One would have assumed that by now, with all the health service centers set up in the rural and urban areas, massive awareness campaigns done by the media and social workers, women who have access to these services would well be on their way to planning their families armed with holistic knowledge. The facts are however quite miserable. A report on Marriage and Motherhood brought out by Population Council proves just the opposite tells us why.

The report documents findings of a baseline survey (2002-2003) on the status of married young women assessing their social networking, partner communication, knowledge of reproductive health issues and corresponding behaviours and practices. The respondents came from the rural districts of Vadodra, Gujarat and Diamond Harbour in West Bengal.

What caught my eye is the finding that “though 75 percent of respondents in Vadodara had heard of oral contraceptive pills, only 38 percent knew that the pill should be taken every day. In contrast, while far fewer married young women had heard of male condoms, of those who had heard of this method, most had correct knowledge about it.”

According to the report use of contraceptive method was very limited in both the settings. Among those who did use contraceptive methods the most commonly practiced methods were the ‘safe period’ method in Vadodra (14.6 percent) and oral contraceptive pills in Diamond Harbour (31.8 percent).

However when it came to awareness about the fertile period, knowledge was limited. Fertile period refers to the days when a woman is most likely to get pregnant which is normally about during one-third of the menstrual cycle. The report claims that “while the majority of women (49 percent in Vadodara and 62 percent in Diamond Harbour) were aware of the concept of a fertile period, only 12 percent and 13 percent respectively could accurately identify the actual fertile period.”

So even when the women were aware of contraceptive methods, their knowledge of the correct usage is very limited. How then could they be effective in preventing pregnancy?

Is this then what right to reproductive choice is all about? Where it is enough for health providers to give women the pills saying that these will prevent pregnancy without bothering to adequately educate them on how the pill works on the female reproductive system?

In any case most contraceptive methods for women involve inserting or injecting or taking in of foreign objects into the body. Be it IUDs, female condoms, pills, hormone injections or the popular method of sterilization, which involves surgical operation. There is no doubt, that the female reproductive system involves much more physiological intricacies, than the male system. Ignorance of the body and its functions can hardly help matters.

Moreover the biological body reacts to any entry of foreign objects. This is quite natural. It is a part of our immune system whose objective is to react to foreign particles entering the body. Side effects are imminent. The failure of the IUDs, in India, as a contraceptive measure was due to the side effects that many women faced following the insertion. Without adequate follow-up and care the method began to fail en masse as more and more rural women began to suffer painful side-effects. Clients need to be made aware of the side effects before hand. IUDs involve potential side effects such as mood changes, acne, headaches, breast tenderness, pelvic pain, cramping (copper IUD), excessive bleeding etc. Contraceptive pills too have certain side effects, which involve some of the above along with weight changes.

If women are unaware of these, contraception turns into a traumatic and stressful experience for them. Such experiences prevent new users from adopting the methods. The result- discontinuation or hostility towards contraception, repeated pregnancies, burden of a large family and trauma of losing children due to undernourishment of both mother and child or even loss of ones own life.

In an interview, Mr. Michael Vlassoff, Country Representative of UNFPA to India states that their survey in India shows that “women want contraception but they are not using them. There are many reasons but one of the main reasons is that services are extremely poor especially in interior parts of the country.”

For successful interventions it is necessary to thoroughly investigate and find out what are the unmet needs of women and what is it that they want and work towards providing these. It involves giving women (or the couples) thorough knowledge about the different contraceptive methods available, there side effects, effectiveness, aid the client in making the correct choice as per their requirement and asserting the importance of regular follow-ups.

In a survey conducted, in three areas of South Delhi, among women who attended government run family planning services, it was found that there is a bias in the information of choices given to women. About 80 percent had received information only about IUDs and 70 percent only about sterilization. The same study found that only 33 percent of the women had been informed about the constraints of IUDs.

Another significant component of health, which is often left out from the gamut of reproductive health care is the information on sexually transmitted diseases (STDs). In the survey conducted by Population Council it was found that only 5 percent and 6 percent of the respondents in Vadodra and Damond Harbour, respectively, reported that a health worker spoke to them about reproductive tract infections or HIV/AIDS when they went for checkups.

On the other hand people have often been found to confuse contraceptive methods with methods for prevention of STDs and HIV. For instance many do not know that IUDs do not protect against STDs or HIV. In fact regular checkups are necessary to check for any infections in the reproductive tract in women who use the IUD method. Deconstructing these misconceptions and misunderstandings and informing women should be a part of counseling on reproductive rights and choices.

Gender inequalities and myths also need to be addressed when we talk of reproductive choices. While son preference constraints many women from adopting sterilization it has also been found that women refrain from contraception because they fear that if the contraception fails then they will be accused by their husbands of infidelity. Women are often barred from adopting contraceptive methods by their husbands for fear that this will give their wives ‘free license’ to have sexual relationships with other men.

There is no doubt that reproductive rights will empower women to take active role in looking after their health and well being as well as that of their families. But to make them the lone players is to shift the entire responsibility away from their male partners. Factually, the reproductive health strategies need to express the truth that men are fertile 365 days and women only 60 days of a year.

While vasectomy is safer, quicker and less expensive, in 2003 it accounted for only 2.5 percent of all sterilizations in India. Myths such as vasectomy causes weakness in men along with socio-cultural stereotypes of masculinity work as deterrents to male contraceptive practices. According to Dr. Avni Amni at Centre for Health and Gender Equity only 5% of Indian men use condom even with the threat posed by HIV AIDS.

Handing out strips of contraceptive pills or packs of condoms is not what reproductive rights and choices should be about. It has to go beyond that. It has to involve men and women in an understanding of their bodies; it has to involve men in understanding their roles and responsibilities towards their partner’s health; it has to involve health services and health providers who are responsible and sensitive to their client’s requirements.