Sexing the Pill

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In the 50th year of the pill, conversations about birth control may have moved from Doordarshan to shiny lifestyle products. But is the market’s peppiness misleading Indian women, asks Poorva Rajaram

Illustrations: Samia Singh

RIYA BAGGA (name changed), a 24-year-old writer in Delhi, had a fit of giggles 30 minutes after emerging from a pharmacy. It had taken her that long to realise why the pharmacists had been staring at her. After a suspected condom failure, she had gone to the store to pick up an emergency I-pill. As she was paying for it, her eye fell on a condom with a vibrator ring, and impulsively, she bought it. Nothing had prepared the pharmacists for Bagga’s casual display of self-knowledge: I might be pregnant but I don’t want to be. I’m not crying about it. I’ll have sex again. It’ll be fun.

The I-pill seems to have brought a misplaced peppiness to birth control in India. It exploded onto our cultural landscape in 2007 as a bonsai-sized bomb. The initial enthusiastic response to its over-the-counter availability and marketing sent advertising censors into their usual tizzy. I-pill ads were banned in January 2010 due to concerns that the pill was being used as routine contraception and its emergency nature had given way to a sneaky afterlife as a cool lifestyle product.

Recently, Piramal Healthcare was told by the Drug Controller General of India to stop airing the surrogate advertising of the I-pill. Then there is also M Ayappan, MD of HLL Lifecare (that manufactures the Moods brand of condoms), who’s decided HLL shouldn’t heavily advertise its emergency pill (Preventol) for ethical reasons. He doesn’t believe enough awareness exists about side-effects and is afraid of promoting promiscuity. Click onto any condom manufacturer’s website: noir lounges, bedroom themes, elevator music and other aspirational lifestyle motifs.

Birth control, it seems, has acquired a glitz far removed from the musty government offices it’d have been associated with decades ago. But beyond the din over birth control as lifestyle products, one question is surprisingly hard to find the answer to: are women able to make informed choices about birth control, caught as they are between a utilitarian, prudish State and a sly market?

FOLLOW THE HONEY
It would be a mistake to think about birth control solely in terms of its shinier aspects — consumption spurts, business turnarounds or artistic fodder. More conversations and explorations reveal that there is an outer rim past which the coolness just won’t spill over. But let’s check out some of the coolness. Latitude 28 is a swish art gallery in New Delhi that recently opened a show called The Pill to commemorate the 50th year of the pill. While the juvenile I-pill bobs along on a sea of disapprobation, its predecessor — known only as ‘the Pill’ — is the preventive variety that continues to bear the aura and burden of female emancipation. The art show said it wanted to explore the controversy, the procedural intricacies, the persistence, the physical dimensions and the ideological baggage of the pill.

Is birth control in India still sterilisation or has the coming of the I-pill skyrocketed us into an age where informed women have every imaginable choice?

Intones Avni Doshi’s curatorial note: “It has also become a global phenomenon, where 100 million women around the world take the pill in its many forms. And everything came together to form a delicious little bite for the media, including the cover stories for Time magazine.” In the Delhi show, at the near-gratuitous end of the spectrum was Mithu Sen’s anatomical Kill Pill, a grid of bloody larvae on handmade paper which cuts straight to violence. Tushar Joag’s mixed media work, Collateral Damage, playfully evoked the side-effects of the pill with plastic spoons twisted out of shape into menacing three-dimensional sperm. The Pill broached the tangled conceptual thicket surrounding birth control issues but it couldn’t realistically provide a way to cope with such messy things. The show sidestepped the haranguing women-as-only-victims trope. It didn’t want to be self-serious. Instead, it had an exultant edge.

With good reason, for the demographic ripeness of Indian birth control is easy to see: lots of people, lots of sex, and lots of sales. Earlier this year, Cipla sold its I-pill brand to Piramal for Rs. 95 crore, and claimed sales of Rs. 31 crore between March 2009 to 2010. (Unwanted- 72 and Preventol, some of its competitors, have distinctly fatalistic names while the I-pill seems to have latched on to an I-everything consumer zeitgeist.) The financial press now watches the contraception industry for its investment possibilities.

Enter Moods Planet in Thiruvananthapuram, Kerala. Counter to any images of a refuge for the cantankerous, Moods Planet is a condom shop with a range of products, including a 24×7 condom- vending machine. The store sells the brands manufactured by the PSU HLL Lifecare. HLL is on its way to becoming a Rs. 1,000-crore turnover per annum company. Every industry in post-liberalisation India is bound to have a story of entrepreneurial ingenuity but not many have had to cope with associations as dire as the ineffectual Nirodh brand. Today, though, as one of HLL’s senior executive puts it, there is pride that in this public sector company “there is no smell of government”. This is a company that soaks in innovation and the knowledge they must market: pleasure. HLL has pioneered the female condom in India and exports to 133 countries. It also produces Crezendo, the condom with a vibrating ring.

A mind-boggling thought — every time you buy a Moods condom, you are contributing to the national exchequer.

THE DRY HUMP
Dr Puneet Bedi is a wry gynaecologist. The senior consultant at Delhi’s Apollo Hospital says he’s glad that the National Family Welfare Programme — our current executor for population control — is so badly run. He charts the Malthusian roots of the present paranoia about population control with references to the McCarthyism of the Americans leading to forced sterilisations in Korea. He points out that birth control in India is still a provider-driven affair, with little space for a pro-rights or pro-choice debate. “Birth control is still thought of as population control, which comes from a first-world notion that too many births are occurring in developing countries.”

