Moradabad, Uttar Pradesh “I can’t tell you how excited I am,” rejoices future dad Deepak Kumar. Commercial director of an FMCG company in Delhi, Kumar arrived in his hometown last week, days before the birth of his child. “My boss refused me paternity leave,” he laughs. The snub, however, did not dampen his enthusiasm as he went shopping to welcome his baby: diapers, towels, powder, lotion … “This will be my fourth child,” he said proudly during a whatsapp video call. from Moradabad, about 191 km from Delhi. “I know what I need to buy,” he says with a smile. Her three children, two boys aged 3 and 5 and a daughter aged nine, and her parents are also delighted to have a new member in the family. “But why so many children”, asks this journalist, apologizing. “What’s your problem? I can take care of them,” Kumar said in a pragmatic response. The second question, investigating his condom use, is also met with contempt. “The condom kills the pleasure of sex. I don’t get pleasure, “he said.”Lekin ye to AIDS se bachne ke liye hota hai na (Isn’t that used to not get infected with AIDS?), ”He asks. “I only have sex with my wife,” he says, adding that his partner has been using emergency contraceptive pills since marriage. “The condom is not a men’s business,” says Kumar, 29.
Meanwhile in Udaipur, Rajasthan, Anjum Gupta knew her man had a problem. A teacher in a public school, Gupta has not been able to conceive since she got married ten years ago. “I was called infertile by my in-laws,” she said, her voice shaking. “Although I was medically fine, the stigma,” said the 32-year-old, “disrupted my life.” After much persuasion over the past five years, her husband, a commodity trader, gave in to have her medically examined. Dr Kshitiz Murdia is not surprised to learn of the mental torture the teacher had to endure. “A disproportionate burden is placed on women when a couple is unable to conceive,” says the managing director and co-founder of Indira IVF, India’s largest infertility chain with 94 centers across India. In India, the subject of male infertility is rarely discussed. “About half of total infertility cases can be attributed to the male factor,” he adds.
Cut to Bengaluru, approximately 1,720 km from Udaipur. Nilay Mehrotra claims to have found factor X to solve the problem of male infertility. Two months ago, the young entrepreneur launched the first do-it-yourself semen test kit in India. Product from Janani, a reproductive health and sexual wellness startup co-founded by Mehrotra in June of last year, eliminates fear of being recognized in a sex or fertility clinic, which can be enough embarrassing. There is a huge elephant in the room and people have ignored it for so long, he points out, alluding to the growing problem of male infertility. “We have to kill the stigma, address the problem and solve the problem,” he says. Indians, he says, need to end taboos around sexual matters. More than seven decades after independence, India finds itself paradoxically sexed, but also annoyed. Infertility rates among young men and women are increasing; millions of childless couples are clamoring for children; a group of states, including the most populous Uttar Pradesh, plan to curb population growth despite experts citing declining total fertility rates; and men remain stubborn in their reluctance to use condoms.
Conservative attitudes towards sex coupled with reluctance and awkwardness to pursue sexual well-being only compounded the problem. Look at the numbers. Over the past decade, the condom user base in the country has fallen 76.5%, from 1.9 crore users in 2008-09 to 45 lakh in 2019-20, according to data from the Population Foundation of India. Kumar isn’t the only one to avoid rubber. There are millions of them, and the main reason remains the same: the apparent lack of pleasure. Kumar, again, isn’t the only one staying away from vasectomy, a male contraceptive option. The reason remains the same. Contraception, they argue, is not the business of man. The dominance of such an archaic state of mind has given rise to an alarming trend. The use of emergency contraceptive pills for women has jumped a staggering 171%: from 10 lakh in 2008-09 to 2.7 crore in 2019-20. During the same period, vasectomies decreased by 81%. (See box)
Neru Mishra, a seasoned social health activist, explains why the needle has not moved. “Only one in 10 sterilization cases is a man,” she says. “Feeling like they would lose their masculinity,” says Mishra, who became an ASHA (Certified Social Health Activist) worker in 2006 and started working in the village of Mirzapur in Uttar Pradesh. “Purush condom ke nu principal baat nahin karte (men don’t talk about condoms), ”she says.
