Reviving a forgotten choice: Community perspectives & expert insights on vasectomy acceptance in rural South India: A qualitative study

Background & objectives Is Vasectomy still an option? The study aims to explore the potential barriers and beliefs regarding vasectomy from community perspective and also seeks to find possible solutions from experts to improve uptake of vasectomy. Methods The study was conducted using a qualitative study design using 11 focus group discussions (FGD) (n=94) conducted among self-help groups of neighbouring villages; and in-depth interviews (IDI) among male non-teaching staff (n=34) until point of saturation. To capture the magnitude of specific barriers and facilitating factors for vasectomy uptake, force field analysis (n=14) was done. Nominal group techniques were conducted among the experts who are involved in providing contraceptive care to obtain possible solutions to improve vasectomy uptake. Participants and experts were selected using a purposive sampling technique with maximum variation, key informant sampling strategies were used. Results Seven thematic categories emerged from FGD and IDI, namely personal belief, gender discrimination, unfavourable workplace environment, religious belief, family disputes, health literacy, and family planning practices. Positive deviance approach by men who undergo vasectomy and participatory methods to involve social and religious leaders in the awareness campaign were the solutions suggested as solutions by experts. Interpretation & conclusions Vasectomy opposition should not be attributed solely to ignorance, but rather to the interconnections of caste, religion, patriarchy, and gendered power relations. Policies should be male-centred, culturally sensitive, incentive-supported, and frame sterilisation as a shared family responsibility.