Amidst the moral policing and unscientific understanding of the purpose of ECPs, buying the pills is a harrowing experience for women in Chennai.

Representative image of a pharmacy: Why emergency contraception is crucial: Chennai residents, activists explainRepresentative image | Picxy: Melwin Clicks
Delve REPRODUCTIVE HEALTH Tuesday, July 05, 2022 - 13:18

In Part 1 of the TNM series on emergency contraceptive pills (ECPs) in Chennai, TNM did a status check across 23 pharmacies in the city and found that none of them stock the pill, which has a 72-hour window in order to work. Residents and pharmacists’ associations said that it’s important that the Tamil Nadu government officially clarify its stand on the issue. But why is access to emergency contraceptives crucial? We spoke to activists and residents of Chennai.

Calling it the worst race against time, a Chennai woman, who wished to remain anonymous, recalled her nightmarish experience back in 2017 while trying to buy an ECP. “I must have gone to at least 15 to 20 pharmacies in the south Chennai area. Amid work and life commitments, it felt like the worst race against time. I went to each pharmacy asking for the pill by a brand name. The i-Pill, I think. Finally at one shop, when the person at the counter said that they did not have i-Pill, someone else working there said they had a different brand in stock. It may have been Unwanted 72,” she recalled. That was when it occurred to her that the other pharmacies had probably used the same loophole — the fact that she was asking for a specific brand name — to deny her the pill, she said. “The entire experience was painful: all the judgment, stigma and the change in attitude as soon as I mentioned what I was looking for.”

The experience is harrowing for women whether they’re married or unmarried. “I went to over half a dozen pharmacies asking for pills,” said Devi (name changed), a Chennai-based writer in her twenties, who had attempted to procure ECPs two months ago. “They all refused to give me the pills without a prescription. What I instead received was the ‘look’. I finally had to book an appointment with a gynaecologist and get a prescription. The doctor asked me for my last menstrual period and gave me the prescription.”

Devi added that while the gynaecologist she approached did not make her uncomfortable, the nurses at the clinic were judgmental. “I knew getting the pills wouldn’t be easy. But still, as the hours passed, I was panicking. I had already undergone a medical termination a year ago, and I wasn’t ready to go through that again. I wasn’t able to calm myself until I had the prescription in my hand.”

Besides the moral policing and unscientific understanding of the purpose of ECPs is the staggering association of the pill with ‘rape culture’. According to writer Shalin Maria Lawrence, her husband was told that people ‘misuse’ the pills while he was trying to buy some. “When he asked them what they meant by misuse, they said people would commit rapes and then just buy ECPs for the surivors. As if the lack of access to ECPs is what functions as a rape deterrent!”

The fight for access and its challenges

The efforts by city-based activists Apoorva Mohan and Archanaa Seker in putting together a list of pharmacies that regularly stock ECPs in Chennai has been a lifeline to many in the city, who have been shamed for trying to buy ECPs and turned away from shops. But the going has not been easy for the activists. Their foremost challenge has been navigating the line between making their database accessible and protecting the pharmacies that are still willing to stock ECPs.

“I usually attempt to first vet the Twitter handle reaching out to me by going through their posts or likes. Some people say we are gatekeeping. But at times, anti-abortion people come to us masquerading as genuine enquiries to find out details about the pharmacies. Once when I told such a person that I don’t trust them, they accused me of running an illegal abortion ring. Another time, a handle tagged the Chennai police on Twitter claiming the same,” Apoorva told TNM. Archanaa too emphasised the need to protect their database and the pharmacies. “Our list has only 10 pharmacies. If this becomes public and they are harassed, even those 10 shops will stop stocking the pills.”

In 2017, Archanaa had written an email to the Directorate of the Drugs Control Department and the Ministry of Family Welfare, highlighting the lack of ECPs in Chennai pharmacies. The Directorate had in turn emailed pharmacies asking for an explanation. “People from the Drugs Control Department came home and assured me that they would ensure that pharmacies regularly stock ECPs,” she told TNM. But a one-time assurance is not enough, she pointed out. “They need to regularly ensure that pharmacies are following directives.”

Class-based access to ECPs

But even reaching out for help via Twitter is a privilege, activists say, adding that the issue on the ground is much larger. Dhivya Mary of the Centre for Women’s Development and Research (CWDR), an organisation that works with women in slums across the city, told TNM that more often than not women in working class neighbourhoods are not aware of ECPs. “The men do not even use condoms. Abortions and forced insertions of IUDs (intrauterine devices) are prevalent problems.”

“I’m from one such neighbourhood,” Dhivya said. Even though she was aware of the concept of sexual health and contraceptives, the goverment hospital where she had her first child had tried to put a Copper T in her. “This is a widespread problem. Informed consent is not an option for women who have deliveries in government hospitals. They nor their families know what forms they are signing. Too many times, women don’t even know that a Copper T has been implanted in their reproductive tract. In fact, there is even supposed to be a check-up once a year for infections. But they go for years not knowing what is in their bodies, until it becomes septic and they develop complications,” she said.

Besides, Archanaa pointed out, in low-income neighbourhoods the pharmacists often reside in the same area. “The degree of privacy and anonymity afforded to richer neighbourhoods is not a privilege they have. If a young woman walks in and asks for ECPs, the pharmacist knows whose daughter she is. Forget ECPs, even condoms can be a cause for awkwardness. Trying to buy a condom from a shop, for them, is equivalent to annoucing to the entire neighbourhood that they are going to have sex that night.”

The activist emphasised that access to ECPs is only the first step in ensuring sexual health. “From a feminist perspective, we also need to taken into account that ECPs can be used by men to coerce their partners into having unprotected sex. Men widely try to avoid using condoms, claiming sex is less pleasurable or that they are uncomfortable. These pills should not be overused, but women are too often conditioned to make their bodies available at a cost to them. The answer is certainly not to ban ECPs, but for awareness about sexual health and bodily autonomy to go hand in hand with making the pills accessible,” she said.

With inputs from Nithya Pandian.

Read: The unsuccessful hunt for an emergency contraceptive pill in Chennai

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