Acceptability of male sterilization in Bangladesh: its problems and perspectives.
The trend of acceptance of voluntary sterilization in Bangladesh is reviewed. The target in 1965 was the performance of about 600-1000 sterilizations per month in contrast to the insertion of 25,000 IUDs. Subsequent change in program emphasis and local initiatives led to an average monthly performance of about 50,000 sterilizations. In early 1977 a voluntary sterilization campaign accomplished 75,000 sterilizations in 70 days, yet a comparison of sterilization acceptance during the post-campaign period (March-August 1977) shows a considerable decline in vasectomy and a slight increase in tubectomy -- in total a significant decline. The attempt is made to explain the increasing difficulty in making male sterilization more acceptable to the population of Bangladesh. The largest majority of clients expressed either a poor or a mixed opinion about vasectomy. As past acceptors of the method become the predominant source of information, this suggests continued unpopularity for vasectomy. 1 of the most frequent causes of dissatisfaction was that the acceptors failed to receive all the help they suggested, indicating that family planning recruiters possibly made false or exaggerated promises in order to persuade the clients to accept vasectomy. 30.6% of the Shibpur and 18.9% of the Shalna clients experienced severe pain during surgery. 68.8% of Shibpur clients and 57.3% of Shalna clients reported a decrease of sexual or physical capacity. Only about 1/2 of the Shibpur clients and 1/3 of the Shalna clients accepted vasectomy for contraceptive reasons, suggesting that financial inducement can potentially attract men who otherwise did not have any serious urge to limit the size of their family.