Photo: Mohamed Nohassi/Unsplash
- Social censorship along with patriarchal morality embedded in the medical system and medico-legal ambiguities continue to act as barriers to abortion.
- The reluctance to acknowledge pain as experienced by female bodies is appropriated by the prevalent public healthcare culture to shun and silence women’s lived experiences and voices.
- A non-paternalistic healthcare approach, understanding of women’s domestic labour and glorification of motherhood and pleasure-affirmative sex education could signal positive outcomes.
- Unregulated overpricing of abortion services was observed in private facilities.
- There was a tendency among service providers to impose value judgements on pre-marital sex and have a moralistic perspective on abortion.
- A gender-based disparity was observed when a man accompanied the beneficiary as a spouse/boyfriend and a woman accompanied them as a sister/friend.
- The lack of clarity on legal knowledge was observed among service providers. Confidentiality was breached mostly in government hospitals due to allowing two patients together in the consultation room.
According to the National Family Health Survey (NFHS)-5 2019-2021, women on average have more sex partners than men in 11 states and Union territories in India.
Statistics are said to shatter stereotypes. One of the stereotypes stemming from patriarchal conditioning is that women don’t desire sex or seek sexual fulfillment as much as men do. While the patriarchal institution of heterosexual marriage in India demands women to perform their reproductive ‘duty’ of a mother, it seldom acknowledges female need and pleasure in the confines of marital sex.
In the rural Gujarat setting of Jayeshbhai Jordaar (2022) – where the sarpanch orders women of the village to stop bathing with soap since men can’t be expected to control their hormones with good-smelling women around – Jayesh (Ranveer Singh) has to struggle hard to even kiss his wife as an act of love. His orthodox family treats Mudra, his wife, as a son-bearing machine.
The family-planning and the healthcare sector has conventionally viewed women’s sexual and reproductive health rights (SRHR) as a function of/within the frameworks of the family and the moral guardianship of the state, acknowledging the reproductive roles of wives and mothers, but denying women bodily autonomy and sexual agency within and outside heterosexual marriages. Virginity and motherhood are glorified, while sexual desire in women is touted as dangerous to patriarchal strongholds of caste-dominated kinship.
In fact, often never-married, single, divorced, widowed women are shamed for having a sexual life and their bodies are censured for the fear of outraging outdating collective morality.
Body beyond bechari: Adolescent desire v. the moral police
The NFHS-5 statistics of women having more sex partners than men could be a positive framework for not framing women’s sex lives through the victimhood lens to begin with.
Society boxes women in the binaries of good/sexually chaste and bad/immoral/loose. Popular culture and our own languages are replete with references to the virgin/vamp and goddess/slut binaries. The portrayal of the feminine body as bechari (Hindi for ‘helpless’) owing to the glaring reality of everyday sexual violence against women has perpetuated the moralistic status quo around conversations on sex.
The stigma is greater when it comes to adolescent girls. Their experience of sexual urges and desire, the teenage phase of romance- and relationship forming, and expressions of bodily autonomy is largely shunned in the SRHR lexicon. The dissemination of information on safe sex, consent, and addressing of issues such as teenage depression, is rare.
Manju’s story from multimedia digital platform Agents of Ishq (AOI)’s comic Stories and A Survey, based on Project UDAYA by the Population Council, delves into a seldom acknowledged discourse of adolescent desire – heartbreak and loneliness. Manju asks the researcher Preeti:
“I had a boyfriend… We even had sexual relations. But now he has got attached to another girl from the village… What should I do, Didi? Should I say something to him? I am scared. My heart feels heavy, as if it is full of dark clouds.”
While Manju’s boyfriend had flirted with her, Manju, who had given her heart to him, felt cheated and even experienced suicidal thoughts.
Debasmita Das, creative associate of AOI, says,
“While popular perceptions would deny that adolescents/young women do not have sexual experiences until marriage, in reality, adolescents do have sex and navigate the domain of desire, which co-exists with the cultural fear of being caught, shamed and punished. So, desire and risk co-exist. They are hesitant to open up about their love stories, heartbreaks and so on. For instance, Manju didn’t have anyone in the family or even a friend to confide in.”
The venture, by writer-filmmaker Paromita Vohra’s Parodevi Pictures, creates cultural products in both Hindi and English for children as well as adults. The content takes a non-clinical approach towards sex education.
