One of the most significant ways to empower women is to give them control of their body. To create an enabling environment for them to make decisions concerning their sexual and reproductive health—including when to have children and how many. Family planning and access to contraception is one of the most effective ways of doing so. Every woman should have the right to have access to these services, including counselling, which will enable her to make an informed choice as well as exercise her right to regulate fertility.
Women should not be bound to use a method due to lack of contraceptive choices. If it is so, it would be a direct violation of rights. An expansion in the basket of contraceptive options is an effort to ensure that family planning doesn't become coercive due to lack of choices—it should be able to cater to the needs of individuals across demographics, religions, regions and socio-economic class, keeping in mind the affordability and accessibility.
Few countries in the world rely as much as India on sterilisation as a method of contraception.
The provides details of four "interrelated and essential" elements of the right to the highest attainable standard of physical and mental health—availability, accessibility, acceptability, and quality.
However, availability and accessibility of contraceptive services have been of concern to women in India. Contrary to the general perception, most women in India do want a smaller family. The national data tells us that the desired family size is less than two children (desired fertility rate is 1.9 as per National Family Health Survey, NFHS III) and almost 32 million (3 crore 20 lakhs) women's need for family planning is not met, i.e., they want to either delay or stop childbearing but are not using or not able to use any contraception for diverse reasons.
Additionally, there has been an unequal share in the use of the modern methods of contraception among women and men in India – where the larger burden has fallen on women. According to the NFHS III, among the total 48.5% use of modern contraceptive methods, men only contribute 6.2% with women accounting for the remaining 42.3% through various methods, which is also skewed towards female sterilisation (37.3 %).
Due to the insufficient access and limited choice of temporary methods of contraception, few countries in the world rely as much as India on sterilisation as a method of contraception. More than one in three (36%) Indian women resort to it as against one in 20 (5%) in Bangladesh. In 2014, close to 150,000 Indian women underwent sterilisation as against some 5000 men. In 2005-2006, female sterilisation accounted for 66% of contraceptive use. The majority of women (77%) who underwent this procedure had not used any method before they were sterilised, and more than half were sterilised before they reached 26 years of age. In a word, sterilisation has so far been used as a proxy for contraception. These are "wake-up statistics" that need to be noted and acted upon.
The move by the Ministry of Health and Family Welfare to introduce three new methods—progestin-only pills, centchroman and injectable contraceptives, to the basket of contraceptive choice has steered concern among activists in terms of the possible side effects of the injectable contraceptive Depot Medroxyprogesterone Acetate (DPMA).
Injectables are contraceptive shots that offer pregnancy protection for up to three months. It is a simple, safe and reversible family planning method than can be administered discreetly.
Although, we are aware that all contraceptives, including injectables, have side effects, hormonal contraceptives are safe and suitable for nearly all women, including those who are breastfeeding, those who have or have not had children, and even those who may just have had an abortion or miscarriage. With regard to injectables, there are no conclusive studies to establish side effects such as permanent bone mineral density loss, weight gain, decreased sex drive etc. Furthermore, there is no evidence of a causal association between DMPA use and an increase in women's risk of HIV acquisition. Since the last DTAB report, more scientific data and evidence are available, supporting the safety and efficacy of the DMPA injectables. A systematic review by The American Congress of Obstetricians and Gynecologists (ACOG) on bone density recovery after DMPA contraception use concludes that bone loss occurring with DMPA use is reversible and is not likely to be an important risk factor for low bone density and fractures in older women although data on fracture risk in DMPA users are lacking.
Injectables are contraceptive shots that offer pregnancy protection for up to three months. It is a simple, safe and reversible family planning method than can be administered discreetly. The method is especially convenient for women who fail to remember to take a pill everyday or negotiate with their partner for using a condom. As per all other methods, it is essential for a woman to visit a doctor for the first screening and counselling on eligibility and potential side effects. It is of the utmost importance that she is fully informed as only this will enable her to make a considered and educated choice.
While the ministry is making all efforts to ensure full preparedness, including the training of service providers, for the roll out of the injectable, it is critical for the government to address the concerns raised with regard to its use by activist groups and others. This can be done by sharing evidence-based information on the benefits and side effects of the injectable.
Contraceptives are not just a means of population stabilisation; they are also an issue of human rights for every woman and man.
The time is opportune for us to bring the issue of rights to the forefront and give it its long due importance. Especially with the government moving forward on the roll-out of three new contraceptives. There is a need to ensure quality at all levels, including counselling, leading to consent that is informed. Contraceptives are not just a means of population stabilisation; they are also an issue of human rights for every woman and man.
A country's success is not just measured by its increased GDP and other growth parameters but also by the extent to which the rights and freedoms guaranteed in the Constitution are exercised. The freedom of choice, the freedom of speech, the empowerment of women and gender equity are indicators that speak volumes. Indeed, it is time that we gave women greater choice. Making more contraceptive choices available is a giant step towards this.