Daybreak - You don't need a prescription to buy an i-pill. What if that changed?

Episode Date: October 17, 2024

A little more than a week ago, we read a really strange piece of news. Apparently, an expert committee recommended the Drugs Controller General of India (DCGI) to ban the over the counter sale of emergency contraceptive pills like i-pill and Unwanted 72. They suggested  women should be only allowed to access it with a doctor’s prescription because of concerns over side effects. This was weird for many reasons. One, levonorgestrel, which is what these pills contain, is one of the safest emergency contraceptives available in the world. It is approved by WHO and the FDA. In fact, it is so safe, that even breastfeeding women can take it.Second, these emergency contraceptive pills are already a part of the Indian  govt’s family welfare programme. It was approved by the DCGI back in 2001. Ten years later, the ministry of health even made it a part of the ASHA workers drug kit.Much to the relief of women, the DCGI came up with a clarification a few days later saying no such ban was going to take place. But the news brought us face to face with the possibility that something as life-changing as the emergency pill—the one saving grace women have when it comes to their reproductive rights and bodily autonomy—could be taken away, just like that.Despite our progressive policy on the matter and the fact that more than 60% of emergency contraceptive pills in our country are sold over the counter, women often hesitate to buy it themselves. The fear of judgment and shame comes in the way of access.In this episode, hosts Snigdha Sharma and Rahel Philipose talk to two experts, Vinoj Manning, the CEO of the Ipas Development Foundation, and Leeza Mangaldas, a sex educator and author of The Sex Book, about about this chasm that exists between our seemingly progressive policies and our actual society and its attitude towards emergency contraceptive pills and women's reproductive rights.Tune in!We are now on WhatsApp at [phone]! Text us or send us a voice note to tell us what you thought of this episode. Daybreak is produced from the newsroom of The Ken, India’s first subscriber-only business news platform. Subscribe for more exclusive, deeply-reported, and analytical business stories.

Hi, this is Rohan Dharma Kumar. If you've heard any of the Ken's podcasts, you've probably heard me, my interruptions, my analogies, and my contrarian takes on most topics. And you might rightly be wondering why am I interrupting this episode too. It's for a special announcement. For the last few months, I and Sita Ramon, Ganesh, my colleague and the Ken's deputy editor, have been working on an ambitious new podcast. It's called Intermission.

We want to tell the secret sauce stories of India's greatest companies. Stories of how they were born, how they fought to survive, how they build their organizations and culture, how they manage to innovate and thrive over decades, and most importantly, how they're poised today. To do that, Sita and I have been reading books, poring over reports, going through financial statements, digging up archives, and talking to dozens of people. And if that wasn't enough, we also decided to throw in video into the mix. Yes, you heard that right. Intermission has also had to find its footing in the world of multi-camera shoots in professional studios, laborious editing and extensive post-production.

Sita and I are still reeling from the intensity of our first studio recording. Intermission launches on March 23rd. To get alert, as soon as we release our first studio. episode, please follow intermission on Spotify and Apple Podcast or subscribe to the Ken's YouTube channel. You can find all of the links at the ken.com slash I am. With that, back to your episode. Last week, we read a really strange piece of news. Apparently, an expert committee recommended the Drugs Control Authority of India to ban

the over-the-counter sale of emergency contraceptive pills like iPill and unwanted 72. They suggested that women should only be allowed to access it with the doctor's prescription because the committee had concerns about the side effects. Now, this was weird for many reasons. One, Leavenor-Destrel, which is what these pills contain, is one of the safest emergency contraceptives available in the world. It's approved by the World Health Organization and it's also approved by FDA. In fact, it's so safe that even breastfeeding women can take it.

Second, these emergency contraceptive pills are already a part of the Indian government's family welfare program. It was approved by the Drug's Comptroller General of India back in 2001. Ten years later, the Ministry of Health even made it a part of the Asha Workers drug kit. So, as you can imagine, ever since, it's been pretty easy to access. In fact, it was also available on quick commerce apps like Blinket, Swiggy and Zepto. until the day when this news came out. I immediately called Rahal and we both checked all of these apps together

and realized that suddenly these pills were not available anywhere on any of these apps. And the weird thing here was that the DGCI had not even made a decision yet. It was just a recommendation by the committee and news reports said that the drug's authority was mulling over it. It was not banned,

but it was possible that it could be banned. Also, important to note, the news was not about a ban on Levanore gestural itself, but a ban on buying it without a prescription. So Snickta and I were obviously pretty alarmed. How could this be happening? We began calling up people to find out more. Soon enough, though, to our relief and to the relief of every woman in India, the drugs control authority came up with a clarification, saying that no such ban was going to take place. But it did bring us face to face with the possibility that something as life-changing or as life-saving, in fact, as the emergency pill, which is the one saving grace that women have in India when it comes to their reproductive rights and bodily autonomy could be taken away.

