The contraceptive conundrum

Recent reports indicated that the Central Drugs Standard Control Organisation (CDSCO) would ban the sale of over-the-counter contraceptive pills, including oral contraceptives and morning-after pills but the body subsequently refuted this. These medications serve as vital hormonal contraception, often the only option for pregnant women in areas where abortion is not easily accessible. This news followed recent Supreme Court and high court decisions in India that restricted women’s abortion rights and introduced new considerations regarding foetal rights previously absent in India’s abortion policies.

A similar trend has emerged in the United States after the Supreme Court’s Dobbs vs Jackson Women’s Health Organisation decision on June 24, 2022, which overturned Roe vs Wade. Since then, there have been increasing efforts to limit access to contraception and abortion services. A study by the Journal of the American Medical Association (JAMA) found that the Dobbs ruling correlated with a decline in oral contraceptive prescriptions, especially emergency contraceptives in states with strict abortion laws. This underscores the critical role of these contraceptives in preventing unwanted pregnancies and the urgent need to improve access, particularly where legal abortion is no longer an option.

Banning over-the-counter contraceptives is illegal and unconstitutional as it violates the right to health for pregnant individuals. Given the patriarchal biases in the medical system and the high rates of unsafe abortions in India, restricting access to contraceptives endangers lives and pushes individuals towards unsafe, underground abortions. Notably, the only approved over-the-counter contraceptive in India, Levonorgestrel, is considered very safe, with minimal side effects. The right to health includes access to contraceptives, and without them, individuals may be forced into unsafe circumstances.

Furthermore, the rationale for such a prohibition appears rooted in patriarchal attempts to control women’s sexuality rather than based on sound medical or scientific evidence. Levonorgestrel is approved by the US FDA and recommended by the WHO for over-the-counter availability. The aim seems to be restricting women’s sexual autonomy, which could lead to increased maternal mortality in a country where an average of eight women die daily due to pregnancy-related causes, according to a 2019 BMJ study. Since their inception, oral contraceptives have empowered women to control their sexual health and avoid unwanted pregnancies.

In the United States, landmark cases like Griswold vs Connecticut (1965) and Eisenstadt vs Baird (1972) established the right to access contraception, linking it to the right to privacy. Currently, 14 states have legally protected this right, while others, such as Hawaii, Maryland, Nevada, and Washington, are considering amendments to do so. Following the Dobbs decision, Congress introduced two bills: the Right to Contraception Act and the Access to Safe Contraception Act, aimed at safeguarding contraceptive access. However, both failed to pass due to insufficient support.

It is crucial that the right to contraception be recognised either through judicial interpretation of the Constitution when this ban is challenged or through legislative action. This legislative effort should also involve overhauling the Medical Termination of Pregnancy Act and decriminalising abortion. Such reforms are essential not just for protecting health rights but also for broader social and economic benefits. Research from the Institute for Women’s Policy Research indicates that access to contraception contributes to increased workforce participation among women, enhances career prospects, and reduces poverty levels.

The motives behind the proposed ban remain unclear, but its potential consequences could be devastating for women’s health, education, and economic stability. Extensive research supports the need for easily accessible over-the-counter contraceptives. This proposed ban represents not only a public health failure but also poses constitutional challenges. The autonomy to make decisions regarding sexual health must rest with individuals, not the government or medical professionals.

The solution lies not in restricting access to contraception but in fostering an environment where people can make informed decisions about their sexual and reproductive health. Ensuring that contraceptives and abortion services are available in stigma-free settings is critical for achieving this goal. A society that respects and upholds reproductive rights will ultimately benefit everyone.

Are there any benefits of oral contraceptives?

Reduced menstrual pain
 Alleviates menstrual cramps
and migraines.
 Makes periods lighter and
more regular.
 Reduced premenstrual symptoms.
 Mitigates symptoms of premenstrual syndrome (PMS).

Reduced acne
 Certain types can help
decrease acne.

Reduced cancer risk
 May lower the risk of ovarian, uterine, and colon cancer.
Protection against health issues
 Guards against acute pelvic inflammatory disease and
ectopic pregnancies.
 Aids in treating polycystic ovary syndrome (PCOS) and endometriosis.
Reduced hot flashes
 Can alleviate hot flashes during menopause.

Improved bone density
 Increases bone density and reduces fracture risk.

Reduced asthmatic symptoms
 May help lessen asthma symptoms.

Effectiveness & fertility
 99% effective when taken consistently.
 Fertility can return almost immediately after discontinuation.

(The author is a bioethicist and a lawyer who recently published Urban Elite vs Union of India published by Penguin Random House India.)