Introduction Sexual and Reproductive Health Rights (SRHR) protect and improve the living conditions of the underprivileged and the marginalized by increasing access and awareness to sexual and healthcare services. It is imperative that these rights are actively protected and improved upon but the pandemic has seriously challenged the efforts and progress of SRHR with respect […]
Sexual and Reproductive Health Rights (SRHR) protect and improve the living conditions of the underprivileged and the marginalized by increasing access and awareness to sexual and healthcare services. It is imperative that these rights are actively protected and improved upon but the pandemic has seriously challenged the efforts and progress of SRHR with respect to SDG, globally and in the Indian subcontinent. To put this into perspective, about a 10% drop in the efforts made for SRHR care will result in 49 million more women losing access to contraceptives, 15 million women being subjected to unplanned pregnancies, 168,000 newborn deaths, 28,000 maternal deaths, and 3 million unsafe abortions .
The pandemic has disrupted access to healthcare, education, transportation, and other essential facilities during the period, with women being the worst affected and data has indicated that abuse, discrimination, and exploitation aimed at women towards has worryingly worsened with effects already visible on women’s reproductive and mental health.
The most common method of contraception in India is female sterilization which although is invasive and irreversible is adopted by 36% of women while male vasectomies are adopted by a mere 0.3%. Despite the progressive stance on SRHR, data has evidently shown the conservative nature and the lack of autonomy found in societies across the country. The hierarchy of caste/class prevents equal distribution of healthcare resources across the country. A woman from a marginalized community might not have access to the same healthcare services as a woman from a class/caste privileged background. Added to that, despite the existence of legal provisions the normalized binary nature of gender is highly non-inclusive of trans persons, often subjecting the community to violence, discrimination and suffering.
India reported almost twice the number of cases related to sexual and gender-based violence; 116 cases during the first week of March 2020, which doubled to 257 cases by the last week of the same month, prompting the National Commission for Women (NCW) to launch a WhatsApp number to aid the process of reporting [2, 3]. The Indian Government launched a national helpline crisis called ‘Kiran’ which provides free mental health rehabilitation services via phone and redirects people to access resources. Although measures and policies are actively being adopted,
the prioritization of resources towards emergency responses to the pandemic has severely affected other essential non-COVID-19 health services. Family planning and reproductive health services were severely disrupted, leaving an estimated 25 million couples in the country without access to contraceptives. In fact, India is likely to witness the highest number of forecast births at 20.1 million . According to Ipas, 1.85 million women in India will be unable to access abortion services due to the impact of the pandemic.
Despite the strong presence of a cadre of women frontline workers, dogmas and misconceptions on reproductive health and justice have hindered the pace of progressive conversations and actions. For example, only 27% of unmarried but sexually active women in rural India use methods of conception . Policies and measures focused on infant and maternal health, such as the Janani Suraksha Yojana 2021 have been introduced to decrease the number of maternal and neonatal deaths and improve overall access to healthcare and nutrition. However, with decreased accessibility to hospitals and effects of the pandemic, the efficacy of these schemes has reduced over time .
Going forward, there is a lot of work to be done towards ensuring and safeguarding women’s reproductive health and rights with a strong emphasis on the infrastructural needs and requirements in rural areas. Technological solutions in abortion services and telemedicine services for consultations on family planning can be a critical step towards reaching the last mile. The post-pandemic era should be perceived as an unique opportunity for radical reforms to India’s public health system .
Gender Equality is yet to be achieved in India, and sexuality is viewed through a heteronormative lens. The deep cultural heritage has a strong influence on jurisprudence, and conversations that diverge from conventional norms are considered sacrilegious.
Despite immense progress, abortion in India remains a stigmatized issue even within the medical fraternity. The pandemic in combination with cultural stigmas and lack of resources has thwarted years of progress . During the period over two million women were unable to access safe abortion practices .
Abortion laws have been amended and liberalized in India as recent as in 2021 yet the law still does not recognize abortion as a woman’s choice that can be sought on-demand as is the practice in 73 other countries. The law does not grant women complete control over reproductive choices.