Just like that. After 20 years of it being around, were we taking it for granted? And why shouldn't we right? But then again, look at what's happening in the US with its own. abortion laws. India comparatively and thankfully seems way more progressive when it comes to a woman's reproductive rights. But we all know, it's not really the same outside the policy world. In real life, even though more than 60% of emergency contraceptives in our country are sold over the counter, women often hesitate to bite themselves. The fear of judgment, of shame, not just from the outside

world, but from their own families also comes in the way. So we decided to talk to two experts about this chasm that exists between our seemingly progressive policies and our actual society and its attitude towards emergency contraceptive pills. The first is Mr. Vinodz Manning, the CEO of the Ipass Development Foundation, India, a 50-plus year-old organization that works to improve the environment for safe abortion and increase access to comprehensive contraceptive care in the country. The second guest, many of you may know her already, is Lisa Mangalas.

She is a sex educator known for her content across social media platforms. She happens to have millions of followers. She's also written The Sex Book and is the founder of a sexual wellness brand called Lizu. Hello and welcome to yet another special episode of Daybreak. I'm Snigda and I'm Rahil and every week we come together to talk about something in business and tech that interests the both of us. And it won't just be us. Depending on what we're talking about,

we will also have a bunch of really interesting people on the show. Stay tuned. Before we even get started with the interviews, we went to Dr. Ankei Sahaitia, a gynecologist and obstetrician based out of Mumbai to get our facts right about Levinogastrel. One of the most common myths about these pills is that they can cause an abortion.

So we asked him about the difference between an emergency. emergency contraceptive pill and an abortion pill. So leban or gestural is nothing but a progesterone. It is used in the emergency contraceptive pill. Ideally, it causes the endometrial landing to thicken, the mucus to thicken, which prevents sperm penetration and implantation. And in certain cases, if taken at the right time, can even prevent ovulation. Abortion pills, if you want to differentiate the two abortion pills, are used to evacuate

and abort an already implanted pregnancy. Lebon or gestural, which is there in the emergency pill, idly helps in preventing pregnancy occurrence in the first place. Also, what exactly are the side effects of these pills? The proven side effects of the emergency pill, if taken unnecessarily, can lead to irregular periods, can lead to frequent periods or even missed periods. In short, when not indicated, it can cause irregular periods.

Also, to make it very clear, emergency contraceptive pills are, as the name suggests, for emergencies. They are not meant to be used as regular birth control. Okay, now that that's out of the way, let's talk to Mr. Vinodz Manning. Vinodz, your organisation, works across the world, right, in making safe abortion and contraception more accessible to women. How is India? How is India placed as a country when it comes to access to contraceptives

compared to the rest of the developing world? And I'm talking about awareness as well. You know, how many women actually know about the existence and availability of emergency contraceptive pills? India, contrary to this controversy, at least from a policy perspective and a drug approval perspective and from the private sector perspective, have been pretty advanced in moving and in line with global trends in getting the product into India. The product got launched in the US in 99, and in India, the drug controller approved it in 2001, 2002. Just for your information, about 85 countries in the world, that's about 50%. Emergency contraceptives are available over the counter without a prescription, so is it in India. So having said that, that's in.

terms of policy. But when it comes to practice, as you mentioned, lack of awareness, lack of distribution, lack of agency of women make this product very difficult for them, women to access them when they need it. Right. And Winoges, I'm sure there are a lot of myths and misconceptions that you and your organization have to tackle very often when you're, you know, speaking to women, working with women on the ground. What are some of the most common myths that you hear around ECPs. Now, our experience shows there are two buckets of misconceptions of myths. One is that, as you say, what is some myths misconceptions among women?

