This Valentine’s Day, Krutika, a 42-year-old mother of three, had her first extramarital fling. He was an office colleague, married and with a family of his own. For both, it was the culmination of an intense attraction, and the hotelroom tryst was no hurried affair. Once done, Krutika, who does not wish to conceal her first name, took an emergency contraceptive pill (ECP) and walked out with her lover basking in the assurance that a couple of hours of unprotected sex would not impregnate her.
Krutika was not worried about her lover not having used a condom. He was from ‘a good family’ and could therefore be excused a prophylactic against anything contagious. As for the risk of pregnancy, the i-Pill she took is quite a popular preventive; she is one of many believers in its promise to work if popped within 24 hours. “I know how to take care of myself and am not unduly worried that he did not use a condom. I don’t have to depend on my partner for contraception,” says Krutika, who has had a few more steamy dates with her boyfriend since then.
In a country where men consider condoms a source of anxiety, inconvenience or sensationlessness, Krutika has joined a growing tribe of women who have befriended ‘morning after’ pills. And while women take charge of their own safety by keeping these handy, condom sales are now in decline. According to sources in HLL Lifecare Ltd, a State-owned condom maker earlier known as Hindustan Latex Ltd, India’s condom market has taken a beating — sales are down by a fifth over the plateau of some years ago—since the advent of the morning-after pill. “Yes, there is not enough buying taking place in the market,” admits an executive of TTK-LIG, a leading condom maker, “We presume that the entire condom market is experiencing a sales slowdown in comparison with the ECP market.”
That ECPs have been a runaway success is beyond doubt. The market leader i-Pill, which made its debut in 2005 with an advertising campaign that caught wide attention, now has a brand called Unwanted 72 as its competition. Both have quickly earned the loyalty of users. In January 2012, alarmed by their popularity and potential for misuse as regular oral contraceptives, the Union Health Ministry ordered all advertisements for emergency contraceptive pills withdrawn. The ban met only patchy compliance. Moreover, these pills were already on a roll. In fact, chemists and doctors in cities like Mumbai and Delhi report something of a sales surge in 2012.
As ECPs fly off shelves, condoms languish. “Condoms are positioned the wrong way,” says an executive of HLL Lifecare Ltd, “The emphasis on their being a disease barrier has not gone down too well with many [consumers].”
Morning-after pills have a ring of both respectability and relevance to women, since they are pitched clearly as pregnancy preventives. Their appeal lies in that singular focus, says Dr Ashok Anand, associate professor of Gynaecology and Obstetrics at Mumbai’s Sir JJ Group of Hospitals. “These pills have in a way become a tool of women’s empowerment,” he says, “but that’s a wrong perspective.” These pills are meant only for emergency use. Doctors are categorical about this. Yet, women appear to be using them as their regular mode of contraception. “Emergency contraceptive pills may not always help,” says gynaecologist Dr Neeta Puri, “Pregnancies will happen if the instruction manual is given a go-by.”
Teenage pregnancies, meanwhile, are on the rise. This is a cause for alarm, says Dr Anand. According to the Delhi-based Consortium on National Consensus for Medical Abortion in India, an estimated 11 million abortions are performed in India every year, and about 20,000 women die of abortion-related complications. “The Government has banned over-the-counter sales of abortion pills,” says Dr Puri, “but these [morning-after] pills are being viewed as a replacement, which they are not.”
Dr Anand worries about what this trend implies to sexual health overall. “The routine use of these pills suggests that they are being favoured over condoms without offering the same protection against sexually transmitted diseases and HIV,” he says.
For men, these pills come as a relief. Most of them are uncomfortable wearing condoms. They consider them unwieldy and ungainly. “Nirodh, with its bulky rubber casing, was probably the worst possible introduction [of the product],” says Dr Puri, “That ugly image has probably stayed with Indian men.”
Nor are they convinced by sensual ad campaigns and condom variants—ribbed, dotted, flavoured, etcetera—that claim to enhance pleasure.
Another practical problem is that they are made to international sizes. Unrolled to full length, condoms measure at least 6.7 inches. This is in accordance with norms set by Schedule ‘R’ of India’s Drug and Cosmetics Act, 1940. Most Indian men, however, have smaller penises. So condoms not only act as ego deflators, they also tend to slip off. According to 25-year-old Vivek Ratnani, an apprentice architect, any condom user will have at least one tale of slippage. “That’s how common it is,” he says, “You give up on a condom because half the time you’re tense it may slip off.” Acting on complaints of slippage, in 2000 the Union Ministry for Health asked the Indian Council for Medical Research (ICMR) to study a possible discrepancy between Indian penis and condom sizes. In its first set of findings released in late 2006, the ICMR found that condoms made in India were too big for Indian organ sizes. The global standard was found 3-5 cm too long for 60 per cent of Indian penises. The study also reported a high failure rate of condoms: every fifth condom used in India either falls off or gets ripped.