In the AOI video Adventures of Ishq vs Samaaj ka Risk, with CREA’s Self Academy, 50 adolescent girls share how fear comes in the way of romance. What do you desire in romance? The answers ranged from “I wish I had a boyfriend”, “I would be in a bedroom with him, we would have fun together”, “sometimes, I feel like having sex”, “I feel like kissing/hugging/touching”, “and who doesn’t love a couple dance”, “my boyfriend driving a bike and me sitting behind”.
Sixteen-year-old Manju was eventually married off, and it is not known whether it was to a boy of her choice or not. In India, criminalisation of ‘love’ relationships, romance and desire among youth is designed to ensure marriages do not take place outside closely guarded caste-dominated kinship networks and faith systems. So, the premium is placed in protecting the female body – the site of family honour – and female virginity.
Sanjina Gupta, founder of Kolkata-based non-profit organisation Rangeen Khidki, informs me that while working across rural Bengal on conducting the ‘My Body My Rights’ gender and sexuality education programme there were times when parents of school-going girls initially called for a boycott, as they wrongly misinterpreted sex education as a tool or a corrupting influence designed to teach adolescents to indulge in or have sex.
State control, misogyny and the medical system
The liberalisation of abortions in India is rooted in a history of state birth control mechanism and not as a feminist rights-based approach to women’s SRHR. In a February 2022 Outlook article entitled ‘Abortion as a Feminist Issue‘, author and professor of political thought at JNU, Nivedita Menon, writes that the right to safe and legal abortion is an essential right of self-determination. In India, abortion has been legal since the Medical Termination of Pregnancy (MTP) Act of 1971.
The current abortion discourse still lacks the “my body, my choice” lens. “My body, my choice” implies that since pregnancy and motherhood entail paradigm physical and mental shifts in a woman’s body and life, and the burden of care-giving absolutely falls on the woman’s shoulders given women’s unpaid labour in care economy, it is only fair that she gets to decide what to do with her body.
Dr Sujoy Dasgupta, a Kolkata-based gynaecologist and infertility specialist, says, “’Why don’t you want to have a baby?’ – this is the usual refrain of a gynaecologist when a woman visits them seeking abortion. Not just in the spectrum of abortion, but even in cases of polycystic ovarian syndrome (PCOS) and painful periods, it is a paternalistic approach which lies at the root of a gender-biased medical system when it comes to providing SRHR to women.”
It is not the prerogative of a healthcare professional to take on the role of a moral guardian, he elaborates. If a woman experiences excessive pain during periods, she is reminded that her mother and grandmother never fussed about it, that they bore the pain silently.
The reluctance to acknowledge and the tendency to invisibilise pain as experienced by female bodies is appropriated by the prevalent public healthcare culture to shun and silence women’s lived experiences and voices.
The Medical Termination of Pregnancy, or MTP, (Amendment) Bill 2021 allows abortions to be conducted within 20 weeks on one doctor’s advice and between 20 and 24 weeks on two doctors’ advice for specific categories of women, including victims of rape (although excluding marital rape). The amendment has introduced a change in Section 3 of the Act to cover unmarried women. As opposed to using the term “married woman and her husband”, the amendment uses the term “woman and her partner”.
Also read: Abortion in India Is Still Mediated by Institutional Moral Policing
However, lived experiences of several women seeking abortion reveal that several questions are asked and paternalistic pieces of advice are given by fathers, mothers, mothers-in-law and gynaecologists: Are you sure you won’t regret it later? Don’t waste time. Your biological clock is ticking away.
The doctor – like the moral guardian/parent – automatically assumes that a woman would want to have a child owing to her gender identity. This renders the medical system a gendered space rife with internalised masculine biases.
Most importantly, the absolute decision-making agency or authority rests with the medical professional and not with the woman. Apart from the medico-legal intricacies, there are socio-political barriers that definitely do not make abortion a feminist or even a female-friendly service.
Married women are routinely asked to bring their husbands or get their husbands’ consent even though the MTP doesn’t demand that. The underlying thought: the husband is the moral guardian of the wife.
Dr Aqsa Shaikh, founder, Human Solidarity Foundation, says, “Questions of marriage and sexual activity are routinely tied in medical conversations, revealing deep-rooted attitudinal biases.”
In the case of an unmarried woman, the trial is arduous. “In 2016, a 23-year-old unmarried woman was denied medical abortion in a private hospital in Kolkata as they insisted she bring her ‘legal guardian’,” Dr Dasgupta recalls, without naming the hospital. He had to eventually get the woman shifted to a friendlier facility.
