Adventures in contraception: Here's how hard it is to get on the pill in 'cosmopolitan' Mumbai
Samira, a 22-year-old girl from a middle class family living in Mumbai goes to her first visit to the gynecologist. Her doctor's first question is "Are you married or unmarried?" She replies, 'unmarried' and the doctor proceeds with the routine check up.
'Are you married?' is the Indian doctor's code for 'Are you having sex?' The assumption is that unmarried women don't have sex -- never mind the rising numbers of young Indians who have premarital sex in both urban and rural India.
"I felt short-changed," says Samira of her encounter with her gynecologist. "She didn't ask me my sexual history or if I knew what contraception nor did she give me any information on sexually transmitted diseases. She assumed based on my marital status that I was a virgin."
"I am not, and it took a lot of courage to speak up and tell her to give me a pap smear, knowing the whole while that she was judging my morals and my character," she recalls. The doctor certainly didn't make it easy. Samira's unsolicited bit of information was met with stony silence and she had to push her gynecologist to tell her about contraceptive measures and details of a pap-smear.
"I had to ask all the questions myself. What was the point of going to her? I could have googled the answers she gave me and I would have gotten a more detailed response," says Samira.
"Girls these days are very bold," says Dr Yamini Mehta of Apollo Clinic. "They come and do the tests on their own without their mothers. They talk openly about sex, they really aren't embarrassed of asking us things so we must also understand that India is changing."
"We can also tell if the patient is a virgin or not once we examine them," she notes. "We know if a patient asks us about the pap smear that there might be an inkling that they are sexually active, so then I enquire about their sexual history." Patients who are not sexually active do not undergo the pap smear, which can be very intrusive.
But why in 2015 must women be embarrassed about being open about their sex life with their own doctor? Worse, why must patients be subjected to the moral values of their physician?
"My gynecologist based out of Khar West in Mumbai assumed I was married because I was wearing a bindi," says Rachna, 27. "And when I said I wasn't married, I got a lecture on how to have one partner. I went for a general checkup and pap smear, so we didn't really talk about contraception. She sort of just assumed I knew about it."
When Mandira, 25, asked her doctor to take her pap smear, the gynecologist informed her mother who was the next patient in line, asking her if "she knew about her daughter."
"I felt violated," says Mandira. "Is there no such thing as doctor-patient privilege? I had to confess to my mother that I was sexually active and though she was eventually okay with it, how dare the doctor release private information about my life? What if my mother wasn't open to discussing this? She could have ruined my family relations forever," she says. (Soon after a debate on contraception went viral on twitter, a group of users created a crowdsourced list of non-judgemental gynaecologists that span over 20 cities, and are planning to translate it into multiple languages here. )
Ironically, in a nation obsessed with family planning, getting contraception is an enormous task for the not-married.
Suraj, 19, and his girlfriend Varuni, 18, have a sexually active relationship, and they share the responsibilities of procuring contraception. "My girlfriend does buy the condoms sometimes. We tend to alternate," adds Suraj. "But she gets weird looks from the shopkeepers so she prefers that I do it."
"Most of our friends are sexually active and use contraception, some tend to use the pill but most prefer to use condoms."
Worse, given the problems in procuring prescription pills, emergency contraceptive pills have become the default form of contraception because they are widely available and can be bought over the counter from pharmacies, doctor's clinics, pharmacies and hospitals. Most use the pill without consulting a doctor. The National Family Health Survey for 2010-11 states that over 83 million women use emergency contraceptives as opposed to 16 million users of male condoms.
[big-image title="Getting contraception in Mumbai and gynaecologists who don't judge. Image: Shutterstock" src="http://www.firstpost.com/wp-content/uploads/2015/08/Getting-contraception-in-Mumbai-and-gynaecologists-2.jpg" ]
Others get their prescriptions by other means."I used the contraceptive pills my dermatologist gave me two years ago to control my acne," says Arunima, 21. "It's just so much easier to explain if my parents find it in my room or my bag."
"Most girls in India are on the contraceptive pill without consulting a doctor or a prescription," adds Ajay Gupta who runs Welcome Medical in Andheri East.
If it's this hard for middle and upper class women, the situation for less affluent Indians is inevitably dire.
Pratibha, 34, who works as a housekeeper, accidentally became pregnant last month because she wasn't even aware of her options for contraception.
"I first went to a ladies doctor when I was pregnant with my first child eight years ago. otherwise there's no need to go," she says, "I don't know about condoms or pills, shills. Who has time to go take them." There's a reason why Ajay Gupta who runs a local medical store notes, "We don't get a lot of people from the lower stratas of society who come to buy contraceptives."
She didn't know she was pregnant for almost three months, and almost at the end of the window within which she could get an abortion.
"I went to the government clinic. They charged me Rs 6000, I was given no information about what would happen. They put me on a table and something was pointed between my legs. I felt a sharp pain. The nurses then made me stand up and there was suddenly a lot of blood and the foetus fell to the floor" she adds.
Where some of us have to lie or bully our doctors to get on the pill, others have to endure the horrors of a bloody abortion. This then is what passes for safe sex in modern India.
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