Key points from the Medical Termination of Pregnancy (MTP Amendment) Act, 2021 :
However, the chronic shortage of doctors in India combined with the widespread impact of the pandemic, women have found it extremely difficult to access and seek expert opinion from doctors and medical boards, often throwing the future of the mother and the fetus at the mercy of the courts. Between the months of May and August 2020, 112 cases of abortion were heard in 14 courts across the country as compared to the 175 cases that were heard over a 35-month span from June 2016 to April 2019.
The entirety of the language used in the law is non inclusive of trans persons and as mentioned earlier, the consideration fails to go beyond gender binary and rather remains gender-blind. Having received medical training based on a binary sex-gender system, doctors have limited knowledge on treating trans bodies . Despite policy level advances, the de facto experience of a trans person’s encounter with the health system poses a severe barrier to accessing and ensuring equal and quality healthcare to all . Moreover, the medical field is also highly inexperienced in dealing with the reproductive health of intersex people.
Rape, Marital Rape, and Assault
According to the National Crime Records Bureau’s 2013 Annual Report, 24,923 rape cases were reported across India in 2012, of which 24,470 were committed by a known member such as a relative or a neighbor, making rape the fourth most common crime against women . The Courts, taking cognizance of the situation have passed strong comments and judgements, some of which are as follows:
On the other hand, there have been a few instances where comments and judgments have been hurtful and this extends beyond the issue of rape alone.
While rape is strictly condoned, the legal framework on marital rape and abuse is ambiguous and discriminatory, echoing the growing need for debate, reformation, and progress in issues that are beyond the conventional .
Sexuality and same-sex marriage
Although Section 377 of the Indian Penal Court has been decriminalized, there is no fundamental right to same-sex marriage in India. The Government of India has added that recognizing same-sex marriages would be in violation of existing codified and personal laws as the current legislative scheme talks about a biological woman as the wife and a man as the husband .
Here are a few judgements concerning the LGBTQIA+ community:
While reproductive rights are actively ensured, in marginalized and underserved communities, lack of access to essential information and knowledge on sexual/reproductive health and associated human rights leave women vulnerable to a host of issues. Moreover, cultural stigmas and disproportionate allocation of resources across the country have pushed women towards unsafe abortions carried out by unregistered medical practitioners that have inadequate training. According to a 2015 Lancet study, 15.6 million abortions occurred in India in 2015, of which 73% were through medical abortion drugs accessed outside of facilities and 5% through traditional unsafe methods . The pandemic has also triggered a sanitary pad crisis owing to a lack of raw materials, and availability of other resources .
While the pandemic negatively impacted the situation, measures were taken up by some state governments to quickly address the effects.
While the Courts have taken a proactive approach on the various issues evolving due to the pandemic, the budget allocated for Mission for Protection and Empowerment of Women has been cut to INR 48 crore in 2021 from INR 901 crore from the previous year  owing to the uncertainty and stretched utilization of resources caused by the ongoing pandemic. Also, the Nirbhaya fund remains largely unused despite the urgent and desperate need for deployment of new resources . Diversion of resources and facilities to handle COVID-19 patients has discontinued shelters, threatened protection to survivors, and obstructed the delivery of critical aids.
In India, significant improvement to SRHR is being made but bearing in mind the existing challenges and the uncertainty of the pandemic, the pace at which action is implemented needs to increase multifold for the country to reach the SDG goal by 2030. Still, there are several areas that need to be improved, including but not limited to
Prepared by Ram
Research And Analysis
1. Riley T et al., Estimates of the potential impact of the COVID-19 pandemic on sexual and reproductive health in low- and middle-income countries, International Perspectives on Sexual and Reproductive Health, 2020, 46:73-76.
11. Banerjee, Aparna. 2017. Interview for NHRC Study on Sexual Health and Well-being. In person. New Delhi
13. Crime in India: 2013 Statistics — page 195 // table
26. Glasier A, Gülmezoglu AM, Schmid GP, Moreno CG, Van Look PF. Sexual and reproductive health: a matter of life and death. Lancet. 2006 Nov 4;368(9547):1595-607. doi: 10.1016/S0140-6736(06)69478-6. PMID: 17084760.