#4 Men, Masculinities, and Reproduction: What do vasectomies reveal about India's fertility politics?

India’s fertility politics historically placed the burden of contraception squarely on women, framing reproductive control as a tool for both population stability and female empowerment (Sreenivas, 2021). While men also became the targets of coercive sterilisations during the emergency period (1975-77), the political backlash led the state to shift its focus decisively to women’s bodies (Srinivasan, 2014). Today, female sterilisation dominates the country’s contraceptive landscape. India accounts for nearly half of global female sterilisations (United Nations, 2022); domestically, 37.9% of women undergo the procedure, while vasectomies constitute a mere 0.3% (NFHS-5, 2019-21). Over time, this deliberate marginalisation of men has entrenched a gender disparity in reproductive responsibility.

Simultaneously, India’s demographic landscape is fracturing. Although India is now the world’s most populous country, its Total Fertility Rate (TFR) has dropped below the replacement level of 2.1. However, sharp regional disparities complicate national policy. While Northern and Eastern states maintain high TFRs, rapidly declining fertility in Southern states has sparked political anxieties over socio-economic impacts and parliamentary representation, even prompting proposals for fertility minimums (United Nations Population Fund, 2025). Yet, despite these dropping rates and rising infertility concerns, the state continues to aggressively sponsor population control measures in various regions.

To address the severe gender imbalance and achieve contraceptive equity, the government has recently attempted to bring men back into the family planning fold. The past decade has seen a revival of non-scalpel vasectomy (NSV) campaigns, supported by the 2016 draft National Policy for Women, which explicitly advocated shifting the focus to male sterilisation and observance of ‘Vasectomy Fortnights.’ Despite these sensitisation efforts to break misconceptions, male sterilisation has failed to gain significant traction.

I use ‘vasectomy’ as a vantage point to highlight India’s gendered fertility politics, shifting the feminist gaze from female to male reproductive bodies. The state of Assam has been taken as a case study as it has recently enforced rigorous measures like male sterilisation programmes, a two-child policy for government jobs, and bans on child marriage and polygamy. While ostensibly framed as protecting women’s rights, these interventions indirectly target socio-political minorities. The blog post analyses which categories of men are now being targeted by family planning, and what expanding these services to men truly means for women and the contraceptive equity agenda. The (fe)male sterilisations exist in the context of India’s ‘fertility paradox’, characterised by the coexistence of dual anxieties around population explosion and fertility decline.

Gendered bodies, identities, and the new politics of male sterilisation: Insights from Assam

The statistical and policy landscape 

According to the National Family Health Survey-5 (NFHS-5, 2019-21), Assam records one of the lowest vasectomy rates in India at a mere 0.1 per cent. This figure represents a stagnation, remaining entirely unchanged since the NFHS-4 (2015-16). While Assam’s rate falls notably below the national average of 0.3 per cent, it presents a paradoxical scenario regionally. Among the Northeast’s seven sister states (Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, and Tripura) reporting an absolute 0.0 per cent, Assam actually displays the highest proportion of male sterilisations. To address regions with high total fertility rates (TFR) of 3 or higher, the Indian government launched Mission Parivar Vikas in 2017. Assam established family planning advocacy working groups in districts like Barpeta, Darrang, Dhubri, and Morigaon, alongside mobile medical teams designed to navigate geographically difficult terrains.

Targeting marginalised minority bodies 

Despite these state-led expansions, fieldwork conducted in one of the above districts between December 2024 and mid-2025 reveals a highly politicised approach on the ground. Interactions with various stakeholders, including sterilised men, their families, surgeons, and accredited social health activists (ASHA) workers, uncovered that NSV campaigns disproportionately focused on marginalised minority groups. Specifically, the state directed its efforts toward economically disadvantaged daily-wage labourers from the ‘Bagania’ (tea garden tribes) and the ‘Miya’ (Bengali-speaking Muslims of Bangladeshi origin) communities. The targeting of the ‘Miya’ community is particularly loaded with socio-political tensions. Historically, this group has long been at the epicentre of Assam’s turbulent ethnic politics, surrounded by debates over immigration, citizenship rights, and demographic anxieties regarding their rising population. Consequently, while the state did not officially declare numerical targets, the state-appointed health workers pushed male sterilisation onto these minority men (and women), using the promise of modest financial compensation to compel participation.

