Amy*, a 31-year-old Chennai local, who has received three abortions in her life, remembers using a condom as protection each time she found out she was pregnant.
Now, her gynaecologist, scared that her body can not handle another termination, is requiring her to come in for shots every few months as an added form of birth control.
Amy recalls that she really had no formal education on other forms of birth control, and while she knew they existed, she just really wasn’t considering it.
Talking about sex is still considered taboo and many Chennai schools currently have no formalized sex education curriculum.
As a result, many men and women are either not aware of the resources that can be used for birth control outside of condoms, or they don’t discuss using them.
“I would say only about 20% of people I know use those other forms of birth control,” says Amy.
According to the National Family Health Survey for 2021, 65.5% of married women in Tamil Nadu reported using some form of modernized birth control.
In spite of this otherwise positive number, over 57% of those who polled using modern methods of birth control are made up of female sterilizations – a very costly procedure, and usually one only had by married women.
The other options, such as the pill, IUD, or male sterilization, make up no more than 8% of the total birth control utilized in Tamil Nadu.
Unmarried women were not included in the studies, which is a reflection of the larger issue at hand. The possibility of them having sex and needing birth control is not as widely discussed, although unmarried women still legally have access to the same resources.
“While it doesn’t have to be, marriage is the legal sanction for people to engage in sexual activity,” Archanaa Seker, a local activist, said.
For the women finding themselves panicked and on their last resort to preventing pregnancy, emergency contraception is notoriously difficult to locate at any pharmacies across Chennai.
With little awareness about the full range of birth control methods on offer and an issue of access to emergency contraception, many women end up facing situations of unwanted pregnancies or are forced to seek medical termination of pregnancies for a variety of personal or health-related reasons.
Though abortions are legal on paper, finding a non-judgemental healthcare provider who will carry out the procedure remains a key challenge for many women in Chennai.
Abortions viewed as taboo in Chennai
Amy remembers not knowing where to go and who would be willing to help her on multiple occasions.
Just before her wedding day, Amy found out she was pregnant for the first time. Scared of what their families would think, and nowhere near ready to raise a child, Amy and her husband made the decision to terminate the pregnancy.
“The first time we had to lie and say we were married to the doctor,” says Amy. “They could have easily said we can’t help you. People are not brave enough to do it publicly, people are still hesitant and not open about a woman hoping to terminate her pregnancy.”
During her second pregnancy, which Amy decided to terminate on her own, she did not go through any doctors she knew personally.
“Last time I did not go to my gynaecologist because I was not sure if she would proceed with doing the termination for me,” says Amy.
Unsure of where to go now that she no longer had her husband with her to bring to the doctor, Amy used her friend Archanaa as a resource to find someone who she knew would help her.
“She took me to a doctor who didn’t make me feel anything about it she was very sweet,” says Amy. “If Archanaa didn’t know a person I would have had the baby, I would not be sure if the hospital does this, I was scared to go ask help from anybody else.”
“In India, abortion is legal, not because it is recognized as a right or a body autonomy or women’s agency point of view, abortion is legal in the country because we have historically used it for population control and family planning,” says Archanaa.
A popularly held notion throughout much of Chennai surrounds the idea that sex is for procreation only, sex follows marriage, kids follow sex, and kids are God’s gift. Anything outside of this scope carries at least some level of stigma.
Therefore, women seeking abortions, who aren’t married and don’t already have a kid, or in other words aren’t using abortion for “family planning,” will be deemed as having loose morals.
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Finding the right healthcare provider for abortions in Chennai
If women want to prevent receiving judgment from the medical professionals who handle their procedures, they have a greater chance of accomplishing this with the more expensive option: a private practitioner.
“Across the board, even in private facilities, in non-profit hospitals, everywhere, if a woman seeks abortion she is judged,” says Dr Vijayaprasad Gopichandran, Assistant Professor, of Community Medicine at ESIC Medical College and PGIMSR. “The difference being that in a government hospital, there is a very evident expression of the judgement, they scold her and abuse her verbally, but in a private facility because there is payment for service it is all a bit subtle, it is not really evident.”
“Most of these healthcare providers, doctors, nurses, medical staff, they all come from the same society, they all carry the same notions regarding marriage, pregnancy, pregnancy outside of wedlock,” says Dr Vijay.
Archana, among other local activists, has worked to create networks for women who don’t know where to go, including lists of medical professionals who provide “non-judgmental” care.
On top of this, she fundraises money for those in these sticky financial situations, making it so that if they prefer a private practitioner, this can happen.
“There is definitely a lot of insensitivity to the condition of the women who are seeking the abortion,” Dr Vijay added. “There are very few centres or hospitals where respectful treatment of women who seek an abortion, or any reproductive health services for that matter, that exist”
Archana explained many of the attitudes some medical professionals form toward these women: seeing them as pests or unwanted visitors.
“They are looked down upon and treated badly for not being able to say no to their partners, not using protection, they are seen as a bunch of ignorant people who have nothing better to do than to get pregnant,” she says.
Stigma surrounding abortions leaves women with little support
Outside of the hospital, and on a personal level, these stigmas remain prevalent.
As felt by Amy throughout her young adult life, these stigmas have been incredibly isolating. Amy always knew that it was expected, a year or two after she got married that she would have a kid.
Their parents would ask them often, “When are you going to give us a grandchild?”
Despite not really ever seeing herself as a person who wanted kids before her current child, her family expected her to fulfil the role a woman holds as caretaker, and enjoy doing it.
Between lying to the doctor when they were unmarried, not telling her husband about one of her terminations, and not telling her parents don’t know about any of her terminations, Amy has kept her terminations hidden from one person or another.
“I don’t think they would be able to accept the fact that I don’t want the kid,” says Amy.
As a result of not feeling like she could tell certain people, Amy has suffered through a lot of her terminations almost entirely on her own, with only her sister offering some support.
For a culmination of reasons, particularly her husband’s alcohol abuse and financial insecurity, Amy knew she couldn’t have another child when she found out she was pregnant last week, but her husband wanted to keep it.
Amy and her husband haven’t talked for over five days now. While Amy was taking her abortion pills at home alone, tired and mentally drained, her husband was gone all day.
When he came home, it was still expected that Amy would continue to cook him dinners during her abortion, and she did.
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Policies on paper much ahead of ground realities on abortion
Even as many women like Amy struggle to access abortions, the policies around the same have been evolving. It is clear that practical realities are what prevents women from having an easy experience.
On Tuesday, July 18, the Tamil Nadu government passed an ordinance that would aim for the creation of more medical boards to make decisions regarding medical termination of pregnancies sought post-24 weeks.
Once the job of one board for all of Tamil Nadu, the decisions will now be handled by 32 separate boards. In theory, this change will exponentially speed up the time it takes women to access abortion post-24 weeks.
This change mirrors other recent ones: in September of 2022, the legal right to abortion was extended to unmarried women across the country after the wording of the 1971 Termination of Pregnancy Act was amended.
The extension to unmarried women was not explicitly stated at the time, but the changes in the law’s wording implied this much. On paper, unmarried women no longer need permission from a legal guardian or spouse to receive an abortion.
But the experience of Amy and those like Archanaa, working to make abortions possible for women seeking the procedure within the scope of the existing laws, shows that the social stigma surrounding the process continues to remain the biggest hurdle.
*name changed on request