So, you want to talk about population in India. First, try to get everyone in the family, female and male, around the discussion table or preferably inside the operating room.

The lobby of a clinic painted pink in Uttar Pradesh’s Chitrakoot district has women waiting in chairs and wandering in through the doors to learn about sterilisation procedures. It’s a one-sided audience, and perhaps a one-sided portion of families who are thinking about family planning as part of proactive initiatives within their realm of duty.

An IndiaSpend study shows that 78 per cent of men think family planning should not be solely a female family member’s responsibility, but this doesn’t seem to translate into general practice.

It’s not an uncommon sight in Bundelkhand to see free condoms distributed to women by clinics ending up as inflated balloons in the hands of children, rather than reaching their intended user base.

In the hinterland districts of Karwi and Ramnagar, sterilisation and birth control education programmes are common but the audience in attendance reflects a glass half-empty: in most cases, only women come to learn about the procedures and pick up the brochures and contraceptives that are distributed.

Rukmaniya has come to the clinic in Chitrakoot to discuss tubectomy procedures; she believes that choosing male sterilisation for her husband would restrict livelihood earnings for her family, of which there are “already four” children.

“Who will earn and feed us then?” she asks.

India’s 1.3 billion population is on track to pass China’s, making it the world’s largest country in 2024. Government programmes have zeroed in on providing access to birth control in India’s most populated 145 districts, but a cultural and policy-enforced responsibility is placed on women to near single-handedly bear the brunt of family planning efforts.

Female sterilisation accounts for 75 per cent of modern family planning methods used, according to the 2015-2016 National Health Survey, whereas men cannot be convinced to make the effort.

Globally, vasectomies are most generally speaking a road oft not taken, with only 2.4 per cent of couples choosing male sterilisation as a contraceptive method. The frequency of vasectomy procedures in India has fallen by 73 per cent between 2008-2009 and 2015-2016, but at the same time, the use of contraceptives also fell by 35 per cent and, according to health ministry data, the use of emergency pills and abortions doubled.

“I feel both partners should not get it done, instead they should just have self-control,” said Kaushal Pandey in an interview with Khabar Lahariya about his views on sterilisation. “They should be determined that it won’t happen, but if there are provisions for men to get sterilised then I guess they can go for it. But genuinely I feel that both should not get it done.”

As fewer family planning strategies include the use of contraceptives such as condoms – often perceived by men as uncomfortable – or male sterilisation, which is thought to be a dent in one’s masculinity, female sterilisations have been on the rise.

Dr Ramji Pandey, chief medical officer (CMO) in Chitrakoot, often advises men to get sterilised but finds they are resistant and not ready to undergo the procedure.

“It is usually said that if a man gets sterilised then he won’t be able to earn for his family,” he continued, adding, “The differences in procedure are minute, but male sterilisations, in actuality, are easier, safer, and quicker to do and don’t involve the invasive stitches of female sterilisations.”

A common cultural perception across Uttar Pradesh held by both men and women is that the sterilisation operation prohibits men from being able to work. Since women, of course, “don’t work” and “have to sit at home”, it makes perfect sense for them to take sole responsibility in getting sterilised for family planning purposes, right? For many, this is internalised and fits in with the narrative that surgery is indeed debilitating – even causing mental health issues!

“Women should get it done because they don’t work whereas I have to work. I work on the field, so a vasectomy can cause mental illness, therefore I am not getting it done and have instead asked my wife to undergo one,” says Budhraj, whose wife is soon planning to go for a sterilisation procedure.

Many women we spoke to stated that after discussing it with their partners, they felt it best that they get the procedure done.

“It was my wish,” said Savita, “and my husband’s”, she added, as an after-thought.

Sanjay Karvariya had a similar discussion with his wife, who offered to get it done because of his past medical surgery – a victim of piles, it seems.

“My wife, just like other wives, is very sweet,” he starts, in semi-confessional mode. “She has asked me not to get it done because I got operated thrice for piles, so she feels it will affect my health,” he said.

And yet female sterilisations, and not vasectomies, have been recently publicised as cases in which the operations themselves are not safe. A government-organised series of female sterilisations at camps across Chhattisgarh in November 2014 resulted in the deaths of 13 women, when 83 operations were conducted over a period of six hours in an unused hospital building. Still, women continue to be expected, even encouraged, to undergo them.

On top of the cultural taboos creating wariness towards vasectomies, the government channels a hefty portion – 85 per cent – of its family planning budget towards female sterilisation in particular, according to Poonam Muttreja, head executive at Population Foundation of India (PFI).

In 2013-14, Rs 340 crore of the total budget of Rs 400 crore was spent on female sterilisation. The government has also set up incentives and worked more aggressively on encouraging people to use contraceptive methods, which some experts say creates more scepticism and wariness about the safety and benefits of the procedures among families.

Studies have also shown that prior to choosing sterilisation as a contraception method, 77 per cent of women had not previously used other forms of birth control. At the same time, 78 per cent of the men surveyed said family planning should not be only women’s business.

In that case, where are the men? It takes one procedure to begin family planning – and despite efforts to encourage sterilisation more broadly, the government’s promotion programmes are not being successful in creating a balance in family planning.

Like Dr Pandey, who encourages men to undergo sterilisation, says, the scale is tipped; but, if we’re talking about equal share in work, we’re waiting for men to begin doing theirs, too.

This piece has been written by Julia Thomas.