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Accessing BASIC Healthcare Is Still A Horror For India’s LGBTQ+ Community

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In 2017, a visibly bleeding Anirban Kundu was refused treatment by several hospitals in Bengal after an accident. “Is she a girl or a boy?”, the staff at one hospital had asked. At another hospital, the staff spent previous time arguing against admitting Kundu in the women’s ward because she had a ‘male name’. If there had been a further delay in treatment, she would not have survived.

Among others, the LGBTIQA+ community faces discrimination in healthcare. A 2017 survey by the College of American Pathologists found that 29% of the transgender respondents and 8% of the lesbian, gay, bisexual, and queer respondents said that they were refused to be seen by a doctor or healthcare provider as a result of their actual or perceived sexual orientation. 6% of LGBTQ respondents said that they were not given healthcare-related to their actual or perceived sexual orientation. While 23% of transgender respondents said that they were intentionally misgendered or called by the wrong name by a doctor or healthcare provider.

This issue isn’t just prevalent in the US. In India, there are approximately 2.5 million people in the LGBTIQA+ community as per the data submitted before the Supreme Court of India. However, with homosexuality being considered a disease by many, it’s not surprising there are hardly a few LGBT IQA+ clinics in India. Access to quality health care is extremely difficult for members of the LGBTIQA+ community, with many finding it distressing to explain themselves, especially to uneducated healthcare workers.

“Transgender health in India and Pakistan”, a 2016 paper by Long C Ming, Muhammad A Hadi, and Tahir M Khan, mentioned the alarming disparity in the access of quality healthcare between transgender patients and their cisgender counterparts. The paper mentions how in India there is no access to treatment of sexually transmitted diseases for almost two-thirds of the transgender people.

LGBTQIA Healthcare

With physicians and healthcare workers lacking knowledge about LGBTIQA+ healthcare, they are ill-equipped to provide adequate treatment. According to a survey in the US by the National Center for Transgender Equality and the National Gay and Lesbian Task Force, 50% of the respondents reported a lack of knowledge by the health care provider and having to teach their medical providers about transgender care.

Looking at the results of the 2006 study by Dr Bharat Reddy on “Medical Students’ Knowledge and Perception of Homosexuality in India” which showed that 55.43% of the respondents “thought homosexuality was a psychological disorder and required therapy” it is apparent we need to educate healthcare professionals on LGBTIQA+ healthcare.

Another reason for the discrimination against the LBGTQ+ community and their health is the implicit bias against the members of this community. A 2015 study, titled “Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual First-Year Medical Students? A Report From the Medical Student CHANGE Study”, which included 4,441 heterosexual first-year medical students, showed that 45.79% expressed at least some explicit bias while 81.51% expressed at least some implicit bias against gay and lesbian people. Personal prejudices and preferences of clinicians and healthcare workers come in the way of them providing equitable care to their LGBTIQA+ patients.

The bias and discrimination against the LGBTIQA+ community in healthcare have had some very rancorous effect on them. According to the aforementioned survey done by the National Center for Transgender Equality and National Gay and Lesbian Task Force, 28% of the respondents stated that they have postponed medical care when they were sick or injured. According to “Health care use among gay, lesbian and bisexual Canadians” by Michael Tjepkema, 75% of lesbians reported delaying or avoiding healthcare, with the three main reasons for doing so being: affordability, fear of discrimination, and past experiences of discrimination.

Doctors and healthcare staff must be educated thoroughly about LGBTIQA+ healthcare and be given the cultural competency to understanding gender identity and sexual orientations. Medical schools should start devoting more time and energy to educating their students about LGBTIQA+ health. As of 2011, medical schools are only providing 5 hours in the entire curriculum to LGBTQ-specific training according to the American Medical Association.

According to a review study conducted by Matthew Morris titled “Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: a systemic review”, Bias-focused educational interventions, Experiential learning interventions, and intergroup contact are effective measures that can increase knowledge, comfort levels, as well as tolerance attitudes towards LGBTIQA+ patients.

Discrimination against a marginalized community is a disease, which must be eradicated, and this disease has to be fought on a war footing basis. As a first step, hospitals and medical institutions must put in place processes that discourage discrimination. Regular training of the stakeholders on bigotry and discrimination and their adverse impact must be made compulsory. Strict assessments of the processes implemented by hospitals to reduce bias against LGBTIQA+ patients must be done on a monthly basis and independent third-party audits on the processes must be conducted and the hospital’s institution found lacking must be disincentivized.

It’s a long journey to eradicate discrimination and marginalization of the LGBTIQA+ community. But the first steps have to be taken. Let’s take those steps together.

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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.

Read more about his campaign.

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.

Read more about her campaign. 

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.

Read more about the campaign here.

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.

Read more about the campaign here.

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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