Abortions for adolescent girls remains a murky but criminalised territory.
Vinitha Jayaprakasan, who works in the Safe Abortion for Everyone (SAFE) programme at The YP Foundation (TYPF), says that medico-legal ambiguities apart, the abortion discourse has underpinnings of moral, religious and socio-cultural systems. It is a largely taboo topic and is further complicated by conditions of poor health and socio-economic conditions. Access to the nearest public abortion facility remains a challenge in remote areas. Owing to biases against teenage relationships, adolescent girls face a lot of stigma and social ostracism if found to be pregnant or seeking abortion. And yet, there is poor dissemination of agency-driven and pleasure-affirmative sex education to control conditions of unwanted pregnancies.
One of the several points of a TYPF report, Assessing Youth-Friendliness of Abortion Services, an analysis of youth-led audits of 54 abortion facilities across seven states of India, is: “Visiting a facility for abortion services was a challenge for me because, when I was enquiring about the services in the reception, the people standing there stared at me and listened to my conversation with the receptionist the whole time.” (in a private facility in Assam accessed by an unmarried female)
Jayaprakasan highlights some of the key observations:
A 2019 report published in The Hindu, states that in the case of a pregnancy of a minor, doctors are often caught between the overlapping portions of the MTP Act 1971 and he Protection of Children from Sexual Offences (POCSO) (Amendment) Bill 2019. On the one hand, the MTP Act’s confidentiality clause requires medical practitioners to protect the person’s identity, but the POCSO Act and the Code of Criminal Procedure mandate practitioners to report sexual offences against children.
In the same report, some doctors said that mature adolescents who mutually choose to have sex must not be criminalised for a natural desire:
“The State must protect the right to safe and legal abortions for girls between the ages of 16 and 18 who visit practitioners with accidental pregnancies and infections. While the MTP and the POSCO Acts’ aims are diametrically opposite, their contradicting overlap means consensual sex between matured adolescents must indeed be kept out of criminal purview.”
If single women face stigma, the marginalisation of women with disability is greater when it comes to barriers to accessing abortion. The legislations around Mental Healthcare Act and Rights of Persons with Disabilities Act (RPWD) and the MTP Act complicate the matter.
Dr Shaikh says,
“The MTP Act lacks awareness of intersectionality. It takes away a woman’s consent in case she is disabled pertaining to locomotive disability, blindness, deafness, on intellectual grounds and from members belonging to sexual and gender minorities. Misogyny rooted in religious and cultural biases go hand in hand with the judgemental tone of the medical system. Complexities arise in terms of the legal and affirmed gender, affirmed name as opposed to old/dead name when it comes to accessing safe abortion.”
Women with disabilities are infantilised by the state healthcare machinery.
Pro-life supporters aruge against abortion on moral, ethical and nationalistic grounds.
Also read: Pregnancy Is Riskier Than Abortion
In an Outlook article entitled ‘Abortion as a Feminist Issue‘, feminist scholar and author Nivedita Menon writes,
“The pregnant body after all, is not two individuals with equal rights, it is a unique entity that cannot be addressed in the language of individualism—a life within a life, one life dependent on the other. Children are seen in the abstract as national resources, but concretely, under the present sexual division of labour, must be taken care of on a day-to-day, minute-to-minute basis by their mothers. There is no social responsibility for child-care at all—for instance surely every employer should have the responsibility to ensure day-care for all (not only women) employees?”
Unsafe abortions and social apathy
The NFHS-5 survey states that a majority of abortions were performed in the private health sector (53%), whereas 20% were performed in the public health sector. More than one-fourth (27%) of the abortions were performed by the woman herself at home.
The WHO’s recommended ratio is one doctor for every 1,000 people. However, India has only one government doctor for every 10,189 people. And according to the 2018 All India Rural Health Statistics, there are only 1,351 gynaecologists and obstetricians at community health clinics in rural areas.
Owing to lack of access to safe spaces of abortions, women are at the mercy of quacks and/or unregistered medical personnel, leading to mortality, excessive bleeding, infections and loss of fertility in some cases, according to Dr Dasgupta.
The NFHS-4 (2015-2016) data showed that 47% of abortions in India were carried out by nurses, auxiliary nurse midwives, lady health visitors or family members.
