A comprehensive study estimated that 50 percent of all pregnancies in India are unintended and nearly a third end in abortions. In theory, access to abortions in India appears gender-just and fairer than other countries; in practice, access to abortion is complicated.
Published Oct 12, 2024 | 1:00 PM ⚊ Updated Oct 12, 2024 | 1:00 PM
Why government must rethink banning the emergency contraceptive pill (Creative Commons)
The Tamil Nadu government has recently made the decision to ban over the counter sales of the emergency contraceptive pill containing the hormone levonorgestrel. This pill prevents pregnancy if taken within 72 hours of unprotected sexual intercourse.
Despite efforts by health activists and physicians such as Dr Kiruba, there are misconceptions galore about the physiological impacts of this hormone. There has been no evidence to indicate that it causes ectopic pregnancies, blood clots or any other adverse effects and the WHO has deemed it is safe. The Ministry of Health and Family Affairs is mulling a wider ban that may be implemented country-wide.
The worry appears to be about its “misuse” without clarifying what misuse implies in this context. Does it mean that women will use the emergency contraception pill in place of other modes of family planning? Does it mean that women will use this pill to prevent pregnancies which are an unhappy outcome of them exercising their bodily and sexual autonomy? Is the worry that this pill allows women freedoms which were not possible earlier, for example to unilaterally prevent an unwanted or mistimed pregnancy?
A comprehensive study estimated that 5o percent of all pregnancies in India are unintended and nearly a third end in abortions. In theory, access to abortions in India appears gender-just and fairer than other countries; in practice, access to abortion is complicated and 67 percent of abortions in India are unsafe with the highest risks for those aged 15-19 years and an estimated 8 women die from unsafe abortions daily in the country.
If this pill is banned, one obvious outcome is that the incidence of abortions will increase, though this may be slight. Despite its introduction in 2005, the awareness regarding the pill remained low ten years later with just 38 percent having this knowledge, per NFHS-4. A systematic review indicated that just 5 percent of women had ever used it and information about repeated use of the pill was not reliable. Thus, there is no solid evidence to indicate that women repeatedly use this pill to prevent pregnancies rather than more permanent methods.
Another misgiving that the pill is substituting other methods of contraception is equally unfounded – the most common method of family planning in India continues to be female sterilisation. Per NFHS- 5, nearly 40 percent of women were sterilised under the age of 25. Over the years, the patterns of female driven sterilisation has not changed but the ages at which women get sterilised have been declining.
Despite the government introducing spacing methods, married women complete having children and get their tubes tied. In fact, condom use has gone up, but only among urban populations and remains under 10 percent.
The state’s targeted family planning methods along with inequitable gender norms have made contraception a woman’s burden. Per NFHS-5, one out of two men in Uttar Pradesh, Bihar, and Telangana believe contraception is a woman’s responsibility. In Andhra Pradesh, Madhya Pradesh, and West Bengal, one in three men share this view, and in Karnataka, 45 percent of men do.
This presents a paradox – women in India have the responsibility of controlling reproduction with little participation from their male partners, but have very little agency when it comes to negotiating consensual safe sex within marriage. Given that gender norms have been intractable for the most part in India, the act of taking away agency from girls and women to decide when and whether they want to have children is an attack on their sexual and reproductive rights. We are already seeing the impacts of abortion bans in the US with those who are the most vulnerable – poor, women of colour, and migrant women adversely impacted.
Critically, the emergency pill can protect those who have been victims of rape and incest. In recent years, the courts have been asked to adjudicate on last-trimester abortions in several cases involving children who were raped or those with disabilities. In a case that beggars belief a ten year old child delivered a baby after being raped by two of her uncles. If this child had access to the emergency pills or was allowed to terminate her pregnancy, she would not have to endure the physical and mental trauma of birthing a baby at the tender age of ten because of sexual assault.
Instead of worrying about whether the increasing rates of premarital sex are contributing to increasing use of the emergency contraceptive pill, the state should push for comprehensive sexuality education (CSE) so that adolescents understand the scope of healthy sexual relationships that are based on respect and are free from coercion.
The International Technical Guidance on Sexuality Education proposed by the UNESCO and UNFPA define CSE as a “curriculum-based process of teaching and learning about the cognitive, emotional, physical, and social aspects of sexuality.”
CSE is absent from most school curriculums and parents have vociferously opposed CSE in schools under the misguided idea that CSE increases rates of premarital sex. Globally the opposite has been true – and in fact under US President George Bush when the government promoted abstinence only education in schools, the rates of teenage pregnancy increased. In India, many adolescents, particularly boys get information related to sex and sexuality from pornography. We should worry about this because pornography objectifies women, centres male pleasure, and normalises violence against women.
Having access to vetted information that imparts life skills as well as technical information about preventing HIV/AIDS, STIs, pregnancies, gender-based violence, and consent is crucial so that young people can make responsible choices and lead healthy lives. This will also result in children understanding concepts of bodily autonomy and reporting abuse earlier.
The state’s focus should be on increasing access to such information, educating parents on the pitfalls of unsupervised access to digital media that unwittingly exposes children to adult content at a young age and continuing the expansion of contraceptive choices. Banning the emergency contraceptive pill will only increase the rates of unintended pregnancies.
(Edited by Ananya Rao)
