Medicine: Mass Sterilization

"Many a Progeny—Many an Agony," read posters on Bombay buses last week. Teeming India is officially committed, more than any other nation in the world, to birth control. At 1,800 "family planning centers" across this nation of 403 million, social workers fit diaphragms and counsel sari-swathed village women on simpler methods of contraception (sample prescription: if nothing better is handy, a suppository of cotton wadding soaked in cooking oil may suffice). Despite back-country ignorance and considered opposition from leaders of India's 5,500,000 Roman Catholics, contraceptives are gaining slow acceptance in India. But more must be done if the government is to achieve its announced goal of cutting the nation's birth rate (40.7 per 1,000 v. the U.S.'s 24.1) by 50%.

Fortnight ago, in sprawling Maharashtra state, local officials decided to celebrate All-India Family Planning Day, Dec. 18, by completing the sterilization of 15,000 male volunteers in a single six-week period. Last week Maharashtra's Public Health Minister Homi Taleyarkhan reported that with the campaign less than half over, 7,000 sterilizations had already been performed.

Green for Safe. The idea of sterilization is as repugnant to many Indians as to anyone else. But India's planners are determined. India's annual population growth would fill a city as big as New York, and there is always the prospect of not enough food to go round. Government officials get impatient over the incompetence and indifference with which many Indians use contraceptives. Attempts to introduce the rhythm system failed in India, even when poor villagers were given strings of calendar beads (green for "safe" days, red for "dangerous"). Some peasant women thought the beads were magic, moved them about until they reached a green bead before intercourse. Last year the Indian government officially endorsed sterilization and budgeted 25 million rupees ($5,250,000) for birth control.

The operation that Maharashtra's doctors were performing in such numbers last week is a vasectomy, a simple surgical procedure that is less costly, complicated and confining than female sterilization. The surgeon merely snips off a small section of the vasa deferentia, the tiny tubes that transport sperm from the testes to the ejaculatory duct. A local anesthetic is used, the vasa are tied off, and two stitches are taken to close the wound in the scrotum. The operation takes about ten minutes and requires only three days of convalescence. Indian surgeons tell patients to abstain from sexual relations for at least a month to avoid any chance of impregnating their wives with live sperm remaining in the tubes.

Vasectomies are not foolproof; the sperm-carrying tubes may regenerate themselves if not properly tied off. A Bombay patient recently went insane when his wife twice conceived after he had undergone a vasectomy, and "sterilized" Indian peasants have beaten their pregnant wives or abandoned them in the uninformed belief that they must have committed adultery. Vasectomies are also not necessarily permanent; if the original ligature is not too close to the testes, a skilled surgeon can perform a successful reunion in about seven out of ten cases.