Social media was recently abuzz after a special report in this publication went viral. It referred to a subcommittee formed by the Central Drugs Standard Control Organisation (CDSCO) that would likely impose a ban on over-the-counter sales of all hormonal contraceptives, including emergency contraceptive pills (ECPs) in India. It evoked massive outrage, as it is a nightmarish move that impacts the bodily and sexual autonomy of all women.
The policymakers seem to have taken “irrational overuse” as a reason for proposing this ban. It paints an inaccurate picture of women abusing these pills, which are associated with tremendous side effects, not as a means of survival but recreationally. Undoubtedly, it would be a gross misinterpretation of on-ground realities and neglect the issue of reproductive health inequity in India. Additionally, the introduction of a prescription from a doctor would be utopian, completely disregarding the stigma attached to sex in our society.
Many women rely on ECPs to avoid unwanted pregnancies arising out of various kinds of emergencies. Our country sees a high number of rape and sexual assault cases. In such scenarios, the traumatised victims may not be in a state of mind to see a gynaecologist or report the crime for years, but the availability of over-the-counter ECPs enables them to avoid pregnancy. Currently, even if the victim is in distress and unable to bring themselves to procure the pills, friends and family can easily step in. The introduction of a prescription acts as an unnecessary and life-threatening barrier.
Another reality is that not all contraceptive methods are absolute. When contraceptive failures happen—be it tearing of the condom, dislocation of IUDs or irregular birth control pills, ECPs act as a contingency plan for many families to avoid an unplanned pregnancy. The requirement to obtain a doctor’s prescription will act as a hurdle either out of embarrassment or, in the case of underprivileged families, inability to pay the consultation fees.
Let us not forget that we live in a country with massive income inequalities where expenditure on sexual health is not considered a priority. In the last few decades, various governments and nonprofits had to provide birth-control measures for free to control population explosion. For many families that live hand-to-mouth, it is an additional burden to pay the doctors’ fees for access to emergency pills caused by contraceptive failure. It might lead to looking for recourse in illegal and unsafe methods.
There are also cases when sexual partners refuse to use contraceptives or mislead the women by stealthing. In many countries like the UK, Australia, Switzerland, etc, stealthing is considered rape and is a crime. Although not illegal in India, it is not uncommon. It is a disempowering act that betrays the trust of women and affects both her mental and physical health. The availability of emergency pills over-the-counter helps them immensely.
Such a policy also perceives all gynaecologists to be devoid of judgements, and doesn’t take into consideration their personal biases that might be in conflict with the patient’s desire to obtain a prescription.
In a similar vein, it is to be noted that most unmarried women resort to unsafe abortions in illegal clinics or at home due to the various regulations attached to abortion in addition to the insensitive nature of the medical staff. The proposed ban of emergency pills is likely to add to this data.
According to the National Family Health Survey 5, 27 percent of abortions were carried out by the woman herself at home. According to the United Nations Population Fund’s State of the World Population Report 2022, around 8 women die each day in India due to unsafe abortions. It also found that between 2007 and 2011, 67 percent of abortions were classified as unsafe. Unsafe abortion was one of the top three causes of maternal deaths.
In the case of X vs Principal Secretary, Health and Family Welfare Department, Govt of NCT, the Supreme Court mentioned the bias of doctors. It recognised that sometimes Registered Medical Practitioners (RMPs) deny abortion due to the social stigma about unmarried women and premarital sex. The Supreme Court urged RMPs not to create obstacles for pregnant people and respect their bodily autonomy. However, it is not always followed in spirit. Though the ban on ECP is not the same as abortion, it should be seen in a similar context of stigmatisation of sexual activities.
Another factor that will harm women’s health is that any ban would lead to black marketeering of many unsafe and unregulated ECPs. These will make their way to unsuspecting women who are in desperate situations.
Considering all of the above, such bans do more harm than good. It is a regressive policy that aims to control women’s bodies. If irrational abuse of the drug is what the government actually fears, then creating awareness is the way to go about it. They should take a leaf out of the family planning campaigns of the past to explain the various side effects these drugs have on one’s body and suggest alternatives for long-term usage.
Further, if they are really concerned about the side effects, the CDSCO’s subcommittee should recommend funding for researching and developing improved drugs instead of robbing women of some of the bodily autonomy we still possess.
Angellica Aribam
Gender rights activist, author, and Founder of Femme First Foundation
(Views are personal)