CHENNAI: From purchasing pads hastily wrapped in black plastic covers, being told to cover up with a dupatta to peeking over one’s shoulders in dark lanes, repression of sexual desires to the pressure to conceive — a woman’s life is punctuated by precarity and control.
Women’s liberation is linked with reproductive rights and the glaring gap can be seen in any newspaper as it teems with stories of sexual assault — Adivasi women giving birth on a road while enroute a hospital miles away, and crying girl children found in dumpsters.
In the 1960s, the famous slogan “My body, my choice” surfaced and was graffitied on walls, scribbled on posters, and hollered on streets as women fought for autonomy. Today, across the world, this fight continues as these words crumble and vanish when it comes to everyday reality.
“Others advocate birth control with a view of preserving the health of women and conserving family property; but we advocate it for the liberation of women,” wrote Thanthai Peiyar.
Yet, in Periyar’s Dravidian state, the not-so-secret shadow ban on emergency contraceptive pills (ECPs) reigns. Introduced in the 2000s in India, these morning-after pills prevent a pregnancy, taken within 72 hours of unprotected sex. While the Drug Controller General of India (DGCI) permits the sale of 0.75mg of Levonorgestrel, an ECP, to be sold without a prescription, most women find it hard to find them in pharmacies.
In pursuit of this pill, Adithi* drove 18-odd kilometers with a friend from Anna Nagar to Adyar, visiting all pharmacies, from the small family-run ones to larger franchises. “I had to go to around over 10 medical stores at night to find one in Adyar that kept i-pills finally.
All of the other ones either said they don’t keep it at the store, it was temporarily out of stock,” says the marketing assistant manager. She adds she faced the brunt of judgemental looks as well.
For women like Adithi, this search for ECPs is bound to get harder. Last month, as reported in The New Indian Express, “The Central Drugs Standard Control Organisation (CDSCO) is likely to recommend a ban on the over-the-counter (OTC) sale of all hormonal contraceptive drugs, including oral emergency contraceptive pills (ECP)” An expert panel, was “formed after the Tamil Nadu government proposed a ban on the OTC sale of hormonal contraceptives citing “its irrational usage” at the 62nd Drugs Consultative Committee meeting held in September 2023.”
Long before this meeting, Coimbatore-based Rahul* accompanied a friend to find ECPs; As their search in Tamil Nadu faltered, they travelled around 40-odd km to Palakkad in Kerala to purchase it. “In Coimbatore, let alone the emergency pills, getting condoms without a stare is bizarre.” The 12 individuals CE spoke to said they found it easier to purchase these tablets in Bengaluru, Mumbai, or Kerala.
As for Krithika Ramani, her search in Chennai seemed to be smoother. “I was fortunate to find a few unbiased pharmacy folks who provided contraceptive pills without judgment or excessive pricing, but it wasn’t easy to locate them or find stocks at all times,” she says. However, the marketer recalls an instance when a couple from another state, visiting Chennai, found themselves in a panic as they couldn’t find contraceptive pills.
While the dominant idea is that ECPs may cause side-effects, nine women CE spoke to, reported no negative effects after usage. According to the WHO fact sheet on the safety of levonorgestrel-alone emergency contraceptive pills, it is “safe for use by all women, including adolescents. Levonorgestrel, the active ingredient in LNG ECPs, has been widely used in various formulations for over 30 years and has been extensively studied in women of reproductive age…LNG ECPs have no serious or lasting side effects.”
Yet, why do pharmacies still not stock these medicines? “The ECP, which comes under many brand names, is a levonorgestrel tablet that has been listed in the National List of Essential Medicines for so many years. It means availability has to be guaranteed at primary, second, and tertiary healthcare levels.
We want open written confirmation that this will be done and this is how things are, we don’t want to keep having these conversations, and so there is no way to rake up this conversation and for a shadow ban on this again,” says activist Archanaa Sekar. She adds, there needs to be distinction in communication about daily, weekly, and emergency contraceptives, and a national-level circular must be released to all pharmacies.
The issue of the ECPs and judgemental medical spaces runs deeper, starting with shame associated with sex. It starts in our classrooms where the syllabus shies away from sessions on safe sex and reproductive systems, families that refuse to have conversations on pleasure, and classification of moral, chaste women and ideas of promiscuity. “Though we are a generation that has a lot of access to information, we still do not know a lot of things when it comes to our sexual health. Awareness is lacking, a lot of people still have vague ideas related to sexual and reproductive health,” says Adithi.
As misconception and misinformation rules, Archanaa says, “For states like Tamil Nadu that wear the garb of social justice and progressive politics, honest conversations addressing emergency contraception are the need of the hour.”
According to the National Family Health Survey (NFHS-5), currently married women between the ages of 15-49 in Tamil Nadu reportedly used only 1.8% of condoms, a stark difference from the 9.5% national average. Around 57.8% of women in the state have gone for female sterilisation while only 0.1% of men have opted for the same.
The burden is on women, points out Archanaa. “Contraception methods are not thought about, the only point seems to be having children or aiming for pregnancy. It seems silly but what a large gap to fill! People tell me they are very shy to go into a shop and buy condoms. For many people, to walk into a retail store is not an option, which means going to your pharmacies. How do you go in and ask for condoms?,” she highlights.
On the other hand, she argues that the low condom usage could also be because “there’s a myth that sex with condoms is less pleasurable than sex without condoms, and men are reluctant to wear them. Women are unable to negotiate that or exert agency with respect to what contraception method to use.” Some women told CE that some men have refused to use condoms. One mentioned the preference for the pull-out method.
A lack of access to ECPs and an inability to negotiate the use of condoms may push women into searching for unsafe termination methods. “As per another study in The Lancet Global Health, in 2015, 8 lakh unsafe abortions were carried out in India. People who try to access abortion care mention that their experiences are rife with stigma and disrespect. Given this, easy access to emergency contraception could help in preventing unwanted pregnancies and thus unsafe abortions that threaten the life of women,” writes Christianez Ratna Kiruba in BehanBox.
Flagging the linear, narrow blinders-wearing approach to sex, the activist points out that “sterlisation becomes the reason to stop having sex, we can look at contraception from a medical standpoint, and only having honest conversations about this will change this. “Anybody that does not follow this linear cycle is seen as an outlier…We can’t talk about contraceptive methods without first addressing what we think of as the most easily cheap and widely available method of contraception that is not being accessed by people. We have to start our conversation about contraception there.”
BURDEN ON WOMEN
Every woman and her closest friends know all too well the struggles of purchasing safe contraceptives, searching for ECPs, and scrambling around for nonjudgemental gynecologists. “Seeing a gynaec is pretty much a disaster if you’re unmarried. I recently had to take my fiancé to the gynaec at night because of certain irregularities in her cycle and we were scared. To find a doctor who understands and doesn’t judge a woman for her choices is impossible. We had to go to three hospitals to get a proper opinion,” says Rahul.