Dr Dasgupta cautions that many a time medical abortion (safe and non-intrusive) is popularised as opposed to surgical abortion, but that that has its own risks. Since a medical abortion can be completed at home in private and without the costs of visiting a doctor and undergoing investigations that are deemed “unnecessary”, women often avail over-the-counter medical abortion pills without seeking a gynaecologist’s intervention. This is completely illegal and unethical, as the law states that only a doctor with a gynaecology or orbstertics specialisation can prescribe a medical abortion pill – not even a cardiologist for that matter.
The Pre-Conception and Pre-Natal Diagnostic Techniques Act (PC-PNDT) came into effect in 1994 after a successful campaign in the face of rising instances of sex-selective abortions. A section of Indian feminists played an instrumental role to ensure the law restricted tests of the biological sex of foetuses. But regardless of such legislation, the sex ratio at birth in India has continued to fall, suggesting that sex-selective abortion continues, according to a 2019 Mint report.
This could be attributed to Indian society’s obsession with the male child and a burden-centric view of the female child.
Often in-laws and husbands of women compel women to opt for late and unsafe abortions. Sometimes, women themselves opt to abort female foetuses. Cementing one’s social capital within the patriarchal family set-up by giving birth to a male child is considered to be one of the incentives in this world of devalued female labour and lives.
Assistant professor at Bennett University and research scholar Shalini Mittal shares the story of a domestic violence survivor who didn’t want to opt for a sex-selective abortion. In ‘retaliation’, her husband poured acid on her genitals. Mittal is one of the co-authors of a March 2020 paper, ‘Role of Psychological Makeup in Psychological Rehabilitation of Acid Attack Victims’.
It is no surprise that when a woman’s motherhood choice comes into conflict with her personal growth and career path, there is no provision or clause that gives her the right to choose the latter over the former. Ambitious women have been recurrently portrayed as selfish/irresponsible/deviant in popular culture, while the same taxing heteronormative framework demands and legitimises her unpaid domestic labour.
Preeti Poddar, child protection officer at Delhi-based child rights NGO Protsahan India Foundation, says that child marriages are a glaring reality in the urban slum colonies of west Delhi, where she primarily works. There were reports that owing to the possibility of low-cost weddings during COVID-19, several girls could never return to school and were instead married off. Once married, and lacking self-awareness, robust health and adequate nutritional parameters, these young girls are often forced or conditioned to have early and frequent pregnancies, leading to miscarriages and other health complications.
Deblina Chatterjee, a public health trainer in Kolkata currently working with the non-profit organisation Anahat for Change Foundation, has previously trained accredited social health activist (ASHA) workers across rural West Bengal. Chatterjee says that men are reluctant to wear condoms and the burden of birth-control is almost always on women. An ASHA worker’s stock of MALA-N (combined oral contraceptive) gets depleted sooner unlike the unclaimed condom. She shares that while oral contraceptives when consumed as per the right guidelines can prevent pregnancy, they do not take care of STIs (sexually transmitted infections) unlike condoms (subsidised at one rupee).
Also read: The Professor Who Had to Spend Half His Life to Make the Drug India Needs
Are there state initiatives to popularise condoms? “Healthcare professionals just like policy makers are apathetic towards abortion seekers’ lives, health and dignity, forget about pleasure and freedom,” Jayaprakasan says.
Running through cycles of bleeding and the ruptures of surgeries and stigma, women’s bodies are often battlegrounds for law, healthcare and patriarchy. As Menon writes,
“An ideal feminist world would not be one in which abortions are free and common, but one in which women have greater control over pregnancy, and in which the circumstances that make pregnancies unwanted, have been transformed. Until then, in a hugely imperfect, unfair and sexist world, I believe feminists must defend women’s access to legal and safe abortions whenever they decide to have them—whatever the reason for their decision.”
Carving alternate spaces of freedom and fantasy, digital storytelling is a slow revolution disrupting conventionally designed SRHR spaces.
The AOI comic The Shame Around My Friend’s Abortion Scarred Us All, based on Akhil’s memory of a school friend who needed help, makes it easy to talk about the scary topic of teenage pregnancy and abortion. Das explains: “If we talk about sex, we have to talk about desire, pleasure, safety, privacy, consent, abortions.” Lifting the heaviness of clouds, such as in Manju’s mind, and entering the dark and unknown space with heart and humour might help.
This story is part of Laadli Media Fellowship 2022.
Sanhati Banerjee is a Kolkata-based independent journalist with special interests in gender, health and popular culture. She is a winner of the Laadli Media Awards for Gender Sensitivity 2021.