What constitutes an insult to the dignity of a woman? Ravaging her malnourished body to cause repeated pregnancies or talking about ways that she can avoid such a fate even when society and the government have failed in their duty to help her access contraception?
These questions are important when large sections of even the “liberated” are outraged over Bihar chief minister Nitish Kumar’s graphic description of withdrawal as one of the means that an educated woman can make her husband practice in order to avoid unwanted pregnancies.
Giggling and blushing MLAs all around him – Kumar himself succumbs to a fit of laughter for a while – contribute to the trivialisation of an issue that has as much been India’s bane as the reluctance to address the root causes behind it without shame and manufactured outrage.
Sex is a taboo word in a country that produces 25 million children every year. Safe sex is anathema. Talking about it in the assembly is sacrilege!
National Family Health Survey 5 (data from 2019-20) says that only 66.7% Indian women have access to any method of contraception and just 56.5% have access to a modern method. (A modern method refers to sterilisation, contraceptive pills, condoms, intrauterine devices or injectable contraceptives.)
In Bihar the numbers are 55.8% for any method and 44.4% for any modern method.
Nitish Kumar’s description in the assembly is of withdrawal, a method where the man retracts before ejaculation. It is an accepted mode of contraception in any basic physiology textbook, albeit an unreliable one.
The total fertility rate – that is the average number of children that a woman would give birth to during her life time – stands according to NFHS 5 at 3 in Bihar while the national average stands at 2.2 which is just a notch above the replacement fertility rate of 2.1. Replacement fertility refers to a situation where the population stops actually growing as death and birth rates reach a balance.
For times immemorial governments in India have made family planning – euphemism for reducing births – their business. Yet if 33% Indian women and 45% Bihari women do not have access to any method of contraception that should be the cause for real outrage for all.
The squeamishness to talk about sex and the political backlash that anything akin to sex education invariably generates has given rise to a situation where Indian men get their sex education from pornography materials and women largely get it from life, learning the hard way about what can cause a pregnancy often ending up as unwitting victims of a system that is quick to punish them.
Unmet contraceptive needs lead to illegal abortions
The need for contraception and sex education go beyond the need of limiting family size which in itself is a multilayered proposition with implications on health, education, economic status etc of a family. It is a question of life and death.
In her seminal book Putting Women First based on her own gynaecology practice in Gadchiroli, Dr Rani Bang gives innumerable examples of women and girls – some of them as young as 13 – getting pregnant within weeks of menarche, sometimes not realising that they are pregnant till its too late to abort and then victimised by the tribal society for their “mistakes”. In a telling statement on what lack of sex education does to young people, Dr Bang recounts the tale of a young boy who wrote her a letter addressing her as “auntie” to talk about his own adolescent sexual insecurities and of a married couple who arrived at her clinic unsure about what constitutes the sexual act. She recounts countless cases in great detail of women and girls who had landed up at her clinic demanding an abortion past the legal timelines and then ending up either with an illegal abortion or worse still delivering an unwanted baby that is buried alive as per local practices.
According to the United Nations Population Fund (UNFPA)’s State of the World Population Report 2022. Between 2007-2011, 67% of abortions in India were classified as unsafe. Many of them happen first because of lack of contraceptive access and awareness, then because of lack of access to safe (and non judgemental) abortion facilities. Every day an estimated 8 women die in India because of unsafe abortions.
Dr Bang is one of the founding members of the Society for Education, Action and Research in Community Health (SEARCH) which runs a 100 bed hospital in Gadchiroli and has been a pioneer in many public health initiatives that have over the years been integrated into national programmes.
That women are acutely aware of the importance of contraception and often at a loss about how to access it was evident when Mewat – categorised as one of the most backward districts in the country – immediately after the inclusion of injectable contraceptives in the National Health Mission basket saw women turning up at the clinics for a shot, often without telling their families. The women told me they wanted to put a stop to the cycle of annual pregnancies in which many of them were caught and as the local health workers talked to them about options, that of getting a shot that would prevent pregnancies for a period of time, was a godsend.
If Nitish Kumar’s speech in the assembly gives women access to one more method of contraception, no matter how rudimentary and primitive, it is worth more than a few laughs. The outrage can be reserved for more deserving causes.
Abantika Ghosh is a former journalist and author. She currently works with Chase India.