It has been a long time in the making and followed by controversy, but the government has decided to make injectable contraceptives available as a family planning method in medical colleges and district hospitals in a phased manner. It will subsequently be rolled out in sub-district hospitals, community health centres and primary health centres. This will be part of the basket of choice of contraception, the others being male and female sterilisation, IUDs, condoms and pills. This will enable women to look at a long-term solution – the injectable affords protection for up to three months – which does not involve sterilisation. The problem with sterilisation, which is a favoured family planning option, is that it is not easily reversible and it can also create complications if not done under proper medical care.
In 2015-16, there were 110 deaths due to botched sterilisation procedures. There has been considerable opposition to injectables over the years from activists on the grounds that they have side-effects and that they could be used to prevent population growth in certain communities. The argument that the injectable is aimed only at women and therefore not gender sensitive doesn’t hold any water, because sterilisation is also focused on women. Over 1.4 lakh women were sterilised in 2014 as against 5,004 men.
Injectables have been part of the family planning programme in many countries for the last two decades. This has been available in the private sector in India since the early 1990s. There are indeed risks associated with injectables as there are with other forms of contraception. The challenge here is in making sure that the women who opt for this are aware of the side-effects, among which are a loss in bone density. However, the benefits are considerable.
The other problem in India is to make sure that trained medical personnel are available in the public health system to administer these injectables. Today, Indian women suffer from a host of problems associated with unwanted pregnancies from unsafe abortions to maternal mortality and life-long morbidity.
Given the high infant mortality rate, many women are not keen on sterilisation since they feel that it shuts out their option of having children later if required. But injectables are only a part of the basket of choice. Male sterilisation is a far simpler procedure and it can also be pushed in the family planning programme.
Men, by and large, make the choices about the number of children a women has and they should be involved in the family planning programme much more. For a start, health workers in family planning are almost solely female.
This should change as in rural areas especially, women are constrained from discussing these issues with the male members of a family. The injectable may be focused on women but it also allows them greater autonomy, which is always a positive step.