nonscalpel vasectomy ( nsv ) is a modified and sophisticated technique of vasectomy that requires no incision but only a small puncture and no stitches .
this is a safe and simple procedure that can be performed in low - resource settings .
nsv technique was introduced in india in 1992 to increase male participation in family planning . despite being a simple and safe method
, nsv seems to have failed to achieve its goal . according to the national family health survey-3 ( nfhs-3 ) ,
the current acceptance of nsv in india has declined from 1.9% to 1% in nfhs-2 .
this questionnaire - based survey was conducted to get insight into apathy of men towards nsv and their current family planning practices .
sample size was calculated using the following formula . considering 50% awareness of population about nsv ( p = 0.5 ) , sample size was calculated to be 384 with 95% confidence level and 5% precision of estimate ( d = 0.05 ) : 
 ( 1)n = z2(p)(1p)d2 .  
healthy male attendants ( aged 1850 years ) of the patients admitted to a tertiary teaching hospital of north india .
the participants were married , having at minimum one child , and had not been sterilized previously .
first part consisted of eight questions about demographic data ( e.g. , age of the respondents , age of their wife , number of alive children , age of their youngest child , and information to calculate their kuppuswamy 's socioeconomic status scale   ( education , occupation , and family income ) ) .
no question which could have identified their identity including name , address , caste , or religion was asked .
second part consisted of 13 close - ended questions : eight questions to assess their knowledge about nsv , four to assess their attitude towards male sterilization and nsv , and one to assess if they had been using any contraception .
there were two open - ended questions also in the second part of questionnaire : one to assess their present choice of contraception if they had been using , while another question was to know their source of information about nsv .
mean age of the respondents was 32.43  5.92 years and mean age of their wives was 28.60  5.45 .
the number of children they had ranged from 1 to 7 ( median = 2 ) .
their mean kuppuswamy 's socioeconomic score was 14.25  4.80 , corresponding to lower middle class iii .
there were 74.1% respondents who believed that limiting family size will help them stabilize their financial condition .
barrier method and copper t were the most popular methods used by 36.3% and 35.9% respondents using family planning methods , respectively .
tubectomy ( female sterilization ) , oral contraceptive pills , and injectable contraceptives were used by 12.1% , 11.7% , and 3.8% respondents , respectively .
most of the respondents ( 97.4% ) were aware of vasectomy as a method for permanent male sterilization ( table 1 ) .
television was reported to be their main source of information ( 47.7% respondents ) followed by friends ( 24.2% ) .
other sources of information were radio ( 16.7% ) , magazines ( 4.5% ) , posters ( 3.5% ) , newspaper ( 2.3% ) , and pamphlets ( 0.7% ) .
the majority of them ( 97.2% ) knew that nsv is done without any charge and cash incentive is given to the nsv client after the procedure .
however , only half of the respondents ( 50.9% ) had knowledge that a monetary compensation is given to the nsv client in case a complication occurs following the procedure , or if the procedure fails . as high as 75.2%
the fact that nsv does not require prolonged bed rest and does not affect sexual performance was known to 62.9% and 69.6% respondents .
a large number of respondents ( 89.7% ) believed that males must also take family planning responsibility .
seven out of ten ( 68.0% ) respondents agreed that permanent sterilization is a possible option for them .
however , only 34.1% respondents were willing to adopt nsv as a method of family planning .
reasons cited by the respondents for unwillingness to adopt nsv were fear of surgical procedure ( 40.7% ) , permanent nature of procedure ( 22.2% ) , religious beliefs ( 19.0% ) , decrease in sexual function ( 10.5% ) , and requirement of prolonged bed rest following procedure affecting daily earnings ( 7.5% ) .
provisional total of population of india is reported to be 1210.2 million after 2011 census .
the percentage decadal growth during 20012011 has registered the sharpest decline since independence  a decrease of 3.9 percentage points from 21.54 to 17.64 . however
, this decline does not undermine the importance of continued efforts to promote family planning measures .
data from national family health survey- ( nfhs-)3 indicated that 56.3% of currently married women were using some method of contraception in 2005 - 2006 .
our study also corroborates the same as 54.0% respondents in our study confirmed to be practicing some method of contraception .
nfhs-3 indicated that only 1% currently married women reported male sterilization as a method of family planning in this survey .
this reported use of male sterilization was even worse than indicated by the national family health survey- ( nfhs-)2 during 1998 - 1999 .
nfhs-2 showed that 1.9% currently married women reported male sterilization as a method of family planning .
almost all the respondents ( 97.4% ) were aware of the nsv as a family planning method .
their source of information was mainly television and friends while printed advertisements ( magazines , pamphlets , and posters ) hardly contributed anything in spreading knowledge .
