Glad you asked.

So India in general has an extremely progressive acceptability for sex education. We have ads on national TV promoting condoms (by the govt. With Bollywood jingles) as well as female contraceptives.

You can pretty much walk into any govt hospital (which are not much to look at) and get free contraceptives and contraception operative procedures.

We have a huge govt funded initiative around sanitary napkins, which is also considered a marketing case study in general [1]. Remember this was done through schools.

The contraception debate in the US (including abortion) seems weird.

India does have a significant proportion of female foeticide for cultural reasons, which is why it is banned in India to do prenatal sex determination. This has entered the cultural psyche to such a degree, that my friends who have conceived in the USA, will explicitly tell their doctors to not tell them about the gender (yes. An Indian citizen can be arrested upon entry to India if it can be proved you paid for sex determination outside of India).

However the impact of contraception innovation in India reaches far beyond it's shores. We are the largest supplier of generics and contraceptives to several third world countries including Africa.

[1] https://scroll.in/article/802833/how-the-advertising-industr...

So from the article:

"India has more married women with an unmet need for family planning than any other country, and social stigma and a lack of privacy in stores has kept condom use to less than 6 percent."

Progressive acceptability maybe - but it appears Indians have very poor compliance, at least with condoms. Here's some data from the UN in 2015. India does OK compared to the rest of the world in regards to contraception. Most contraception use in India is by permanent sterilization - which is likely BTL (bilateral tubal ligation).

http://www.un.org/en/development/desa/population/publication...

Young, educated people in Indian urban centers are essentially a demographic that doesn't need to be targeted because they're almost always sensible enough. Take away any of those three conditions, and the need for proper education among that group becomes harder -- as does the difficulty of reaching, convincing, and actually implementing any sustainable "culture of contraceptive use" among them.

It's what you'd expect where adults, especially lower- or lower-middle-class adult women, will almost never talk about sex, resorting to grown-up versions of "wee-wee", or oblique "that time of the month"-ish circumlocutions, if they do at all.

India also has a pretty grim history of adult men being forced to undergo (often botched) sterilization during the infamous Emergency declaration in around 1977, with a significant number of casualties. This kind of history obviously muddies the waters (as if the almost-institutional cultural reluctance to engage with these matters wasn't enough).

https://en.wikipedia.org/wiki/Compulsory_sterilization#India

https://en.wikipedia.org/wiki/The_Emergency_(India)#Forced_s...

I must say, though, that there are more TV ads than ever, and even the occasional billboard (which residents' unions will often try to shutter on the grounds of "public morality") for condoms or contraceptive pills. AFAIK (and it's no wonder why) the government doesn't advertise morning-after pills at all, but Indian Big Pharma does (and, again, I doubt how many of the people who'd actually benefit from the ads see them or act upon the information). Unlike the situation in the US, here the driver is some kind of ill-defined "decency" rather than the threat of swift retaliation from an enraged petty deity: not that it makes much of a difference.

The TV based ads are almost entirely targeted towards the rural demographic. I'm not saying it's enough ...And whatever limitation exists is a consequence of lack of funds rather than intent.

The condom issue has been well known for decades. Since the 60s, contraceptive health in India has been entirely focused on women for this same reason .. as a way to give them the choice instead of asking men.

The compulsory sterilization was an extremely tiny slice of history..For which the political party in question is being punished TO THIS DAY.

You are right about the colloquialism around talking about sex. Actually it's funnier than "wee wee". There is a cultural bias against women being "impure" at a certain time of the month - and then being disallowed in the family kitchen. The marketing campaign around this was a version of "don't touch the pickle".

Point being - this is not unusual. But the Family Planning bodies in India are now masters or crafting the marketing and the messaging to bring the conversation out in the open.

They did this very successfully with contraception in villages by organizing women committees..And for sanitary napkins in schools.

It's a function of sheer numbers. Doing anything for a billion people is hard.

Well, India is different I think because it's a matter of national importance. I guess the Indian government really has no other option besides forcing the idea of contraceptives onto the population. This is not a bad thing, but I just want to clarify that overpopulation is a very strong motivator, and is something that few countries in the world have to deal with.

Few Western countries. Population is a huge problem in much of Asia. We should all praise the success of Bangladesh in addressing the problem so quickly, they really dodged a bullet there.

Quite few countries, and the common theme isn't really "the west" anymore, but rather the "not too poor to have decent education" :

https://www.ted.com/talks/hans_rosling_on_global_population_...

