Abortion and contraception in India: the role of men

‘All unwanted pregnancies and abortions can be traced back to the male ego. Go figure!’ Image: Nalini M.

The callous attitude of Indian men that  ‘she can always abort’ in cases of an unwanted pregnancy caused by failure to use a condom needs to be tackled at the root.

Despite India pursuing an aggressive family planning program and the fact that we live in an age of information, abortion rates are showing no signs of slowing down. How does one explain this anomaly? Could it be that the condom lived up to its premise of a 2-12 % failure rate, or was it never used to begin with? What about female birth control? Is the information out there and easy to access? Is it always the women’s problem to deal with the messy aftermath of sex, while the male enjoys unbridled pleasure?  Can actual abortion figures ever be determined in a country where self-induced abortions are still performed and go largely unreported?

India’s abortion law is relatively liberal in comparison with Asian countries. Under the 1971 Medical Termination of Pregnancy (MTP) Act, abortions can be performed by a registered physician in a government-approved hospital or facility (MTP centre) during the first 20 weeks of pregnancy. According to Ipas, an NGO dedicated to spreading awareness on safe abortions and sexual reproductive health (SRH), despite this act and it’s provisions, an estimated 60 percent of abortions performed in India are unsafe. Not just this, a woman in India dies every two hours because of an abortion gone wrong.

Dr. Lourdes Tirouvanziam Louis from Pondicherry explains that traditional methods to induce abortions are still practiced in south India as they are in the north. She says, ‘The woman is given a lot of ‘healthy’ food such as papaya, sesame seeds, saffron, pineapple, cinnamon and some roots, all the same time over many days until the abortion takes place. At times, she is made to sit in a steam bath in which many herbs have been boiled to provoke the abortion. At times, she is taken to a charlatan who inserts thin branches of neem into her uterus to provoke bleeding and an abortion. Toxic concoctions are given and the belly beaten violently. The body once damaged will never fully recover. The liver and kidneys go for a toss because all sorts of toxic concoctions have been ingested.’

Louis’ grandfather Dr. Paramananda Mariadasu wrote extensively on these methods in his book ‘Medicine Traditionelle de l’Inde’ which has been translated from French to English. Although written in the 1930s, the book is still relevant as the methods described are practiced till date because of the unwillingness of some women to get a legal abortion at an approved MTP centre or private clinic. The risk of word getting out is too high, and family honour trumps everything else in a society where sex outside marriage is frowned upon. Practitioners in government Medical Termination Pregnancy (MTP) centres can often be judgemental and intimidating towards single, unmarried woman who are desperate for confidentiality. Girls under 18 are required to have a parent or guardian along with them without which the abortion won’t be performed. This is when private clinics or backstreet abortionists enter the picture.

The morning after pill

What happens the morning after a night of unplanned passion? Enter the iPill, one of India’s most favoured emergency contraceptive pills that has soared in popularity with urban Indian women. According to a Times report, the iPill is being used indiscriminately and irresponsibly as a primary method of pregnancy prevention instead of an emergency backup plan. A chemist in Gurgaon reported teenagers buying iPill boxes in bulk, sometimes ten at a time. Despite its high effectiveness rate of 90-95 %, there is still a chance of a pregnancy going undetected, not to mention long term side effects such as ovarian damage, irregular hormonal activity, disturbed menstrual cycles, decreased libido and complications in future pregnancies.

Is it however fair to blame only ill-informed college girls of misusing the iPill? Married since six years, website content writer Prema admits to having taken the iPill twice during her marriage despite being fully aware of its side effects. She says, ‘It’s the same old argument at home with my husband refusing to wear the condom because of lack of pleasure for him. We practice the withdrawal method that has worked so far. As I have two children and don’t intend having more, my gynac has advised me to insert Copper T, the intra uterine device. He says it’s high time my husband enjoys sex without a condom in a pleasurable, stress-free manner. I am a little hesitant as a friend had bleeding complications with Copper T however I’ve decided to go blindly into it as I trust my gynacologist who is the gentlest guy ever. My mother too has used Copper T without complaints and encourages me to do the same.’  Nazneen, a 36 year old mother of two says, ‘The success rate of IUDs has been proven and there’s not too many side effects. Maybe you’ll have extended bleeding of ten days during periods but that’s fine. Also not all women suffer side effects of birth control pills, and if they do, they can always adopt another method like an IUD.’

