NFHS-6: Men Still Carry Almost No Contraceptive Burden as WHO Sets Male-Method Benchmarks

The news

New Delhi. The World Health Organization (WHO) has issued new guidelines on expanding contraceptive options and, for the first time, benchmarks for a new generation of reversible male contraceptives, a Data Point analysis in The Hindu by Bindu Shajan Perappadan and Nitika Francis reports. A chart note says WHO has developed its first “Target Product Profile” for male methods, setting out the safety, effectiveness, acceptability and affordability they should aim for. “Choice is a gender equality issue,” said Pascale Allotey, Director of WHO’s Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing. WHO said its own research has challenged the assumption that men would not use new contraceptives. The timing matters for India, where fertility has fallen below the replacement level. The paper’s chart, drawing on Sample Registration System data, says India reached the National Population Policy 2000 goal of a Total Fertility Rate (TFR) of 2.0 in 2021 and that TFR fell to 1.9 in 2025. TFR is the average number of children a woman would bear over her lifetime at current rates. The National Family Health Survey-6 (NFHS-6) for 2023-24 shows unmet need for family planning among married women down one percentage point from NFHS-5 (2019-21). The share of currently married women aged 15-49 using any method rose from 66.7% to 69.1%, but modern methods fell from 56.4% to 52.7%, while traditional methods — mainly rhythm or fertility awareness and withdrawal — rose by six percentage points, from 10.3% to 16.4% per the chart, the largest change in any method between the two surveys. The survey does not establish why; the authors suggest concerns over side-effects, convenience, privacy, partner preferences, access and a wish to avoid hormonal or invasive methods. Female sterilisation fell marginally from 37.9% to 36.5%, while male sterilisation was 0.5%, up from 0.3%. Over three decades, female sterilisation rose quickly between NFHS-1 and NFHS-3 and has stayed at about 36-38%; male sterilisation fell from 3.4% in NFHS-1 to 0.5%, though the chart plots the NFHS-1 figure as 3.5%. Male sterilisation rose in 22 States between the two surveys, but only Telangana, from 2% to 3.6%, rose by more than one percentage point, even though early low-fertility States might have been expected to do better. The authors note that male sterilisation is less invasive than female sterilisation and can be done under local anaesthesia, and conclude that as India moved to replacement-level fertility, vasectomy went from a visible component of family planning to a marginal one. They urge India to use the WHO guidelines to correct the gender imbalance. The syllabus link is GS1 on population and women’s issues and GS2 on health.

Static syllabus linkage

1. NFHS is India’s main household survey on population and health. The National Family Health Survey is conducted by the Ministry of Health and Family Welfare with the International Institute for Population Sciences (IIPS), Mumbai, as the nodal agency. It is a large, representative survey that provides State- and district-level estimates on fertility, family planning, maternal and child health, nutrition and more. The first round was in 1992-93, and the fifth covered 2019-21. Unmet need for family planning refers to women who want to stop or delay childbearing but are not using any method.
2. India was the first country with a national family planning programme. India launched its National Family Planning Programme in 1952, the first in the world. In the 1970s the programme became target-driven, and the forced sterilisations of the Emergency (1975-77), heavily targeted at men, created a lasting backlash against vasectomy. After the International Conference on Population and Development in Cairo in 1994, which moved global policy from demographic targets to reproductive rights and choice, India abandoned method-specific targets. The National Population Policy, 2000 set the aim of reaching replacement-level fertility and addressing unmet need for contraception.
3. Replacement fertility and the method mix explain the numbers. Replacement-level fertility is a TFR of about 2.1 children per woman, the level at which a population replaces itself over the long run, ignoring migration. Modern methods include sterilisation, IUDs, oral pills, injectables and condoms; traditional methods such as rhythm and withdrawal have much higher failure rates. Tubectomy, female sterilisation, requires entry into the abdomen, while vasectomy, especially the no-scalpel technique, is a minor procedure under local anaesthesia with quicker recovery. The present reversible options for men are essentially limited to condoms, which is why the WHO benchmark on new male methods matters.
4. Government schemes widen choice, and India has researched a male injectable. Mission Parivar Vikas was launched in 2016 to expand access to contraceptives in high-fertility districts. The basket of methods in the public system has been expanded to include the injectable contraceptive under the name Antara and the non-hormonal weekly pill Chhaya. RISUG, reversible inhibition of sperm under guidance, is an injectable male contraceptive developed in India and tested in trials supported by the Indian Council of Medical Research. The Sustainable Development Goals include universal access to sexual and reproductive health services, including family planning, under target 3.7.

