[New birth control options have long been advocated by international organizations, among them the United States Agency for International Development and the Bill & Melinda Gates Foundation. They say Indian women — often worn out, anemic and at higher risk of death because they bear children young and often — urgently need methods to delay or space pregnancies.]
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Women
lined up for examinations this month before sterilization surgery at a
government
hospital in
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MAHENDRAGARH, India
For decades, India
New birth control options have
long been advocated by international organizations, among them the United
States Agency for International Development and the Bill & Melinda Gates Foundation. They say
Indian women — often worn out, anemic and at higher risk of death because they
bear children young and often — urgently need methods to delay or space
pregnancies.
The number of lives touched by
such policies is enormous and growing. India China United States
Paradoxically, here in India,
the keenest opposition to these newer
methods of birth control —
ones seen in the West as empowering women to control their fertility — has come
from some women’s activist groups that distrust the safety of these methods and
believe that profit-hungry Western pharmaceutical companies are pushing them.
Despite growing evidence of the safety of the injectables and their
increasingly widespread use across South Asia , these groups have continued
to oppose them. And it is Mr. Modi’s socially conservative Bharatiya Janata
Party that has broken with decades of resistance to injectables.
The shift in policy has come in
part because the government is less concerned about opposition from civil
society groups, most of them more closely aligned with the previous ruling
party, the Indian National Congress. Officials were also spurred by a medical disaster in the
Indian state of Chhattisgarh, where 13 women died in 2014 after
undergoing tubal ligation at a high-volume government
“sterilization camp.”
“I thought it was incumbent on
the government to provide it as a choice,” said C. K. Mishra, additional
secretary in the Ministry of Health and Family Welfare, of the contraceptive
Depot medroxyprogesterone acetate, or DMPA, which has been used in the private
sector since 1993. Still, the method will be introduced gingerly, limited at
first to select district hospitals and medical colleges and then expanded next
year to hospitals throughout the country. Implanted contraceptives may follow.
“We want to be very careful,” Mr. Mishra said.
“We don’t want to put a single step wrong.”
In the context of India
More than a decade later, when India
The court forwarded the matter
to India Bangladesh Sri Lanka Nepal
Opponents contend that India India Russia China United States
“Invariably these new methods
are tried on women who have no infrastructure to fall back on, who have no
other resources to go for private health care,” said Navsharan Singh, a senior
program specialist at the International Development Research Center, which is
financed by the government of Canada. She said the current plan, to deliver the
drugs through major hospitals, improved the prospects for follow-up.
Some opposition is tinged with
ideology, with critics tracing American support for population control back to
a Cold War era when they say birth control was seen as a way to combat poverty
and to stop the spread of Communism by curbing chronic poverty. Mohan
Rao, a professor of social sciences at Jawaharlal Nehru University and longtime opponent of injectables,
said the government would have introduced them years ago were it not for
India’s “mass-based women’s organizations.” He added, “They had a clear
analysis of what is imperialism and what imperialism does to populations in
third-world countries.”
In 2010, K. Sujatha Rao, then
the union secretary in the Ministry of Health and Family Welfare in the
Congress-led government, recommended lifting the ban on injectable
contraceptives. But she left her post shortly thereafter, she said, and
“because of civil society pressure, when I left, the government didn’t push it
at all.”
The atmosphere around
injectable contraceptives began to shift after Mr. Modi’s party took over in
May 2014, and it gained momentum after the Chhattisgarh catastrophe, about six
months later. Last year, “All the stars aligned,” said Dr. Jyoti Vajpayee, a
gynecologist who oversees family planning programs here for the Gates
Foundation.
“This government has come back
in a majority, so they can afford to take risks,” she said.
She and others had long sought
to convince officials that existing options — male and female sterilization,
the pill, IUDs and condoms — were insufficient for millions of
Indian women who marry in their late teens and spend years carrying
back-to-back pregnancies.
Research has shown that,
globally, 30 percent of maternal deaths and 10 percent of child deaths could be
prevented if women spaced their pregnancies two years apart.
At a meeting in August, the
Drug Technical Advisory Board recommended that DMPA be included in the family
planning program, saying 20 years of private use and studies of similar drugs
by the Indian Council for Medical Research had established that they were safe
to introduce without a pilot program.
Dr. C. N. Purandare, past
president of the Federation of Obstetric and Gynecological Societies of India
and a proponent of the drugs, praised the government for what he called “a bold
step.”
Not that the traditional method
is being phased out. At a recent sterilization camp about 90 miles west of Delhi
The women here, many of whom
had traveled from their villages, said that they were eager to go for “the
operation,” and that the cash incentive of 1,400 rupees, about $20, had not
affected their decision. They had been urged on by outreach workers who had
accompanied them to the camp, older women from their own villages.
These women are paid 1,000
rupees for each patient with two or fewer children who comes in for sterilization
and 240 rupees for each patient with three or more. They admitted that there
were drawbacks to sterilization, especially for young women who might someday
want to have another child.
“We have to tell them a lot of
things to convince them,” said Sudesh Wati, 50.
Young women often listen to the
outreach workers.
“After she spoke to me, I made
up my mind that in today’s times, nobody wants more than two children,” said
Krishna Yadav, 35, gesturing at an amiable gray-haired woman standing nearby.
“She has been telling me this for the last two months.”
Asked about injectable
contraceptives, the women mostly looked blank. They had never heard of them.
In any case, said Lalit Sharma,
a nurse who trains outreach workers, when a new method comes online, women will
almost certainly accept it.
“Whatever method it might be,”
he said, “if the government implements it, they blindly trust it.”
