In practice, how strong are procreation rights of women in Kerala? How many women have a say on whether and when they want to have kids?

Representative image, Picxy
Delve Health Tuesday, December 24, 2019 - 11:37

Only a few weeks ago, a young mother of six in Thiruvananthapuram surrendered four of her kids to Kerala State Council for Child Welfare, citing her poor financial situation and her abusive husband which made it difficult for her to rear the children. The couple’s six children were born in the past seven years; the youngest child is three months old, and the eldest, seven years old. According to the woman, her husband, a daily-wager, was an alcoholic who didn’t take care of the children and was against sterilisation, despite health officials trying to educate him. 

My Body, My Rights, a global movement by Amnesty International, promotes sexual and reproductive rights for all. According to it, every person should have access to sexual and reproductive services. Everyone has the right to make a decision about their own body, health, sexuality and procreation, without fear, coercion, violence and discrimination. 

But in practice, how strong are procreation rights of women in Kerala? How many women have a say in their reproduction? Do they want to have a kid, and if so, what if they want to stop with one or two, or stop having more kids, or get a sterilisation procedure done? 

Women’s rights to make decision

Rajeena M, who works as the Malappuram district programme coordinator of Mahila Samakhya, the government initiative that addresses issues of socially and economically marginalised women and helps them learn about their rights and choices, and change their perceptions, highlights many instances to support her argument that more needs to be done to promote decision making by women in families and other institutions. 

“Decision making has nothing to do with the education of the women or the class they belong to. There are highly educated, employed women who have no rights over even their own hard earned money. How would they have a say in procreation rights? Just a day ago, we saw a woman who got beaten up by her husband (with whom she has three kids) for expressing a desire to have sex. He thrashed her asking ‘who taught you to speak like this’? A ‘good woman’, according to our society and religious standards, is expected to please her husband; her pleasure or happiness is not meant to be her partner’s concern. And this is where we speak about the right to have or not have a baby,” she says.   

In northern Kerala, many girls are still married off as soon as they turn 18; the match would have been fixed even before that. Pregnancy soon follows, and then a second one, and if the couple wants a boy, they ‘try their luck again till they hit the jackpot’. Back-to-back childbirths take a toll on the mother’s health, but no one seems to care. 

“There are older women who say, we had 10 kids, and we are still healthy. But they don’t understand that it’s a different era – the lifestyle, food habits and health of this generation is different. It’s unfair to compare. However, having children is a personal choice. And if both the parents want to have as many children as they want, let them, if they have the health and financial status to give their kids a better life. If not, please don’t,” suggests Rajeena. 

The laws on paper are clear – but the practice is muddled

Reproductive health is an integral part of right to health, and there’s no legal hindrance on a woman’s decision on procreation. Articles 12 and 16 of the UN Convention on the Elimination of all forms of Discrimination against Women (1978) stresses on the right to make free and informed decisions about health care and treatment, including fertility and sexuality decisions.

A woman doesn’t require spousal consent for opting for birth control measures, according to the Medical Termination of Pregnancy (MTP) Act, 1971 (amended in 2002 and rules framed in 2003). Under Indian law, pregnancy termination is possible only under four circumstances – if it poses a risk to the mother’s health, if the unborn child is at the risk of serious physical or mental issues, in cases of rape, and if pregnancy is caused due to failure of contraceptives used by a married woman or her husband. In all of these cases, only the consent of the female is required, unless she is a minor or mentally ill. Even in such cases, the signature of a guardian is enough, not even a parent and most importantly, it need not be a man who should sign a consent form. 

But in practice, this is not the case. Most of our hospitals insist on consent forms signed by the spouse when a woman goes for either abortion or birth control procedures, questioning the right of a woman over her body.

Salini Remani, Pathanamthitta district programme coordinator at Mahila Samakhya, recalls an incident two years ago when she accompanied a 16-year-old rape survivor and her mother to a medical college in south Kerala for an abortion. “The girl was pregnant from a love affair and the guy was in jail under POCSO Act. Her mother was 57 and ill, and her father was homebound due to psychiatric issues. At the hospital, a nurse approached the girl’s mother thrice asking if there were any men with them. She replied in the negative thrice. And then we saw the notice on the wall – signature of a ‘concerned’ male was required in the applications for sterilisation and abortion. Male ‘caregivers’ were required in instances like surgeries,” she says.

According to a gynaecologist in North Kerala, filing a consent form is a standard procedure on the part of the hospital to avoid further issues in case of any complications. “Legally, only the patient’s consent is required, if she is an adult. Family’s signature is collected just to ensure that everything is safe. Some hospitals insist on men’s signature; that must be their set of rules.”

