Inclusive Sexual and Reproductive Health and Rights: A Roundtable with Orinam || @chennaipride @Archytypes @Fred_Rogerss

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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.

The Madras Neo-Malthusian League

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While writing a term paper on debates about contraception in Madras State, I came across an organization called the Madras Neo-Malthusian League. The following article is an excerpt from the paper I wrote. 

 

The Madras Neo-Malthusian League (MNML) was formed in 1928 in Madras. Its membership was mostly confined to elite, upper class Brahmin men. The MNML leadership made no real effort to collaborate or form links with nationalist organizations in the Presidency, but focused on establishing international connections with leaders of birth control movements in other countries, notably Margaret Sanger, Marie Stopes and Edith How-Martyn.The MNML’s ideology had its roots in the Malthusian theory of overpopulation, but where Malthus advocated only abstinence[1] and celibacy as methods of population control; the MNML saw the propagation of contraceptives as a natural extension of the Malthusian world-view.[2] The MNML also sought to “entrench the systematic regulation of human reproduction in order to bring about a desired demographic change”[3], in order to build a ‘stronger nation’. In this way, their agenda can be characterized as eugenic.[4] However, while the focus of eugenics in the west was heredity, Indian eugenicists focused on caste-based marriages as a site to bring about demographic change,[5] thus centering marriage as a site in which “the task of revitalizing the nation as a whole” was undertaken.[6] As Sarah Hodges succinctly says, “eugenics in India fed into, and was supported by, late colonial debates on national progress, scientific modernity… and marriage reform”.[7]

In order to carry out their agenda of ‘revitalizing the nation’ through demographic change, the MNML saw the lower classes and castes as the appropriate targets for birth control advocacy. As MNML leader P S Sivaswami Iyer put it, birth control was seen as being “essentially for the benefit of the masses”[8], in order to control the “profligate breeding of the urban poor” and “alleviate” their burdens.[9]

A few significant points should be noted regarding the nature of the policy and activities of the MNML. Firstly, as I stated earlier, the members of the League were primarily Brahmin, upper class men. Their meetings were conducted in English, and they were more concerned with opening international dialogue than national conversations about birth control. Many scholars have suggested that the MNML’s agenda was to use contraception as a means to justify Brahminnical control of society and its reproduction, as well as control of women and lower castes. As Anandhi points out, MNML members such as Krishanmurthi Ayyer alluded to Hinduism’s “natural” and “unconscious” propagation of birth control within its sacred texts, thus creating a caste privilege and using this to justify the legitimacy of celibate widows and vegetarianism (which was perceived as reducing fertility!), all of which were upper caste practices.[10] Thus, “in privileging this Brahminnical Hindu construction of ideal bodies as reproductive, the bodies of lower classes/castes were represented by the neo-Malthusian as invested with uncontrolled sexuality requiring outside intervention”[11] by Brahmin men, who were innately “sexually responsible”[12]. Sanjam Ahluwalia describes this as “eugenic patriotism”, a position adopted by MNML leaders who “valued certain reproductive functions over others, yet presented their specific class, caste and gender interests as universally beneficial to an emerging nation”.[13]Secondly, it was not only non-Brahmin sexuality that was perceived as requiring the control of Brahmin men, but also female sexuality. The MNML did not believe that women knew, or should know, anything about contraception. In fact, when Margaret Sanger requested the President of the MNML, Sir Vepa Ramasesan, to arrange a woman speaker at a birth control rally, he replied, “we are not aware of any organization of Indian women interested in considering the problems that would be raised in a Birth Control Conference”.[14] Sir Vepa Ramasesan added that no medical woman in India had any knowledge of birth control, or the desire to advocate its benefits. Incidentally, this was untrue. While medical stalwart Dr Muthulakshmi Reddi was not in favor of contraception, Dr Devadesan was a passionate advocate of birth control in Madras.[15]

