India: In Amritsar, It’s ‘V’ For Vasectomies
By Benita Sen
15 November, 2012
Women’s Feature Service
Amritsar (Women’s Feature Service) – It's a confident, responsible man who can go through a little inconvenience to shoulder the responsibility of safe sex, rather than passing it on to his partner. In India, however, the onus of planning the family still falls almost solely on the woman. Whether it’s ensuring the use of condoms or adopting a more permanent method like sterilisation, rarely do the men come forward. There are a lot of misconceptions regarding vasectomy – a surprising number of men still confuse sterility with impotence. So invariably it’s the women who consent to undergoing a painful tubectomy instead.
The National Population Policy 2000, formulated to address the unmet needs for contraception, among other things, describes men as the “under-served population” as far as health and reproductive services go. But Punjab is partially reversing the trend by vigorously advocating the No Scalpel Vasectomy (NSV), a unique approach to male contraception that is proving a boon to both men and women in terms of their health status.
It's the men from the vibrant town of Amritsar who have taken the lead in fulfilling their family planning responsibility. The numbers say it all. In 2010-11, of every 100 birth control surgeries performed in India, only five were on men. In comparison, in Punjab, of 100 birth control surgeries 21 were vasectomies. In Amritsar, 45 cent of the surgeries performed were on men.
NSV, or key-hole vasectomy, an improvement over the traditional method, was pioneered in China in 1974 by Dr Li Shunqiang. It came to India in 1991 when urologist Dr R.C.M. Kaza, Director and Professor of Surgery, Maulana Azad Medical College, Delhi, learnt the technique, becoming the foremost exponent of this method in the country.
This new procedure has many advantages. For instance, during surgery, instead of making four scalpel incisions on either side of the scrotum as was done earlier, here the scrotum is simply punctured with a sharp instrument. The wound is smaller, the blood loss is minimal and there are no stitches. This narrows chances of complications like haematomas (swellings containing blood). And the best part is that the patient can walk out of the clinic in an hour. The fear of infection is negligible and the problem of Post-Vasectomy Pain Syndrome, or PVPS, often experienced for a few days with the earlier method, is virtually non-existent in this case.
Of course, post-surgery couples are advised to use contraception for at least three months after the procedure until the patient’s semen test confirms that there are no sperms in the sample. This is mandatory, as only after this is done can the doctor declare the NSV successful.
One of those few doctors who can be credited with popularising this “elegant procedure without pain, stitching and cutting” is Dr Baljit Kaur, 48. When men walk into Dr Baljit Kaur’s clinic in Amritsar, she takes care to explains all aspects of the procedure to them and help them take that all-important decision of undergoing an NSV.
Dr Kaur, an alumnus of the Government Medical College, Patiala, joined government service in December 1993 as a fertility regulation specialist. In her initial years of practice she performed about 1,200-1,300 tubectomies a year – the female surgical sterilisation procedure, which is one of the most common family planning methods in India – besides conducting several abortions. She recalls, "After doing so many surgeries and abortions and seeing women suffer, I went through a extremely low phase."
Then in August 1999, while she was working with the Urban Family Welfare Centre in Amritsar, she learnt of Dr Kaza and the new vasectomy procedure he was advocating. She immediately understood the importance of his work and sought training with him – being the first woman to do so. Later, Dr Baljit was also appointed as one of the first NSV trainers in the state. She toured every district of Punjab three times between 1999 and 2006, training more than 300 doctors in this procedure.
So how did Punjab emerge a trend-setter in this regard? Motivating men has become the mantra here. Beginning with periodic camps that were organised in the early years, NSVs are now being performed on a daily basis in this district. Even the number of doctors capable of doing this operation has grown. In 2005, 17 surgeons were trained with Dr Kaza to become trainers. They, in turn, went into 17 districts to teach their counterparts. Since 2010-11, in Amritsar district, every government health centre has an NSV surgeon.
Additionally, regular advocacy meetings are been held with the Health Secretary, the Health Minister as well as grassroots representatives like chairpersons of Zilla Panchayats. Incidentally, in March 2000, Dr Baljit had conducted India’s first NSV advocacy programme in Amritsar in which she involved people from various sectors – politicians and non-profit workers to international bodies like the UNFPA, doctors as well as policy-makers. Since then, she has conducted more than 120 such workshops.
Moreover, the NSV advocacy group in Punjab, led by this wonder surgeon who can do up to 11 NSVs in an hour, also came up with an innovative way to popularise the method: Since 2005, Tuesday has been declared as the NSV Day throughout the state and each district holds NSV camps for at least one week every year.
Family planning and other reproductive health issues are extremely important for a state like Punjab that already has a poor sex ratio – according to the Census 2011 figures, it has 893 women per 1000 men, compared to the national average of 984. In such a scenario, Dr Baljit and others have been playing an important role in improving the quality of life for women. Dr Bajit firmly believes that NSV is the answer to the problems caused by unplanned pregnancies and painful tubectomies.
Fortunately for Amritsar’s women, it’s been nearly two decades now that Dr Baljit has been working towards changing the negative attitudes that surrounded vasectomy. Her competence and reputation has convinced men from all strata of society – from labourers and farmers to government executives and businessmen - to trust her to perform an NSV on them. “I have found that if you talk to men with conviction, they will put faith in you. People look for clinical competence and professional handling. If you have that, nothing stops them from coming to a woman doctor,” she says.
According to Dr Baljit, who has done almost one lakh NSV operations, men expect more out of the system for themselves than women do. “No man will ever accept the kind of treatment we have been meting out to our women in the name of tubal ligation,” she says. Being a trainer for the National Standards and Quality Assurance, she has ensured that her centre sets the benchmark in care-giving and patients are assured that operative and post-operative issues will be addressed with utmost care.
Thousands of women have benefited from a continued emphasis on NSVs in Punjab. The National Population Policy has suggested that NSV be popularised and made a part of teaching curriculum. Punjab has done just that. Rigorous training is provided at the Medical College Hospital in Amritsar and every surgeon that passes out from here is qualified to perform NSV. The hospital, the only facility in India where NSV is being done by the surgery department, has six surgical units with a fixed staff, all of whom have been trained by Dr Kaza and Dr Baljit. The positive effects of so many qualified NSV surgeons will soon be visible throughout the state.
Meanwhile, as Dr Baljit points out, the situation cannot be transformed overnight, "Bringing about perceptions and behavioural changes can take years. Motivating and spreading the word has to go hand in hand with providing excellent services.”
Amritsar is accepting the change; it’s time the other states follow its lead.
Women's Feature Service began in 1978 as an UNESCO-UNFPA initiative. Until 1991, it was a project of Inter Press Service (IPS) Third World News Agency. The only international women's news/features syndicate, Women's Feature Service produces features and opinions on development from a gender perspective. http://www.wfsnews.org/
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