Instead of putting its efforts into improving the delivery of existing contraceptive methods, the government has recently chosen to introduce the injectable contraceptive, depot medroxyprogesterone acetate (DMPA), which is known to have adverse effects on women’s health.
The articulation of population as a ‘problem’ or talking in terms of a ‘population explosion’ is deeply problematic, for it brings with it the spectre of ‘control’ and eventually, in a country like ours, control over women’s body and fertility. Countries that have achieved lower fertility rates have done so due to economic and social development and improvements in public services, including health services. Simply put, if a family is convinced that their one child or two children will not only survive but be healthy, they won’t have more children.
Women, even rural women, today want fewer children. However, they are forced to have more children due to several reasons that range from economic compulsions, lack of negotiating power within the family, to limited access to health services including contraceptive services.
Women’s groups and various health groups have been cautioning the government for decades against introducing injectable contraceptives in the public health system.
Case against injectables
First, there are concerns regarding the preparedness of the government health system to implement this contraceptive method. DMPA may be easy to administer, but health workers need to be capable of assessment before administering it and of managing side effects that some women may experience. Also, DMPA requires administration once every three months. The Government of India guidelines on the injectable contraceptive mention side effects like menstrual changes, irregular bleeding, prolonged/heavy bleeding, amenorrhea (stopping of menstruation), weight gain, headaches, changes in mood or sex drive, and decrease in bone mineral density. Moreover, studies from Africa have shown that the risk of HIV infection may increase for women who have been administered injectable contraceptives. Second, the government needs to introspect whether existing methods have been made available to people through informed choice, in a safe manner.
Gaps in the system
Regular stock-outs of oral contraceptives and condoms, lack of training to the auxiliary nurse midwife or ANMs on intrauterine contraceptive devices (IUCDs), instances of lack of informed consent for post-partum IUCD, and the rampant violation of the guidelines for sterilisation, which in 2014 led to the deaths of 13 women, all reflect gaps in implementing and monitoring such programmes. It is strange that while the existing contraceptive methods are not being provided properly, the government has gone on to introduce a method that raises so many questions and may prove to be more complicated in its implementation. Why didn’t the government put all its efforts into promoting male vasectomy, for instance, which is a safer option and less of a problem for women?
By introducing DMPA in the public health programme, the government also has to answer whose interests are actually being served. There are serious concerns that some agencies are pushing this for profit. Experience from the private sector, where these contraceptives had been made available previously, shows that very few women had opted for injectable contraceptives.
The government should have been more cautious in introducing this method. It appears that by introducing injectable contraceptives under the guise of ‘expanding the basket of choices’, the government actually aims to control women’s fertility rather than uphold their reproductive rights.