The MNML chose to disperse information about contraception via informal “man-to-man” conversations. Wives were informed (by their husbands, of course) on a “need-to-know” basis only,[16] thus maintaining their “sexual innocence” and allowing their husbands to “exercise sexual control over them”.[17] Malthus himself might have agreed with this, in fact, as Chandrasekhar observes, “one can read the Essay (An Essay on the Principle of Population) from cover to cover without encountering a passage that indicates Malthus ever thought women had anything to do with population”.[18] Anandhi views this agreement of views as a motivating factor for the formation of a neo-Malthusian League, as it increased “the ease with which the upper class agenda of Malthus and the Brahminnical Hindu agenda of upper caste Indian men could come together and reduce women to reproductive bodies requiring male control”.[19] Thus, though the views of the League clashed with the views of nationalist leaders on the subject of contraception, both perspectives “converged in privileging reproductive sexuality and inferiorizing other forms of female sexuality”.[20]Finally, the League’s championship of contraception can be seen as a way in which its leaders deployed their larger agenda to defend social and sexual practices such as child marriage, which were increasingly coming under attack. In order to mask their defense of these practices, MNML leaders sought to present early motherhood rather than early marriage as being the root of a ‘weak nation’.[21]

It should be noted that the League was widely discredited for being ineffectual and hypocritical (one League member had thirteen children!).[22] The members of the League seemed to address their speeches to each other rather than the ‘masses’ they claimed to be speaking to. No practical steps were taken by them, though contraceptives were distributed by some leaders, these activities were on a very small scale.

Hodges, however, sees some merit in the MNML as a voluntary association “outside the formal political realm”.[23] She does not dismiss it as simply another facet of patriarchy. I find this conclusion less convincing than Anandhi’s assertion that in spite of the fact that all proponents and opponents of birth control involved in the dialogue spoke in terms of reproductive control (i.e. the concern of a man and a woman engaging in intercourse), “it was mediated by concerns of maintaining class, caste and other boundaries through regulating women’s body and sexuality”.[24]


[1] In “A Dirty, Filthy Book”, S Chandrasekhar asserts that Malthus “never advocated contraception; on the contrary he indirectly condemned it” (p 11)

[2] Susanne Klausen and Alison Bashford, “Fertility Control: Eugenics, Neo-Malthusians and Feminism” in The Oxford Handbook of the History of Eugenics ed Philippa Levine and Alison Bashford (New York: Oxford University Press, 2010) p 99

[3] ibid. p 98

[4] It should be noted that not all eugenicists were supporters of contraception. Critics of birth control felt that rather than performing the eugenic role of creating “docile” workers’ bodies, and gradually breeding out the poor, it might actually produce a landscape of “moral licentiousness in the form of sexual excesses” (Hodges, 2008 p 44)

[5] Sarah Hodges, “South Asia’s Eugenic Past” in The Oxford Handbook of the History of Eugenics ed Philippa Levine and Alison Bashford (New York: Oxford University Press: 2010) p 231

[6] ibid. p 228

[7] Sarah Hodges, “Indian Eugenics in an Age of Reform” in Reproductive Health In India ed Sarah Hodges (London: Orient Blackswan, 2006) p 116

[8] Sarah Hodges, Contraception, Colonialism and Commerce: Birth Control in South India 1920-1940 (Burlington: Ashgate, 2008) p 53

[9] ibid. p 56-64

[10] S Anandhi, “Reproductive Bodies and Regulated Sexuality: Birth Control Debates in Early 20th century Tamil Nadu” in A Question of Silence? The Sexual Economies of Modern India ed Mary E John and Janaki Nair (New Delhi: Kali for Women, 1998) p 143

[11] ibid. p 144

[12] Sanjam Ahluwalia, Reproductive Restraints: Birth Control in India, 1877-1947 (Urbana: University of Illinois Press, 2008) p 42

[13] ibid. p 18

[14] op. cit.  Ramusack (2006) p 64.

[15] ibid.

[16] op. cit. Hodges (2008) p 82

[17] op. cit. Ahluwalia (2008) p 48

[18] op. cit. Chandrasekhar, p 12

[19] op. cit. Anandhi (1998) p 145

[20] ibid. p 145

[21] op. cit. Hodges (2008) p 74-75

[22] ibid. p 49

[23] ibid. p 50

[24] op. cit. Anandhi (1998) p 140