The dehumanising ordeal of accessing ECPs at a Chennai Govt hospital

Without disclosing that we are reporters, we asked for emergency contraceptives at five government hospitals in the city. We finally got them at one hospital — but only after being humiliated and moral policed for an hour and a half.
TNM's reporters seeking ECPs at Chennai's Kasturba Gandhi Hospital
TNM's reporters seeking ECPs at Chennai's Kasturba Gandhi Hospital

December is the follow-up month at TNM where we go back to headlines of the past for a status update. In this series, we strive to bring focus back to promises made by governments, revisit official investigations that should have been completed by now and exhume issues of public interest that lost steam over time.

It was close to noon on a Thursday when two TNM reporters walked into the Kasturba Gandhi hospital in Chennai, popularly known as Gosha. Our first stop to ask for Emergency Contraceptive Pills (ECPs) was the pharmacy in the gynaecology department of the hospital. For the next one and a half hours, we were shunted from building to building with no clear information on how and where to procure the pills, and were even given the wrong tablets at one point of time. 

Without disclosing that we are reporters, we asked for ECPs. The pharmacy in the gynaecology department said they do not stock any, and redirected us to the outpatient (OP) ward of the same department where a senior doctor was taken aback by our request for an ECP. She hesitantly told us that the family planning department’s OP ward was where we had to go. When we reached the said ward, a lone nurse was seated there. She initially gave us a judgemental stare, but after some questioning, she handed us two packs of Mala N. These are not emergency contraceptives. Mala N is a Combined Oral Contraceptive (COC), and is composed of levonorgestrel, ethinyloestradil and ferrous fumarate. It comes in packs of 28 pills: 21 hormonal tablets and seven iron supplements to be taken in a particular order during the menstrual cycle, to prevent pregnancy. Most ECPs such as the Union government produced Ezy Pill consist of a single dosage of levonorgestrel, to be taken 48 to 72 hours after sex, for preventing pregnancies.

Pictured above and below: Mala N, a Combined Oral Contraceptive (COC), consisting of 28 pills. These are not ECPs, but TNM's reporters were mistakenly handed these at the Kastubra Gandhi Hospital for Women and Children in Egmore, Chennai.

After discovering that we were given the wrong pills, we went back to the family planning OP. By this time there was a doctor present, to whom the nurse pointed us out saying, “These two were the ones.” We repeated our request for ECPs and returned the Mala N indicating that they were the wrong pills. 

Another nurse then asked for our names, phone numbers and home addresses, which she recorded in a large register. “Husband’s name?” she demanded. We, both women, replied that we are unmarried. “Who told you that you could get these pills here?” she asked angrily. The atmosphere in the small consultation room had changed dramatically. She demanded that we provide our fathers’ names instead and asked us to wait outside. We could hear the nurse who had previously handed us the Mala N getting admonished inside. “Do you just hand over the pills to whoever comes and asks? They say they’re unmarried!” the second nurse berated the first. The fact that unmarried women could have sex lives and then seek ECPs had caused a storm of derision and shock.

Soon, there were five staff members in the ward including two junior doctors and a counsellor questioning how we ended up at this hospital for ECPs. We informed them it was Ma Subramanian, the Health Minister of Tamil Nadu, who had told media in July 2022 that ECPs are given free of cost at all government hospitals. The Health Minister had been reacting to TNM’s ground reports from the same month on the unavailability of ECPs in Chennai’s private pharmacies.

After we referred to the Health Minister’s statement, we were instructed to return to the gynaecology department. Once we told them that it was the gynaecology department that directed us to family planning OP, they told us to get ourselves registered at a different building and return with a registration slip. We did as instructed, but it only got worse from there. We were both asked to wait outside for fifteen minutes (which eventually became a 30-minute long wait) to consult with a senior doctor. Seated right next to the door, we heard the counsellor look in our direction and say, “Nammalukku nu vandhu vaiykithinga parunga.” Loosely, it translates to, “Look at what things (referring to TNM reporters) we have to deal with.”

While we waited, a junior doctor and the counsellor asked us in covert terms when we’d last had sex. What was baffling was that medical practitioners whose daily work involves dealing with sexual wellness would not even utter the word ‘sex’. Instead we were questioned using euphemisms such as “When did you last have contact?” After questioning, the junior doctors were seen frantically calling senior doctors to find out whether or not we could be handed the pills.

