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India’s Approach To The Pandemic Can’t Ignore Deep-Rooted Stigma In Our Society

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This post is a part of YKA’s dedicated coverage of the novel coronavirus outbreak and aims to present factual, reliable information. Read more.

The pandemic has adversely affected the social, psychological, economic frameworks of countries around the world. Developing nations, of course, have been even more greatly affected due to the layers of challenges. Take India for example, besides the increasing number of COVID-19 cases,  thousand of deaths, forecasted slow-down in the economy, stretched medical systems and migrant crisis, there is also the social challenge of stigmatisation and discrimination.

Fear and misinformation have led to the rise of stigma and discrimination against a range of groups including patients affected by COVID19, their families, health workers, migrant workers etc. This stigma has, in turn, made circumstances even more difficult for these groups, many of whom are already vulnerable and at risk.

Thus, for us to collectively beat this pandemic as a nation, it is crucial to counter misinformation and stigma, and amplify positive stories and messaging.

To address this issue, Dasra organized a multi-stakeholder webinar to discuss Collaborative Action to Prevent Stigma & Discrimination on June 9, 2020, in partnership with the Ministry of Health and Family Welfare, UNICEF, and USAID.

The webinar saw representation from the government, international agencies, civil society organisations and intermediaries. The primary audience for the webinar was civil society organizations working around the country who can tackle the issues of stigma and discrimination through their programmes at the community level.

“The pandemic is causing strong emotions to come out among people. These emotions lie on a wide spectrum, ranging from fear and anxiety to anger and frustration, and affect interpersonal relations between people,” noted Siddharth Shrestha, Chief, C4D, UNICEF India.

Frontline health workers or caretakers, people in quarantine, people with mild symptoms, and the migrant population are groups that fall under the high-vulnerability category when it comes to stigmatisation and discrimination.

Recognising this problem, several stakeholder groups have come to the fore to tackle it. For example, the Government of India, under the Ministry of Health & Family Welfare has convened a National Risk Communication & Community Engagement Coalition, with support from several development sector partners to support this issue.

Civil society, too, recognises that it lies at the heart of the movement, and its role is key to ensuring the risk to stigmatisation is addressed. Thus while the government leverages its digital communication tools for mass communication via social media posts, announcements over radio or television broadcasts, push messages on mobile phones, on-ground non-governmental organisations that have a footprint in the communities are facilitating one-to-one engagements.

“Civil society organisations can play a crucial role in minimising this social issue associated with the ongoing health crisis. They have the last mile reach, and the first sense of contact in terms of both gaining understanding the ground situation and emotions as well as offering knowledge and awareness to the community members,” Rajinder Chaudhary, Chief Media, Ministry of Health & Family Welfare said during the webinar.

So, what is leading to stigmatisation around the pandemic? It is the fear of the unknown associated with COVID-19, especially because it’s a new disease. As scientists and doctors around the world continue to carry out research on the virus, there are fast changing perceptions around the origin, spread and impact of the disease, leading to fear and anxiety.

Representational image.

This emphasizes the need to disseminate localised fact-based COVID-19-related health and awareness information. “For a country as large, wide and diverse as India, every kind of messaging—from PSA by Bollywood actors to door-to-door communication by CSOs—is required; rather than sending out a generic message at the national level by the government,” Chaudhary added.

Addressing the roots of stigmatisation, Dr Vivek Virendra Singh, UNICEF, said that the scale of stigma is directly associated with the underlying values of a country. This means that stigmatisation will only come to the surface if there are certain levels of existing discriminations in society. And thus, COVID19-related stigmatisation in India finds links with discrimination in the country on the basis of caste, religion and gender.

“Plague, cholera and influenza all arrived from ‘another country’ before they became a pandemic. This forced a travel ban and gave the diseases the sense of ‘foreignness’ and differential treatment. Coupled with institutional quarantines, forced home isolations and a police-monitored implementation of these, the pandemic begins to be associated with the fear of the strangers or the fear of the unknown,” Dr Singh added.

The stigmatisation of any kind has several consequences, of course. However, during a pandemic, the consequences of stigmatisation can be more worrisome — not just for the victim but for the larger community and region. The fear of stigmatisation forces people with mild symptoms to hide their health condition or avoid seeking medical help. This means that fewer cases would be detected, leading to a negative outcome where the disease may be spreading faster/wider than known, making it even more difficult to contain or control it. At a more personal level, stigma increases the sense of emotional isolation, leading to feelings of guilt, anxiety, lack of self-esteem and reduced confidence.

