Birth Control in India: Market, Technology and Health (1930 – 60s)

URVI DESAI takes a look at the sociopolitical history of birth control in colonial and postcolonial India

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THE history of modern birth control in India far precedes the family planning programmes initiated in 1951 under the Five Year Plans by the Government of India. 

By the early 1930s, several kinds of contraceptives had already entered the Indian markets. Products such as diaphragms, condoms, tonics, birth control pills, foam powder, jellies, and chemical contraceptives were being manufactured and sold. 

Companies that manufactured the products were both Indian and foreign, large and small firms. No single product dominated the market. Moving from colonial to postcolonial, the private market, medical personnel, as well as national leaders and international advocates, served as proponents of birth control products in India. 

The evidence presented in this essay suggests that this fraternity, that largely comprised men, showed flexibility in interpretation of women's health—that is, the health of women was not their first concern. 

However, this essay is not simply a criticism of elite advocacy and state policy as literature on family planning in India has been. I nuance the discussion of early contraceptive use and sale in India by considering the ground-level realities of grim maternal and infant health. 

In the first part of this essay, I offer data that shows that the health condition of urban and rural working class women was bleak. With specific attention paid to Gujarati-speaking Bombay, I argue that the promotion of birth control in India did not only come from a place of racist eugenics; I suggest that advocacy came also from an instinct to reduce the visible suffering of millions of women and children, in other words, from a place of "goodwill." 

Simultaneously, I discuss how women themselves conversed about sex, birth control, and marriage, were receptive to new birth control technologies, and were keen to artificially limit or space their pregnancies. 

In other words, birth control was not simply an imperial project imposed from above on hapless Indian women. 

This argument is also bolstered by the fact that the private contraceptive market was thriving in colonial and postcolonial India with the wide sale of contraceptives.

In the second part, I nuance the discussion on "goodwill" and examine the dangers that arose from patronizing leadership, both colonial and postcolonial, that upheld rather than contested existing power structures. I discuss how contraceptives were aggressively promoted as scientific and modern, despite little or no quality control. 

Aside from the condom, the contraceptive technologies that flooded Indian markets during the 1930–60s were aimed at women, and involved invasive or oral applications. 

These birth control technologies were questionably effective, uncomfortable at best, and corrosive to the inner linings of the vagina, at worst. As such, good intentions resulted in harming many of the women these initiatives were meant to help. 

In sum, India's independence and the institution of democracy offered little relief or disruption in thought regarding maternal health, and most women themselves went unheard in discussions that affected them directly.

Positive Reception to Birth Control

Late colonial attitudes towards birth control may be glimpsed in widely influential writings from that period. In November 1936, the popular Gujarati domestic journal Guna Sundari ran an essay titled "Mata-no Sahkar" (Mother's Guidance) written by Shrimati Sarojbehn Vyas. 

The essay was structured in a manner where an older woman shared advice and experience to the journal's presumably younger readers. Vyas wrote, "In order that there be no injustice by the parents towards the child, if the parents do not want children, they should certainly not have children. Restraint is wonderful; however, if and when restraint is impossible, scientific contraceptives should be used without hesitation." (1)

Similarly, in June 1940, the Gujarati domestic journal Streebodh ran a detailed essay on birth control (in Gujarati called Santti-Niyaman) titled "Acharya Santti-Niyaman" written by Shri Snatak Satyavrat.(2)

He noted that while abstaining from sexual activity is best for avoiding pregnancy, it is not realistic: 

"The natural kind of birth control is self-control. Most people are unable to exercise such restraint and therefore individuals should keep an open mind towards artificial birth control methods… Sexual attraction between the husband and wife is natural, whether in Europe, America or India… It is not only men who experience pleasure during sex, but also women. However, only women face the consequences of childbirth alone." (3)

These and other such writings were very influential amongst the literate community. The local networks were pervasive, and in several instances, the first points of contact and information for readers with questions about birth control. 

Away from the power corridors of the medical industry and state leadership, similar opinion–columns, Q/A sections on contraception, and more, were abundant in popular journals. 

This, along with the bustling sale of contraceptives, sheds light on how young women in Bombay were receptive to birth control and keen to space and limit their pregnancies. 

Gravity of Maternal Health

The demand for birth control products by young women is as important to the discussion as having a grasp of the available health infrastructure at the time. 

There were serious medical inadequacies and loss of life during childbirth of mother and child. The local markets and advocates recognized this and responded to this requirement, alongside echoing imperial Malthusian motives, represented by the international population control movement, especially as expressed in the rise of notions of family planning. 

This is not to suggest that these were philanthropic initiatives. Instead, it is an attempt to scrutinize where the demand and supply of birth control came from. 

Indian demographer, Sripati Chandrasekhar (1918–2001), who lived in Madras, New York, and California and was Minister of Health and Family Planning during the Indira Gandhi government in 1967, conducted research on maternal and infant health. 

