A group of women in Pushkar, Rajasthan. Roughly 889 girls are born to every 1,000 boys in Rajasthan, revealing discriminatory sex-selective practices that echo thoughout much of the north and west of the Indian subcontinent.

Piecemeal Change for Reproductive Rights in Modi’s India

In the United States this week, a landmark case is being presented to the post-Scalia Supreme Court over the future of women’s access to safe and legal abortions. In many places around the world, notably India, reproductive practices that curb fertility involve an entirely different vernacular: sterilization, misinformation, and must.

The onus of our abiding environmental ills is typically placed on one of two sides: are the industrialized elite, guzzling gas in Ubers and airplanes, or the global poor, with excessive fertility and consumptive families to support, more responsible? There is no clean answer to this, but the fact remains that while many industrialized nations have tamed their populations — some even struggling to meet the reproductive replacement rate — “developing” nations are as Malthusian as ever. In fact, India is slated to surpass China in total population.

The control of population — or, in more optimistic and individual terms, reproductive rights and gender parity — indexes development. India’s gambit with modernity, spurred by Rajiv Ghandi’s “opening” of the country to global forces in the 1990’s, was preluded by the institution of euphemized “beautification” practices — really, the clearance of ungainly slums and the systematic sterilization of poor, low-caste men — in the 1970’s. Sanjay Gandhi used loans from international organizations such as the World Bank to fund mass, discriminatory sterilization. Today, these practices continue, with approximately four million tubal ligations, India’s contraceptive par excellence, funded by the government each year and women living in rural parts of India bearing the burden, facing an onslaught of barriers and maltreatment with regards to their family planning.

Through direct cash payment, women are incentivized to undergo sterilization. Incentives alone are not the culprit here: dis-incentivizing carbon pollution through a carbon tax may be our only hope at curtailing total environmental degradation. But, in this case, a matrix of incentives that are seemingly far-removed from the fundamental issues of women’s health, well-being, and right to information produces a different set of concerns. For instance, village “motivators” receive 150 rupees, or $2.44, for every patient they recruit to a sterilization camp. In turn, a typical woman receives 1,400 rupees, or $23, for their terminal disavowal of fertility. And when doctors themselves have quotas to hit, sterilization becomes a true numbers game — a game that, not surprisingly, gains public visibility only when it devolves into its grotesque apotheosis, such as the performance of 83 operations in 6 hours and the resultant 13 deaths of women in Chhattisgarh in 2014.

When women don’t have access to government-funded sterilization, there is the shadowy, almost mythic option of the jhola waala, literally “bag carrying,” doctor: itinerant men with a bag full of tricks to terminate pregnancies, none of which involve any sort of modern medicine.

Now, Modi and his Bharatiya Janata Party are moving towards modernizing female contraceptives as well as facilitating access to them. The World Health Organization has been a proponent of injectable contraceptives, also known as Depo-Provera, or DMPA, citing them as a safe and effective form of birth control, and Modi is apparently listening. This year, he will make injectables free of charge and available in government facilities.

Modi’s introduction of injectables is part and parcel of his larger goal of portraying himself as deeply committed to improving the lives of India’s marginalized communities. Historically, he has chosen superficial silence, yet internal endorsement, over the oppression of various minority communities, and he has also favored economic liberalization policies that strengthen domestic manufacturing and open the country up to foreign investment at the expense of its vast agricultural sector. Yet, as Modi continues to tweet, central to this year’s budget is the “qualitative transformation” of India’s “villages.” The women in these villages are poised to benefit most from injectables for a number of reasons.

In contradistinction to the wholesale control of reproduction for national and economic reasons — reminiscent of China’s one-child policy, which will only continue to produce demographic challenges for the country — injectables have the potential to embolden choice on two fronts. Not only will its introduction diversify contraceptive choice as it is added to the list of government-sponsored options, but it can increase the ability of women to deliberately space their pregnancies. Many women carry pregnancies back-to-back, which increases natal mortality and poses serious maternal health issues. A woman using DMP, which is injected every three months, can become pregnant approximately 12–18 months following the discontinuation of injections, an interval that, when tilted towards the latter number, corresponds with the recommended spacing time: 18 months to 5 years.

Navsharan Singh, a senior program specialist at the International Development Research Center, lauds this new plan’s deliverance of drugs through major hospitals, which strengthens the likelihood of follow-ups and guarantees abundant resources. Yet, the problem for many women is not a lack of this type of infrastructure, but lack of proximity to it. Due to a lack of ambient health centers, women have to travel far and wide, on their own rupee, to more urban areas. Will the increasing use of injectables help women in the long run if the only way of getting a follow-up or additional resources remains aloof?

Reproductive rights exist and are fought for in a world of contradictions: while the specter of defunding Planned Parenthood has become a refrain in certain political corners in the United States, abortion has been legal since the 1970’s in India, yet remains fraught. And it is Modi’s right-wing Hindu nationalist government that, unlike a scholar from the liberal Jawaharlal Nehru University who dismisses them as imperialistic, is putting forth injectables as a free and safe form of contraceptive.

Universal access to contraceptives is not a panacea: with the advent of sonograms to determine the gender of fetuses and persistent elevation of male over female children, there are millions of “missing women” in India — women who, due to sex-selective practices and sustained neglect of female children over their lifetime — are demographically nonexistent, especially in northern and western states. There also remains the importance, promulgated in the 1994 International Conference on Population and Development, for women’s reproductive rights to be mutually reinforced by women’s education and access to counsel and information.