Editor’s Note: This month, that is November 2020, FII’s #MoodOfTheMonth is Sexual And Reproductive Health, where we invite various articles to highlight how health outcomes are determined with respect to a person’s social, political, economic and cultural contexts of their gender and sexuality, and how these identities shape their life experiences vis-a-vis SRHR in India. If you’d like to share your article, email us at firstname.lastname@example.org.
Posted by Aliya
I believe that it is important to set the context while narrating experiences because financial status plays a crucial role in determining access to reproductive health services, especially in India. I am from a middle-class family with moderately progressive beliefs (meaning that, while my family believes in the importance of education for women, they are also firmly set in their beliefs that women need to get married within a certain age and bear a child).
This article however isn’t about me. It is about a close friend of mine, Anisha – a 30-year-old with a three-year-old child. Anisha was firm in the knowledge that she did not want more children, having suffered from a miscarriage before the birth of her child, a difficult pregnancy during which she had preeclampsia (high blood pressure during pregnancy which can put the baby’s life at risk) leading to an emergency cesarean delivery, and an abortion soon after the birth of her child. It is a well-established fact in the medical community that a pregnancy soon after a cesarean delivery puts the pregnant woman’s life at risk. Anisha became pregnant within four months of giving birth to her child because of which two gynaecologists suggested performing an abortion, which she did.
She became pregnant four months after her cesarean section because her husband refused to use contraception despite her repeated insistence he use it. Unfortunately, this is quite commonplace. In a significant number of Indian relationships, the burden of contraception falls on the woman. According to data from the government, in the eight years between 2008 and 2016, condom use declined by 52% and vasectomies fell by 73%. In contrast, the number of women utilising intrauterine contraceptive devices has remained consistent over the years.
Anisha tried two forms of IUDs (intrauterine devices meant to provide long term birth control)—the Copper T and Mirena, both of which gave her adverse reactions. This is quite common. In 2010, more than 15 crore women worldwide were using IUDs. The failure rate for the Copper T is 1% in the first year of usage. Side-effects of the Copper T include bleeding between periods, cramps, and severe menstrual cramps.
Enter family planning (tubectomy) – also known as sterilisation, a procedure considered as a means of permanent contraception that women often feel forced to undergo if non-surgical methods of contraception (such as condoms and IUDs) fail or are unavailable to them. According to the BBC, out of 40 lakh sterilisation procedures in India in 2013-14, less than 1 lakh procedures (2.5%) were undergone by men. This is just another indicator of how unfair the distribution of responsibilities surrounding reproduction is in India.
I accompanied Anisha to her gynaecologist who had helped deliver her baby and had inserted both the Copper T and Mirena. The doctor is a consultant at a branch of a large chain of hospitals in India. We explained how we wanted her to perform the sterilisation procedure in light of the circumstances that Anisha didn’t want more children, IUDs were causing her difficulties, and the fact that her husband refused to use contraception. The gynaecologist told us, “I would rather you have multiple abortions than get sterilised. You are very young, you will regret this later. You don’t know what you want.”
What she said was so problematic that I am going to break it down in parts to explain the issues I have with it:
- A statement beginning with “I would rather you have” is not a qualified medical opinion. It is a personal opinion. I am not paying for personal opinions. If I wanted personal opinions, I would go ask any neighbor of mine what they thought.
- In case she wanted to express her personal opinions, she could have phrased it differently, she could have said, “I don’t think this is the best idea because” followed by her reasoning. To tell us what she would rather happen to Anisha’s body is not acceptable. No one should have that kind of control. An abortion is no joke. It is quite traumatic – both mentally and physically.
- According to the gynaecologist, Anisha was old enough to make the decision to have more children, but she was too young to know what she wanted to do with her body. This makes absolutely no sense since the same gynaecologist had helped Anisha deliver a child three years prior. I will rephrase this to clearly explain why this is difficult for me to understand.
At 27, Anisha was old enough to know she wanted a child, but somehow at 30, she was too young to make decisions about whether or not she wanted more children. This must be a new, undiscovered type of logical fallacy. In case it is, I would like credit for having identified it first.
This experience horrified me. The fact that the gynaecologist was saying this without second thought is indicative of how commonplace this kind of statement is.
I wish I could say that our terrible experience ended there. It didn’t. We consulted with another gynaecologist at the same hospital who was again quite reluctant to perform the procedure. She said she needed time to think. She also said she wanted Anisha’s husband’s signature on the pre-surgery forms.
Having taken a course in corporate law in college, I decided to check Indian laws to see if a husband’s consent was actually required in this case. Once I found out this wasn’t necessary, I asked around and found out that another gynaecologist at the same hospital was amenable to performing the procedure with the woman’s parent’s signature.
In this case, the hospital is taking away a woman’s autonomy over her own body and allowing doctors to do what they please – doctors are given the freedom to choose whether they require the spouse’s consent or a parent’s signature on the consent form. This means that, in case a married woman decides to do family planning without informing her husband, the hospital gives doctors the right to deny it if they wish to. Why should doctors be allowed to ask for a husband’s consent when this is not something even the government requires?
The reason I decided to write this article despite the fact that it was quite difficult is because I don’t want this to happen to other women. If this is the way doctors are treating women with the privilege of knowledge and education at an expensive hospital, I can’t begin to imagine what happens to people with less privilege.
The next time your gynaecologist says a statement that you feel is unwarranted, recognise that your intuition is probably right. Visit another gynaecologist, ask other female friends for recommendations, check online to see whether what your doctor is saying is legally permissible or not. I realise that it is quite easy to give advice but actually doing all this is quite hard. Take along a friend, a cousin, a co-worker, a sibling, a neighbor – anyone who will be supportive and ask the questions you can’t.
I am not sure how many people this article will help but even if it helps a person or two, I feel like my job will be done. Let your female friends know how doctors and hospitals are overstepping their bounds as well. As women in a staunchly patriarchal society, we have to look out for each other!
Aliya M, writing under a pseudonym, is in her mid-twenties and holds a Post Graduate Diploma in Management and is based in Chennai. While she would like to see gender equality in her lifetime, she knows that is a far fetched dream and wants to do her part to at least achieve some semblance of gender equality. You can find her on Instagram.
Featured Image Source: Feminism In India