It's inconceivable!

Fertility is an exclusive domain of women, but the choice of contraception is dictated by males cancelling the sexual dignity and autonomy of a woman by reducing her to a meek partner in coitus, thereby bolstering false male machismo in a brazen disregard for her choice, writes Sudhir Kumar.

India’s patriarchy is as intransigent as it can get. It reflects amply between the sheets where the choice of contraceptives is a given with no questions asked from the distaff side: it is a male prerogative and has to be a male condom too.

It is actually a no-brainer as patriarchal males have gloated over their self-assigned role as gatekeepers of women’s sexual behaviour and reproductive health. And it is all happening in the land of Kamasutra, the celebrated treatise on human coitus, and Khajuraho, the spectacular specimen of sexuality chiselled on stones. 

The fact is India’s bulging basket of condoms is skewed in the favour of males — Moods, Nirodh, Durex, Skore, Manforce, Kohinoor, KamaSutra, Okamoto, Carex, Playgard — you name it, and it is all there to satiate a man’s libido and his ego too that stems from his patriarchal entitlement and machismo. 

Ironically, the latest National Family Health Survey (NFHS)-5 survey reveals a disturbing fact. About 35.1 per cent of men believe that contraception is ‘women’s business’ while 19.6 per cent of men think that women who use contraceptives may become promiscuous. Among the states and UTs, Chandigarh topped the dubious ranking with 69 per cent of the surveyed men who believed that contraception is women’s business while 44.1 per cent of the men from Kerala held that women who use contraception may become promiscuous. Among the men, 64.7 per cent of Sikhs believed that contraception is women’s business while the number stood at 35.9 per cent for Hindus and 31.9 per cent for Muslims. 

India did take a corrective step on April 6, 2016, when the then-Union Minister for Health and Family Welfare J P Nadda formally launched the country’s first indigenously developed natural latex-based female condom — VELVET — to expand the basket of contraceptive choices, reduce unwanted pregnancies and the attendant trauma of unsafe abortions, prevent STDs, and give women more protection during sex by providing a quality and affordable healthcare product. 

VELVET was developed in-house by HLL Lifecare Ltd (HLL), an enterprise of the Union Health and Family Welfare Ministry at its R&D centre at Thiruvananthapuram. It has a shelf life of five years and is similar to the male condom in both efficacy and reliability for safe sex. It passed the international functionality trials for safety, stability, efficacy and toxicological studies conducted by the Universal Access for Female Condoms (UAFC) in South Africa. It was pre-qualified by the WHO and the UNFPA, making it eligible for institutional procurement under donor-funded programmes. “VELVET has the potential to become a game-changer for women through control over their reproductive freedom and will also go a long way in meeting the unmet contraceptive needs of the country,” Nadda said.

Globally, the first female condom was introduced in the market in the 1980s, but it has remained a lesser-known contraceptive measure. Initially, most international institutions and donor agencies perceived female condoms as a niche product for sex workers, with the result that it largely remained extraneous to their policies and budgets. This was despite the fact that in 2012, the UN Commission on Life-saving Commodities for Women and Children had approved an initial list of 13 life-saving commodities, and the list included female condoms.

In India too, the female condom has not taken off in a big way due to factors like a conservative mindset, lack of accessibility, absence of subsidy (unlike Nirodh), and inhibitions among its users. This brings to the fore India’s family planning strategy, which is flawed in its pronounced slant on female sterilisations (tubectomy) as its primary mode of contraception, though vasectomy is safer and non-invasive. As per NFHS-5 (2019-2021), 37.9 per cent of women use sterilisation to prevent unwanted pregnancies, much higher than non-surgical methods like pills (5.1 per cent), injectables (0.6 per cent), condoms (9.5 per cent of males), IUDs (2.1 per cent) and male sterilisation (0.3 per cent). Between 2008 and 2019, only 3 per cent of all 51.6 million sterilisations done in India were vasectomies. 

The government also provides a financial inducement for sterilisations as part of its family planning measures. A male undergoing vasectomy gets Rs 3,000 as incentive money. Similarly, females get Rs 3,000 for post-delivery tubectomy and Rs 2,000 for post-abortion sterilisation.

This is also a fact that sterilisation was dovetailed in India’s family planning policy partly because of international pressure. US President Lyndon B Johnson denied food aid in 1965 unless sterilisation was accepted as State policy. The World Bank provided a loan of $66 million from 1972 to 1980 for India’s sterilisation programmes to reduce its population growth rate.

India’s unmet need for female contraceptives is estimated at around 21 per cent, which is quite huge. It then becomes imperative to remove the sexist bias in promoting female condoms and also find ingenious ways to popularise them.

In Africa, female hairdressers sell female condoms as African women spend a lot of time on their hair-do, and communication about condoms can be freely carried out.

In 2013, Beatrijs Janssen, a healthcare expert from the Netherlands during a social marketing conference in Kochi, talked about measures like a hawker carrying a belly tray at a busy traffic junction, a bus station or in a cricket or soccer stadium and peddling female condoms.

“India may not be ready for it now, but the innovative concept has already sparked huge interest in several countries. The prime focus is to have mobility, instead of a stationary booth to sell condoms. Another key focus is to remove the inhibitions about contraceptives. I understand that in India also, people are reluctant to ask for a contraceptive in a drug store,” she said.

Expansion of the contraceptive choice must become the basic postulate as each new contraception method brings a three per cent additional contribution to the Contraceptive Prevalence Rate (CPR).

In India, the CPR is only 52 per cent as against 90 per cent in developed countries. A greater use of female condoms can also correct the skewed female sterilisation statistics. In fact, any talk of women’s empowerment would be meaningless if they were denied control over their sexuality and reproductive rights. India needs to ramp up its family planning strategy which does not include female condoms.

These need a vigorous push for greater social acceptability and should be competitively priced to meet some of the UN Sustainable Development Goals like promoting gender equality, reducing the maternal mortality ratio and halting the spread of HIV/AIDS. Also, a female condom shouldn’t be viewed only as an instrument for family planning, but also as a tool for pleasure enhancement.