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Study Reveals That If You Have ‘Sex Problems’, These ‘Friendly’ Services Won’t Help

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By Manasa Priya Vasudevan:

sex clinic - yp foundationYou may have spotted posters from train windows, as you enter stations, or at traffic signals that offer to solve your ‘sex problems’. Right from these unremarkable flyers touting unregistered medical practitioners, to over-the-counter (OTC) contraceptives that are dealt, as though, to fugitives, and the dark coloured polyethene bags that seal off sanitary napkins from the outside gaze, the enigma that surrounds transactions of sexual and reproductive health (SRH) services in the country, is only comparable to that which surrounds illicit drug trade. Social and cultural practice is to regulate even the most basic conversation on sexual and reproductive health and rights (SRHR), and bring it within the axes of ‘marriage’ and ‘procreation’, so much so that we have prominent judges of the high courts issuing ‘marriage’ as a sentence for rapists, post-conviction, as if submitting to matrimony is the ultimate atonement. This systemic epidemic of sex-shaming equals to most of us having no information whilst growing up, or being ashamed of our curiosity about our bodies, sex and desire. The utter absence of comprehensive sexuality education (CSE) also contributes to high maternal mortality rates, rampant early and child marriage, a strapping HIV-positive population as well as a significant unmet need for contraception.

It is in this climate that we at The YP Foundation decided to conduct a preliminary audit of government and non-government health centres in and around communities in the National Capital Region, where we impart comprehensive sexuality education. 18 young volunteers and staff from the Know Your Body Know Your Rights Program conceptualised and implemented an audit to assess the quality of SRH services for youth. They took on the role of …well regular young people in need of condoms, birth control, pregnancy kits, HIV counselling etc.

Here is what we found:-

Shame Games

yp foundation sex and reproductive health studyThe National Adolescent Health Programme (Rashtriya Kishor Swasthya Karyakram; RKSK) guidelines 2014, perhaps the most progressive and comprehensive of the Indian policy landscape, stresses on the importance of the presence of 3 components in every centre that provides SRH facilities: information, commodities and services. Now, regardless of the availability of commodities or services, the real challenge that the hospital and staff seemed to struggle with was information disclosure. How does one confide to staff who are uncomfortable to speak on the subject themselves?

We discovered along the way, that hospital staff had two ways of dealing with their unease. In most of our interactions, we encountered either:

Strategic silence – sometimes their limited information on the subject through clipped responses, censored the questions we could have asked or the conversations we could have pursued to build trust and thereof safe spaces.

Or, overt moralising, what I like to call the ‘circle of shame’ – shaming us for shaming them by requesting access to improper things, and subsequently bringing shame upon our family and ourselves.

Neither assuaged the experience.

“The chemist shop in the facility premises required doctor’s permission to buy a kit. Firstly, we were sent to three different rooms to get the CMO/doctor’s permission. In the third room, a female assistant lashed out at us saying, ‘Sharam nahi aati? Parents ki izzat mitti me mila di (Aren’t you ashamed of yourself? You are ruining your family’s honour).’ It would have been downright humiliating for any person let alone a distressed young girl. In the end, I wanted to be out of the hospital as soon as possible.”

Health care practitioners should ideally play the role of a facilitator. But increasingly, we began to observe that either consciously or unconsciously, they would slip into the role of a gatekeeper. A moralising ground does not qualify as a safe space, and in fact adversely contributes to mental trauma.

Sticky-Stacky Stigmas

It was also interesting to note that their stigma against talking about, leave alone treating, SRH services piggybacked somewhat comfortably on their stigmas attached to sex outside of the confines of marriage, which in turn piggybacked on their intolerance towards people of a different religion, weak academic performers, independent youth and a host of other seemingly unconnected things.

“The room was empty except for 3-4 doctors who looked like the ‘gossipy neighbourhood aunties’. And as we were about to find out, they behaved exactly in the same manner. What college, they asked. What subjects, what percentage. Do you live with parents? Are you sexually active? With more than one guy- this was not so much as asked as shouted. And then, are you Christian?”

On some occasions, the younger doctors seemed happy enough to treat the patient without passing judgement, but the older doctors and assisting nurses assumed the garb of a disciplinarian.

On other occasions, doctors were found to be selectively empathetic – privileging one SRH service over the other. There was a stark difference in the attitudes of some health care practitioners who were warm and helpful when it came to services such as contraception, HIV and STIs, but haranguing when it came to abortion.

On still other occasions, they were guilty of granting smoother SRH services to boys over girls; and upper middle class, English speaking patients, whilst reserving dispassionate judgement for everyone else – the peer educators would come out with lukewarm reports only to find a disillusioned fellow patient. So despite wielding our English-speaking class privilege, being at the receiving end of such differential treatment based on banal biases, made us sit up and think – what then, would be the treatment meted out to young girls from the communities we work in?

yp foundation sex and reproductive health study 2

Lack Of Signages

Information education and communication (IEC) material was available only partially and sporadically, across all centres!

“GTB Hospital is like a maze. It is a huge hospital and there is no clarity whatsoever as to which building one has to go to as there is a shortage of sign boards. It is not like the services are not available here, just that reaching the right place is a herculean task.”

Proactive disclosure of the gamut of SRH problems and services through intuitive flyers and sign boards that lead the way to counselling rooms and testing labs also can minimise patient-patient or patient-staff interaction, offering the former the benefit of privacy and shrouding them from harsh judgement and scrutiny of community moral police.

Due to the stigma surrounding most SRH services, especially HIV/pregnancy testing or counselling in the case of sexual contraception/abuse/violence, and the larger community’s likelihood to suppress and shame, creating safe spaces by guaranteeing privacy and confidentiality, also becomes doubly important to encourage young people to avail of these services. Unfortunately, there is no escaping nosy neighbours of neighbours anywhere in India, least of all at community health centres!

“It was an open room where all the patients stood in barely a line and just stated their problems in front of everybody. No privacy whatsoever.”

“One of the things that I didn’t like about this centre was that a patient having an upset stomach walked into the room, right in the middle of my abortion counselling session.”

On the whole, the team had mixed feelings on the pilot study. Their preliminary excitement regarding the ‘plain-clothes audit’ was short lived. The volunteers may have been assuming the
guise of young people in need of counselling, contraception or kits, but their masks were fast rendered inconsequential. The slut-shaming and unsparing character assassination that accompanied
the study was but directed at their realities. Such personal assault dampened their spirit and frustrated some of them to the point of tears. Both the government and non-government health centres were ridden with the same-old age-old, patriarchal, sexist and non-secular bigotry transmitted by staff and communities who frequented their corridors. Uninterrupted treatment was accorded only to the PEs who conformed to their narrow ideals.

In the name of patient history, a person’s identity was dissected, its markers scrutinised: starting with gender, sexuality, class, religion, academic merit, and then moving on to an avalanche of micro markers – none of which was their business. Not surprisingly, the tendency to regulate a woman’s sexuality over a man’s was painfully evident, and how. Add to this mix, a trans person, a Dalit or a differently abled person and the experience could well be traumatic. We then wonder if the singular subject of this exclusive public health system is simply – an able-bodied Hindu man.

Illustrations by Vanika Sharma, ‘Know Your Body Know Your Rights’

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

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A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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