Generation Equality

Generation Equality

Vijay Gopichandran


The young girl with the doe eyes stood outside my clinic door peeping inside anxiously looking at me as if asking “may I come in?” I invited her inside with a nod of my head and she walked in with wary steps. Right behind her walked in an elder lady carrying a little baby, not more than 6 months old. The baby was bawling. The young girl looked back at the baby with tired eyes, imploring it to stop crying. The elder lady started rocking the baby to quieten it and said to the young girl, “you tell the doctor about your problems, I will stand with him outside. I will see if he quietens” and she walked out with the baby still crying loudly. I looked at the young girl and asked her how she was.


“Doctor, I have a fever with chills for the past 3 days. But I am pregnant now, and so doctors are not giving me medicines for fever. They asked me to take ginger water. I have been taking it, but still, I am feeling very weak and tired”, said the girl. Saying this was a great effort for her. She was panting heavily as she spoke. I put the back of my palm to her forehead and checked for her temperature. She was cold and there was no fever. “It looks like your fever has come down now,” I told her. “No doctor, I am feeling feverish inside. It is not hot outside”, saying this she started panting again. “I also have a scratchy throat,” she said. I asked her to open her mouth wide so that I could examine her throat. When she opened her mouth, I was shocked by the pallor in her tongue and mouth. It indicated that she was severely anemic and had very little hemoglobin, the oxygen-carrying molecule in her blood. This is a dangerous condition in a pregnant woman. I did a more thorough clinical examination and found her to be having a fast heart rate, low blood pressure, and gross pallor, all indicating a severe form of anemia. It was the extreme weakness due to the anemia that she was interpreting as a ‘feverish sensation’.


When I asked her when her last menstrual period was, she said it was on 10^th January 2020. She also said that her previous child, which her mother was carrying right behind her, was just 6 months old. She had not had periods for the first 5 months following her delivery as she was regularly breastfeeding her baby. Then she had her first period in the fifth month. The village health nurse (VHN) had asked her to come to get an injection Antara (depot medroxyprogesterone acetate), an injectable contraceptive drug that gives protection against pregnancy for a period of three months. The injectable contraceptive must be given during the first five 5 days of the menstrual bleeding. If it is given later than that, a pregnancy test must be performed before giving the injection. The VHN had given the drug on 26^th January 2020 during a camp that was conducted near her house during the Indian Republic day celebration. As she started developing severe vomiting and dizziness like how she experienced during pregnancy, she got suspicious and got a pregnancy test done at home and found that she was pregnant. Unfortunately, the VHN had given the injectable contraceptive drug after the girl had conceived the baby.


“I went to the upgraded community health center immediately after knowing that I am pregnant. I wanted to abort the baby. My previous baby is barely 6 months old and I could not afford to have another one right now.”, she said. The Medical Termination of Pregnancy Act in India allows for a woman to have an abortion if it is a result of failed contraception. In this case, the woman was completely misled by the VHN about the time period when she must get the injectable contraception and therefore the woman could claim that this is a case of failed contraception. However, the health system was not favorable to this poor girl. The doctor and nurses in the upgraded community health center referred her to the tertiary care center, which is about 40 km away from her home. When she went there, they did an ultrasound scan to check the gestational age of the fetus. They confirmed the pregnancy by scan but refused to offer her an abortion, the reason being that they wanted to hold the VHN accountable for the mistake that she made by giving the injectable contraceptive after 14 days of the last menstrual period. So they sent her back home, saying that they will contact the VHN and enquire her and then help this girl to have her abortion after obtaining an explanation from the VHN.

“I went to the VHN and told her about this episode. The VHN said that it is not her mistake and refused to help me any further. I want an abortion. Could you please help me?” she literally was in tears when she said this.


Today the girl is about 8 weeks pregnant. Though we can offer her an MTP we are available only during the weekend at the clinic. So, if we do offer her a medical termination in concurrence with my colleague, and neither of us is available in case of emergencies, it might turn out to be dangerous. Over and above this, the girl was also severely anemic. At this point, our intention was to somehow offer this girl a safe abortion service. She is from a very poor background and so cannot afford to get it done from a private health facility. The public health system was not offering her the service and we were not able to offer it ourselves.  Then my colleague called her senior colleague from her workplace, who is an obstetrician and gynecologist. She advised us to send this girl to the apex center for maternal and child health issues in the city where she offered to help the girl out.


There have been systemic failures at multiple levels in the story of this young girl. I keep referring to her as a ‘girl’ and not a ‘woman’ because, we later during the day, realized that she was barely 17 years old. Her official documented age in the records is 21, but on probing we understood that she is not even of voting age. Poverty and social pressures had pushed her into child marriage. The primary health care system has failed to protect her from unwanted pregnancy. Tamil Nadu claims to have a very robust primary health care system. But even today, there are young girls like this who do not have access to effective contraception. The girl was given an injectable contraceptive at the wrong time, which proved to be ineffective. And instead of taking responsibility for this mistake, the health system is shuttling her from pillar to post in search of a basic right to safe abortion. After several weeks of running around, she must now go to a tertiary care center almost 100 km from her home, to obtain a simple medical termination of pregnancy. And in all this, the most remarkable part was that the only male in this picture was her 6-month-old son. The husband, the father or the father-in-law were nowhere in this picture. Neither did they help her navigate the unfriendly health system nor did they seek out any help actively and support her. Today is International Women’s Day, and the theme for this year 2020 is Generation Equality. The Generation Equality campaign demands health care services that are responsive to women’s needs and is respectful of them. This episode happening on this important day speaks volumes about how much longer we must move towards the goal of equality of women in our society.