Fifty three year old Francoise, a French national who often resides in Pondicherry, reports never having a pregnancy scare or side effects with regular birth control pills.  She believes that it’s better for women to use their own contraception because using a condom (or not) may be used as blackmail by males who like to dominate.  Francoise adds,' In France it's very rare for settled couples to use condoms -  probably because it’s less pleasurable for both man and woman. Since they are loyal, there is no need of condoms for AIDS and other diseases protection.'

In a sharp and interesting contrast, CR, a 30 year old Parisian woman who is a Phd graduate in the History of Cinema says, ‘In the 70s there was a feminist slogan: "La femme est complice de son aliénation" (The woman is an accomplice of her alienation). Why does a woman accept taking the risk to get pregnant because her man does not like using a condom? Is loving him not enough? Does she too believe that he owns her body? Men can't change their attitude if women don’t fight for respect.. which might be too easy to say from where I stand.’

Like CR, Loney Jacob, a clinical psychologist and co-ordinator at PsyCounsel based out of Kochi, affirms that women are the owners of their bodies. She states, ‘No one guards a house better than an owner does which is why women get to say what is acceptable and set the boundaries. Both genders need to find a way to respect each other’s bodies.’

Aline, another young French woman who has lived and worked in Nepal, suspects a sinister plot carefully crafted out by big pharma saying, 'I think the pharmaceutical lobbies are very happy that women continue to take the pills. It does make them wealthy. They created different generations of pills and it now appears that the last generation pills are more dangerous than the first ones. Moreover the men are totally out of the story. It's really violent for women as they already have to deal with their periods, with pregnancy and delivery, and then undergo the side effects of contraception. It's totally unbalanced!'

Lack of sexual health knowledge

Global NGO Ipas found in a study that 80 percent of abortions in India happened due to lack of knowledge or absence of contraceptives. Meanwhile, teenage pregnancies are on the rise in the land of Kama Sutra. In Mumbai, the rate of abortion in under- 15 teenage girls jumped to 144% in the last three years. Why is this happening?

Loney Jacob believes that we Indians as a population of people, irrespective of gender, have very little information on how our bodies function. Agreeing that there is a total lack of objective, factual information available, she says, ‘Our minds imprison our bodies. When we lack respect of our own bodies we experience shame. Our children need to be unshackled from this mindset. School may be a good place to start disseminating information.’

However sex education in schools is either non-existent or based on teaching abstinence. Curious teenagers with frenzied hormones aren’t listening. It is pertinent to note that educating adolescents about birth control options available to them can be viewed as propagating pre marital sex. How does one reconcile this to a society obsessed with virgin brides and hymens? The easier way out is to not talk about it – the kids are anyway going to have sex, and if worst comes to worse, well, the girl will pro-actively seek out an abortion, or consume emergency pills, and basically do what it takes to save her family and the boys’ from shame.

Family planning in India

According to one report, latest figures produced by Family Planning 2020 (FP2020) reveal that female sterilisation comprises 74.4% of the modern contraceptive methods used in India, while male sterilisation is pegged at a mere 2.3%. A closer look at the chart below shows that more than 86% of the time, it’s the women taking on the onus of birth control.

Family planning education. Photo: Family Planning 2020 (FP2020)

In 2014, the PGI Hospital, Chandigarh, reported 0 vasectomies for men while 520 women underwent tubectomies. This could be attributed to a widespread and mistaken belief that vasectomies weaken men who need their sperm to go out and work. Also male sterilization is taboo in a patriarchal society where males are generally skittish about messing around with their reproductive organs. As they say, ‘No male wants to shoot blanks.’

The infamous Chhatisgarh botched sterilisations which killed 14 women made international headlines in 2014. A shocking 83 women were allegedly operated upon in five hours with one single instrument by Dr. R. K. Gupta who was once honoured by the chief minister for ‘maximum number of family planning operations.’

Carried out under the auspices of the Ministry of Health and Family Welfare, women in rural areas are given monetary incentives to undergo surgeries in hurried, unsanitary conditions.  Targets need to be met and in one such case, a doctor in Indore, in the central Indian state of Madhya Pradesh conducted 196 female sterilisations in a day.

The side effects of botched tubectomies include perforation of fallopian tubes and major vessels, infections, bleeding and abdominal pain. But how many of the women are aware of these possible repercussions? How many doctors are held accountable in cases when something goes wrong?

