India Needs To Start Talking About Contraceptives

The findings of the much awaited National Family Health Survey 2015-16 (NFHS-4) were released last week. Among the major findings was the worrying statistic that more than 50 per cent of children in India are anaemic. However, there was good news too: the number of child marriages have gone down; the survey also found that 53 per cent of women in India have a bank account, and Kerala has achieved single digit in its Infant Mortality Rate.

There’s one finding in the NFHS-4 that hints at a larger problem that hasn’t seen as much coverage. It seems HIV/AIDS awareness in the 15-49 age group is at 20.9 per cent among women and 32.3 per cent among men. One of the telling gaps in the survey is that it includes data on contraceptive usage among married women of this age group, but doesn’t focus on usage of contraceptives among unmarried Indian youth. (The previous NFHS had some data, but not enough to make nationally representative conclusions and frame policies based on them.)

The United Nations Sustainable Development Goal 3 (SDG) for 2030, to which India has committed, calls for ensuring universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes. Though the SDG goal does not specifically talk about unmarried youth, in India’s context, this demographic needs urgent attention.

Private surveys exist, but nationally representative data needed

The NFHS 2005-06 interviewed 40,817 women and 25,504 men urban respondents. Of these, only 184 women and 747 men were unmarried and sexually active. In rural areas, only 436 women and 1,233 men among the respondents were sexually active and unmarried. Obviously, this is not an adequate sample from which one can draw conclusions.

But there have been few private studies which highlight the issue. For instance, in 2011, the Population Council of India conducted a study titled “Condom Use Before Marriage and Its Correlates: Evidence from India” that covered six states (Andhra Pradesh, Maharashtra, Tamil Nadu Bihar, Jharkhand and Rajasthan). The survey interviewed 2,408 married or unmarried youth aged 15–24 who had had premarital sex, of whom 392 females and 986 males were unmarried at the time of survey.

The study found only seven per cent of young women and 27 per cent of young men had ever used condoms in pre-marital sex. Only three per cent and 13 per cent, respectively, always used a condom. Among respondents who were unmarried at the time of the survey, 14 per cent of women and 28 per cent of men had used a condom during their last sexual encounter.

Social stigma and stereotypes: A big factor

A drawback of these private surveys is the limited sample size of sexually active unmarried youth which highlights the need for a nationally representative study on unmarried youth and their sexual behaviors.

The lack of data highlights the need for government interventions for this demographic, but apart from addressing lack of data, it is equally important to address the societal stereotypes and stigma which hinder access to contraceptives.

Even in metro cities like Delhi and Mumbai, buying condoms can be an awkward experience, especially for women. A social experiment conducted by Prankbaaz highlights the sexism and bias towards women in these situations. In the video below, a young girl goes to buy condoms and the moment she leaves, crass comments are made.

This stigma has been debated on Quora as well. In this discussion thread titled “Is it really difficult for women to buy condoms in India?”, women shared their experiences of being judged by shopkeepers when they went to buy condoms.

These anecdotes suggest that the Indian youth is at least keen to engage in such conversations. However, what is important is to have an environment in which these questions and concerns are addressed, rather than suppressed. In 2016, the New Education Policy (NEP) draft prepared by the TSR Subramanian committee suggested that adolescents be provided with age-appropriate context intervention focused on unprotected sex, SRH concerns, including HIV/AIDS and drug and substance abuse. However, the Ministry of Human Resource Development (MHRD) replaced this with just a single sentence that says, “The Adolescent Education Programme and National Population Education Programme need to be extended to all schools as early as possible”.  The Union Health Ministry’s new resource manual, Sathiyaa, is a step that deserves applause.

Unfortunately, Sathiyaa seems to be one of the few laudable steps. Recently, Union Minister for Women & Child Development Maneka Gandhi said, “Early curfew for girls who live in hostels could be necessary for their own safety. At 16 or 17 you are hormonally very challenged. So to protect you from your own hormonal outbursts, perhaps a lakshman rekha is drawn. It really is for your own safety.” Leaving aside the dubious medical accuracy of her statement, the fact is that contraception is far more effective a safety measure than a curfew.

Depriving children of age-appropriate SRH education is a violation of international conventions and frameworks. India is signatory to the Convention on the Rights of the Child (CRC), 1989, and the International Covenant on Economic, Social and Cultural Rights (ICESCR). The CRC and the ICESCR give children a wide range of rights which could be interpreted as to include the right to receive comprehensive sexuality education for children to protect themselves from abuse, exploitation, and undesirable life outcomes.

By 2020, the average age in India will be 29 and it will become the world’s youngest country, with 64 per cent of its population in the working age group. With this booming youth population, it is vital to address the sexual and reproductive needs of this section. With rising education levels and employment opportunities, the mean age for marriage has increased as has the number that opts for pre-marital sex, live-in relationships, and one night stands. Yet contraceptives (especially condoms) remain taboo and an area of serious policy concern.