Rising teen sex, unwanted pregnancies, AIDS

Condoms have been around in India's family planning programme for nearly half a century, but its usage is still very low. The latest National Family Health Survey suggests just about 5% of women were able to convince their male partners to use the rubber, even though both were well aware of the benefits of the condom as a tool to protect against sexually transmitted diseases and prevent unwanted pregnancy. It is worrying that condom use remains almost stagnant after 10 years“ 5.2% in NFHS-III of 2005-06 and 5.6% in NFHS-IV of 2015-16.

Meanwhile, Indian society is changing. Since the mid-1990s, medical researchers have picked up signs of increased sexual activity among Indian teens, signalling a behavioural change among the adolescent. Three years ago, researchers from Lady Hardinge Medical College, Delhi, reported a steady increase in teenage sexual activity, based on the medical records of children attending the sexually transmitted infection (STI) clinic of Smt. Sucheta Kriplani Hospital between 2007 and 2011.

"The societal sexual practices have undergone tremendous changes, which is reflected in a steady rise in STIs (predominantly viral), sexual abuse and homosexuality in children. There is an urgent need for strengthening of school health programmes aiming at adolescent sexual health," concluded the study published in the  Indian Journal of Sexually Transmitted Diseases.

Many more teens are having sex today than ever before. They need to be educated and encouraged to adopt safe practices. Sexually transmitted diseases are on the rise in India, which again necessitates promotion of safe sex concepts. A 2014 analysis of condom use of Indian males by scientists at ICMR's National Institute for Research in Reproductive Health, Mumbai, found that the most practical contraception tool not only suffers from an image problem, but widespread social stigma and taboo limit its acceptability.

Significant barriers are, lack of privacy in stores and social stigma associated with condom use. There is also a perception that condoms are for pre-marital sex -- to avoid unwanted pregnancy -- and there is no need of it in a regular conjugal relation between long-standing partners. A potential factor contributing to the condom's popularity might be active social marketing programmes and commercial advertising of condoms, according to the ICMR study published in the  Indian Journal of Medical Research.

The decision of the Ministry of Information and Broadcasting to slot condom advertisements only for late night shows contradicts these and many other medical researches that established the benefits of condoms as the most viable option to space out pregnancy and prevent a large number of sexually-transmitted diseases. The subsequent clarification (after a notice from the Rajasthan High Court) fails to clear the air because what's "sexually explicit", or titillating is subjective in nature and changes with time. Instead of moving with the times, the Narendra Modi-led NDA government decided to swim in the opposite direction to try something that was tried by the Atal Bihari Vajpayee-led NDA government almost 15 years ago.

Those days, Sushma Swaraj was the I&B minister before she became health minister. As I&B minister, Sushma objected to condom ads on Doordarshan. Later, as health minister, she asked the National AIDS Control Organisation (NACO) to focus its educational drive away from condoms. The policy change confused the volunteers in state AIDS control societies as they had no clue on how to talk about safe sex without mentioning condoms.

"UNAIDS was not at all happy with that decision. The UN body promotes condoms aggressively," J V R Prasad Rao, a former union health secretary, told DH. Swaraj took the decision after some women and health groups in Delhi and Maharashtra raised protests on the TV ads on condoms, claiming that the campaigns were not "culturally sensitive", according to a 2003 World Bank report. They suggested that the government should develop different campaigns that promote a "moral framework with gender sensitivity". The minister also claimed that teachers, parents and many others had complained that condom ads adversely affected the younger generation. Nearly 15 years down the line, Smriti Irani used the same argument to impose a time bar on the airing of condom ads.

"Condoms are the most practical way of preventing unwanted pregnancy and preventing AIDS. We roped in Rahul Dravid to promote condoms and used images of cricket stumps covered with condoms, though it was suggestive. We also brought out specific condom brands named Dipper for truck drivers (dipper at night)," said S Y Quraishi, former project director of NACO. Quraishi, who later went on to become India's Chief Election Commissioner, was in charge of NACO when the policy decision taken by Swaraj was reversed by her successor Anbumani Ramadoss in the UPA-1 government.    

Reviewing 11 condom ads prepared by the BBC World Service Trust and NACO, Swaraj approved seven and suggested changes in two, clarified Quraishi. The impact of her decision, however, was never reviewed academically because it was too short-lived as the next government brought back the old policies, said Prasad Rao. It's early days yet to say what impact Irani's decision will have.

"To increase the acceptability of condoms, there is a need to create a positive image that use of condoms could prevent unwanted pregnancies and sexually-transmitted diseases for a sexually active population," felt the ICMR researchers. The question is, does the Modi government think likewise or not.