According to the Fourth National Family Health Survey 2015-16, only 5.6 percent of Indian men use condoms. “Their refusal placed the burden of family planning almost entirely on women,” says Dipa Nag Chowdhury, director of programs at the Population Foundation of India (PFI). Much of the resistance in men is due to misconceptions related to decreased sexual pleasure and loss of virility. Social norms and prohibitions on discussing safe sex between sexual partners create barriers to condom use, she adds. The problem with men turns out to be a bigger problem for Mankind Pharma, the company that makes Manforce, the largest brand of condoms in India. The results of a recent consumer survey conducted by the brand, which has a 36.3% market share by volume, turned everything upside down. Perception – a condom reduces pleasure – stays upright. “Users in rural and urban India feel that condoms are dirty and oily with a smell of latex,” said Rajeev Juneja, general manager and vice president of Mankind Pharma. The condom maker has seen volumes drop from 55 crore in FY19 to 47 crore in FY21. The rural market, Juneja points out, is still small and accounts for only 29 percent of overall sales Marketers aren’t surprised by the low consumption of condoms in the backcountry. Reason: Poor positioning of the product. “A condom has always been touted as something that protects you against sexually transmitted diseases,” says Ashita Aggarwal, professor of marketing at the SP Jain Institute of Management and Research. Protection has become the dominant theme, while population control has taken a back seat. Another problem was not to address the central problem. For a long time, most brands, including those made by the government’s HLL Lifecare, such as Moods and Ustad, never explained that condoms did not interfere with intercourse or pleasure. In a country where sex is still considered a man’s act and where female orgasm remains a foreign concept, men have never had a reason to wear a condom. “The condoms reached the village, but the right message got lost during the transition,” she adds. Image: Frank Bienewald / LightRocket via Getty ImagesOne powerful message, however, spread quickly in small towns and villages: the need to have babies. Over the past two decades, infertility clinics, which started in cities, have started to dot the rural landscape. Take, for example, Indira IVF. The largest specialist IVF clinic in India opened its first center in 2011 in Udaipur, Rajasthan. Look at its evolution over the last four years: from 31 centers in 2017 to 94 in 2020; from an income of Rs 470 crore in FY18 to Rs 658 crore in FY21.
Clearly, the business of bringing joy into the lives of millions of childless couples is booming. An EY report in 2015 pointed out that India had 27.5 million infertile couples of reproductive age. Five years later, conservative estimates put the number at 29-32 million. At Indira IVF, men in the 30-40 age group contribute the most to attendance among all age groups. Additionally, men in the 30-35 age group experienced consistent year-over-year growth from FY18 to FY20. “This indicates an increase in awareness of the male infertility as more men come forward for treatment, ”said Murdia, CEO and co-founder of Indira IVF. Although conversations about reproductive health are slowly starting, Murdia believes it is still early days. “We have to keep this momentum going,” he said. The crux, he explains, is not just having a child, but also understanding the life-threatening illnesses that individuals can have.
Meanwhile, in Lucknow, capital of the state of Uttar Pradesh, Munna Yadav doesn’t mind a population control bill that tends to penalize those with more children. Those with more than two children would not only be barred from participating in local agency surveys, but could also not apply for government jobs or get any grants. “Who wants jobs in the public service,” says the 25-year-old driver who dropped out of school at the age of 13. My father, he explains, had seven children because he thought more hands would be useful in farming. “Now you have to have a big income to feed a big family,” he says. Yadav has two sons, aged 2 and 6, and intends to switch to family planning. “My wife is having an operation,” he informs. But why not him? “Why should men,” he retorts. “Mard nahin karate ye sab (men don’t do such things, “he said. Tuesdays Use condoms? “I don’t and I won’t,” he said with a smile.
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