Bleeding and hurting: How these Delhi women are manipulated into using invasive birth control

By Richa (with inputs from HRLN’s Reproductive Rights Initiative)
Richa is a communication officer at HRLN

Sixty-five years ago, in 1952, the Indian government became the first in the world to formulate a national family planning programme to tackle the problem of its burgeoning population. It was carried out in several ways, one of which was the jarring practice of conducting forced sterilizations of men during the Emergency in the 1970s on the orders of the then-Prime Minister Indira Gandhi’s son, Sanjay Gandhi.

Sterilization still remained in vogue thereafter, even as the Gandhis’ gimmick proved to be ‘politically expensive’, now shifting its focus almost exclusively to women. Decades on, the impact of India’s extensive family planning programme remains uneven and continues to endanger the lives of the young women , targeting particularly the politically less-powerful, vulnerable and poor women.

Today, almost the entire burden of “family planning” is borne by women.

Implemented with callousness, this scheme has taken a toll on their health. It has, over time, assumed different strategies such as a coercive target approach, contraceptive-specific incentives for healthcare providers, incentivizing sterilization drives by ASHA (accredited social health activists) workers, among others.

On paper, currently, the Family Planning Programme provides choices between Intra-Uterine Contraceptive Devices (IUCD), condoms and Oral Contraceptive Pills (OCPs). But in reality, Indian women who rely on government hospitals for their healthcare typically have access to only one type of Post-Partum IUCD (PPIUCD): the Copper-T, which is a ‘T’-shaped piece of plastic shaped thus to fit around the uterus. The device contains either copper or levonorgestrel (a birth control hormone) and serves as a form of long-acting, reversible contraception.

However, many hospitals in India insert them into women’s bodies without obtaining informed consent or offering counseling, in clear violation of the rights of women.

A fact-finding team from Human Rights Law Network and Urban Rights Forum for the Homeless (A network of 23 organisations working on issues of homelessness and housing rights in Delhi), led by Madhulika Masih, visited slums in Delhi last year, focusing especially on the clusters in Baljeet Nagar and Chilla Khadar. Women that the team spoke to said that IUDs had been inserted against their will. Further, hospitals refused to help them when they sought to get the devices removed after suffering prolonged bleeding and pain. Doctors in various hospitals were even blatantly rude to them, they said, dismissing them with questions like, “Will you keep making babies all the time?”

The women also said that they had been coerced into undergoing the procedures even after refusing it, and being told that the hospital staff had cheated them by already obtaining their thumb prints (and consequently, ‘consent’) without informing them about the process. Compelled to undergo the procedure soon after giving birth, most of them reported severe complications, including excessive bleeding, backaches, weakness, nausea, and vomiting.

These women said that the PPIUCD was not their preferred choice of contraception, but none of them had ever been counseled or given other choices about postpartum care or family planning. Some were even given to believe that “operation” (permanent sterilization) was the only method to avoid pregnancy.

The most common side-effects these women complained of were menstrual cycle changes, longer and heavier-than-usual periods, bleeding or spotting between periods, and pain during menstruation. Some also reported cramps and pain beyond the first few days of insertion, heavy menstrual bleeding or bleeding between periods — all effects that possibly contributed to anaemia and weakness in the already malnourished women.

After months of suffering pain, some women visited private or government hospitals (in this case, Delhi’s Lal Bahadur Shastri Hospital) to get their PPIUCDs removed and were mostly refused. They reported being humiliated by the hospital staff, pushed around, shouted at and, in some cases, physically abused by medical staff for having more than two children.

Vulnerable, poor and illiterate, these women were then forced to visit private doctors, shelling out extra for relief of some kind.

These are only a few instances of widespread medical abuse and negligence. Women in urban slum and rural areas are particularly vulnerable because of their lack of literacy or economic strength — in blatant violation of the non-discrimination provisions under Article 15 of the Indian Constitution. When knowledge about their reproductive choices is withheld from women, it amounts to a negation of their right to make informed choices and nullifies the exercise of sexual and reproductive autonomy, which are also legal rights enshrined in Article 21 of the Constitution.

Forced temporary sterilization, implemented carelessly and coercively, thus attempts to control a woman’s fertility without her consent, violating her physical integrity and security, and in this way, constitutes violence against women. The implementation of family planning measures needs vigorous course correction. Not only do women deserve complete information about the choices and the freedom to accept or deny a procedure, the government should provide for the immediate removal of devices if a woman experiences discomfort. In addition, immediate interim relief should be provided to women who are forced to undergo physical and mental trauma at the hands of ignorant, negligent and apathetic medical practitioners. There is also an urgent need to provide a choice of contraceptive methods to enable couples to achieve their reproductive goals instead of merely pushing for the PPIUCD and female sterilization as the mainstay of the national programme.