There are two India's if you look only from rate of population growth. The four southern states have a similar accrual rates that of the west, and rate of increase in the "northern" states.

To quote the article referenced below:

"..Nine Indian states (Kerala, Tamil Nadu, Andhra Pradesh, Himachal Pradesh, Punjab, West Bengal, Delhi, Karnataka and Maharashtra) had fertility rates less than the replacement level of 2.1.

Kerala and Tamil Nadu, at 1.7, had lower fertility levels than Norway and the Netherlands, at 1.9 and 1.8 respectively."

http://www.indiaspend.com/cover-story/ageing-india-south-ind...

i agree. Population is an existential crisis here and that probably breaks through mental barriers.

Having said that, I would also say that contraception (and its weird, twisted forms) are very much part of our culture ;)

https://en.wikipedia.org/wiki/The_Pregnant_King

I can't see how it would have a positive effect. HIV infection rates in the gay community have shot up in recent years unfortunately as people have become complacent with condoms. Without the risk of pregnancy one can only assume the same thing will happen in the straight community.

>HIV infection rates in the gay community have shot up in recent years unfortunately as people have become complacent with condoms.

This is not accurate in the US. HIV diagnoses among gay men have increased less than 1% from 2010-2014 according to the CDC: https://www.cdc.gov/hiv/group/msm/

To be fair, the straight and gay communities are really just opposite sides of the same fish tank, not two fish tanks, as a metaphor for compartmentalizing the sharing of diseases.

It's still reasonable to differentiate the primary motivation for condom use in the two 'communities'.

Keep in mind that receptive anal sex carries a risk of infection 18 times higher than that of receptive vaginal sex. Moreover, receptive vaginal sex is twice as likely to result in infection as insertive vaginal sex.

http://www.catie.ca/en/pif/summer-2012/putting-number-it-ris...

There's a correlation between substance abuse (not addiction) and infections.

> “Chemsex is a rapidly emerging pattern of drug use, not just amongst men who have sex with men as often assumed, but heterosexual patients as well,” Dr Richard Ma of the Royal College of GPs’ Sex Drugs Group told the Telegraph. [https://www.rt.com/uk/320758-chemsex-hiv-outbreak-doctors/]

I see this as something related to the bar/disco/club culture rather than something linked to condoms.

I wonder if fewer unwanted children can lead to a reduction in STDs via economic effects, e.g. reduced poverty.

Could you explain this further? I don't quite understand.

Poor people are typically less educated and (I guess) are not as well informed about STDs as more affluent people. In countries without a proper healthcare system they are probably also less likely to get STDs treated.

Unwanted children are typically not good for getting out of poverty.

Freakonomics in a way!

Interesting. Didn't think of it like that.

Free contraceptive injections (and reversals that cost a bit) sounds like a great plan for improving quality of life for humanity, actually.

Not OP but argument is likely that condoms are expensive.

Depends I suppose. They're generally free from your local doctor/clinic/sexual health charity in the UK.

There can be a huge social stigma about walking into sexual health clinics. I'll provide an example.

In my city, the old STD clinic was in a random building with mixed use (commercial, health, residential). The clinic was on the 5th floor and not marked. You only really knew it was a STD clinic if you had an appointment there. The clinic moved into a new building and were lucky to expand into a large space. Like many new buildings, way finding is important and the waiting room was marked with Sexual Health Clinic and the elevator level was marked with Sexual Health Clinic. Even though you don't need to use your own name at this clinic, they saw a huge decline in visits since it was quite obvious when someone was attending the clinic. People didn't want to be seen in the Sexual Health Clinic.

Interesting. Generational thing possibly? I'm mid-20's and those kind of things are talked about openly, even in mixed gender company.

Planned Parenthood has a big bowl of them in the lobby. You can walk in there and grab a handful no questions asked. (In the US)

I don't really see how this would be much different that the pill, though.

There's likely a subset of men who wear condoms when sleeping around so they can decrease their risk of babies (a measure so they don't have to trust that the woman they're with is both on the pill and taking it regularly). They might not wear them if this contraceptive decreases pregnancy risk in a similar way. STDs may not seem risky enough to merit condoms for a portion of this subset.

This smaller subset would be at higher risk of STDs if they adopt use of this contraceptive and stop condom use while still sleeping around. If the trend continued, the incidence of STDs would increase, which would change the risk factor of STDs, which would sway a subset back into condom use.

All is balance.