Contraceptive Cruelty: How patriarchy determines birth control use in India

Many women are made to believe that they must shoulder the responsibility of contraception alone, or disproportionately.
Contraceptive Cruelty: How patriarchy determines birth control use in India
Contraceptive Cruelty: How patriarchy determines birth control use in India
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A month or so before her wedding, 23-year-old Rituparna’s mother suggested that they go to a gynaecologist for a ‘normal check-up’. Once there however, her mother told the gynaecologist about Rituparna’s last menstruation cycle and the date of the wedding, then asked for an appropriate birth control pill.

A slightly surprised Rituparna went back home with the prescription. A few hours later, her aunt and mother took her into a separate room when she asked them why she needed to use the pills.

“They told me how we (women) have to offer this (sex) and we cannot expect men to take the lead (in contraception). My mother said, ‘They feel it’s an insult to them. In our time, we didn’t have an option. I married your father in December and had conceived you by March’, my mother told me,” Rituparna narrates.

So, a week before her wedding, Rituparna began taking the pills. She knew about the side-effects in theory but she had no idea they would affect her so badly. “The nausea and irregular bleeding lasted for a month. People expect butterflies in the first few months of marriage, but I had cramps for three months after the wedding,” she says. 

Rituparna is among the many women who are made to believe that they must shoulder the responsibility of contraception alone, or disproportionately. And while Rituparna’s husband was horrified at the side-effects and said they would use condoms instead, not all partners are willing to share the responsibility. 

A UN study, Trends in Contraceptive Use Worldwide 2015 found that female sterilization is the most popular method of contraception in India, at 65%, and another study shows that male sterilization stands at 2.3%, even though tubectomies tend to be more complicated than vasectomies and take a heavier toll on women’s bodies as compared to vasectomy on men.

Because government data only includes married women and men, there is no way to estimate the usage of contraceptives or lack of it among the rising number of sexually active unmarried people.

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Sonik, a 27-year-old consultant with a telecom firm in Gurgaon says that he generally makes it a point to use condoms, but there’s a catch: If something happens on the spur of the moment, he is unlikely to stop and volunteer to arrange contraception.

“I know that it (emergency contraceptive pill) causes cramps, nausea and irregular bleeding. And it is not as if I don’t care if the girl gets pregnant, but I’d go for it (sex),” he says. But he insists that for him, “condoms are the only (long-term) option”, because he does not want his partner undergo the side effects of birth-control pills.

24-year-old Drishya* only remembers using a condom twice in her life. Both of her sexual partners used the rhythm (abstinence from sex) and pull-out methods. But after a recent pregnancy scare, both she and her boyfriend, who lives in a different city, agreed to use condoms the next time they had sex. 

The next time they met, Drishya expected her boyfriend to bring protection, but instead, he just refused to be intimate with her, even when she offered to get the condoms. 

“I don’t understand. I know that I am the one who will get pregnant if our contraceptive methods don’t work, but isn’t birth control his responsibility as well?” she asks. He never really gave her a reason for his refusal to use condoms, but only said that he just didn’t want her to get pregnant.

It is also difficult for women to speak about contraception in the first place. Drishya confesses that she feels shy and conscious when reminding her partner to get condoms. “Telling them once or twice is fine, but having to repeatedly say it bothers me. My previous partner even had me convinced that there was no risk if he pulled out,” she says.

Although condoms are 98% effective, and generally do not cause side effects, their usage in India is very low. Contraceptive prevalence for condoms is 6%, meaning that 6% of women (or their partners) in India between the ages of 15-49 use that method.

But the low usage and refusal are not just because of it affects pleasure, breaks the flow, or is a hassle to carry around, or even patriarchal attitudes.

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A 2006 survey of 1,000 men by the Indian Council of Medical Research found that condoms manufactured by international firms were too large for Indian men. But today, even though different sizes are available, there does not appear to be any attempt to create awareness about this or dent the inflated importance of penis size.

This situation is made worse by government policies that set sterilisation targets for women and approve drugs that have serious side effects on women.

“Nausea, vomiting, breast tenderness and weight gain are common problems associated with these methods because they work by altering the hormonal balance in the body. In extreme cases, a Copper-T (IUD) may cause infection and the birth control pills may, over time, put women who are genetically prone to cancer, at higher risk,” Dr Marina Varghese, a Kochi-based gynaecologist, explains.

Such disregard for women’s health is pervasive, and includes even the sciences, which is projected as free from gender prejudices. For instance, The Ladies Finger reported in extensive detail, that women’s reproductive health has been treated with sheer disregard as a matter of routine.

A recent study co-sponsored by United Nations, tested a birth control shot on 320 men in monogamous relationships with women between the ages of 18 to 45. It had 96% success rate in continuing users at preventing pregnancies. Side-effects included pain where the injection was administered, increased libido, moodiness and acne.

When the study was called off in March 2011, earlier than planned, because of the side-effects, there was a quite a furore because the same sensitivity shown to the men has not been displayed when it comes to women’s reproductive health, either in India or worldwide.

Why, despite overwhelming evidence about the serious health impacts of most contraceptives on women, does their use persist?

Charlie Moloney’s analysis in IndiaSpend concludes that more often, men are the decision makers when it comes to contraception, especially in rural areas where medical stores and access to health workers may be difficult. So even if a woman is aware of the given methods and may want to stop having children, or have a gap of few years between pregnancies, it is the man who goes to the store, making the decision.

Sameer, a 23-year-old freelance film score composer says that while the responsibility of contraception should be mutually shared, it should fall on men if it has to fall on someone exclusively. “Men don’t get pregnant. And from my interactions with men from various walks of life, I gather that many of them have at some point, put some pressure on their partners to put out. They’re not bad people but it’s just the patriarchal mindset they’re brought up in. So, the least they can do is wear a condom,” he reasons.

(*Name changed)

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