Among women, a very strong belief is that if you use ECPs, emergency contraceptive pills, it causes abortion in the future. Or it costs later on pregnancies could get aborted. It's a very, very common. myth. Contrary to that, they also believe some of them that use of ECPs, repeated use of contraceptive, the emergency contraceptives can lead to infertility. Both these are absolutely myths. So these are some of the myths that women have about the use of ECPs. But what compounds the problem is the societal myths which lead to stigma. A strong belief people have, society has is

the availability of emergency contraceptive pills promotes promiscuity in the society. And that ECPs should not be available for young unmarried women because it gives them sexual freedom. Now, these are part of the societal myths very often which probably are behind some of the conversation

about restricting the availability of the pills. Vinod, can you tell us a little bit about the role of the gynecologists or the doctor, you know, in kind of changing these attitudes? And I'm asking this because it's very often doctors who spread this kind of misconception about the use of ECPs, you know, especially in rural areas or maybe actually it's the same in urban areas as well. One disclaimer I would have is it's not just about gynecologists, it's about any kind of. doctor that's available because in most of the areas, rural areas that we work in, we don't have gynecologists. Women access all types of doctors, all types of providers for their health needs. So they as a community, and I'm combining all of them, have a big role to play in changing such attitudes, promoting the accessibility of emergency contraceptives. But maybe let me just give you a

national figure. You see, overall, the unmet need for contraception is around 9%. There's 9% of women in the between the age group of 15 to 49 feel that they need. They have a need for contraception, but which is not met. This literally doubles when you look at young people between the age of 15 to 24. So what is the implication is that they are very higher proportion, higher probability of them having an unwanted pregnancy. Therefore, the relative need for a product like emergency contraceptive is far more important to younger people, more vulnerable people because in their reproductive cycle, they may want to manage a pregnancy, but they don't have the contraception, access to contraception.

The need is not met. So that's the relative importance of this product. Right. Now, what happens is doctors are realizing this, could definitely play a far more proactive role in educating them and counseling. them, counseling people, clients who come in. Because knowledge of emergency contraceptives is very low. It is estimated that less than 15% women both rural and urban know about the details about the emergency contraception and that it is, it is not a contraceptive, but it is an emergency

contraception that is post-coital and you can use it up to three days. So the education, the counseling is one big piece. The other important piece is about providing and support the environment by giving them good information and saying that I as a provider am available to you use this product, but if there is anything that you need post that, I am there to provide you the support that is expected from a health provider. And finally, accessibility. If only all gynaecologists, all doctors could carry a stock of emergency contraceptives and contraceptives and provided to clients who need them at their point of service, at their clinics, it will go a long way in addressing the challenges that this product has today.

Right. You know, actually, Vinod, I wanted to point out one of the reasons why I asked you this question about doctors is also because a lot of doctors are pro-life, you know, which is why they kind of discourage the use of ECPs. There was this one particular study that was done in Uttar Pradesh that found this. And I'm sure this happens not just in UPI and other places in India as well. Do you know about any such cases? See, technically, especially a doctor who, even if he's pro-life,

I have a problem with that at all because it's not the doctor's decision, it is the client's decision, right? So there is a problem. there itself. But having, not getting into that argument, ECP is not even, you know, ECP happens, it's not abortion. It happens prior to that, prior to the pregnancy, initiation of pregnancy. So the emergency contraceptives, like contraceptives, should not get into this debate of pro-life, anti-choice or pro-choice debate. Right. Vinod, you know the nature of the conversation around family planning, birth control, even ECPs for that matter,

you know, it's vastly different here in India than the rest of the world, right? Is it kind of unique in that sense? It would be interesting to know, you know, from an international standpoint, especially considering the work that your organization is doing. How different is that conversation here in India? See, our problem is India, India is very unique or maybe South Asia is unique, right? do not have too much of an anti-choice discourse. But the problem is at the end of it, the gender dynamics in India is very strong. Men, in-laws, everybody other than the woman is controlling

the, what you call it, controlling the decisions on family planning and etc. Right. So the agency for women is lost in this whole debate. Secondly, you know, the patriarchal norms that we have is so deep-scented, even among providers. We talked about provider, mits, etc, and I didn't talk about it then. But today you go to a traditional, check it out where you are. Very modern girls. If they go in and say, if you're unmarried, you have your own set of complications and constraints, but let's take a married young person. You go and tell you a provider that I want to have a contraception or I want an emergency contraception and I'm married, right?

