The responsibility of practicing contraception makes for an essential aspect of a couple’s fertility work. The pattern and use of these contraceptive methods are decided by a range of social, economic, cultural, political, and demographic factors. In heterosexual relationships, a large part of the family health work is inadvertently feminized and the lion’s share of the contraceptive burden disproportionately falls on the shoulders of women and women alone. The unequal power dynamics in intimate partner relationships deeply influence the contraceptive behavior of couples and is also one of the foremost reasons why many women are at the receiving end of forced contraception.
Most often than not, making contraceptive choices are not just a matter of accessibility, availability, or effectiveness of the methods, but rather is also a direct consequence of the systemic and structural barriers experienced by women. Apart from the normative barriers that undermine women’s autonomy in seeking contraception, women also face several relational barriers.
Patriarchal Society And Healthcare
Within the reproductive and healthcare market, they have a highly compromised command as consumers in comparison to their male counterparts. There are still pharmacies and hospitals, especially in the rural interiors of India that refuse to provide contraceptive services to women without the approval of their husbands or other elder members of the family.
In a patriarchal society such as ours, women have historically been victims of gender-based power imbalances that feed on the idea that men should be in charge of women’s sexuality and their child-bearing and spacing choices. This attitude prevents women from taking, independent, active and informed decisions in the process of family planning.
Most men do not consider women’s preferences when it comes to contraceptive usage because they feel threatened with losing control over their partners and more generally their sense of masculinity. Some of them also believe that their partners would become more adulterous with the liberty to choose contraception, inviting increased community ridicule.
In the male-headed households, where men are in complete charge of handling the resources and their partner’s mobility, there is a high chance that women may encounter difficulties in freely seeking health care services as and when they feel the need to. In such patriarchal families where there is a strict interplay of social and gender norms, practicing contraception in the open, defying the wishes of their partners can have detrimental consequences for women sometimes amounting to separation, divorce, abandonment, and even physical violence.
An absence of education, employment, and excessive financial dependence on their partners or their in-laws are all factors that will only add onto these existing barriers further barring women from taking autonomous decisions related to their sexual and reproductive health, subsequently pushing them to settle for suboptimal and lesser effective methods of contraception.
When there are structural imbalances in a relationship that make it tough for women to openly express, and communicate their choices, women shift to methods that they would not opt for otherwise to retain the peace and harmony of the relationship even if that means putting their bodies in jeopardy. There are instances where women undergo permanent sterilizations and hysterectomies over other safer options just because they could avoid abuses and violence arising out of discussing sex and contraception with their partners.
Why Don’t Indian Men Use Male Contraception?
In our society, male-centric contraceptives like condoms, despite being the most effective, painless, and cost-effective mode of contraception along with being an STD preventative continue to largely remain unaccepted and overlooked because of the prevalent misconceptions that they would negatively affect the “manliness” and virility of men making them sexually inferior to women. Condoms are further believed to cause decreased sexual pleasure, reduced erection, and dissatisfaction in males.
Many men refuse to use them because of the fear of being conceived as “less of a man”. Such blatantly incorrect and faulty understanding of male contraceptives has led to a lopsided, and gendered use of contraception. It has also furthered the promotion and practice of certain regressive female contraceptive methods that mercilessly put female bodies through hazardous, painful, and sometimes irreversible medical procedures which have long-lasting health implications.
Withdrawal is another method that is mostly employed by men in intimate partner relationships to escape from using condoms. Most men cite “withdrawal before ejaculation” during sex as a fair enough justification for the non-use of condoms. However, they overlook the fact that withdrawal is a highly ineffective and unscientific way of preventing pregnancy and in no way can be considered as a substitute for condoms. At the very best it can only be seen as an excuse put up by men for not using condoms. Such an attitude exhibited by male partners reflects on their irresponsibility and insensitivity towards their partner’s need for effective contraception.
Nearly 75.4% of married Indian men are known to use absolutely no contraception at all according to the data from NFHS. 73.3% of men refrain from using contraception while engaging in sexual intercourse with their wives and 69.4% of men do not when having sex with their girlfriends or live-in partners. Statistics of unmarried men show that 52.9% of them fail to use any form of contraception. These numbers are in stark contrast to the rate of female sterilization, where about 39% of the Indian women undergo the procedure every year, reflecting on the vehement promotion of sterilization of female bodies by the Indian Family Planning Programs.
Further, the statistics from NFHS 5 show a spike in the use of IUDs, and pills particularly in the Western region of the country. The survey also showed that the male sterilization rates were significantly low in almost all the states with as many as zero men using it as a method of contraception in 7 states including Goa, Tripura, Karnataka, Manipur, Meghalaya, Mizoram, and Nagaland.
For the longest period, India had relied disproportionately on female sterilizations, within fact conducting as much as 4 million sterilizations per year. It is beyond shameful that despite female sterilizations being medically deemed a lot less invasive, it still ranks as the highest practiced mode of contraception in India.
The procedure is highly invasive, and permanent which includes the cutting and tying of fallopian tubes. It is also medically regarded as painful with an increased probability of post-operative complications in cases of improper care. Women coming from intersectionally marginalized positions stand at a far higher chance of undergoing coerced sterilization practices due to a reduced sense of bodily autonomy and agency.
Family Planning In India
India’s family planning campaigns run by the government and the civil society inadvertently focus on promoting and publicizing those methods that are centric on women and their bodies. This further shifts the onus of contraception entirely on women while men who have a monopoly over decision-making in most households continue to remain severely ignorant, unaware, and misinformed about the importance of healthy contraceptive practices. Consequently, women are time and again manipulated and forced to put their bodies at the discretion of others. Therefore, it has now become important to systematically engage in undoing the damage.
This can begin with dismantling the societal myths and taboos around the use of effective male methods such as condoms and male vasectomies. Additionally, greater resources should be employed in carrying out a larger number of male-centric family planning campaigns, along with giving impetus for developing a wider basket of male contraceptives. Both of these measures are inevitable in tackling the gender skewed nature of contraception.
Further ahead, the government along with other stakeholders should rigorously work towards finding inclusive ways that would encourage and incentivize men from across the age spectrum, belonging to both rural and urban spaces in actively performing contraception and equally partaking in family planning by voluntarily taking responsibility and accountability on issues about reproduction instead of simply brushing it aside as a matter of “women’s concern” or as “women’s business”.