it seems that circulation of information about family planning by word of mouth is very important .
there has been a general assumption that men , exercising dominations in gender relations , end up shunning of their responsibility of family planning .
however , our study provides a new insight as almost nine of ten respondents believed that family planning is also the responsibility of males .
it is further important to highlight the fact that only 68.0% of the male respondents approve male sterilization as a possible option of family planning for them .
this highlights the fact that there is large gap in their knowledge about advantages of vasectomy which contribute to their reluctance to undergo vasectomy .
fear of surgical procedure was cited as the most frequent cause ( 40.7% ) for unwillingness to accept nsv .
many advantages of nsv including no incision , no stitches , and minimal pain were known to only two - thirds of the respondents .
it becomes imperative that the procedure should be promoted as simple and painless , and campaign materials should refrain from using the word  operation  in conjunction with nsv .
furthermore , it also merits to be highlighted that a monetary compensation would be given to the client if any complication occurs due to the procedure or in case of failure of the procedure ; this fact is known to only half of the respondents ( 50.9% ) .
permanent nature of vasectomy was the second common cause ( 22.2% ) for unwillingness to accept nsv .
there are a number of reasons for the concern including difficult or impossible remarriage if the current wife dies as person will not be able to father any children after being permanently sterilized , or what he would do if all of his living children died [ 79 ] .
these worries may be overcome by propagating advantages of permanent family planning method , in case family is complete .
nsv needs to be propagated as one - time simple and safe solution to the worry felt at the time of intercourse .
awareness of problems associated with other family planning methods ( side effects of intrauterine device , associated uneasiness with condoms , and problem of daily intake of oral contraceptive pills ) may prove a trigger for promoting a person to take a final decision about nsv .
religious reasons were cited by the respondents as a third common barrier to nsv uptake .
it may definitely be inferred that involvement of community leaders may enhance the acceptability of nsv .
requirement of prolonged bed rest after vasectomy was another important reason cited by the respondents for their reluctance to adopt nsv .
this is highlighted by the fact that only 37.1% respondents were not of clear opinion that nsv does not require prolonged bed rest .
this aspect is likely to be important for the people who work on the basis of daily wages .
promotional activities should specifically highlight this important issue that the clients may join their work the next day following the nsv .
worry about the impact on sexual life following nsv was another barrier to nsv uptake .
a large number of respondents ( 31.4% ) were not sure that sexual performance would not be affected following nsv .
this aspect was also highlighted in another survey where it was noted that  men would not tell other people if they had been sterilized , fearing being shamed and taunted by community members , who might refer to them using such words as namard ( meaning infertile )  . in a survey conducted to study the factors affecting vasectomy acceptability in the kigoma region of tanzania , it was pointed out rumors that vasectomy results in decreased sexual desire or performance or that the procedure is equivalent to castration were prevalent and were mentioned by respondents . in conclusion
, the nsv promotional activities should focus on bridging the prevailing information gap regarding nsv among the potential clients . a client satisfied with nsv
kaza , nsv master trainer to the government of india as follows :  nsv is as much an iec operation as a surgical operation  .
airing positive stories and examples of successful nsv cases through the powerful media of television is likely to improve the acceptability of nsv among the masses .
there is a need to design and develop a need - based iec strategy to bridge the existing information gap among the eligible couples regarding nsv to improve its adoption .
involvement of community leaders and satisfied clients in the promotional activities and utilization of television and radio would enhance the effectiveness of such interventions .
 though nonscalpel vasectomy ( nsv ) technique was introduced in india in 1992 to increase male participation in family planning , it has failed to get adequate momentum and to achieve its goal . 
 we conducted a cross - sectional questionnaire - based survey to get insight into apathy of men towards nsv . 
 the study included 428 respondents . 
 most of the respondents ( 97.4% ) were aware of nsv as a method for permanent male sterilization . 
 the majority of them ( 97.2% ) knew that nsv is done without any charge and cash incentive is given to the nsv client after the procedure . 
 though 68.0% respondents agreed that permanent sterilization is a possible option for them , only 34.1% respondents were willing to adopt nsv as a method of family planning . 
 fear of surgical procedure ( 40.7% ) , permanent nature of procedure ( 22.2% ) , and religious belief ( 19.0% ) were the common reasons for unwillingness to adopt nsv . 
 we conclude that there is a need to design and develop need - based information , education and communication ( iec ) strategy to bridge the existing information gap among the eligible couples regarding nsv to improve its adoption . 
 involvement of community leaders and satisfied clients and utilization of television and radio would enhance the effectiveness of such interventions . 
1. Introduction
2. Methods
3. Results
4. Discussion