The ICMR’s findings have led to calls for size variants and even custom-made condoms. In Ratnani’s opinion, none of it will help. “Whatever manufacturers do, condoms will continue to slip as no Indian man will go to a chemist and ask for a smaller size,” he says, declaring a preference for pills, the purchase of which in his experience raises fewer eyebrows. “Most men are too shy to ask for condoms,” says Paras Shah, pharmacist in South Mumbai, “There is also a social taboo on buying them. Often, they buy them using gestures instead of asking directly. This attitude cannot be changed, so i-Pill has become popular.”
That women want to be in control of contraception is a phenomenon that at least one condom maker has responded to. In 2008, HLL came up with the idea of condoms for women. Launched under the brand Velvet, this novel product were test-marketed with the help of vending machines put up at five-star hotels, pubs and nightclubs in and around Delhi. Fashionable outlets like Smokehouse Grill in Greater Kailash, Elevate at Noida’s Centrestage Mall and Deck in Gurgaon were among the locations, but the dispensers flopped and were removed.
Convinced of the concept, however, HLL’s family planning division decided to distribute female condoms among commercial sex workers, to whom these prophylactics were offered at Rs 3.50 apiece (while Velvet sold at Rs 100 for three). Unfortunately, they have still not caught on. That they are not easy to use (and require training) is a drawback. Misperceptions of their discomfort have also kept users away. With low demand, chemists are reluctant to stock them.
The only heartening news for condom makers comes from the Andhra Pradesh AIDS Control Society. The state has doubled its use of condoms since 2009, according to this state body. The All India Organisation for Chemists and Druggists rubbishes this claim. The Society distributes condoms free and there is no way to ascertain actual usage.
The Andhra government, however, is convinced that usage has risen too. Last year, it enlisted the services of folk singer Pedulla Srinivas to popularise condoms as a way to contain the spread of HIV. His Condom Song, which appeared in May 2012, has become an internet sensation. Its video features four anthropomorphic condoms wriggling around in a village in Rangareddi district of Andhra Pradesh, singing a ditty with a refrain that the video helpfully translates as ‘I am the condom friend ever useful to you.’ It has notched up over 5 million hits and gone viral on the web.
Condom promotion remains the central thrust of India’s fight against HIV-AIDS. This is a strategy that the National AIDS Control Organisation swears by, despite doubts having arisen over its wisdom. Research elsewhere in the world has shown that condoms are not as effective in curtailing the dreaded disease as their proponents claim. In fact, a 2003 study by the UN AIDS Programme admitted that condoms have a 10 per cent failure rate in preventing HIV transmission. Other studies suggest that this rate could be as high as 55 per cent.
In any case, the use of condoms in India is woefully low where it matters most. It is difficult to spot a condom vending machine in Mumbai’s red-light district of Kamathipura, for example. Clients refuse to let a rubber sheath get in the way of a service they pay for. “If a sex worker insists that a client use one, he will go somewhere else,” says Supriya Mhatre, a social worker, “Besides, men pay extra for condomless sex, so why should the sex worker lose out on the money?”
Efforts by such bodies as the Population Sciences Institute and Indian Health Organisation have not been able to raise condom usage. The mechanical sale of condoms via vending machines was once seen as a way around purchase embarrassment. But even this has not worked. Some months ago, the Brihanmumbai Municipal Corporation installed about 1,200 vending machines across the city. Few knew how to operate these dispensers, and the fear of having to fumble with them made furtive purchases that much harder. What’s worse, most of these machines have either been stolen or vandalised. It happens elsewhere too. In 2012, about 70 condom dispensers were installed in Ludhiana, Punjab. They have all been stolen.
If not theft, condom dispensers risk the wrath of groups that see their existence as a sign of immorality. In 2005, Chennai saw street protests erupt when the Tamil government announced a plan to install 500 condom vending machines in the state capital and 1,000 elsewhere in the state. Attitudes have not changed much since, says social activist Selvam Thevar.
“No one uses a condom if he is sleeping with his wife,” says Harish Kulkarni, a rightwing political worker in Mumbai, “Buying one means he will indulge in something dirty.” As a moral activist, he also believes that the ‘dirty’ men who buy condoms should be beaten up. He does not seem to have heard of morning-after pills yet. And this is perhaps another reason for their success.