On the 2nd of September, 2022, Prajnya and Orinam organised a Roundtable on Inclusive Sexual and Reproductive Health and Rights. The roundtable was a part of a research internship undertaken by the author, Meghna, a postgraduate student of Sustainable Development Practice at TERI School of Advanced Studies, New Delhi. Through the research project, Meghna aims to explore concepts of accessibility and inclusivity to Sexual and Reproductive Health and Rights in Tamil Nadu. Through this, the roundtable not only shed light on the structural violence and discrimination in the healthcare sector against individuals who do not conform to the binary sexual orientations, gender identities and gender expressions, but also helped provide critical points in order to reimagine gender-affirmative healthcare. The session was moderated by Dr. L. Ramakrishnan and had on the panel – Fred, Dr. Prabha Swaminathan and Archanaa Seker, who gave us their insights on the theme of the roundtable
1. Fred works as an LGBTQIAP+ affirmative counsellor.
2. Dr. Prabha Swaminathan is a gynaecologist associated with Dr. Rela Institute & Medical Centre, Chennai and Chettinad Hospitals, Chennai. She is committed to providing gender-inclusive healthcare, as well as healthcare and support services for survivors of domestic violence. She has been working with NGOs for domestic violence and intimate partner violence and is also trained and certified as a workplace sexual harassment Internal Committee member.
3. Archanaa Seker is a writer, researcher and feminist rights activist based in Chennai. She works with the queer community and independently works on enabling access to Emergency Contraceptive Pills and abortions to those who need it and reach out. She also engages with state agencies to fill the gaps in SRHR.
4. The session was moderated by Dr. L. Ramakrishnan who is a public health professional, associated with Solidarity and Action Against The HIV Infection in India (SAATHII). He works towards inclusive access to healthcare, justice and social protection for communities marginalized on account of gender, sexuality and/or HIV status.
The roundtable began with the panellists being asked what it means to them to be an inclusive SRHR provider. Archanaa began by answering that she has been working on enabling access to Emergency Contraceptive Pills for anyone who needs them for around a decade. “If access to contraception was inclusive and it could be accessed by everybody, there wouldn’t be a need for somebody like me. If you ask me what it is to have inclusive and accessible SRHR, I would say, the dream is I become redundant, or what I do becomes redundant.”, she said. Archanaa also added that despite ECPs not being illegal for sale or purchase in Tamil Nadu, the fact that they are not easily available is a result of confusion in the state, particularly one that involves Government agencies, pharmaceutical associations and pharmacies.
“While I want ECP to be available at pharmacies just like we can buy a crocin or a Dolo-650 just off the counter, and I want every pharmacist to be able to give it without asking any questions, I do realise, they can’t stop at just making the pill available without looking at usage, over usage or misusage. And from a feminist point of view, I think we must think and talk about it,” she said.
Moving beyond assumptions of the cis-binary heterosexual contexts, there are barriers that are persistent for community members. Giving insights into this, Fred mentioned that organisations like Orinam that offer resources for gender-affirmative healthcare are essential for community members. Inclusivity, Fred said, to him, meant that “people in medical professions must be aware of gender identities, gender expressions and sexual orientations for the LGBTQ+ community to visit them when there is a need”. This makes it imperative to note that healthcare providers must take cognisance of the fact that bodies can come in many configurations which may or may not align with the individual’s gender identity. Dr Prabha Swaminathan added to the discussion by saying that she, an OB-GYN, recognises that medical professionals have to be mindful and considerate if there are vulnerable individuals seeking support. She said, “no one should be left behind as far as health is concerned so that everyone has equal access and ability to get help.”
Furthermore, during the roundtable, discussing the barriers to accessing SRHR, Archanaa mentioned that the society is still stuck with very strict gender norms, including those that limit, prohibit or silence any discussion of ‘pleasurable sex’. Accessing SRHR can be destigmatised only if the shame is taken away from bodies, body parts and sex itself.
Archanaa also spoke about the reaction in India to the Roe v/s Wade judgement being overturned in the United States. While many people contrasted India’s seemingly progressive abortion laws with the rollback of reproductive rights in the US, Archanaa pointed out that the ground reality in terms of access to safe abortion services is fraught in the country. She directed the audience to the Guardian article, Feminists in India applaud their abortion rights – but they don’t extend to Dalit women by Shreeja Rao.
The roundtable also brought forth the question of how the medical sciences traditionally does not maintain any distinction between biological sex and gender, and thereby fails to address the issues of transmasculine individuals. Here, Fred mentioned that there is apprehension about opening up about one’s gender identity, especially to medical practitioners. Added to this is the toxic masculinity that is prevalent in the LGBTQIA+ community. These notions and stereotypes about the sexual orientations of transmasculine individuals is also reflected by medical practitioners who are supposedly gender-affirmative.
The concluding thoughts of the roundtable had Dr. Prabha Swaminathan talk about the aspects of abortion in the medical fraternity where one is always taught to deny abortion the first time, and to be pro-life. Concepts of gender beyond the binary, and identities on the LGBTQIA+ spectrum are also not considered normal in the medical profession. She mentions that very little time is given to develop a proper understanding of sexuality in the medical curriculum. It is the lack of this that has made most gynaecologists not understand sex and sexuality. For this, children must be taught from a very young age about sex and sexuality through sex education in schools. This thought was echoed by Fred as well. Fred also brought to light that legislation and policies must focus on making use of language that is inclusive of all identities. A brilliant Twitter thread was also suggested by Archanaa on the same which can be found here. Additionally, Archanaa supplemented this discussion by adding that it is essential for both medical professionals and institutions such as the state to move towards approaching sexual and reproductive health from a feminist and rights-based perspective.