By Ila Ananya
Governments everywhere have always had a continued interest in controlling and profiting from women’s bodies. They do this brazenly and in all kinds of ways — one of which is to control contraceptive methods and their availability.
So while women in Tamil Nadu have hardly any access to emergency contraceptive pills (because some people consider its availability a ‘moral concern’) that the government is trying to lift its unofficial ban on, the Indian government is now all set to roll out free birth control injections for women that suppress ovulation. They’re the same depot medroxyprogesterone acetate (DMPA) injections that The Ladies Finger had reported on last year — the ones some doctors — with evidently classist and casteist attitudes — have said they would endorse for the poor but, fearing side effects, wouldn’t prescribe to their own patients in private practice.
The Ladies Finger’s piece showed that the decision to use DMPA was worrying because there had been no detailed discussion on the drug’s side effects. These include irregular bleeding or no periods, loss of bone mineral density, depression, and suppression of immune response. A pilot study on DMPA was considered “not required” as it was being prescribed in the private sector for over 20 years — even though the use of injectable contraceptives is actually extremely low. According to The Ladies Finger, “it is unclear how equipped these health workers are … to counsel women about contraceptives, screen patients and manage possible side effects, let alone inject DMPA, the effects of which are irreversible for three months.”
The government is going ahead with its decision despite the drug’s effects on women’s bodies, and the injections will be introduced in medical colleges and district hospitals in a phased manner. What some doctors have said about the injection is in many ways also like the 1950s, when the United States carried out a large-scale trial of the birth control pill on Puerto Rican women. There too, no woman was informed about the pill’s side effects and potential risks, or even told that it was a clinical trial. When three women died unexpectedly (one of the pill’s side effects is that it increases the incidence of blood clotting), their deaths were dismissed as unrelated to the trial and not investigated.
Just as it was so easy for the US to use women living in its less developed territory for a medical trial, some doctors here have also been willing to use these DMPA injections on poor women as there is less possibility of a strong response if something goes wrong.
According to The Times of India, this most recent move by the Indian government is one that will “give women more choices to protect their reproductive rights”. Others have said that this injectable contraceptive is an addition to what is called a “basket of family planning choices for Indian women” — as though there is a huge available range for women to happily and easily choose from with no complications. This is despite a decrease in contraceptive use in India, and an almost happy ignorance of the kind of negotiation women often have to deal with to even get men to use condoms. It appears as if DMPA has been pushed for with the same herding attitude by which governments have pushed women into horrific mass sterilisation drives where, according to the National Alliance on Maternal Health and Human Rights (NAMHHR), about 1,000 out of the 4 to 5 million women undergoing sterilisation die each year.
This connection between governments and the kind of birth control options available to women is an obvious one. Perhaps the a more telling example of this has been how Donald Trump’s victory has prompted many women to line up at their doctor’s for intrauterine devices (IUDs), before he implements any of his grand plans for women’s reproductive rights. There’s the overwhelming sense that Trump’s victory is a very real threat to the already compromised autonomy women are expected to be content with; in the same way women in India are expected to be happy with their “basket of family planning choices”. In Ohio, Governor John Kasich signed a bill on 13 December, banning abortions after 20 weeks of pregnancy.
Every country has such stories. While in Albania, the government had banned contraceptives until 1992, Japan allowed women to use low-dose birth control pills only in 1999. The demand for the pills shot up when Japanese women became furious that the Ministry of Health and Welfare had approved the use of Pfizer Inc.’s Viagra in six months flat, when their demand for low-dose birth control pills had been hanging fire for over a decade. The Ministry (which unsurprisingly comprised only six women out of a total 204 bureaucrats) continued to allow the high-dose birth control pill that had been banned in the US way back in 1988 because it could cause blood clotting.
For years, governments have either provided women with potentially risky birth control pills or pushed them into mass sterilisation drives. If it wasn’t either, they have turned the use of birth control pills into a moral issue to keep women from controlling their own bodies and preventing sexual autonomy. And now, with the Indian Government’s newest introduction of injectable contraceptives, women, towards whom all kinds of contraceptive methods are hurled, have had no say in this as usual. As Dr Veena Shatrugna, former Deputy Director, National Institute of Nutrition, Hyderabad, said about contraceptive use, the government is “looking at women as targets”.