The Times of India, Saira Kurup & Divya A, TNN, May 9, 2010, 12.32am IST
It's been called the invention that "defined the 20th century". On May 9, 1960, the US Food and Drug Administration approved the world's first birth-control pill called Enovid-10. New technology gave women the right to choose, control over their reproductive lives and saved millions from unsafe abortions. The pill came to be seen as "liberator" and a significant step forward in the struggle for equal rights for women.
But India is more circumspect. "It does give (women) some freedoms; but it also brings with it 'unfreedoms'. Women are expected to carry the responsibility of contraception, and the problems it brings to their health," says Mohan Rao, professor at Centre of Social Medicine and Community Health at Delhi's Jawaharlal Nehru University.
The Indian experience has been hugely different from that of the West. For Western women, the pill has been linked to being able to join the labour force. Today, it is the preferred form of contraception for American women under 30.
But in India, the pill never really took off. The National Family Health Survey-3 statistics reveal that just 49% of Indian women use modern contraception such as the pill and IUDs. "Of the 49%, just 3.1% use the pill," says K G Santhya, associate, Population Council, an international NGO. The main reason is probably the skewed nature of the national family planning programme (FPP) in the last few decades.
"The focus was on terminal methods like female sterilization, rather than spacing methods," adds Santhya. That mindset was so widely promoted that sterilization remains India's most common contraceptive method.
Poverty was another reason. "Our average woman is not suited for the pill; she is hungry, she is anaemic and has an extremely low BMI. Above all, she has no access to medical care. It's also likely that her husband decides on contraception," says Rao. Illiteracy and ignorance are also factors. "The overall literacy and information availability is not adequate. So, women tend to forget about taking the pill daily and that adds to the failure rate," says Alok Banerjee, technical advisor with Parivar Sewa Sanstha, an NGO that provides reproductive health interventions. Santhya says that a Population Council survey of six states found that just 35% of the young women knew that the pill should be taken daily or weekly.
Banerjee adds that there's also an element of mistrust because the early pill contained a high level of the female hormone estrogen, which causes side-effects. "The estrogen levels have been reduced now, but the mindset has not changed."
This is a pity, says social scientist Mala Kapur Shankardass. "Ever since the introduction of the pill, the most important decision of her life is within a woman's control, and she is no longer at the mercy of her husband for contraception or abstinence. She can quietly and discreetly buy the pill over the counter any day."
"She does not need the permission of intrusive in-laws for birth control procedures. She can quietly and discreetly buy the pill over the counter any day," says Shankardass.
Delhi housewife Gulshan Dutta, 45, agrees. She remembers when advertisements for the pill, Mala-D, started to air on Doordarshan. "It was embarrassing to watch those ads in front of my husband and other family members but secretly, I was happy that I could space the birth of my children according to my wish."
Bhawna (name changed), a lecturer, adds: "It has also given a lot of liberty to women when it comes to pre-marital sex." She says she was on the pill for four years till she married her live-in partner.
"It, in a way, let us live together and no each other completely without worrying about pregnancy. Those four years of togetherness have acted as a strong foundation for our married life," she adds.
The pill's newer cousins include the morning-after and abortion pill. These don't need to be taken daily. But
over-the-counter availability leaves them open to misuse, say experts. Shankardass adds a word of caution here. She says, "The pill was introduced as a device in the hands of women to make choices responsibly. But the morning-after pill, especially the way in which it is advertised, induces a careless attitude."
Perhaps the pill's real success may lie in the search for a male version, to force men to take responsibility for birth control too. But the male pill may be some years away.
Meanwhile, the good news is that India's family planning programme is shifting focus to terminal and spacing methods which will emphasize hormonal contraception — injectables and the pill.
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