CONTRACEPTIVES IN INDIA
Village women in India Contraceptive prevalence rate: 54.8 percent (2007/08, CIA World Factbook). This is up from 48 percent in the early 2000s and 37.5 percept in the early 1990s. Abortion is legal, condoms are advertised on colorful billboards, and government health services offer small bounties for patients undergoing vasectomies and tubal ligations. In some regions, most notably Kerala, better health care and higher infant survival rates are associated with lowered fertility rates. Two thirds of Kerala women use birth control compared to 40 percent nationwide. The population is relatively stable in Kerala.
In spite of the availability of various contraceptive methods like sterilization, IUD, condoms, hormonal pills, and other temporary methods, the adopters of the program mostly opt for sterilization, more often tubal ligation or tubectomy. A packet of three condoms sold for lest than two cents in India in the 1990s.
Type of birth control used: 71 percent sterilization, mostly women. Less than 7 percent of married women use condoms or the birth control pill, despite their wide availability. Family planning advocates want the RU486 abortion pill to be legalized. RU486 can cause side effects such as bleeding and should be administered under proper medical supervision.
The Indian government has only made token attempts to introduce condoms and birth control pills. A program for vasectomies for men and intrauterine devices for women failed in part because the health infrastructure could not provide adequate sanitary condition, medical training for health workers and follow-up care and many patient died of infections and tetanus. Sterilization of women has been selected because it is the simplest and surest method of birth control. [Source: Molly Moore, Washington Post, August 21, 1994]
Beliefs About Contraceptives in India
Some women in India tried to avoid pregnancy by fumigating their vagina with steam from a special kettle. Women in Egypt and India have used suppositories made highly acidic elephant or crocodile dung as a contraceptive. The acid acts as a spermicide. To encourage women to use more conventional methods the New Delhi branch of the Family Planning Clinic has offered instruction on the latest methods of pedicure.
Jayaji Krishna Nath, M.D. and Vishwarath R. Nayar wrote in the Encyclopedia of Sexuality: “Because of widely varying customs, beliefs, and the very low level of involvement of the wife in the decision-making process, it is the women who ultimately are adopting the method of contraception. It is not surprising to know in a male-dominated society, especially in rural areas, that people generally perceive that the program is mostly meant for the women folk as they are bearers of the children. Some common beliefs, like “using a contraception reduces a man’s masculinity” and “contraception impairs the health of working men,” also acts as a barrier for the adoption of the program by men. [Source: Jayaji Krishna Nath, M.D., and Vishwarath R. Nayar, Encyclopedia of Sexuality*/]
“Methodwise data of adopters generally reveals that the temporary methods are mostly utilized by people with relatively high educational backgrounds and those living in urban areas. The condom, a simple reversible and nonchemical method of contraception, is widely accepted by couples in the younger age group, mostly for spacing pregnancies.” */
Promotion of Contraceptive Use in India
Jayaji Krishna Nath, M.D. and Vishwarath R. Nayar wrote in the Encyclopedia of Sexuality: “The Health Care Delivery System program makes extensive use of various mass-media sources including television, radio, newspapers, posters, and pamphlets, besides interpersonal communication, in its strategies for explaining the various methods of contraception and removing the sociocultural barriers that work against the program. [Source: Jayaji Krishna Nath, M.D., and Vishwarath R. Nayar, Encyclopedia of Sexuality */]
“The government has adopted a primary health-care approach that uses various indigenous and local medical practitioners, traditional birth attendants, and religious and community leaders as change-agents in convincing the eligible couples to adopt family planning. The medical termination of pregnancy, which is legalized in the country, is also considered as one of the methods of family planning. In spite of vast investments in a supportive infrastructure and manpower, the achievements of the Family Planning Program have fallen short of its targets. Rigorous efforts are needed to implement the program more effectively.” */
Officials in Andhra Pradesh launched a program to install condom vending machines in barbershops, cigarette shops and grocery stores in 27,000 villages. Members of the Sonagchi Project have handed out condoms wearing green smocks. Many of the condoms that were given out free in Varanasi were snatched up by weavers making brocade saris who rubbed them on bobbins to speed up weaving and stop the yarn from snapping. One weaver told Reuters, “It is the fine quality lubricants on the condom that does the wonder trick of speeding the spin of the bobbin.” Fourteen condoms are needed to make one sari.
Sterilization in India
In the 1970s Indira Gandhi imposed a forced sterilization program for men, which was greeted with a great deal of criticism. Today 97 percent of all sterilizations are performed on women even though male vasectomies are generally safer, require a shorter recovery time and have fewer complications than female tubectomies (the surgical blocking of a segment of both fallopian tubes). In 2002-03 there were 114,426 vasectomies. and 4.6 million tubal ligations. In 1993, 4.1 million women were sterilized.
Under Indira Gandhi, family planning oriented towards sterilization. With Sanjay Gandhi, Indira's son, at the helm, the government tried to reduce the number of births by offering men money and transistor radios for vasectomies. When that didn't work it tried more heavy handed methods and some people were sterilized without their knowledge. There was public backlash against the government and the program didn't work. The population rose at an alarming rate. Critics have called sterilization inhumane and have said it hasn’t helped keep the population down."I call it down right body snatching," one social scientist told the Washington Post. "Family planning has degenerated into quotas and human beings have become the targets." Indonesia had more success with the "supermarket" method of birth control.
