About a month ago, multiple news outlets in India reported on a rather troubling proposal – the Central Drugs Standard Control Organisation (CDSCO), India’s national drug regulatory authority, was apparently likely to ban the sale of over-the-counter hormonal contraceptives, including emergency contraceptive (EC) pills across the country, based on recommendations from an “expert panel”. The CDSCO later clarified that no such ban was being proposed and that the status quo would be maintained. However, news had already set off a wave of concern across academics, health professionals and activists, with many issuing statements and opinions warning against the move, arguing that it would increase barriers to obtaining contraceptives, lead to unwanted pregnancies, and would increase black marketeering and subsequent costs. This sense of concern is justified. Conservative strains among health professionals and indeed, society at large, demonstrate an anxiety about young people exercising sexual autonomy outside the prescribed norms of marriage and pro-creation. However, evidence overwhelmingly points to not just the fact that young people in India are sexually active outside of marriage, but that they need options for preventing unwanted births. Given this context, ensuring that over-the-counter sale of the EC pill is maintained is crucial, but only one part of the picture.

The EC pill was introduced in India in 2005 and is part of the country’s national family planning program. It has been available over the counter since then, and over the years, its use has grown. This suggests a great demand for the pill, and that it has been a means for women to exercise their agency in controlling fertility. While the on-paper EC pills are to be made available under the National Health Mission and meant to be sold over-the-counter, access is contingent on availability and access. For instance, since 2017 there have been consistent reports that in the state of Tamil Nadu, pharmacies largely did not stock EC pills, and the ones who did, were not willing to sell it without a prescription. Investigations in large metropolitan cities of India (Chennai and Hyderabad) have highlighted how frustrating the search for an EC pill can be. The situation was so dire, that activists began stocking EC pills sourced from other states, and were contacted through email and social media, to provide them to young people. In Tamil Nadu, even though the health department clarified that there is no ban on the pills and that they are available freely at government institutions, the shadow ban continued. The notion that EC pills are “unsafe” and “misused” prevails. And since this appears to be the case even among health professionals and pharmacists who are supposed to be in the know, one cannot help but put it down to an implicit bias. After all, despite all the evidence and concern around antibiotic resistance, no pharmacist appears reluctant to stock them, and most are willing to sell them without prescription.

But even if EC pills were readily available over the counter, as they are in many cities in India, social stigma makes it almost impossible for women (unmarried women especially) to walk into a pharmacy in their neighbourhood and ask for a pill or a condom. In Mumbai, Delhi and Lucknow – three cities where I have done research with adolescent girls and young women, I repeatedly heard how difficult it is to go into a pharmacy and buy an EC pill or even a condom. At best, a pharmacist would turn them away if they looked like they were under 18 years (since the law criminalizes adolescent sexual relations), and at worst word could eventually get around to their families. Thus the easy availability of pills is indeed helpful and critical, but is not sufficient in and of itself.

What it comes down to, then,  is that in India, like in other places across the world, sexuality is a highly regulated business. As a woman in India, one is expected to be sexually active only after marriage, and thereafter remain solely monogamous with one’s husband. Chronologically, the woman is then expected to immediate conceive and rapidly give birth to two children – at most (based on family planning campaigns to stem population grown). Socially, this must imply also preferably a male child in the first year of marriage, and another after 2-3 years spacing for health reasons, of course. What business do women have going about having sex outside marriage in the first place? And if they can escape the consequences so easily what would it do to our “moral order”? Pharmacists, doctors and society at large, may see the easy availability of the pill as “enabling” such “immoral behaviour”, but they typically couch it in they language of “rationality” and “regulation”.

This makes it essential to reflect on the broader concerns and barriers to sexual and reproductive health for unmarried and adolescent/young people in India. Although the EC pill is a safe and easily available method to ensure that unwanted pregnancies do not take place, without any absolute medical contraindications, and suitable for use at all ages, it must not be used in place of routine contraception. Moreover, in case EC fails, women must be able to access safe and timely abortion. Yet, in India, access to much needed routine contraception and safe and timely abortion are both rife with attitudinal barriers. While the government of India has a programme that addresses sexual and reproductive health concerns of adolescents, has it been able to translate it to safe and judgment-free access to contraceptives for girls and young women on the ground? Are health care providers, social workers and pharmacists, prepared to leave behind archaic notions of morality and honour, and allow young people to exercise their rights?

For now, the CDSCO has announced that status quo on the sale of the EC pill will be maintained, but it is certainly time to shift the status quo on sexual morality.