Barriers to acceptance of vasectomy among married males in India: A systematic review.

Vasectomy was introduced under the National Family Planning Programme in 1954 to enhance male participation in family planning in India. Despite adopting the non-scalpel technique in 1992 to popularise vasectomy, its acceptance among married couples has declined from 3.31% to 0.3% over the past 3 decades. This study aims to identify the barriers among the married male population in India for adopting vasectomy as a method of family planning. This systematic review was conducted following PRISMA guidelines after PROSPERO registration (CRD42023434518). Six electronic databases (MEDLINE, Embase, Global Health, Allied and Complementary Medicine, APA PsycInfo, and CAB Abstracts Archive) were searched using terms including "vasectomy", "barriers", and "India" for studies reporting the barriers to accepting vasectomy as a family planning method. Qualitative, quantitative, and mixed-method studies on Indian male populations, reported in English and published up to May 2023, were included. Quality assessments were conducted using the JBI Critical Appraisal Tools. Extracted data were analysed using a thematic synthesis. Twenty-four studies conducted across India were included in the systematic review (18 cross-sectional, 2 interview-based, 2 mixed-method, 1 case-control and 1 focus group discussion-based). Five themes of barriers were identified: fear, social issues, cultural issues, knowledge, and health system issues. Men feared undergoing a surgical procedure for sterilisation. They presumed the procedure would lead to loss of libido, physical weakness leading to income loss, and social stigma from community members. Health education and financial incentives are likely to increase vasectomy acceptance in India.