KOCHI: Kerala is going through a cultural shift, one as swift as how new smartphone models enter the market. And clearly, the gap between generations is widening by the day.
Besides tech savviness, one evident sign of this shift is sexual liberation that manifests in different ways in different age groups. One aspect, however, remains the same across generations — the lack of awareness about safe sex, contraceptives, sexually transmitted infections (STIs), and reproductive health, say sexuality educators and health care experts.
This lack of awareness is not unique to Kerala or India but is seen worldwide, particularly in developing and underdeveloped countries, where comprehensive sexuality education remains inaccessible. Taking note of this, the World Health Organization (WHO), since 2007, has been observing September 26 as World Contraception Day, and September 28 as International Safe Abortion Day.
The WHO asserts that abortion is healthcare, and health is a human right. And, in India, the Medical Termination of Pregnancy (MTP) Act, 2021, allows abortion up to 24 weeks of pregnancy.
Here is a look at the Kerala scene when it comes to safe sex practices and access to safe abortion.
‘Only for emergencies’
Advocate Anson P D Alexander, director of Kanal, an NGO based in Thiruvananthapuram, highlights a worrying trend — the increasing reliance on emergency contraceptive pills to prevent pregnancies.
“An increasing number of youngsters are depending on morning-after pills, with some using them multiple times a week,” he explains. “Most of them are unaware of the side effects of frequent use.”
This behaviour persists despite the availability of cheaper, side-effect-free alternatives like condoms, which also help prevent STDs. Anson believes men are still reluctant to take responsibility for contraception, leaving women to bear the physical consequences of emergency pills, which can cause nausea, vomiting, headaches, fatigue, abdominal pain, and menstrual changes.
“What they fail to realise is that it is an emergency pill, meant for use only when other options are unavailable. Condoms are widely available at a much lower cost, yet men still pressure women into taking pills that have physical consequences,” Anson adds.
This misuse of emergency contraceptives spans all age groups — teenagers, young adults, and even middle-aged couples. Anson attributes this issue to the societal reluctance to embrace age-appropriate sexuality education, despite the growing acceptance of casual relationships and one-night stands among the youth.
Lack of acceptance
Dr Veena J S, an assistant professor at a medical sciences institute, believes safe sex remains a largely ignored concept in Kerala. She has seen professionals resort to using morning-after pills, which contain high levels of hormones. “Bleeding is a common side effect, and in some cases, it can persist for weeks, causing fatigue,” she says.
Her advice is simple: use emergency pills sparingly.
Dr Veena also highlights the option of female condoms, though they are not available in physical stores and are costly online. “If these were more accessible, it would grant women better autonomy over their contraceptive choices,” she says.
Contraception should be part of a lifestyle, but even among the educated, there is a persistent lack of awareness and reluctance to use it. “Society needs to encourage its use for it to gain wider acceptance.”
Anson recounts the case of a middle-aged woman whose husband had died over a decade ago, leaving her with two children. She later entered a relationship and had an unplanned pregnancy.
“The man threatened to kill himself if she didn’t have an abortion because he had another family. She bore the entire burden of their relationship, and fearing the stigma, she didn’t tell her family. She couldn’t access a safe abortion,” he says.
Instances like these are common across Kerala, Veena adds, noting that the lack of access to safe abortions is a significant issue. “Many hospitals refuse the service or demand the presence and permission of a husband or family member,” she explains.
The law allows for abortion up to 24 weeks, but the decision ultimately rests with doctors, who sometimes deny the service despite the law stating that the woman’s consent is sufficient.
Anson and Veena have both encountered married couples and young individuals who struggled to find a willing doctor to terminate an unwanted pregnancy.
Several reasons
Dr Praveen Gopinath, a gynaecologist from Kannur, notes that patients from across the state approach his hospital for abortion services. “Many patients report difficulties in finding hospitals willing to perform abortions. Doctors’ religious beliefs and the persistent stigma surrounding abortion are likely reasons,” he says.
Apparently, the same moralistic attitudes apply to contraception as well. Dr Praveen points out that many doctors hesitate to prescribe oral contraceptive pills to unmarried women.
Dr Edwin Peter of the Sex Education Kerala (SEK) Foundation believes that social stigma and prudish behaviour are major reasons why oral contraceptives are not made widely available to young people. “Though both IUDs and contraceptive pills are widely accepted globally, in Kerala, they are not being made available for many,” he notes.
“The combined result of all this is that many youngsters, especially college students, consume morning-after pills like Poppins!”
The SEK is currently conducting research on contraceptive use among college students, and one alarming trend is the incorrect use of condoms, which results in contraception failure. “It is important to note that condoms are also the most effective ways to prevent STIs. These ‘failures’ should be concerning,” Dr Edwin says.
Despite the increasing sexual liberation in society, comprehensive sexuality education remains a distant dream.
“Recognising this issue, the courts have directed to include sexuality education in the curriculum. That’s a positive step,” Dr Edwin says. Dedicated women-friendly MTP clinics in every district will also help reproductive health of the community. “There are district and taluk hospitals, but they are not very compassionate, perhaps due to the limited resources,” he says.
However, he is not too hopeful of government interventions in education sector due to backlash from conservative parents and religious communities. “Society needs to evolve, but that won’t happen without government intervention. It’s a conundrum,” he says.