Change is possible

In an email interview, Dr. Kalpana Apte, the Senior Assistant Secretary General  of Family Planning Association of India (FPA India), agrees that when men take responsibility for contraception or support women in taking up and continuing using a method, it can immensely help in reducing the unmet need for contraception. She says, 'Our experience in Barwani District of Madhya Pradesh has shown us that the active engagement of couples through ASHA (Accredited Social Health Activist - a grassroots health care functionary, helped married adolescent couples aged 15-19 years to adopt contraceptive methods. The uptake increased from around 2% at the baseline to over 20% at the midline survey in 24 months. A majority of these users have opted for condoms.'

Photo: Times of India, 2 January 2016.

 Why aren’t men using condoms?

Pratap, an attractive virile tourist guide from North India admits that Indian men in general do not like using condoms. ‘It takes too much time to put them on, and many men lose the erection by then. Secondly, a man needs a strong erection for the condom to stay on; you can’t be semi flaccid. This is we prefer to just not put it, it’s a question of ego. Also condoms hurt and are painful for men. I am not aware of larger sizes sold in the market. But there are pills women can use to avoid pregnancy.’

Mrinal furthers the argument with more detail. Married for several years with a three year old son, he reports that he has never used a condom during his married life and his wife has never used birth control pills. ‘I am the expert of withdrawal!’, he announced with much gusto and bravado, ‘I know that exact second when the sperm will exit and I pull out just in time. This way, I have my pleasure and my wife does not need to suffer side effects of birth control. She has never had an unwanted pregnancy till date. But most men can’t rely on this withdrawal method. It requires hell lot of mental power. I can’t describe what it takes to just know that exact moment’. He then goes on to describe a universal pet hate that males hold towards condoms – lack of pleasure and sensitivity. He says, ‘You can come up with ultra thin, spotted, dotted, knitted, or chocolate condoms but it just doesn’t compare to the real thing. We still feel nothing. We need direct contact, skin-to-skin contact.  Only a woman who loves us and wants to keep us will understand this.’

Forum comments in an internet discussion.

Is this a gender specific issue or something that needs to be seen in context of the male anatomy? Nepali transgender activist Bhumika Shrestha has often spoken to me about how men don’t spare transgender women either. She says, ‘It’s true that most of them insist on not wearing a condom because they claim they are not fully satisfied.’

Yazad, a young married male, sees little truth in this argument and insists that sex can be as just as pleasurable when using a condom. He explains, ‘As long as a man can get away with not using a condom, he will do it by exercising some sort of control on his girlfriend or wife. She will take on the burden of birth control, tie up her tubes, take injections, whatever, for her man’s pleasure. However the same man will unfailingly use a condom when having sex outside marriage.  The stakes are too high as he doesn’t want to impregnate a woman outside his marriage nor contact STDs from other women. If condoms were such a deal breaker, men wouldn’t be chasing extra marital affairs and one night stands, with condoms stashed in tow.’

Religion, birth control and abortion

Nalini’s marriage was arranged to a Non Resident India in the USA. Her marriage quickly deteriorated because of domestic violence coupled with isolation in a foreign land and controlled telephonic communication to her parents in India. When she was pregnant with his child, her parents convinced her to have an abortion and return to India as they feared for her life, and did not want a baby born in catastrophic conditions. Nalini says, ‘Unlike Catholics who equate abortion with murder and are extremely vocal about it, Hinduism has no such restrictions that are drilled into us repeatedly. And yet, I suffered and cried after my unborn child was aborted. This feeling has nothing to do with religion or guilt – it is about love. It’s not just religious-minded women who suffer emotionally after an abortion. Others do too. Let me add that I do not regret what I did. I was compelled to do so.’

Jyotilaxmi, a lawyer who lives and works out of Mumbai, adds an interesting dimension to the argument saying, ‘I’ve known women who’ve undergone abortions only because their husbands did not want a baby saying there was a financial crisis. But what role did he play in preventing the pregnancy? Nothing! He too should have been cautious but our society permits men to shrug responsibility of unplanned pregnancies. The easy solution is always to ask the woman to get an abortion if other forms of contraception fail. ‘

In this vein, Siddhant a young Indian transman is dismayed when his married friend from the local gym carelessly informs him about the possibility of his girlfriend being pregnant with his child as she missed her period. Siddhant says,’ I was shocked at his response when I asked him what he would do if she was pregnant. He replied, ‘Usme mera kya hai?’ (which roughly translates into ‘What have I got to do with it?’).’ The guy rests easy knowing fully well that the girl will terminate the pregnancy - after all it’s always the woman’s job to clear up the ‘mess’.

Do men feel the guilt of abortion?