But I have an emergency contraception because I don't want a child. So the first question the doctor asks is, do you have any child now? You answer no. and say, no, no, I would advise that you have the child because it's very important that you have, finish your, you know, finish your fertility cycle and then have your first child. Why? Because society demands that. The men need to prove their fertility. The families need to have their succession higher in. And that's what leads to, you know, and providers are finally products of the society, products of the patriarchal norms that we have. So the debate here is very different. It comes from different societal conditions and patriarchal norms. Yeah, they'll even ask questions, like, does your husband know or do you have his permission, right? Absolutely. Absolutely. But, you know, Vinod, let's get back to this news that there could be a possible ban on the sale of

emergency contraceptive pills without a prescription, right? There was this expert committee that supposedly studied these side effects and then they made this recommendation to the drugs control authority. Now, I don't understand what happened with that. Like, we don't know how did they come to that conclusion. I mean, obviously, they did come out with that clarification later that there is no ban, but what I'm trying to say is that how does this process work? Like, how do they make these decisions about such life-changing life?

saving drugs. Like, why is the whole process not more transparent? Let's step back. To answer your question, let me step back. How does a new drug get approved in India? The Director General, the direct drug control authorities, the DGCI, DCGI, Drug Control General of India, that department on an appeal of new drug, they do clinical trials, they do safety assessments, there is expert consultation, there is a lot of dossiers set up on providing, you know, the clinical trials are right from one to four clinical trials, different type of trials are tested. There's a very standard clear practice, which is very similar to that of the FDA in the US on which the drug is approved. So this drug, for example, got approved in 2001 in India,

right so the and nothing has changed the composition is the same everything has changed there should not even be any more questions around this this drug is being used in india the drug is being used by the government it is a part of the government family planning program right and suddenly we have this issue now the problem is because these processes lack clarity as you said leading to a lot of public confusion and fear. As it is, people are worried about ECP. There is so much Mitch. When some newspapers carry this article, media carries this article, and it creates even more myths among women, among people users. So I do agree with you that there is a need for greater transparency by involving a range of stakeholders, which currently are not there.

In my opinion, there is not enough adequate stakeholders of healthcare providers and advocacy groups that can ensure a diverse perspectives are considered. And then a clear communication protocol saying this is where the regulatory decisions are and this is where each of these products, drugs are there. You're not trying to demystify the process. But having said this, in this particular case, I don't. even think that should be any conversation around this because the product has been an established product, right?

Right. So while we're on the subject of accessibility, Winogh, we live in Bangalore and our office is actually located in Indranagar. Not too far from where we are, there is this clinic that's been around for quite a while now. It's called proactive for her. The cell there was that, you know, it's meant to be this progressive non-judgmental clinic so anyone can go in, you know, consult with a gynecologist.

and it's very unlike your traditional experience. You know, you're constantly asked for consent every step of the way and it's just meant to be a much more pleasant experience overall. The catch, of course, is that it is on the more expensive side. My question is, how far are we from a reality where regular public health infrastructure for women is like that, right? Realistically speaking, do you think that there is a possibility somewhere down the line where we'll have healthcare like that for absolutely everyone?

You drive a very, very important, very critical point which drives from the inequality. You know, everything in our society is so much, so much, what do you call it, stat against the poor. Right? You were giving me an example of Bangalore. Let me tell you, I was in Bangalore last week. And I was shocked to find out. We work with the government. The government provides free abortion.

services and there are these, you know, I don't know whether you're aware, we have medical abortion that is abortion done through tablets. You know, it's a combination tablet. If you can go to a chemist and buy the product for, it's supposed to be given under the supervision of a provider, but the tablet per se costs about 500 rupees. One of the largest chain hospitals in Bangalore charge $45,000 for this outpatient procedure. What do they do? They give, it's a 500 rupee product. It's mind blowing.

And unfortunately, just if they walk around, there are government clinics, not too many of them unfortunately, which is why they are able to charge this much, which is providing the services, but people don't know about it. And there's not enough provider, not enough government clinics.

