The Twitter handle of condom brand Durex tweeted recently that 95 per cent of Indians do not use condoms, prefixing the unsourced percentage with the question “What’s happening India?” This sparked an outpouring of opinions and complaints about condom usage, and a subsequent Twitter poll of the company pointed to “lack of feeling” as the main reason why users did not like condoms. By that time, #HateCondoms had begun trending on Twitter India.
Besides leading to unplanned pregnancies, not using condoms makes people highly vulnerable to sexually transmitted infections.The National AIDS Control Organisation (NACO) says the majority of HIV infections occur because of unprotected sex. (AIDS is the final stage of HIV infection, when the body becomes too weak to defend against life-threatening diseases.)
Durex’s claim of 95 per cent of Indians not using condoms, however, is a bit alarmist as it leaves out a lot of context. To begin with, the brand seems to have arrived at the number from a 2016 National Family Health Survey, which said that only 5.6 per cent ofmarriedwomen reported the use of male condoms for family planning.The survey subjects were married couples, which makes pregnancy more likely than the risk of contracting a sexually transmitted infection. Furthermore, 36 per cent of women in the same section of the survey (out of a total 5.1 lakh married women) had been sterilised. Hence, the non-use of condoms among married couples in the survey could be partly because sterilisation would prevent pregnancy. To top it all, the survey said that the “the most common reason” for discontinuing condom usage was a planned pregnancy.
Sexually Transmitted Diseases/Infections
Nevertheless, the debate started by the claim has shone light on the connection between condoms and preventing sexually transmitted infections. The consequences of not using condoms can be complex. For example, it puts the health of women at greater risk than men. Sexually transmitted infections like chlamydia, syphilis and gonorrhea can affect women more than men, due to anatomical reasons. The lining of a vagina is thinner than the skin on the penis, and the moist condition of female genitals makes them more susceptible to bacterial infections. Worse, women are less likely to have symptoms when they have a STD, so it often goes unnoticed for a long time. The delay in treatment is sometimes fatal.
Even if a woman is using an intrauterine form of contraceptive (birth control device placed inside a uterus), it can only prevent pregnancy and does not protect against STDs. Syphilis, if left untreated, can lead to serious complications, including blindness. A simple act of using condoms can stop the spread of these infections.
Although the number of pregnancies in women in India aged 15-19 years fell to 7.9 per cent during the National Family Health Survey-4 in 2015-16 from 16 per cent during NFHS-3 2005-06, it still has 11.8 million teenage pregnancies according to a United Nations Population Fund report.
Early marriage puts adolescent girls at the risk of becoming pregnant as contraceptive awareness among them is poor. With over 50 per cent of the population under the age of 25, India has a teenage population of a staggering 243 million, most of whom are sexually active. A 2007 study by the International Institute for Population Sciences showed 42 per cent of men and 26 per cent of women aged 15-24, who were in a relationship were found to have had sex with their partner. The study focused on married and unmarried young women and unmarried young men aged 15–24.
When faced with unwanted pregnancy, women often opt for abortion. In 2016, the number of abortions in India doubled from eight years ago. More than 10 million women undergo abortion secretly every year; the NFHS-4 report said 26 per cent of women surveyed revealed that they had performed abortions on themselves at home. A fraction even had quacks do the abortions.
For those women who are aware of oral contraceptives and emergency contraceptive pills (also known as the morning-after pill) to avoid pregnancy, procuring them is often a daunting task. The social stigma attached to sex in general and morning-after pills and abortions discourages women from going to a pharmacy to procure the medication.
Although it’s entirely legal for morning-after pills to be sold over the counter, in many places people give lectures on morality to women when they ask for contraceptive pills. In Tamil Nadu some pharmacies don’t sell morning-after pills out of moral objections.
The lack of proper health care facilities in many places, particularly rural areas, aggravates the problem.
The stigma of becoming an unwed mother is strong in India, due to which many single women abandon their babies. Not using condoms can result in unplanned pregnancies, and the “unwanted” babies are often dumped in public places or sometimes left on garbage heaps.
A recently published Niti Aayog report says that sex ratio at birth (SRB) — the number of girls born for every 1,000 boys — has declined from 906 in 2012-2014 to 900 in 2013-2015. SRB had already been declining in India since the 1950s, due mainly to practices like female foeticide, which stems from a socially accepted preference for the male child. Not using contraception to avoid unplanned pregnancies can only lead to further lowering of SRB.
Government efforts to promote condoms
Over the years, India has come a long way in reducing HIV infections. Between 2007 and 2015, new HIV infections have fallen by 32 per cent and AIDS-related deaths by 54 per cent, according to NACO data. Some of the progress must be credited to government efforts at promoting condom use. NACO has helped distribute free condoms to high-risk groups such as sex workers, transgender people and gay men, and installed condom vending machines for free dispersion of condoms. The anti-AIDS programme has also provided access to free condoms in public health care centres, government hospitals and among rural health workers.
Such measures go as far back as 1968, when the nationwide promotion of condoms started with the ‘Nirodh’ campaign. The primary aim of the campaign was to change people’s outlook towards condoms, which until then had been that they were meant to be used only during pre-marital sex. More campaigns like ‘Ek Duje Ke Liye’, which targeted married couples, Yahi Hai Sahi” (This is the Right Choice), ‘Condom, Bindaas Bol’ (Condom-Just Say It) were meant to remove the embarrassment associated with buying condoms.
Among the recent initiatives by the government, the global charity AIDS Healthcare Foundation (AHF) has launched India's first free condom store. An online initiative, which delivers 144 pieces of condoms to users who order them.The order can be placed via mail and a call to a toll-free number.It takes about six to seven days for delivery. The online store discreetly delivers the package and, encouragingly, has already found lakhs of buyers.