On 25 November, 2016 — at the beginning of the annual campaign ‘16 Days of Activism Against Gender-Based Violence — the government made a declaration that injectable contraceptives would be rolled out in phases, available to the public for free at medical colleges and district hospitals, under the National Family Planning Programme.
The new drug called Depot Medroxyprogesterone Acetate (DPMA), administered in the form of an injection, is known to thicken the mucous in a woman's cervix which stops sperm from reaching the egg, thereby preventing pregnancy. A cheaper alternative to other means of contraception such as intrauterine devices, sterilisation and pills, the DPMA users will, however, be susceptible to a plethora of side-effects such as osteoporosis, irregularity in the menstrual cycle, nausea, headaches. The decision to approve and include DPMA as a contraceptive choice is not recent. Last year, in August, the Ministry of Health and Family Welfare, under the recommendation of the Drug Technical Advisory Board of the Drug Controller General of India, decided to include DPMA — as a contraceptive choice — in its family planning programme.
This decision of the government has prompted a huge debate on the gendered approach to contraception, and India women’s sexual and reproductive health rights. Activists have pointed out the blatant gender bias in the India’s family planning programme — how women are expected to make informed choices about contraceptives and sterilisations, while in fact male sterilisation is an easier and less invasive procedure.
In September 2015, the Supreme Court directed the Centre to end mass sterilisation camps, stating that the poor and vulnerable were becoming reduced to mere statistics, and were victim to the government’s campaigns towards population control, which was driven by unrealistic and informal targets and incentives. The matter came up on a public interest litigation (PIL) filed by public health rights activist, Devika Biswas. The Court stated that the government had violated “reproductive freedoms of the most vulnerable groups of society whose economic and social conditions make them easy targets to coercion”.
Mass sterilisation camps are seen as the easiest way to introduce and administer birth control to economically marginalised women in regions where there is a dearth of health facilities. Often a doctor sets up camp and operates on women who are mobilised by health workers. There is little free will in this setting: many women want small families, and several come in for compensation. These women, often illiterate, have little or no agency to make peremptory requests of this system. These camps are in every way a blatant violation of fundamental rights and oppresses the vulnerable.
The Bench, led by Justice Madan B Lokur, stated, “Policies of the government must not mirror the systemic discrimination prevalent in society... it is imperative for both the Union and the State Governments to implement schemes announced by the Union in a manner that respects the fundamental rights of the beneficiaries of the scheme.” Besides this, it was also suggested to the Centre that it finalises and adopts a rights-based, gender-sensitive National Health Policy.
The announcement that the government would roll out DPMA is no way gender-sensitive and places the onus of birth control choices on women. It also absolves men of the responsibility of adopting safe sex measures. India’s family planning programme is the one of the oldest in the world — it was formulated in 1951, and has continued, over the years, without ever being cross-cut by gender mainstreaming.
In 1994, findings from the International Conference on Population and Development stated that birth control and family planning would have a community-based approach. The findings stated that the stabilisation of population was not only dependent on making an array of reproductive health services available, accessible and affordable, but also identified key issues such as accessible primary and secondary education for young girls and women, availability of basic amenities such as safe drinking water and sanitation, and empowering women to access education and employment, and recognise the violation of their rights.
Rolling out the DPMA without the provision for other integrated services that ultimately lead to a generation of empowered women is what is missing from the policy of the government. Without these provisions, it would condone more gender-based violence — physical, sexual and emotional — on vulnerable women. What we need is a rights-based approach to family planning where women decide what is good for their reproductive and sexual health.