To every solution, there is a problem. This seems to be the dictum followed by many in our country and the case of the injectable contraceptive is no exception. So, we see a certain amount of hysteria as the government signals its rollout of the injectable Deoxy Medroxy Progestrone Acetate (DPMA) in government medical colleges and district hospitals. This will afford women protection from pregnancy for three months and will be one more in the basket of choices on offer in the reproductive health programme.
Now you will ask, does it have side-effects? Yes, it does as do many drugs. It can case loss of bone density, menstrual irregularity and fatigue. But it also gives women autonomy over their reproductive choices. There is nothing clandestine in the manner in which this injectable has been introduced. The Drug Technical Advisory Body has cleared it and it has the support of a coalition of 32 non-governmental organisations.
The real problem as I see it lies in whether it will be accessible to the women who really need it. It has been readily available in the private sector for years now. Some of the objections raised by activists over the years against an injectable contraceptive are frankly ridiculous. One of them is that this will be used to control the population of Muslims. This would involve a complicated strategy of luring Muslim women to clinics where they would be injected with the contraceptive and the process repeated every year with them not realising the stealthy plot behind this. And we will assume that they will come without a fuss, no questions asked and submit themselves to frequent jabs.
The issue which should worry us is the fact that unwanted pregnancies are leading to high maternal and child deaths and morbidities. Our concern should be that women are forced to go in for sterilisation, which is not easily reversible if at all. Most women, especially those from poor and marginalised communities, don’t want to shut off their reproductive options. Often, their children don’t survive beyond infancy and childhood. They may well want to have another child or two. Sterilisation, which has been pushed actively by many state governments, is not something that they prefer but undergo for want of other choices. Sterilisation also invokes some amount of disquiet as one experiment with it enforced by Sanjay Gandhi was uniquely cruel and coercive. There are of course other options in the basket of choice on offer. Among these are pills, condoms and IUDs apart from male and female sterilisation. In the official zeal to bring down numbers, sterilisation tops the show.
These choices are available but given that the majority of women have to depend on the public health system, their access to these is patchy. In the case of the injectable, it will ultimately have to be dispensed by public health clinics. This will mean that there have to be trained workers to counsel women, tell them of the side-effects and the benefits of this and also the need to come back for follow-ups every three months. At the moment, this seems a tall order.
However, there is a huge lacuna in the reproductive health programme which can be plugged with great effect. It is that of involving men in the family planning programme. In rural India, where family planning services are needed most, the health workers are mostly women. They find it difficult to discuss issues of reproductive health, spacing and contraception with men, who in most instances decide on their family size. But the situation would be different if there were more male health workers. According to Rural Health Statistics for 2015, three are just 55,657 male workers for all of India while at least 153,655 are needed.
The whole family planning programme in India has been focused on women, who in effect have little autonomy on the matter. The gripe that the injectable is meant solely for women is pointless since the women make up 98% of the sterilised population as well. Though the procedure for men is simpler, most men simply will not go in for this as there are many misconceptions like the fact that this makes them weak and they will suffer a loss of libido.
The injectable should be popularised in a much more aggressive manner in the family planning programme as a viable option to sterilisation.