Having said that, I do believe that the societal attitudes, not just towards ECPs and contraceptives, but overall the fertility is shifting to the positive because of a few things like awareness, increased awareness, increased educational levels. The digital presence is a huge,

huge, what do you call it, balancer of thing. You know, the level of information rural girls have through digital sources is also, I think it adds on to shifting. And therefore, they are also exposed to stronger role models, which makes them also try and gain agency within their within their society. Talking about the role of the internet and spreading awareness

and finding stronger role models, our next guest does just that and more. She's one of the most well-known sex educators in India. My name is Lisa Mandelvas. I'm an award-winning sexuality educator and author of the sex book. I started creating content online focused on sexuality education

that is judgment-free, scientifically accurate, and with a strong focus on women's pleasure in about 2017. And it's been several years now. My community really grew. I've also started a pleasure brand called Lizoo's. So sex and pleasure has been the key focus areas of my work and life and thinking for the last nearly a decade. Lisa, what was your initial reaction to this news?

I was surprised because why would we, like the last thing we need to be doing is cracking down on hard-fought freedoms, you know? At least with the marital rape thing, it's something that needs to be overturned. We're not going backwards like the U.S. did on abortion. So I hope we keep taking steps forward. And I was happy to find that that news had been slightly misinterpreted or a mountain had been made of a molehill or whatever it is. However, I mean, in states like Tamil Nadu, it is already hard to act. access emergency contraception, even though it legally should be available. So there's, I feel like there's the law, there's the application of the law,

there's the biases of the people who are supposed to be working within the laws, whether it's doctors, whether it's chemists, whether it's local states, administration, you know. These pills have been available over-the-counter in India for roughly 20 years now, right, Lisa? And you work with a lot of young women who've actually grown up being aware of the existence of ECPs thanks to the internet. what's the kind of impact that you've seen, you know, these pills have on their right to make decisions about their own bodies? I think that emergency contraception is something that allows for people to have some autonomy over what I wish we had even more autonomy around. Like the fact that contraception can fail, even if you have another method in place or that you could be a survivor of assault.

or, I mean, unfortunately, women have so little agency and so many aspects of their own sexual and romantic lives that I think something like emergency contraception, the fact that people even think in 2024 we should be debating its availability is like, why are we still having this conversation, you know? That's so true. Actually, you know, earlier we were just speaking to Vinogne Manning from iPass and he was telling us how policy-wise India is pretty progressive, you know, when we look at reproductive rights and women's bodily autonomy. but then he also pointed out how things are very different on the ground in terms of, you know, acceptance and awareness. I just think there's like such a continuous attack on women's agency and autonomy at every level

in their navigation of their own sort of particularly sexual rights that it's just absurd that people think that women will have more sex or women will, as if women have that agency at all, you know, like people will talk as if women are so busy having this wild, amazing sex that they're rushing off to get the emergency contraception tomorrow. I wish that was the case. I wish that was the case. Women are made to be terrified of sex.

Women are made to feel like they're only on agency to have the kind of sex that they want or to even want sex. Sex is something that just happens to women. And then women have to deal with the consequences of that sex, you know? So I just think like the whole, like the conversation is absurd. But people will talk as if women have so much sexual agency that any kind of sexual health resources or solutions are like, you know, fueling these horny women, like, who are having all these orgasms. Like, I wish it was like that. That's just not how it is.

You know? So I find it very funny. There's a moral panic around anything that allows women some agency. It's like, look at the, what agency do we even have to get here? Like, all you're going to be doing is preventing people who might not have. even, you know, it's just, it's like the conversation is so skewed. And I think there's massive double standards in how we look at women's sexuality. True. And then of course, there are all those myths and misconceptions that make all of this like 10 times worse, right?

I think a lot of people are very afraid of taking this medication because there's like this fear mongering around how bad. it is for you, how bad it is for you. Like, oh, you're taking this hormone bomb. It's going to, like, make you infertile. It's going to wreck your cycle forever. It's going to, like, as if taking, I think the fact that there's so much, unfortunately, so much shame around particularly premarital sex already is, like, playing on the mind of the young person where they almost think they deserve some sort of negative outcome, like

punishment for this shameful thing they went ahead and did anyway. So there's like a guilt and shame clouding their perception of potential outcomes already. Now you're having to take this pill and you feel so guilty about what you did already that suddenly this pill and what can happen to you also seems like much worse than it. You know, the whole, I think fear, guilt and shame surrounding firstly having the sex, now having to take this pill and ends up creating urban legend around how. bad these pills are for you. And they're actually not so horribly bad for you, you know? Leven Orchestra, which is why, I mean, there's different EECs, and I'm sure the Gynac on this show will, can, can elaborate.