Resistance and bodily autonomy 

However, these marginalised men were far from passive recipients of state intervention as they actively bargained with the healthcare system and vocalised their resistance. Surgeons noted that while both male and female sterilisation carry medical risks, vasectomies are generally less invasive. Yet, men complained far more frequently and aggressively than women. “One 38-year-old Bagania man reported persistent post-surgical weakness that hampered his daily life, while doctors frequently encountered men seeking medication for a perceived loss of sexual drive.” Drawing a parallel to Ameeriar’s (2025) observations on maternal rage, where vocalised pain exposes structural inequalities and resists institutional silencing, the complaints from these men can be understood as a form of protest. They were actively protesting both the physical changes to their bodies and the state’s aggressive sterilisation agenda. In some instances, this resistance took a subversive turn, with men asking surgeons to make ‘fake cuts’ so they could claim the financial incentive without undergoing the surgery, requests that doctors consistently rejected.

Structural barriers and medical regulations

The momentum of the NSV campaigns, which peaked between 2017 and 2019, progressively fractured due to the COVID-19 pandemic and crucial shifts in medical regulations. Following tragic medical mishaps in temporary camps in states like Chhattisgarh, which led to the deaths of several women, the Supreme Court of India banned camp-based sterilisations in 2016. Consequently, all procedures were restricted to designated hospitals. This spatial shift created immense logistical barriers for rural men. Facilities were located in central towns far removed from minority settlements, and surgeries were scheduled strictly during daylight hours. For daily-wage labourers, the prospect of losing a day’s pay to travel, combined with the fear that post-operative weakness would permanently compromise their capacity for the physical labour their families depended on, made vasectomies economically unviable.

The shift to female “bioavailability”

These structural barriers inadvertently triggered gendered consequences, shifting the burden of state-mandated family planning onto women. Because families desperately needed the financial compensation offered by the state but could not risk the male breadwinner’s income, men frequently sent their wives to undergo the procedure instead, or women voluntarily offered themselves as scapegoats. Health workers, caught in the crossfire of daily sterilisation targets, leaned into this dynamic. As one ASHA worker noted, “fulfilling female targets was significantly easier because women are more compliant and rarely complain.” This illustrates what Cohen (2007) terms “bioavailability”, the phenomenon where women’s bodies are perceived as more accessible and medically manageable by institutional structures. Because women are socialised to endure invasive gynaecological interventions, reproductive responsibilities fall disproportionately on them, while men are culturally shielded and posited as being “too sensitive” regarding genital interference (Friedman & Hashiloni-Dolev, 2023).

The contemporary politics of male sterilisation in Assam highlights a profound failure to equitably distribute reproductive responsibilities. Instead of transforming patriarchal norms, state interventions capitalised on the easy availability of female bodies, reinforcing entrenched reproductive hierarchies and ensuring women remain the perpetual focal point of state-controlled family planning.

Beyond vasectomies: Revisiting reproductive paradoxes in India

When it comes to the Global South nations, the dominant narrative revolves around “population explosion”, propagated by Western demographers and population control agencies. However, the neo-Malthusian discourse obsessed with curbing the hyperfertility of non-Western subjects tends to ignore the existence of infertility in the supposedly overpopulated areas, which Inhorn and van-Balen (2002) call “fertility-infertility dialectic”. Non-Western contexts are strongly marked by pro-natalist norms, and in the face of reproductive failure, infertile individuals from these nations often exhibit an intense desire for biological parenthood through reproductive technologies, just like Western subjects do. But international population policies have historically ignored such needs, prioritising fertility reduction instead. Infertility patterns in regions labelled “overpopulated” expose the tensions between individual reproductive struggles and broader demographic politics (Inhorn & van Balen, 2002).

