Women shoulder disproportionate burden of contraception

They have been married 10 years and have two children. She was relying on daily contraceptive pills for the last five years, but constantly anxious about their side effects. Recently she was diagnosed with high cholesterol and high blood pressure, which heighten a risk of stroke, linked to her use of the pills.

She suggested sterilization to her husband, allowing her to stop taking the pills. Nam, her husband, reacted strongly, believing that a vasectomy would cause impotence and reduced masculinity, likening it to castration. The couple began sleeping separately to preclude pregnancy. Concerned this arrangement would harm their relationship, Lan eventually chose to undergo tubal ligation at the hospital.

Dr. Thanh offers reproductive health guidance to patients. Photo by VnExpress/Thuy An

Dr. Phan Chi Thanh of the Central Obstetrics and Gynecology Hospital explains that while tubal ligation almost entirely prevents pregnancy, the procedure involves laparoscopy.

“This is not something people typically choose without necessity; it requires time and affects health.”

Lan, who had already undergone three cesarean sections, faced increased health risks associated with further surgery. Doctors advised her to consider alternative contraceptive methods, such as implants or intrauterine devices.

Ngoc, 30, who has two daughters and is pregnant with a third, made a similar decision. After her husband refused a vasectomy, believing it would diminish his sexual performance and masculinity, she sought tubal ligation during her next cesarean.

“To maintain our marriage, I had no choice,” she says.

Thanh explains female sterilization involves blocking the fallopian tubes to prevent sperm from meeting the egg.

“Despite progress in gender equality and societal attitudes, contraceptive responsibilities often fall disproportionately on women, and when unwanted outcomes occur, women frequently bear the blame,” Thanh says.

In online forums, many women share their experiences of undergoing sterilization to satisfy their husbands and preserve family stability, fearing neglect or infidelity.

According to the 2020 Population and Family Planning Survey, female sterilization rates in Vietnam far exceed male sterilization. Of the nearly 13 million married women aged 15-49 nationwide, over 120,000 have undergone sterilization, compared to more than 10,000 men.

Around 0.9% of married women in this age group have opted for sterilization, with over 55% of them choosing the procedure after having three or more children, and over 40% after having two. Globally, male sterilization is much more common. In the U.S., where abortion laws are strict, an estimated 500,000 men undergo vasectomy each year. The U.S. National Family Growth survey for 2012-17 found that 5-6% of men aged 18-45 had undergone the procedure.

Dr. Pham Quang Khai, a urologist at E Hospital, says the burden of contraception often falls on women because men believe condoms reduce sensation and vasectomy affects their sexual performance.

Doctors recommend that men share contraceptive responsibilities with their wives to safeguard both partners’ health and enhance marital intimacy.

*The characters’ names have been changed.