I'm not a doctor and I want to make that clear. But these are safe medications. And it's not so much that they can like irrevocably wreck you or whatever that is what you should be thinking about. It's just that instead of using it as your default. contraceptive method. If you're having regular sex, you have more effective methods out there. So why not take one that is statistically more efficacious, right? Like an IUD, where there's less room for error, where you don't have to go get it, whether where you are in the cycle doesn't

matter as much because you're constantly on it. It's just good to know that if you're sexually active and you're keen not to get pregnant, there are other methods with statistically higher efficacy and ease of use that you might benefit from. Exactly. It's all about having that choice, right? Like, most women, at least the ones who know about ECPs and then they decide to take it, they can read because these pills come with this long list of do's and don'ts and the possible side effects in all languages, including that warning where it says that you're not supposed to use it as regular birth control.

It's meant for emergencies, right? Often it's like the fears are so overstayed or even if you take it a few times or whatever. You can take this pill and yes, it might interfere with your period date or, I mean, there's some, there are minor side effects, but there's not, and I don't need to be downplaying side effects either, but it is safe medication, you know? I mean, people tend to very conveniently use arguments for and against medication that serves their ideologies. Like we all went and took that COVID vaccine, right? And I'm glad we did. I'm just saying we all went and took that COVID vaccine. Some people died. statistically negligible number apparently because the rest of us still had to go take it. And so when it comes to contraception, though, people will state like the rarest of rare as if it's the as if it's representational of what could happen to you, you know?

Whereas like there is enough and more certification involved before medication can be available over the counter. And I think doctors agree that it is a safe medication. And also this whole thing of like how many people need to do. be involved before a woman can make a decision for herself, you know? I think especially when there's a very short window, things should also be at the woman, at the behest of the woman's decision, whether it's abortion, whether it's, I mean, there's various things where you still, you have to involve doctors in your decision making by law where I think we need to be recognizing also

women's, like the wish of the woman, not just what uncles think, you know? Plus, there's also that question of people having access to this sort of information, which of course is something that you've been relentlessly doing through the internet. We deny them information and then we're like, you're too dumb to make a decision. So some uncle who might be biased or bigoted or, I don't know, whatever, colluding with your abuser. Who knows, man? Some random third party has to take these decisions for you. So I think the whole system needs an overhaul, right?

Right. Lisa, can you talk a little bit about the role of the role of the. of social media, like the role that social media plays when it comes to informing people on things like this. And also, where do things stand now compared to when you started? I have some thoughts. Social media, I think, can be and has been for many people, I think, very useful. I think a lot of people, not just social media, but the internet in general has tended to be the go-to for anyone with internet. access when they have a sex question or a question about contraception. Like, it's their first point of information because their parents, school, and other people

seem to be less reliable sources, unfortunately, right? I wish that wasn't the case. I wish we were able to go to some sort of credible adult who cares about us. But that tends not to be an option. So the internet is your first point. I think for like the vast majority, if you have an internet connection, that's where you're going with a sex question. And so I think that it behooves us to have really great and easy to access resources findable on the internet because there's also a lot of rubbish on the internet, right?

There's lots of misinformation. Unfortunately, media, literacy and dissonment is like absolutely key when you're sifting through the internet trying to look for answers to something because you'll find some really valuable information, but you'll also find like sex negative, misogynistic, unscientific. stuff as well, right? So I think we again, like equipping young people with the sense of discernment and with at least some information so that they know when they're looking, you know, which sources to trust and which not would be great. I've been trying to make sex education fun to watch because nobody wants to watch boring videos or read some boring

articles, right? And unfortunately, so often any public health communication to a young person just seems dreadfully boring. So I think that you know, if people in the public health and policy, family planning, et cetera, et cetera, arenas are trying to reach out to young people and empower them with this information, I feel like we got to stop pretending we don't do this stuff, you know, someone in a white coat, like talking down to the young person, wagging their finger, as if they never have sex, but like you lesser mortals doing this naughty stuff, you know. I think we need it.

