Freedom of choice

In examining the issue of freedom of choice, several factors must be taken into account. An Indian woman's reproductive decisions are influenced by societal factors which include the social, political and economic context in which she lives and the gender norms that shape her life. Also to be taken into consideration is a woman's life cycle stage and other socio-demographic characteristics that govern her contraceptive use, her childbearing experience and the three domains of her life - family, community and individual.

The majority of women in India are married off at a young age, sometimes even before they are able to understand the bodily changes that accompany puberty. As soon as she is married, family members pressured her to prove her fertility by getting pregnant before the first year of her marriage has lapsed. In most cases, if her first issue is female, she is again subjected to great pressure to produce a male progeny. This vicious cycle of events hinders a woman from educating herself about contraceptive use, the choices available to her, the methods she can use to effectively space her children and how she can conserve her own health, maintain a balance between household chores and child-bearing and manage her various roles effectively to the satisfaction of her husband, in-laws, and herself.

Whether she is an urban woman or from a rural area, she is most likely unaware that she can seek advice from her doctor. This is mainly due to a lack of awareness since most government programmes and campaigns are run sporadically. Moreover, there is little involvement of private practitioners in educating/ counseling a woman on her reproductive health options.

Only a very limited number of Indian women have the opportunity to choose whether or when to have a child. Women, particularly women in rural areas, do not have access to safe and self-controlled methods of contraception. The public health system emphasizes permanent methods like sterilization, or long-term methods like IUD's that are provider dependent and require trained (health personnel). In fact, sterilization accounts for more than 75% of total contraception, with female sterilization accounting for almost 95% of all sterilizations. (Office of the United Nations Resident Coordinator in India, 2001)

The idea of contraception is that it should be seen as a pillar of reproductive health rather than a means of population stabilization. Ideally, it should include spacing, safety and the health of mother and child. Presently, a plethora of contraceptive methods that are available India, with newer options intermittently introduced. There are oral pills (both low dose combined oral contraceptives and progestin-only contraceptives), the DMPA injectable contraceptive (which is excellent for mid-term spacing),Norplant implants, Intrauterine Devices (IUD's), condoms, vaginal creams and spermicides, and terminal methods such as female sterilization and vasectomy. Users have a range of methods of contraceptives from which to choose. But the question is, 'Can they make an informed choice? 'This means, when a person makes a freely thought-out decision based on accurate, useful information, it is called informed choice. How many couples have access to such information?

There are multiple benefits from informed choices: People use contraceptives longer if they choose the methods for themselves; access to a range of methods makes it easier for users to choose a method they like and to switch to other methods whenever needed. What's more, this process initiates a trusting partnership between users and providers and enables individuals and families to take more responsibility for their own health.

To make informed choices, people need ample, easy to grasp information about methods of contraception. An informed choice requires access to a range of methods and support for individual choice from social policies and community practices. The outcome should be a free, informed, conscious decision by the individual about whether or not she or he desires to obtain contraceptive services, and if so, what method or procedure she or he will choose and consent to receive!

The solution lies in providing information on safe, effective and tested contraceptive methods that have been used successfully in countries throughout the world. It also means a concerted effort by medical practitioners in the public and private sectors to disseminate correct, comprehensive and user-friendly information to women in the child-bearing age about the contraceptive options available to them. It further requires greater male participation in matters of maternal health, spacing and contraception as well as respectful dialogue amongst partners. Finally, it means that limiting family size is not the only objective, rather, complete reproductive health should be the target - which includes safe pregnancy, the well-being of mother and child, spacing options which allow a woman to plan her family effectively, general gynecological care, protection from sexually transmitted diseases (STD's) and their proper diagnosis and treatment. An underlying factor is improvement of the quality of counseling services to help women understand their reproductive requirements.

The increasing number of abortions proxy as evidence of widespread unmet needs for contraceptive methods and their apparent unavailability or inaccessibility. Therefore, the need for more options is already imperative. Meeting these needs permits women to exercise their reproductive rights and choose appropriate options from a basket of contraceptive choices.