“There are times when I’ve told my husband to get sterilised. I have already had two surgeries for our babies, I don’t want another surgery.” But 33-year-old Reena Lal’s husband has given her a categorical no.

Statistics reveal that sterilisation surgeries and contraceptives to prevent conception are a matter squarely in the woman’s domain. This could also be because birth control medication or even the emergency pill is made solely for women. The consequences have been dismaying. As per a report of the National Health Mission, in 2017-18, 93.1 per cent of the sterilisations performed in India were on women. “Women continue to bear an uneven burden of the terminal methods of family planning and sterilisation. As per HMIS in 2017-18 (till October) of the total 14,73,418 sterilisation procedures only 6.8  per cent were male sterilisation while 93.1 per cent were female sterilisation.”

Thus, instead of choosing the better contraceptive options available as a result of medical research, women are exercising harsher options. Over eight years until 2016, as India’s population surged, the use of contraceptives declined almost 35 per cent. Instead, abortions and consumption of emergency pills—both of which have health hazards and side effects—doubled, according to health ministry data.

The spread of education has not had the desired effect. Despite a 14 per cent percentage-point rise in national literacy over a decade to 2011, hazardous birth control measures of the last resort, emergency birth-control medication and abortions, are becoming the first choice among both poorer as well as wealthier Indians.

While condom use declined 52 per cent over eight years and vasectomies fell 73 per cent—indicating greater reluctance among men to use birth control—the use of oral birth control pills fell 30 per cent between 2008 and 2016, the data showed. 

With no other option, women are left to their own devices. For Lal, before getting married she was in a relationship and used the emergency (morning after) pill a couple of times. “I was so stupid then. You don’t want to risk a pregnancy, so to be on the safe side I took an extra precautionary measure,” she says. It was only after marriage, when she attended a seminar, that she understood the detrimental effects of the emergency medication. 

Dr Smita Dwivedi, a gynaecologist in a government hospital, says that an emergency pill is just what it’s called—“for an emergency”—for it affects a woman’s health by raising hormonal levels. She also says that men think they would lose out on sexual pleasure if they wear condoms. And the most cases she has found men not wanting vasectomy because they believe it would impede their “manhood”. “They also think it will impact their working life as they would have to take leave, but the recovery period is not long.”

Usually, doctors recommend rest for just 24 hours and only light activity for 2-3 days after a vasectomy. This fact, however, is not widely publicised, leading to misconceptions.

Anantya Gautam, an unmarried woman of 27, says she takes necessary precautions but did have to take the emergency pill on a few occasions. This led to more than a couple of complications and now she is very wary of taking the pill. There was once a case of unwanted pregnancy and she had to get it terminated. “In my case, my partner never turned up even for the procedure. Forget about monetary support, I didn’t require it—what I needed was emotional support, which he did not provide.”

Since marriage, Lal hasn’t taken any contraceptive measure herself, while her husband has used the condom. “After my first child, our family doctor asked if I wanted the copper rod inserted. I was scared. I didn’t want to put anything inside and there are chances that you could still conceive. With pills, they say, your body goes for a toss and you gain weight and what-not.”

Here is another misconception. Though some women do gain weight when they start taking birth control pills, it’s often a side effect that’s due to fluid retention, not extra fat. It’s a temporary phase that fades away after 2-3 months.

Circumstances made Lal rethink her choices. “It was 8-9 months after my first child was born, and one night after a long period of abstaining from alcohol, we went for a party and had one too many. Well, that night we had unprotected sex and I conceived”. This, she says, was an unplanned pregnancy which she didn’t terminate.

“From pregnancy to childbirth to the raising of the child, all responsibilities lie with the woman,” Lal adds. “All men do is give their sperm and the women does everything. My husband says the more children the merrier, but it’s not his body which goes through everything. After two kids, my life is all about diapers and feeds, I can’t do it anymore.”

While her husband refuses to get sterilised, the two reasons he cites are fear of losing pleasure and secondly that he’s a private person and doesn’t want to be prodded by doctors. “As for me, I’m not going to get anything done. I have been dissected twice”—and this, she says, is enough. “Even if you have the support system to bring up your child, the mother has to be completely invested. All people do is glorify motherhood and if you feel differently then you’re judged.”

And this brings her back to the fact that women have to be responsible for preventing conception on top of everything else. “Science should develop something for men, some pill. Why just women go through things?” she asks. 

In India, a team from IIT Kharagpur led by Sujoy Guha had developed an injection called RISUG: an intravasal injectable male contraceptive. The drug has had three trials. In Phase I, male volunteers were injected with RISUG and showed sterility for many years. The longest duration of the RISUG bearer was more than 10 years.  In October 2002, the health ministry aborted the Phase III trial due to reports of albumin in urine and scrotal swelling in participants. The clinical trials have now resumed.

The National Health Scheme (NHS) of the UK cites research presently being done for men in two areas—hormonal contraception and non-hormonal methods. The goal of hormonal contraception research is to find a way of temporarily blocking the effects of testosterone so testicles stop producing healthy sperm cells. However, this needs to be achieved without lowering testosterone levels to such an extent that it triggers side effects, such as a loss of sexual desire.

No wonder, with men’s avoidance of contraception, women continue to bear an unequal load. Compared to 3 lakh men who agreed to vasectomies in 2008-09, more than 5.5 million women agreed to use intrauterine contraceptive device (IUCDs) to avoid pregnancy the same year. Over the years, the number of women resorting to these devices has remained steady instead of increasing with growing population.

Names have been changed to protect identities.

This article was first published in Patriot.