One of his better-known papers was published in the journal Eugenics Review in 1954 and was titled "Some Observations on Infant Mortality in India: 1901–1951." (4)

The report stated that in comparison to India's infant mortality rates, other countries such as the USA, England, and Sweden showed markedly lower rates (Table 1). The difference between India and other countries was steep and there was much reason for alarm. 

Table 1. Infant Mortality Rates (per 1,000 Live Birth) for Selected Countries for certain years between 1900–1952

From the start, the Indian birth control movement was aimed at women of certain social and economic backgrounds, namely the rural and urban poor. 

Based on the data in Chandrasekhar's report, it could be seen that even as advocates of birth control promoted it with race and class bias, it is important to consider that it was these more vulnerable women who faced the greatest medical risks during childbirth due to health concerns of disease, malnourishment, and limited medical recourse. 

This is seen in the data provided below that reflected infant mortality rates based on caste and community (Table 2).

Table 2. Infant Mortality Rates (per 1,000 Live Birth) by Community in Bombay City, 1938–47

In the case of Bombay City, different communities had starkly different infant mortality rates during the years 1938–1947. Scheduled Caste communities, known to be socially and economically disadvantaged, had the highest infant mortality rates whereas the Parsee community, the wealthiest and widely property-owning section of Bombay society, had the lowest rates, comparable even with developed countries such as England, Holland, and Sweden (Table 1). 

The reasons for this contrast in infant mortality in Bombay during the same period point to differentiated access to nutrition, hygiene, medical facilities, and living conditions across the city's various communities. It is more than likely that data in other parts of the country, vis-à-vis Scheduled Caste communities and other vulnerable sections, is similar to those of Bombay, if not worse.

"Concern" for Lived Experiences of Child Mothers

Statistical government data through this late colonial period offers a big picture of the poor maternal health of women and children, however the social and cultural environment that surrounded the most vulnerable girls comes through most sharply in case studies as recorded in medical journals. 

One particularly shocking instance was recorded in a medical report in the journal Association of Medical Women in India (AMWI) in 1933. The doctor wrote that in Bombay "an unmarried Mohammedan girl was admitted on 18th March, 1932, being 6 ½ months pregnant – the age given by the father as 7 years." Her baby was ultimately born through C-section (Figure 1). An indication of the girl's extreme youth is clear as it is noted that her "milk teeth still present, except the right lower incisor. The left lower incisor was just erupting in front of the milk tooth, which was becoming loose and the first molars." The doctor also included the detail that, "The date of birth (mother's) as taken from the Municipal Records and verified by the Health Officer was 11th October, 1925. Is this the youngest case reported of pregnancy going on to full term with living child?" (5)

Figure 1. Report of pregnancy of 7-year-old child, The Journal of the Association of Medical Women in India (February 1933)

According to the Child Marriage Restraint Act or Sarda Act of 1929 (applicable at the time), the minimum marriageable age for girls was 14 and boys 18. It is difficult to say whether the family kept hidden that the young child was married for fear of persecution by law—for her being married carried more consequences than that she was made pregnant—or whether her conception occurred through an assault from a non-family member. 

However, then as now, it may be agreed that her marital status mattered little in the shocking pregnancy of a child. The doctor does not spend time enquiring how this pregnancy occurred and neither is there evidence that suggests the family filed an investigation or criminal case. 

In this environment, the instinct to prevent such pregnancies that could be life threatening, and which were assuredly life harming, was to protect women's health against pregnancy, if not assure their sexual safety, far more than what being afforded to young girls at the time. In a real sense, those engaged in the burgeoning fields of maternal health and family planning did espouse a goodwill that aimed to mitigate suffering.

Experiments in Contraception

However, this goodwill initiative becomes suspect when we look at the contraceptive technologies that were made available. From this vantage, the discussion about goodwill and eugenics becomes most complex. This is because manufacturers, leadership, and medical personnel appear to have shirked their responsibilities, by providing inferior and often downright harmful treatments to vulnerable women. 

Despite the relative progress of discussing family planning and maternal health, the leaders of these initiatives also maintained existing social and economic structures, which excluded most vulnerable women from benefit. Attempts to offer remedies remained well within the power hierarchies of caste, class, and sex.

These social and conceptual categories resulted in many adverse consequences, especially in the hazardous impact of poor quality products on the bodies of female consumers, despite claims, by advocates and advertisements, of being modern, scientific, and safe. 

In November 1936, on a train ride to Washington DC, international birth control and family planning advocate Margaret Sanger wrote to her fellow activist colleague Edith How-Martyn, who had just returned to the UK from India. Sanger was curious about a new form of contraception that was being developed—foam powder. 

Foam powder contraception contained a chemical spermicide to be placed inside the woman's vagina. They were aggressively promoted in the Indian markets and medical clinics during the 1930s and 1940s. Sanger's letter makes clear the experimental and potential uncertainties of using this new product on a wide scale:

"Now as to the report on the Foam Powder. While we have not tried it out on dogs or animals, we are testing it out on a large scale on humans… While it is too early to make definite statements, I believe that within a few months we can give report on some aspects of the powder, its efficaciousness or its harmlessness or both. My advice to you is… not to discourage its use in any way… There are always people as well as 'bitches' who are sensitive to chemicals, quinine, iodine, formaldehyde, also lactic acid. But one case does not prove anything yet." (6)

Several contraceptive companies, both Indian and non-Indian, some with international manufacture and local retail capacity, offered foam powder in Indian markets (Table 3). 