Why UPSC loves this

1. GS1 covers population and women’s issues; GS2 covers health. Mains has asked about India’s demographic transition, the demographic dividend and the gendered nature of social policy. The sterilisation gap, 36.5% for women against 0.5% for men, is a compact statistic for answers on patriarchy in health policy.
2. Prelims tests the institutions and definitions of demography. UPSC has asked about the TFR, the replacement level and the conduct of NFHS. The ICPD 1994, the 1952 programme, IIPS as the nodal agency and the meaning of unmet need are all fair targets.
3. Essay and ethics use family planning to discuss consent and coercion. The Emergency’s sterilisation drives and later deaths in sterilisation camps are staple examples of how targets can override consent. The rise in traditional methods and the WHO emphasis on choice give a modern counterpoint about rights-based policy.

Analysis

1. A falling TFR has hidden an unfinished gender agenda. India’s family planning success is usually measured by fertility, and by that measure it has succeeded, with TFR at 1.9 by the chart. But the method used to reach it has been overwhelmingly female sterilisation, at 36.5%, against 0.5% for men. A policy that achieves its demographic target by operating on women’s bodies has succeeded on its own terms and failed on the terms of Cairo 1994. Now that the numbers no longer demand urgency, the state has room to pursue equity rather than targets.
2. The rise in traditional methods is a warning, not a triumph of choice. Traditional methods rose by six percentage points while modern methods fell from 56.4% to 52.7%. Rhythm and withdrawal have far higher failure rates, so this shift could mean more unintended pregnancies even as total use rises to 69.1%. The authors list side-effects, privacy and a wish to avoid hormonal or invasive methods as possible reasons, which point to a weakness in counselling and in the range of methods offered. The counter-view is that in a low-fertility, better-educated population, some couples choose these methods knowingly. Either way, the data call for better quality of care, not complacency.
3. The male sterilisation gap is social, not medical. The authors point out that vasectomy is less invasive and done under local anaesthesia, so medical risk does not explain why it fell from 3.4% to 0.5% over three decades. The explanations are social: fears about loss of strength or masculinity, the memory of coercion during the Emergency, and a health system whose front-line workers are women talking to women. Even Telangana, the best performer, reached only 3.6%. Changing this requires male health workers, messaging aimed at men and incentives that do not become coercion.
4. New male methods could matter more than new messaging. Decades of campaigns have not moved vasectomy numbers, which suggests that the problem is also the lack of reversible options for men apart from condoms. WHO’s Target Product Profile gives developers a clear standard for safety, effectiveness, acceptability and affordability, which can speed up research and approval. India has its own candidate in RISUG, developed domestically, and could lead in bringing a male method to market. The caution is that a new method alone does not change who is expected to take responsibility, as the history of the condom shows.
5. Below-replacement fertility changes the policy question itself. With TFR at 1.9, the aim of family planning is no longer to reduce births but to let couples have the number of children they want, when they want them. That shifts attention to spacing methods, quality of care, reduction of unmet need among young and poor women, and male participation. It also brings new concerns, like ageing and regional divergence between low-fertility southern States and higher-fertility northern ones. A programme built on sterilisation targets is poorly suited to this new phase.

Administrator's brainstorm