And I think that's why my content has worked, I think, because I am not talking down. I'm not, we're just talking together. It's like peer to peer, I don't pretend like I don't have sex or sorry, like I don't have sex or like I'm somehow morally superior and giving you this like lecture, you know, I think I try and keep the fear and shame out of it completely because I don't feel any and to make it sound like a thing that people are just just a part of life, you know? Right. So social media platforms obviously have a huge role to play here.

I mean, at least the hope is that we'll get to a point where this sort of information becomes a really normal part of public health care. But, I mean, again, that's obviously, yeah, it's a long way off. Unfortunately, the social media platforms now are making it very difficult to do this work. Even for organizations like the UNFPA or Planned Parenthood or, I mean, literally doesn't matter how big you are, the social media platforms are cracking down on sex. sex education, sexual health and reproductive rights, information, particularly when it comes to the information pertaining to female bodies and queer sexuality, anything that's not like cis-hete and male is particularly censored. You can read about this stuff. I think that Ken has

even done a story about it, but there's, over the last few years, there's been increasing amounts of censorship around, yeah, content, whether it's SDIs, contraception, pleasure, identity, like anything in the sexuality arena is now subject to more and more censorship on META's platforms, as well as, to some extent, Amazon, Google, YouTube, you know, when you're looking for these products and things as well, it's harder to find, it's harder to market them. It's anything in the sexual wellness arena, basically, whether it's content, or some sort of resource, product, service, etc. The platforms that now everybody relies on,

it is not a level playing field. You will find, you know, some information is easier to find than other information. The platforms are by design, making it harder and harder to find, like, yeah, rights-based sexual health education. Easier to find porn, sadly.

And that brings us to the end of this episode. I hope it gave you a perspective about where things stand as of now when it comes to contraception and women's reproductive autonomy in India. But before we go, we asked a few women to imagine a world where emergency contraceptive pills did not exist. Here's what they had to say. In a world where women have limited control over choices regarding their own bodies anyway, where the onus of contraception falls on the woman,

and where men are not the most careful or trustworthy when it comes to using contraceptive men, methods like condoms, it would be absolutely terrifying to see the few things women can control like contraceptive pills disappear or become harder to procure. World without contraceptive pills would mean I wouldn't be able to have sex stress-free or without fear. I would have very little control over my body and I would have to depend on potentially judgmental doctors to deal with issues of unwanted pregnancy. According to NFHs FI data, at least one third of the men believe that the owners of contraception is on women.

Emergency contraceptive pills may not be a perfect solution, but it is a good solution for women who need to prevent unplanned pregnancies, especially in situations where they don't want their partners to know about it. Because we know in our country, you know, women can't really go to doctors without men knowing about it. and unplanned pregnancies are absolutely a bad idea anywhere, but especially in a country as populace as India. It's so concerning that the second I try to imagine a world without emergency contraceptive pills, I genuinely came up with nothing because truly that's like the ones fail-safe that we have,

right? Something dependable, cheap and something that you can access. easily. And when I thought of what I would do if I didn't have that as an option, I had to go Google alternative to emergency contraceptive pills. And the first thing that comes up is an IUD. So I guess you, apparently you can immediately put in an IUD after having unprotected sex, like within five days and that would like prevent any pregnancy. But immediately I was like, what a nightmare, because I have read about how incredibly painful IUD insertions are because they don't give you local Zisha and I've heard like people pass out when you've had like copper T's inserted and stuff.

So immediately I was like, oh God, spiraling that that's the only all, that's only like other effective alternative to emergency contraceptive pills. So I guess we don't have those and you have to go get an IUD inserted immediately and that means like making a doctor's appointment, go to see a gynaecologist, like finding out if that's even an option for you that if it'll even work for you. And then figuring out the pain and having to deal with all of that and having something inserted inside your body. What a nightmare. Daybreak is produced from the newsroom of the Ken, India's first subscriber-focused business news

platform. What you're listening to is just a small sample of our subscriber-only offerings. A full subscription unlocks daily long-form feature stories, newsletters and podcast extras. Head to the Ken.com and click on the red subscribe button on the top of the Ken website. Today's episode was hosted and produced by Rahal Philippos and I Sinkda Sharma and it was edited by Rajiv Sien.