Dr Bedi firmly rejects the “naive” feminist notion that men have absconded from their duties of birth control. “In the present social system,” he says, “contraception will be designed for women. Controlling semen count would be scientifically complicated. And after 1970s, male sterilisation is not a term you can use in public.” He also doesn’t see sterilisation for woman as necessarily bad in all cases. Critical of almost every feature of the birth control landscape in India, he believes the I-pill has a high rate of failure and real side-effects. From his point of view, there is no grand solution, simply a medically informed weighing of benefits and risks. Birth control, for him, would begin with the right sex education and skirt government interference of any kind. Comments Dr Bedi, “There is no sex education in India right now. I meet college students who think babies are conceived by kissing.”

‘I heard someone at a conference discuss ‘insertive probe’ and ‘receptive cavity’ and realised they were talking about sex,’ says Anne Philpott

The right kind of sex education simply cannot ignore pleasure as a human motive. At the 2004 AIDS conference in Bangkok, attended by 20,000 activists, Anne Philpott had an epiphany. Says the Delhi-based public health professional, “I heard someone use the terms ‘insertive probe’ and ‘receptive cavity’ and suddenly realised they were talking about sex.” Today, Philpott is a member of an international organisation called The Pleasure Project that works on eroticising safe sex. Its slogan is: “Putting the sexy back into safer sex.” She hopes to bring the creative and marketing skills of the porn industry to the world of public health. The Pleasure Project has travelled much, featured both in Playboy and, perhaps less intuitively, in The Lancet, a leading medical journal. It has promoted the female condom as something pleasurable to use (including pushing HLL to bring them to India) and worked with porn filmmakers in the UK to insert condoms into films.

NUMB DOWN THERE, UP THERE, EVERYWHERE
Does the coming of the I-pill signal an age where informed women have every imaginable choice? The latest National Family Health Survey-3 (2005-06) tells you otherwise. The survey plots female sterilisation at 37.3 percent, male sterilisation at 1 percent, condom usage at 5.2 percent, oral pills at 3.1 percent, intrauterine device use at 1.7 percent and traditional methods at 8 percent. The numbers show sterilisation is the most prevalent contraception in India. But at places like SAMA, a Delhi resource group for women’s health which are just as opposed as Dr Bedi to population control, they continue to hope that ‘barrier methods’ like condoms will make it to the National Family Welfare Programme. SAMA objects to the policy that debars people with more than two children from holding office or contesting Panchayat elections, and publicises the side-effects of many hormone-based contraceptives, including the I-pill.

‘There is no sex education in India. I still meet college students in Delhi who think babies are conceived by kissing,’ says Dr Puneet Bedi

N Sarojini, 48, a seasoned women’s rights activist at SAMA, worries that feminists will be perceived as having a blanket anti-technology stance. “It’s not that we are anti-technology. We’re just insisting that birth control be administered with counselling, follow-up care and the informed consent of the patient. None of this occurs in government clinics.”

If you’ve shuddered at stories of how the pill was first tested on poor, uneducated Puerto Rican women without their informed consent in the 1950s, then keep an eye on what still goes on in India. In 1997, women’s groups across India had to mount a campaign to outlaw the use of quinacrine, an anti-malarial drug, as a method of non-surgical sterilisation. This method could have entered the National Family Welfare Programme too if it wasn’t for the women’s groups who raised awareness of its possible side-effects — cancer and ectopic pregnancies among others — and got the Supreme Court to ban the drug.

Injectible contraceptives, though, were not banned. They have had a tortuous four-decade history of failing to get approval from various governments across the world because of their ravaging side-effects. In India, they are easily available over the counter. The highest stakes for pharmaceutical companies are when their products gain acceptance into the National Family Welfare Programme. In spite of strong pressure on the government, injectible contraceptives have not yet been accepted into public health, because of the vigil of activists like Sarojini. The strain of interrogating every possible contraceptive seems to mount on Sarojini when she says, “We get accused of saying no to every option. It’s not as if we don’t want women to have birth control.”

As if misleading campaigns, greedy pharmaceutical promoters, an often mercenary medical profession and a utilitarian government policy are not enough to fight, there is always Indians’ strong tendency to self-medicate. The unpopularity and ideological isolation of those who preach caution is clear when you remember that Indian women across age, caste and class, pop contraceptive pills (regardless of any health risks) are considered inauspicious when they are menstruating on the eve of temple visits, weddings, pujasand any range of social activities .

In a characteristic moment of advertising megalomania, the HLL Lifecare brochure exclaims “The Pink Revolution”. A Pink Revolution would involve contraception reaching the ‘masses’ in the same ‘unproblematic’ way the Green Revolution delivered food for all. Consumers would be justified in being outraged that advertising is still peddling tired collectivist metaphors that belonged squarely to the past. Yet, it works as a simple reminder of a badly kept secret: ‘new India’ is not really very new.

The complex issues of birth control in post-liberalisation India cannot be ironed out into a simplistic arc in which women go from being guinea pigs to decision makers. But they can lead you to an old and commonsensical moral bottomline — women deserve better.

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