Even though she was the representative of the shelter home where the girl was staying, Salini had a tough time with the paperwork and convincing the authorities, explaining matters related to the POCSO case with supplementing documents like CWC order, hospital records and copy of the FIR. But the hostility continued even then, “The doctor was adamant on discharging the girl from the hospital if they had no men to sign the papers. The man responsible for the situation was remanded in police custody and the girl’s 70-year-old father was ill. The doctor and nurses started lecturing about the complications; the girl and her mother started crying. After hours of verbal altercations, intervention by state-level officials of the shelter home, police arrival, their cross checking of the case file and my ID card, advice of the sub-inspector to ‘follow the rules’, and me and other officials explaining MTP provisions and POCSO provisions directly and over phone, the doctor said that duty time was almost over. Finally, writing down that any complication would be my responsibility and no one in the hospital would be responsible for any problem that develops after the abortion, I signed the papers. I told them that we only wanted to terminate this unwanted pregnancy.”

Explaining the right of a woman over her body, Salini says, “This was the case when there are supportive government documents and laws to ease the formalities of MTP for a minor. This must be the case in most medical colleges where a ‘responsible’ or ‘concerned’ man had to be there to even fill out an application form. Which means, the decision to terminate a pregnancy lies in the male who impregnated and not the woman who bears the child. She has no role at all, even if it was a rape.”

Fear of sin, label of promiscuity

Abortion is one of the most contentious topics worldwide as pro-life vs pro-choice arguments exist for mostly religious reasons. However, keeping aside the ‘sin’ factor, there are people who lack awareness, may be due to the glorification of motherhood. Rajeena remembers a case of a girl who was dead against abortion after being impregnated by her father. “She kept saying, whatever be the situation, isn’t it my father’s child? I want to see the baby.”

Rajeena observes that contrary to popular belief, changes are happening in decision making powers among women in lower social strata. “With more women gaining financial independence, thanks to initiatives like MNREGA and Kudumbasree, women have a say in decisions, which is a welcome change. To bring it about in procreation, there’s a long way to go. A woman once shared with us instances of smearing pain balm all over her body to ‘repel’ the husband as she doesn’t dare to tell him that she is not ‘in the mood’. Imagine telling him to use condoms. The woman would soon be considered ‘promiscuous’ and all hell will break loose,” she adds. 

Interestingly, there are very few men who opt for vasectomy, the simpler procedure of sterilisation which requires no hospitalisation and is relatively painless. In a 2015-16 report of the Union Health Ministry, among the 41,41,502 sterilisation procedures conducted in the country, 40,61,462 were tubectomies. Many men feel that getting sterilised affects their libido, makes sex less pleasurable and turns them weak. Neither do they take responsibility, nor do they let women decide for themselves. 

‘Do not blame it on women’

According to Health Management Information System (HMIS) data, the total number of spontaneous or induced abortions that happened in India in 2016-17 was 9,70,436. Every day, 10 women are believed to lose their lives because of unsafe abortions in the country. 

“It’s not a lack of awareness about reproductive rights or sexual health that stands in the way of our women from opting for sterilisation or abortion; it’s their vulnerabilities,” says Arathi PM, assistant professor at School of Indian Legal Thought, Mahatma Gandhi University. 

“There’s a taboo surrounding procreation rights, and even years after the discussions on body rights began, we are still at the same point, may be in a worse stage. Family is a trap of patriarchy and while staying in the system, women decide to stay out of the fight, not because they are weak, but they just don’t want to. It’s not fair to blame it on them, let the onus be on the men. Women are aware of their rights, but they do not have the physical situation to make a choice on those, nor the decision-making capacity. In a patriarchal society, having kids is a man’s decision. Despite ours being a relatively liberal society, women are wary of how society, family, and hospitals treat them, because at the implementation level, it’s patriarchy that decides matters. That’s why hospitals are asking for consent forms signed by men,” she observes.

“Consider the case of the mother of six in Thiruvananthapuram. One day for sterilisation depends on so many factors for her – there’s no one to take care of the young kids when she is away, the financial burden… all these needs to be addressed,” says Arathi. And she puts forward a suggestion. “Public health facilities have to be affordable and reachable, while hospitals facilitate involvement of women in implementing various programmes like promoting use of contraceptives. Free facilities and compensation of expenses, including wage losses, should be implemented. That way, it can be addressed,” she adds.

What next?

Taboos need to be broken regarding the body, procreation, and sexuality rights. It’s high time outlooks changed, says Rajeena. “The hospital formats for consent need to change along with the outlook of medical practitioners. They need to break from patriarchal notions and realise that my body is my right and I am my own responsibility. And as always, education should begin from home. A girl is constantly being told that she is being groomed to live in another family after marriage and on reaching the ‘other home’, she is unwelcome there, and is reminded every minute that this is not her home. She has to deal with the trauma forever. Education, instead of marriage, should be the primary purpose she should be groomed for. And she should learn how to handle her earnings on her own. To have a say in her sex life, proper sex education needs to be made compulsory for all, not the ones provided by religious institutions, but professional pre-marital counselling about living together, understanding each other and developing physical and mental compatibility,” she says. 

(Vandana is a movie-maniac, an unapologetic feminist, a believer of human rights, and admits if she is wrong or ignorant, or both.)