Mrinal admits that men do not feel the same self-hatred and loneliness that women undergo when their babies (foetuses) are aborted. He attributes this to the fact that the child has been conceived inside the women and ‘disposed off’ by her, so it’s inevitable she feels the pain more than her partner. Women are also natural mothers. Amit, a practicing lawyer, however trashes this argument saying, ‘It all boils down to love. If you truly love your woman, her tears, guilt and isolation will be yours. You will suffer as much as she does, and this has nothing to do with clusters of cells and foetuses being conceived inside her and not you.’

There are a few instances when males are outraged and tearful at the loss of their unborn child, such as when the woman goes ahead with an abortion without telling him she was pregnant. In most cases, it’s likely that she took the decision herself because she knew that he would have wanted the same. Could the power she wields over her body to get a safe and confidential abortion without telling him be emasculating and unsettling?

Like numerous other males, Ahmed an atheist and advertising professional based out of Mumbai, also confesses to being clueless about the possible long term repercussions of an abortion. According to Abortionfacts.com, ‘The nine most common "major" complications are infection, excessive bleeding, embolism, ripping or perforation of the uterus, anesthesia complications, convulsions, hemorrhage, cervical injury, and endotoxic shock.’

After her abortion, Nalini faced severe complications during her next pregnancy and eventually suffered a miscarriage. While she could not know for sure if the miscarriage and abortion were related, she did confess to feeling that she was punished for aborting her first child.

Single motherhood and abortion

If Indian society allowed single mothers who had children out of wedlock to live a life of dignity, some women would probably not resort to an abortion. However unwed motherhood by choice is anathema in the Indian context - not to mention a beaurocratic nightmare. Even a financially independent woman might have to think several times before having a child outside marriage. It’s such conditions that encourage irresponsible sexual behaviour and complacency on the part of men who can rest easy knowing that the woman has no other choice than to abort if contraception fails.

Neena Gupta, an Indian actress stunned Indian society in the late 80s by going ahead with her pregnancy, and having the daughter of celebrity Caribbean cricketer Vivian Richards. Forward to 2015, and Neena in this interview says, ‘'If you want to live in India and in society, you have to marry. Do not be this modern woman that I was, saying I don't believe in marriage. You have to marry.’ Raising a child alone in India outside wedlock requires a skin as thick as hide, financial resources and immense emotional support to take on the administrative red tape, humiliation, judgemental neighbours and covetous males, not to mention the turmoil faced by the ‘bastard’ child.

Compare this to the Western world where single motherhood is not as contentious. Kevin Hurter explains the situation in America saying that dead beat Dads are being chased after by the government. He says, ‘If a woman goes to a welfare office for assistance and offers the name of the father, the man is sent legal documents and summoned for a paternity test after which he’ll need to contribute to child support. If he claims unemployment, his name still goes on file just in case he gets a tax refund, lotto, or inheritance in the future. In some states, a driving licence can be revoked if you owe paternity making it difficult to keep a job if you can’t drive’.

Is it fair to blame men all the time?

There have been instances of educated women including feminists who have had a series of abortions with boyfriends over the years, with the trend continuing into marriage. Amit says, ‘In such cases, the issue is not illiteracy or lack of information but the acceptance of an institutionalized patriarchy and cultural expectations that exists across cultures. Even in the Western world, it is the norm for women in marriages or committed relationships to take on the onus of birth control whether by getting foreign objects inserted into them or living a state of unnatural infertility to ensure that their man has unhindered pleasure. She does it because she fears he will leave her or cheat on her, or perhaps out of love. But the end decision is still hers. We can’t keep judging and blaming Indian men all the time for being macho and patriarchal. Also, look at abortion debates raging in the Western world. It’s the same old narrative ‘how dare male politicians control our bodies ’. When will the narrative shift to the male who is actually controlling her body – her own partner who is absolved of not using protection, and who counts on being bailed out by a handy abortion?’

It’s a man’s world

Amit closes the argument insisting that there can never be equality between men and women because they are different biologically, and this difference gets passed down from generation to generation. Our great-great- grandfathers were having unbarriered sex, and our sons will do the same (at least when it comes to marriages and committed relationships).

The topic of birth control and abortion is complex and vast. In the Indian context the pressing concern is to educate women and men about the birth control options available to them, and to insist that men too share the responsibility. The callous and dismissive attitude of ‘she can always abort’ in case of an unwanted pregnancy caused by failure to use a condom needs to be tackled at the root.

A woman's body is neither a rag doll nor a battleground.

(Some names have been changed to protect identities)

Source: Open Democracy