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In India, women are a neglected lot, from
times immemorial. In marriage women’s sexual rights
are at the mercy of their husbands. In fact, in many
instances, they are not accepted in their husband’s
families until they give birth to male children. They
have no autonomy over their own bodies. Women are
portrayed as sex symbols in the media. Abandoned wives
and ill-informed and poor rural girls are lured into
prostitution, where they are exposed to various
infections because their clients refuse to use condoms.
They get infected and spread infection to other clients
who in turn infect their unsuspecting wives. This not a
sob story. It is a fact of life. These poor and
illiterate women do not ever realise if they have any
reproductive rights at all. Reproductive rights include the right to:-
- an enjoyable and
fulfilling sexual relationship without fear of
infection and disease. To achieve this sex
education of adolescents and youth is essential.
- a choice as to have
or not to have children.
- a caring family
planning service backed by a safe and empathetic
abortion service that treats women with dignity
and respect, and ensures privacy. Family planning
services must mean planning a family. If a women
is infertile or has repeated abortion or
still-births, she must be treated. If she does
not want children she must have easy access to a
family planning service which gives her an option
of methods to suit various ages and circumstances
in her reproductive life.
Over the last two decades
there has been an impressive rise in the use of
contraceptives in India. As per recent studies up to 37
per cent of total currently married women in the
reproductive age group of 15-49 and their husbands were
using a method of contraception (Population Research
Bureau, 1996). According to the Population Action
International, Washington D.C., the modern family
planning devices practiced in India during early 1997 was
pills (18.2%), IUD (13.3%), condom (13%), male
sterilization (19.6%) and female sterilisation (15.9%).
Still the figures are lower than desired and that effects
the reproductive health of the nation drastically.
Among
all the factors that influence reproductive health,
fertility regulation is undoubtedly the most important
one as it has a bearing on, among others, the prevention
of unwanted pregnancy and its consequences, the
prevention of STDs and infertility, sexuality, infant
survival and well-being and safe motherhood. In India 50
per cent of all pregnancies are unplanned and a quarter
certainly unwanted.
The Impact of
Unplanned Pregnancies
Unwanted pregnancy is a major public health
problem with potentially serious consequences for the
health of the women. Not only is it a denial of a
women’s fundamental right to control her fertility;
but it also exposes her to the hazards of pregnancy and
childbirth, or possibly an abortion done under unsafe
conditions. Many unwanted pregnancies result in
abortions. The number of Medical Termination of
Pregnancies (MTP), from a mere 25 reported in the year
1972-73, has gone up to 632,529 in 1991-92. But these
figures are grossly under-reported as it is estimated
that in India, every year approximately an additional 5-6
million abortions are conducted by private practitioners
(Khan, et al, 1994). Majority of these case are done in
rural areas having inadequate facilities and in
unhygienic and unscientific way.
In a developing country life India one in 50 women dies
from complications of pregnancy and childbirth, compared
to only one in 2700 in developed countries. Also, when a
mother dies, the chances of the death of her children
under five years of age increase by 50 per cent. Birth
spacing is equally important for the mother and as well
as her child. In India the traditional practice of
prolonged breast-feeding, which helps to achieve longer
birth intervals, is gradually eroding. However,
contraceptive use is rising and it helps maintain
adequate birth intervals. But where the use of modern
contraceptives is not rising as fast as the decline in
breast-feeding, many women and their children are being
exposed to unavoidable health risks, which can even lead
to death. For example, it is known that children up to
five years of age are at a higher risk of mortality if
they are born within 24 months of the preceding birth as
compared to those born after an interval longer than 24
months. The use of contraceptives to delay the first
birth is also important as early marriages are still
common in our country. Motherhood at a very young age
entails adverse consequences for the health of the mother
and her child. This practice needs to be discouraged.
Thus, there are two major challenges for policy-makers
and scientists with regard to evolving polices and
programmes for delaying births.
- The maintenance of
the practice of prolonged breast-feeding but at
the same time promoting the timely introduction
and use of appropriate contraceptives to achieve
adequate birth intervals.
- The development of
suitable and more acceptable methods of birth
spacing for lactating women. In case of vaginal
methods like barrier methods (condoms, diaphragm
and cervical caps) and spermicide, no improvement
has been made unlike pills and IUDs. Hence, their
effectiveness and acceptability remain low. In
the coming years improving vaginal methods will
be a major challenge. Another major challenge in
male contraception is the issue of acceptability.
In India almost negligible use of vasectomy
(which is much simpler than tubectomy) and low
use of condoms point to the difficulties that lie
ahead in popularising male contraception. Another
formidable challenge in this direction would be
to develop vaccines for men for fertility
regulation.
Social
Perspectives in Contraceptive Use
It is really strange as to why eligible women in
the reproductive age groups, who say they do not want
more children, do not practice contraception - the
phenomena better known as ‘unmet needs’. In
India about one in five married women who would like to
use family planning methods does use it. This varies from
10 per cent in Andhra Pradesh to 30 per cent in Uttar
Pradesh (NFHS, 1992-93). It is known that in India the
majority of the married women have the knowledge of
contraceptives, but there are certain factors that appear
to influence contraceptive use in most societies.
Therefore, it is difficult and unwise to make
generalisation. An important challenge is to discover
quickly which factors are more important than others in
different societies and to translate this understanding
into effective policies and action.
Sexual Behaviour
and STDs
Sexual behaviour has a bearing on the risk of
unwanted pregnancy and of contracting Sexually
Transmitted Diseases (STDs) particularly gonorrhoea,
syphilis, chancroid and AIDS. It poses an invisible
threat to our country, looking at its alarming growth.
According to WHO estimates of South East-Asia, India
figures second, next only to Thailand, in the number of
HIV/AIDS infected persons. A nation-wide survey conducted
during 1992-93, by the International Institute for
Population Sciences, Mumbai with information on AIDS from
13 states of India, suggested that one in every sixth
women had never heard of AIDS and there are many
misconceptions about its transmission and prevention.
According to national surveillance data, the major
concentration of HIV infection is in the states of
Maharashtra, Tamil Nadu, Manipur and Karnataka. With the
risk of these diseases and unwanted pregnancies in India,
especially among adolescents, the study of sexual
behaviour in our country is becoming essential and
urgent. A major problem is that sexuality is often
associated with strict social, moral, and religious
beliefs and this makes any study on the subject
difficult. But such knowledge is essential not only for
developing sound advice for people but also in deciding
which types of contraceptive will most suit people’s
needs. Further, it is necessary to identify and dismantle
the lingering misconceptions about contraception which is
a deterrent to its acceptability. We believe that a
concerted effort on the part of the government to
initiate a mass campaign with participation from the
family planning programme will definitely be the right
step towards success in this direction.
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