Fact-finding: Delhi slum women recount experience with IUCDs
Today, almost the entire burden of “family planning” is borne by women. And implemented with callousness, this has taken a toll on the health of large sections of women in the country. It has, over times, taken different strategic approaches such as a coercive target approach, contraceptive-specific incentives, incentivizing sterilization drives by ASHA, among others.
On paper, currently, the Family Planning Programme provides choices between Intra-Uterine Contraceptive Devices (IUCD), condoms and Oral Contraceptive Pills (OCPs).
Indian women who rely on government hospitals for their health care typically have access to only one type of Post-Partum IUCD (PPIUCD): the Copper-T -- a 'T'-shaped piece of plastic shaped thus because it fits 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, due to widespread apathy on the part of medical personnel, many hospitals in India often insert them without obtaining informed consent or counseling, resulting in the violation of the rights of women.
A fact-finding team visited slums in Delhi last year, focusing especially on the slum clusters of 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 despite, in several cases, refusing it, only to find out that the hospital staff had earlier cheated them by 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, back ache, 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 largely refused to do so. 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.