India’s “fertility-infertility dialectic” is particularly striking since it reflects a paradox of dual anxieties around overpopulation and low fertility and/or rising infertility. Although the 1994 International Conference on Population and Development (ICPD) recognised infertility as a public health concern, India’s reproductive and child health programmes still inadequately address it. However, rising infertility, driven by factors such as delayed marriage, ageing, and lifestyle changes, is now becoming a concern as it is beginning to impact the demographic and socio-political landscape. A 2023 study found that infertility rates were found to be higher in southern states, including Goa, Kerala, Karnataka, Tamil Nadu, and Telangana, with a high prevalence of infertility (above 20 per cent) and low fertility rates. Despite infertility being culturally feminised, there is now growing attention to male infertility and sperm health among the medical community and wider public. Moreover, this is accompanied by booming assisted reproductive technology (ART) centres and andrology clinics addressing men’s sexual-reproductive issues across the nation. 

Historically, biomedicine and the state have always tied their hands by enmeshing reproduction and citizenship (Hermannsdóttir & Dybbroe, 2023; Korolczuk, 2016). In India, the state and medical institutions have always aimed to simultaneously assist, control, and regulate individuals’ reproductive capacities. The state continues to enter (non-)citizens’ bodies with the help of biomedicine, and the latter legitimises its practices and authority through the state. (Fe)Male sterilisation and infertility medicine in India exemplify biomedicine and the state’s collective agendas in governing reproduction. By situating state-sponsored sterilisation in this fertility paradox, it becomes evident that while family planning in India has traditionally been synonymous with population control, contemporary fertility governance has evolved into a biopolitical and biomedical project of designing and planning (wo)men’s procreative agendas.

While the state continues to struggle to involve men in its birth control agendas and women remain the primary contraceptors, infertility medicine has successfully leveraged men’s desire to have biogenetically healthy children and fulfil marital obligations. Men are increasingly being incorporated into discussions on population explosion and decline. Based on socio-economic and politico-legal identities, they are getting positioned as “reproductive actors”, whether as hyper-fertile subjects to be sterilised or as sub-fertile or infertile subjects needing treatment. This produces a “sterilisation-infertility paradox”, wherein biomedicine and the state simultaneously curtail and rehabilitate men’s reproductive capacities, defining who counts as a “procreative (non-)citizen or subject” in modern India.

 

References:

• Ameeriar, L. (2025). Breathing through the rage: Maternal refusal as ethnographic method. Medical Anthropology Quarterly, e70031.

• Cohen, L. (2007). Operability, bioavailability, and exception. In A. Ong & S. J. Collier (Eds.), Global assemblages: Technology, politics, and ethics as anthropological problems (pp. 79-90). Blackwell Publishing.

• Friedman, N., & Hashiloni-Dolev, Y. (2023). Sedated masculinity: The use of anaesthesia during vasectomy in Israel. Culture, Health & Sexuality, 25(3), 398-412.

• Hermannsdóttir, T., & Dybbroe, B. (2023). Components of reproductive citizenship: Narratives from a restrictive abortion landscape. Citizenship Studies, 27(8), 1022-1037.

• Inhorn, M. C., & van Balen, F. (2002). Infertility around the globe: New thinking on childlessness, gender, and reproductive technologies. University of California Press.

• Korolczuk, E. (2016). ‘The purest citizens’ and ‘IVF children’: Reproductive citizenship in contemporary Poland. Reproductive Biomedicine & Society Online, 3, 126-133.

• Kundu, S., Ali, B., & Dhillon, P. (2023). Surging trends of infertility and its behavioural determinants in India. PLoS One, 18(7), 1-19.

• Sreenivas, M. (2021). Feminism, family planning and national planning. Journal of South Asian Studies, 44(2), 313-328.

• Srinivasan, K. (2014, March). Family planning programs in India: An overview and need for a revision. (MIDS Working Paper No. 216).

• United Nations. (2022). World family planning 2022: Meeting the changing needs for family planning-Contraceptive use by age and method (UN DESA/POP/2022/TR/NO. 4). Department of Economic and Social Affairs, Population Division.

• United Nations Population Fund. (2025). The real fertility crisis: The pursuit of reproductive agency in a changing world.

• Where are fertility rates headed? (2026). Economic & Political Weekly, LXI(25), 8.