Despite its burgeoning population, India has a strange relationship with birth control, especially condoms. Apart from being among the cheapest methods of birth control, condoms are the only contraception that protect against both pregnancy and sexually transmitted diseases. Yet, the word is often beeped on Indian television and movies and condom ads are allocated late night slots on channels so as to reduce the possibility of “non-mature” audiences getting exposed to the contraceptive.

Not just unwanted births, India faces a much bigger threat from sexually transmitted diseases, particularly HIV-AIDS which killed over 130,000 people in the country. The problem, however, is not of awareness, despite all this coyness about even a mention of the word 'condom' in public life, but of adoption. Latest data released from the National Family Health Survey, which is among the most detailed source of health statistics in the country, showed that condoms are among the least popular method of contraception in the country and worryingly, their usage seems to have reduced over time.

Only one in 20 married women aged between 15-49 were using condoms for family planning in the year 2005-06 for family planning, according to the older survey, NFHS-3. Though the whole data for the latest survey hasn’t been released, NFHS-4 shows that even though awareness among women has gone up about effectiveness of condoms, the usage is still lukewarm in most states.

Surgical sterilisation

Take Andhra Pradesh, which had the highest level of awareness among women, as 86.3% of them reported being aware of condoms and their ability to prevent sexually transmitted diseases, but only a negligible number of women in the state reported using condoms as a method of birth control. Similarly, Tamil Nadu, which is counted among the most advanced states, saw two in three women being aware about condoms but less than one in hundred using them.

The lack of popularity of condoms as a birth control method could have something to do with the prevalence of sterilisation of men and women as a contraceptive. While surgical sterilisation prevents unwanted pregnancies, it doesn’t ensure protection against sexually transmitted infections and diseases.

Moreover, India’s experience with surgical sterilisation has been far from satisfactory, despite the highest percentage of women in the world opting for these surgeries, as doctors often operate in inhuman conditions. A case in point is the recent death of 15 women in sterilisation camps in Chhattisgarh due to botched up and rushed procedures, even as another 70 women were hospitalised in critical condition.

“It’s basically like cattle camps, it is absolutely inhuman. These venues are not meant for so many people,” Abhijit Das, director of the Centre for Health and Social Justice told Al Jazeera.

According to latest numbers, sterilisation is being used by more than one in three women around the country as a method of family planning. Meanwhile, usage of intrauterine devices and birth control pills have also increased but the usage of condoms declined in six states out of 15 for which data was made available in the latest NFHS.

Tamil Nadu saw one of the largest drops in condoms usage as it dropped from 2.3% to 0.8% of the population while Bihar also saw it fall from 2.3% to just 1%. Only West Bengal and Sikkim recorded a rise in condom usage by more than 1% over the previous survey while all other states either declined or recorded a marginal increase.