respectively.
- Such huge differences indicate that women continue to bear virtually all of the burden of sterilisation.
- Implication: This in turn poses a challenge for India to achieve Sustainable Development Goal 5 — ‘gender equality and empowerment of all women and girls by 2030’ — among others.
Awareness and Advocacy Initiatives
- Observance of Vasectomy Day: In one attempt to bridge this gap, the world observes Vasectomy Day on the third Friday of November (it was on November 15 this year).
- Past Effort: In 2017, India observed a ‘vasectomy fortnight’ as well.
- Objectives of advocacy: The initiative is to revitalise the procedure by increasing awareness, generating demand among men, and debunking misconceptions.
- In the end, the goal is for people already looking for contraceptives as well as those who would if they knew about safe options to consider vasectomies more favourably.
The ground reality, solutions
- Field survey insights: For example, two of the three writers of this article surveyed a village in Chhatrapati Sambhaji Nagar, Maharashtra, in March 2024 as part of a field exercise.
- The women said sterilisation was their responsibility and that the men do not believe they need to have vasectomies.
- Most of them also expressed a belief that men should not be “burdened” by it because they already work hard to make ends meet, and that undergoing the procedure could rob the men of their day’s wages, worsening their hardship.
- Lack of awareness: These women were also unaware of the Indian government’s cash incentives to those who undergo vasectomies to offset the loss of wages.
- In fact, many studies in India have suggested that illiteracy, male egos, misconceptions about its impact on libido, and family opposition have led to the poor acceptance of vasectomies.
- Many men are not aware of their role in ensuring the safe passage of reproductive years in the lives of their female partners
- Healthcare challenges: The unavailability of skilled providers has aggravated the situation, especially in rural areas.
- To make matters worse, many trained community health workers themselves know little about no-scalpel vasectomies.
- Potential for change: As things stand, with increasing awareness of gender equality and rights, it is certainly possible to build a society in which male sterilisation is accepted as normative through proper and timely course correction.
Suggested Interventions
- Adolescent sensitisation: As a first step, sensitisation should begin during early adolescence in schools, where awareness programmes and monitored peer-group discussions can lay the foundation for accepting sterilisation as a shared responsibility.
- Sustained social and behaviour change communication initiatives will be instrumental in debunking myths around and destigmatising vasectomies.
- Vasectomy is a safe and simple procedure compared to tubectomy, the corresponding surgical procedure for women involving their fallopian tubes.
- Enhanced financial incentives: Second, these information, education and communication activities should be supplemented with greater conditional cash incentives for vasectomies with the goal to improve male participation.
- A study in Maharashtra in 2019 showed that more men in rural tribal areas opted for vasectomies after being offered a conditional cash incentive.
- Madhya Pradesh’s move in 2022 to increase this incentive by 50% is appreciable in this light.
An international comparison
- Drawing lessons from global successes: Third, India should draw from the lessons from other countries that have increased vasectomy uptake.
- South Korea: South Korea has the highest prevalence of the procedure worldwide
- Reported that men are more likely to shoulder contraceptive responsibilities as a result of progressive societal norms and greater gender equality.
- Bhutan: Bhutan has popularised vasectomy among its men by making the procedure socially acceptable.
- Availing good-quality services.
- Organising government-run vasectomy camps.
- Brazil: Brazil increased vasectomy uptake by running awareness campaigns on mass media.
- The prevalence rate has risen from 0.8% in the 1980s to 5% in the last decade.
Conclusion
Greater public awareness of vasectomies allows both partners in a union to make informed family planning decisions. In tandem, the government must strengthen the national health system to align with policy objectives, invest in training more health professionals to perform the procedure, and promote technical advancements to increase the use of non-scalpel vasectomies. he resulting policy should not have only intention. It should also lay out concrete steps to achieve its targets. The need of the hour is demand- and service-focused efforts rather than mere formulation
Context
Bringing down cost of access to research papers is only one of many issues.
Introduction
The "One Nation, One Subscription" (ONOS) plan, introduced in India, aims to address the high costs of accessing research papers, which have long been a barrier for scholars and the public. ONOS seeks to centralise subscriptions to academic journals, replacing existing library consortia with a single, government-negotiated fee. While this could expand access to expensive journals, especially for underfunded government institutions, the plan has sparked concerns.
Centralisation of Research Access
- While generally undesirable, centralisation promised to be a boon vis-à-vis public access to research through India’s ‘One Nation, One Subscription’ (ONOS) plan.
- ONOS was first proposed in the country’s fifth draft National Science, Technology, and Innovation Policy (2020).
- It was in response to the hefty fees research journals charged — and still do — for scholars and the people at large to access the papers they published.
What is the revenue model of Research Journals?
- Fee Structure: In this revenue model, journals accept and publish papers submitted by scholars and charge those who want to read them a fee.
- Research institutes also subscribe to these journals, so scholars can avail all the papers through their libraries.
- As these fees climbed over time, librarians banded up in consortia to increase their bargaining power at negotiations.
How is ONOS implementation supposed to happen on the ground?
- Cabinet Approval: ONOS, which the Union Cabinet approved on November 25, replaces these consortia with the national government and obliges journals to provide a single fee to access them.
- Impact on Government Institutes: The upshot is expensive journals will now become available at underfunded government institutes as well.
What are the limitations of ONOS?
- Limited to publicly funded institutes: However, ONOS will be limited to publicly funded institutes; and it allows the stranglehold of commercial publishers on scholarly publishing to continue.
- Commercial publishers' control: Many journals subsist on publicly funded research while also charging people money to access it.
- ONOS may reduce these sums but the government’s willingness to allocate ₹6,000 crore for three calendar years for 30 major publishers must be seen against the backdrop of the gross expenditure on research and development as a fraction of the GDP having become stagnant.
What are the alternative approaches?
- Promotion of open-access models: The government could have promoted the adoption of ‘green’ and/or ‘diamond’ open-access models
- that guarantee public access by default or have supported, as a matter of policy,
- home-grown journals sensitive to Indian scholars’ circumstances while enhancing the discoverability of their research.
- Support for home-grown journals: The decision to instead channel a large sum of money to publishers abroad does not factor in India’s potential to influence research access modalities in the developing world.
What are the concerns with ONOS?
- Lack of transparency: The lack of transparency is also perturbing, including over whether the list of journals will be monitored to cull titles that have become irrelevant or predatory, or to add those that have gained currency in recent years.
- Shift towards ‘Gold’ Open-Access: Most of all, at a time when many journals have switched to ‘gold’ open-access —
- where researchers pay to have a paper published that is then available for free —
- and preprint papers are gaining in popularity as a means of communicating research, the government’s justification for adopting the ONOS strategy in its present form is weak.
- No consultation with institutes: Add to this the absence of consultation with the institutes on their specific needs, and any celebration of ONOS will have to be deemed premature.
Conclusion
While the ONOS plan aims to reduce research access costs, it fails to address key issues like the continued dominance of commercial publishers and limited scope to publicly funded institutes. The government's focus on foreign publishers over open-access models, lack of transparency, and absence of consultation with institutions weaken ONOS, making its success uncertain and premature.