Table 3. Contraceptive firms providing foam powder in India

The foam powder products were comprised of chemicals such as chloramine-T, pyridine mercuric chloride, and phenylmercuric acetate that were thought to have spermicidal properties. 

Whatever their spermicidal properties, however, these chemicals were known to be toxic in certain contexts. Chloramine-T has corrosive properties, while pyridine mercuric chloride—used in photography, and as a disinfectant, wood preservative and fungicide—was known to be corrosive to mucous membranes. Phenylmercuric acetate is used as a preservative in paints and as a disinfectant in agricultural and leather processing work. Upon human contact it would cause a condition called Contact Urticaria Syndrome, an allergic wheal-and-flare response when in direct contact with skin. 

Despite these harmful properties, more than two years later foam powder continued to dominate the Indian markets as the recommended contraceptive by doctors and advocates alike. 

The reasons for this relate to its relative ease of manufacture and availability at the consumer level. In 1938, Sanger's secretary wrote to How-Martyn about medical reports that had just arrived on foam powder. (7)

The secretary wrote about the clinical report's findings on foam powder as a contraceptive, and quotes from it that "[i]t is recognized that there are occasional cases which complain of burning when using the foam powder. The percentage of these, however, is small and they may be connected with the idiosyncrasies to paraformaldehyde (recognised by physicians). The innocuousness of foam powder of the usual formula is supported by the experiments on dogs…".

Dangerous chemicals were also used in foam sponges (which differ from foam powder both in constituents and application) that had to be kept inside the woman's body for several hours every day in anticipation of sex. 

The persistent provision of the harmful foam powder as well as the uncomfortable and inconvenience (and possibly toxic) foam sponge is a commentary first on how there were gaping holes in research on contraceptive products for women and second, women's complaints of irritation, pain and injury were routinely dismissed. 

It may be noted that the women who used these products were largely from vulnerable sections of Indian society, and these contraceptive experiments were arguably as damaging and dangerous to them as the risks of multiple or successive childbirths. 

These dangers are over and above any discomfort of the sponges in terms of the long hours of use, the limited pleasure women would experience during sex given the distressing contraptions inside them, and the laborious removal and cleansing of contraception from their vagina post sex. 

Conclusion

Over the course of the late colonial decades of the early 20th century, birth control access in India had steadily increased. As the growth of budgets, resources, infrastructure, and personnel indicates, there was zeal on the part of the colonial and later independent state to further the use of contraception. 

The private birth control market simultaneously experimented with a range of products, most of which were female contraceptives that were aggressively marketed to consumers regardless of their questionable efficacy and safety. The woman's body continued to be a site upon which to experiment and control, with complaints of discomfort and pain systematically undermined. 

While all these point to major lapses on the part of the state and market in protecting women's health, the question about why there was such a demand for birth control in India should not be ignored. 

The grim statistics regarding maternal and infant mortality and the incredible suffering of many women due to multiple successive pregnancies are an important part of the story. This is because the requirements for birth control were legitimate, and yet, both the colonial and postcolonial state and markets failed to responsibly address women's health and recognize it as important in itself. 

Further, the stunning absence of representation and consultation of urban and rural working class women in policy-making circles is another indicator of selective "goodwill." 

Instead, in independent India, we see more of the same paternalism characteristic of colonial Indian society, where the elite take it upon themselves what is appropriate for everyone else. As such, women's individual opinions and wellbeing were ignored in conversations that directly affected them.

Indeed, independence and the institution of democracy marked only a slight departure in matters of women's health that was drowned in headlines of national development and population control; rhetoric neither helpful nor accurate—borrowed from colonial masters and refined by the rulers of present-day India. 

(Urvi Desai is a doctoral candidate at McGill University. The views expressed are personal.)

References

1. Vyas, "Mata-no Sahkar," 203.
2. Shri Snatak Satyavrat, "Aacharya nu Santii-Niyaman," Streebodh (June 1940): 298–306.
3. Satyavrat, "Aacharya nu Santii-Niyaman," 304–305.
4. S Chandrasekhar, "Some Observations on Infant Mortality in India: 1901–1951", Eugenics Review, Vol XLVI, No 4 (1954). 
5. Hilda L Keane, "A Case of Early Maternity", The Journal of the Association of Medical Women in India, Vol XXI, No 1 (February 1933): 20.
6. Sanger, Margaret. Margaret Sanger to Edith How-Martyn, November 6, 1936. From Wellcome Archives, London, UK.
7. Sanger, Margaret. Margaret Sanger's secretary to Edith How-Martyn, December 8, 1938. Wellcome Archives, London.