So how can one tackle this at the local level? Dr Ritu Chauhan, WHO, stated that the fear of the unknown can only be tackled by sending out positive messaging around COVID19.

“People need to know that not everyone who’s infected by the virus faces hospitalisation or death. There are far more cases, in India, for example, of mild to asymptomatic cases. In fact, a 93-year-old has recently recovered from COVID in India,” she said, adding that people in need should also be connected to relevant helplines, ranging from COVID19 support and mental health to child support and women helpline.

Further, response to any pandemic has to be “first, fast and frequent” while making announcements, ensuring fact-based information dissemination and building public trust in stakeholder response. Communities need to be served with the right technical advice, based on evidence, so that they can make informed decisions. This requires resource material in local languages, countering misinformation with facts quickly and a strategic approach to risk communication.

NAGAON, INDIA-MARCH 22,2020: A Doctor use thermal screening devices on youth who return from Kerela state in the wake of deadly coronavirus at Civil Hospital in Nagaon district of Assam, India – PHOTOGRAPH BY Anuwar Ali Hazarika / Barcroft Studios / via Getty Images)

New norms and routines — such as lockdowns, quarantine and social distancing — should be communicated with positive mass messaging to allow people to empathetically understand the need to keep themselves safe and help each other. And, most importantly, strong values of care behaviour have to be communicated to communities.

Civil Society Organizations have a key role to play in preventing stigma and discrimination, due to their proximity to the communities and understanding of local contexts, here are a few key recommendations for CSOs to engage on the issue:

  • Be a role model
  • Amplify Positive Messages
  • Build Solidarity
  • Support Communities

Responding to stigma and discrimination, UNICEF pointed out six key messages that people need to adopt at the individual level. These are:

  • Focus on facts and evidence in messaging
  • Focus on positive messaging, with a glass-half-full attitude
  • Remember that a pandemic can infect anyone; it is not biased towards any community, gender, nationality, profession or status of wealth
  • Focus on what people can do to support each other
  • Appreciate frontline providers to encourage and motivate them
  • Respond to those in stress with empathy

Access WHO and UNICEF’s presentations during the webinar here.

The webinar also heard voices from the ground through the work of SEWA, a member-based organization of self-employed women from the unorganized sector. It provides voice and identity for social discrimination and unionises and provides visibility for economic distribution.

Speaking about SEWA’s approach to stigma and discrimination, Rehanaben Riyawala said that women workers across several occupations have reported changes in people’s attitudes and behaviours since the COVID-19 outbreak. Due to this, women domestic workers, street vendors and migrant labourers are facing a loss of income and livelihood due to the fear and stigma associated with the disease. In this regard, SEWA’s response has been 6-fold. It has focused on:

  • Trade-Wise Education
  • Access to Telemedicine
  • Accurate COVID-19 Awareness
  • Engagement Session for Children
  • Support for Social Enterprise Restructuring
  • Support to Carry on Providing Essential Services

SEWA has been able to work on these six fronts through the virtual work platforms (such as Zoom and Google Hangouts), door-to-door community events (at the village and block level), social media messaging (primarily on Facebook) and text messages on the phone (as push notifications around awareness).

Representational image. Indian doctors wait in an area set aside for possible COVID-19 patients at a free screening camp at a government run homeopathic hospital in New Delhi, India, Friday, March 13, 2020. The camp is part of the government’s surveillance for fever and other symptoms related to the coronavirus. The vast majority of people recover from the new virus. According to the World Health Organization, people with mild illness recover in about two weeks, while those with more severe illness may take three to six weeks to recover. (AP Photo/Manish Swarup)

Paliben Solanki is one of those women who has been at the receiving end of these messages through SEWA. She lives in a village in Rajasthan that has been marked as a containment zone. She shared, “Since we work with women self-help groups, we need to ensure the right messaging to help the women force carry out their roles and responsibilities with minimum risk to their lives. For example, we encourage our women to regularly drink traditional immunity boosters, wear washable masks, replace masks when they feel sweaty, wash masks in hot water. We also advise them on drinking immunity boosters and bathing upon returning home after every visit.

While stigma and discrimination have deep roots in societal cultures and traditions and would take years before a behavioural change at a large scale is visible, this disease has emphasised on the need to act towards addressing this problem on a fast pace. Lest the ongoing health crisis could turn into a vicious cycle of stretched medical systems and marginalisation of the marginalised.

If you’d like to be part of the fight against stigma and discrimination during the time of COVID-19, write to us, or simply use #TogetherAgainstCOVID19 and tag MoHFW, UNICEF India and Dasra

Scroll through for LIVE updates here.

This summary was originally published on the Dasra website and has been reproduced 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.

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