Sterilization remained the cornerstone of India’s family planning strategy after Indira Gandhi and remains so today. Married women using birth control who are sterilized (1988): the United States (36 percent); China (35 percent); India (31 percent); Britain (23 percent) and the Netherlands (15 percent).
At revival-like political rallies in Andhara Pradesh in the early 2000s, politicians called people with large families forward, scolded them and pressured them to get sterilized. As a result the number of people who were sterilized increased from 513,726 in 1995 to 814,061 in 2000. More than half of the women in the state have had their fallopian tubes tied, the highest rate in India and one of the highest in the world. [Source: New York Times]
Village Sterilizations in India
In the 1990s sterilizations were performed in schools and government offices that had been cleared of furniture by doctors who did more than 50 operations a day. Pricks for blood samples were often performed with same needle and pregnant women were offered a special deals on having an abortion and a sterilization at the same time. "It saves on drug consumption,"one doctor told the Washington Post, "You only have to use one dose of anesthesia." [Source: Molly Moore, Washington Post, August 21, 1994]
Molly Moore wrote in the Washington Post, "In the sterilization season, women arrive at the school house by the jeep load. They lie on makeshift operating tables where a doctor allocates a total of 45 seconds to each patient—slitting open the belly, inserting a laparoscope, tying the fallopian tubes, dipping the parascope in a pail of water and then moving on to the next patient. A nurse stitches the patient's wound, slaps an adhesive pad across the sutures and sends the woman to the recovery room, a dim ward where dozens of women lie side by side on the concrete floor, filling the room with the low moans and quavering wails of excruciating pain."
“I did it out of helplessness," a 30-year-old mother of six told the Washington Post. "We've had so many children, and we are so poor we can't look after them well. And I expect some reward for this. I expect a house." She, like most other women who had the operation, returned to her villages three hours after the operation and received no follow up medical care, despite the pain the possibility of infection.
Sterilization Quotas and Incentives in India
"States get more health funds," wrote Moore, “if they show concrete results. As a result districts in many states—particularly the poor northern states—imposed sterilization quotas on virtually every government employee in the district, from tax collectors to school teachers." "If they don't meet the quota, they don't get their salary," a state legislator told her. [Source: Molly Moore, Washington Post, August 21, 1994]
Sterilization quotas have persisted. School teachers have left their jobs for months at a time so they could round up women for the procedures. Some districts raised their sterilization numbers by bribing Nepalese women to come to India for the operation or having sterilizations done on women who were well into menopause. Government workers who brought in women for sterilizations won prizes: a wall clock for 3 patients, a transistor radio for four, a bicycle for 10 and a television for 25.
Poor people who have been sterilized have been given priority for houses, plots of land and loans. Some women have been given free radios for getting sterilized. In the 1990s sterilized women received 145 rupees (about $4.60) and sometimes a couple of kilograms of clarified butter. Families sometimes qualified for materials to build a house or a loan for a cow or small piece of land. Sometimes people who asked for a loan under different pretexts, or electricity, were told they have to get sterilized first. "At the end of the year you are judged on how many sterilizations you have gotten; nothing else is a considered," a health education officer told the Washington Post.
Abortion in India
In the 1990s, some 80 percent of the abortions were performed on married women between 20 and 34 who wanted smaller families and longer periods between children. Abortion in India was legalized in India in 1969. The ratio of abortion to births is 22 times higher in India than in the U.S. For every legal abortion in India it is estimated there are 10 illegal ones. In 1994, it was estimated there were 600,000 legal abortions and 6 million illegal one. One reason there are so many illegal abortions is that there are so few facilities that can perform legal ones. Legal abortions also require lots of paperwork. [Source: Molly Moore, Washington Post, August 21, 1994]
Many of the illegal abortions are performed by poorly trained midwives and even witches and magicians who insert twigs and other object into pregnant women. Some researchers estimate that between 15,000 and 25,000 women are killed every year by illegal abortions (more than are killed by malaria). Botched abortions account for nearly 15 percent of all maternal deaths.
Jayaji Krishna Nath, M.D. and Vishwarath R. Nayar wrote in the Encyclopedia of Sexuality: “ Abortion is not considered a method of contraception in the strict sense, although it is treated as one of the methods of family planning because of its dramatic impact on birthrates. The Medical Termination of Pregnancy Act (1971) has great importance. Attempts are continuously made to induce all women seeking abortion to accept a suitable method of family planning, although abortion is mostly advocated on health grounds. The main health reasons for recommending an abortion are: (1) when continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health; and (2) when there is a substantial risk the child, if born, would suffer from such physical or mental abnormalities as to be seriously handicapped. [Source: Jayaji Krishna Nath, M.D., and Vishwarath R. Nayar, Encyclopedia of Sexuality*/]
“Since the inception of the 1971 Act, the annual number of abortions is around 7.6 million. Despite legalisation of abortion, the lack of trained health personnel and termination by local Dais who abort by using unscientific instruments, the death rates for women who have undergone termination of their pregnancies are also high, especially in the remote rural and tribal areas. It is also observed that young unmarried girls who experience a premarital pregnancy and approach unqualified charlatans seeking an abortion also experience similar high risks of mortality and morbidity. Though official statistics on these situations are not available, these situations are common, and their incidence may well be in an upward trend because of modernization and Westernization. */
Image Sources:
Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, Ministry of Tourism, Government of India, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Foreign Policy, Wikipedia, BBC, CNN, and various books, websites and other publications.
Last updated June 2015