Meanwhile, we witnessed another woman who seemed to be in her early twenties and needed a contraceptive injection, humiliated and shouted at for not understanding instructions. We also witnessed how a married woman who was seeking abortion was provided false information about Medical Termination of Pregnancy (MTP) laws in India and eventually turned away. “You have to consult with your husband. Also if we do the abortion here, you have to stay back and get the family planning surgery done as well. Those are the government rules,” we overheard one of the hospital staff tell the woman who was 10 weeks pregnant. This is incorrect. India’s MTP laws allow abortion up to 24 weeks and do not require the permission of the partner. Neither is there any legal requirement that a woman accessing abortion must also go through with a sterilisation surgery.

The woman at Kasturba hospital who later spoke to TNM on the condition of anonymity said that she was married with two daughters. Due to the younger daughter’s ill health, she wanted to terminate her pregnancy in order to provide care for the child with more ease. “My husband and I want to try for a third child in a few years. That’s why I told them to put in an IUD (Intrauterine Device) instead, but they’re saying if I want a third child later, I may as well have this one now since I’m already pregnant,” she told TNM.

When we were finally called in, one at a time, the round of questioning from no less than five staff members present in the room, including two junior doctors, did not end. They wanted to know if the person we’d had sex with was a “life partner”. The initial questioning continued to be along moral policing lines rather than gathering medical history. The notebook pictured below would be required at any further consultation. It reads like a crime record: “Previous history of coitus”, “unmarried” and “previous history of use of condoms.”

Pictured above and below: Details regarding sexual life of reporter reads like a crime record. This notebook would be compulsory for future consultations. 

Nearing the end of our consultation, the counsellor was called to the desk from the other end of the consultation room. “The counsellor has to advise you before we hand over the pills,” one of the junior doctors said. Approaching the desk, the counsellor grumbled, “What to even tell these people?” before she half-heartedly explained the effects of the tablets. 

After an hour and a half of humiliation and moral policing, we left the building around 12.30 pm with ECPs. We agreed on the fact that the ECPs in our hands had to be one of our most prized possessions given how difficult it is for unmarried women to get one in Chennai. Just then, one of the nurses came running down the stairs after us. She told us to be careful going forward and that it won’t be easy to get ECPs as unmarried women. “For married women, it’s simple. They can consult with their husbands and come here to collect the pills. There are a lot of formalities for unmarried women,” she said. When asked what kind of formalities and if it was by government order, she replied. “Formalities like consulting with a senior doctor regarding whether you can be given the pills or not.” We asked her why this was so, she replied, “Isn't it wrong to have sex when you’re not married?” 

After a humilating ordeal of one and a half hours, TNM's reporters are handed the Union government produced ECPs called Ezy Pill

Ironically, in the halls of Kasturba Gandhi hospital hangs a large, framed portrait of Periyar, the rationalist leader and founder of the Dravida Kazhagam. Underneath the portrait, is the following line, “A woman is not a birthing machine.” The Dravida Munnetra Kazhagam’s (DMK) poll promise was one of social justice and upholding Periyarist ideals. However, the experience of TNM’s reporters beg the following questions: are Periyar’s ideals empty political gestures? In reality, are women in Tamil Nadu not entitled to reproductive rights, ownership of their own bodies and sexualities? And is the state government going to decide for women when they can or cannot have sex? 

A portarit of Periyar, the rationalist leader who also advocated for women's sexual freedoms, seen at Kasturba Gandhi Hospital

Earlier that week, the reporters had visited the Institute of Obstetrics and Gynaecology, Egmore, where similarly, the doctors and other medical staff expressed outrage and disdain upon hearing that unmarried women wanted ECPs. We approached a senior doctor at the family planning OP there, who angrily turned to her colleague and expressed disgust, “Enna ma’am ithu?” (what is this, ma’am?). The conversation occurred after we were similarly shunted from building to building, before finally being directed to the FP ward. When we mentioned the Health Minister’s claims, she grudgingly told us to go back to the gynaecology OP ward, even though we told her it was them who sent us to her. 

When one of us had returned to the gynaecology ward, the nurse inside threw the OP sheet to the other nurse seated next to her after learning that we needed an ECP. “This woman wants something it seems,” she said. The other nurse sharply asked, “Are you married or unmarried?”. Visibly disappointed with the response she went inside to consult the doctors. Meanwhile, one of the medical practitioners scanned the reporter. Her gaze swiftly went up and down, for several minutes until the reporter expressed discomfort. The nurse came back after a few minutes and redirected the reporter to the FP OP once again. At the end of an hour and a half, our search was fruitless. 

TNM also visited four other government hospitals including the Rajiv Gandhi Government General Hospital (RGGGH) and Stanley Medical College Hospital. In September 2022, TNM filed several Right To Information (RTI) petitions seeking information on availability of ECPs in Chennai’s government healthcare facilities. Kasturba Gandhi hospital was the only public hospital in Chennai to respond via an RTI confirming that they have ECPs in stock.

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