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.

Three stories from Tamil Nadu

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I want to link and excerpt Pushpa Iyengar’s column (Chennai Corner) in the Outlook this week. The link may not work after this week, hence the excerpt.

The first two parts of the excerpt are about neo-natal deaths and infanticide. She then profiles two outstanding members of the Indian Administrative Service’s Tamil Nadu cadre.

The citation: Pushpa Iyengar, Chennai Corner, Outlookindia.com, August 20, 2008.

The links:

http://www.outlookindia.com/full.asp?fodname=20080820&fname=chennai&sid=1
http://www.outlookindia.com/full.asp?fodname=20080820&fname=chennai&sid=1&pn=2

The excerpt:

Is Tamil Nadu Really Progressive?
Tamil Nadu is seen as a progressive state with many of the parameters on different social indices better than many other states in the country. However, here’s a shocker from no less than the health secretary V. K Subburaj. He says 40,000 infants die every year within a month of their birth in Tamil Nadu. India accounts for 10 lakh neonatal deaths every year. Low birth weight and anemia among mothers/ pregnant women are believed to be among the major reasons.

What is of even more concern to public health experts is that while the infant mortality rate (IMR) is 37 (number of deaths per thousand live births), the Sample Registration Survey (SRS) shows that there are pockets in the state where the IMR is as high as 54. Not surprisingly these are the western districts which include Dharmapuri, Salem, Namakkal, Nilgiris, Coimbatore and Erode where female infanticide and foeticide continues to be a scourge. The best performers are eastern districts including Thanjavur, Nagapattinam, Tiruvarur, Ariyalur, Perambalur, Tiruchi, Pudukottai and Karur where the IMR at 28 is the lowest. Even Chennai and its surrounding districts including Tiruvallur, Vellore, Kancheepuram, Villupuram, Cuddalore and Tiruvannamalai were higher at 32.

Just because Chennai is a metro city with malls and metrosexual men, it does not mean attitudes towards girl children are any different. The latest instance is of Kuppusamy of Kasimedu who refused to accept his newborn daughter at the Government Kasturba Women’s Hospital, Triplicane, claiming that the midwife had told him that his wife Sonia had delivered a boy. This, despite Sonia and the doctors who delivered her telling him that his newborn was a girl.

Bringing Down Female Infanticide
But Sheela Rani Chunkath can be credited with significantly changing the social attitudes to female infants in the western districts back in 1996 when she was posted as the director of Reproductive and Child Health.Sheela Rani, currently chairperson of Tamil Nadu Industrial Investment Corporation, has been given the Prime Minister’s Award for Public Administration for 2006-7 and she met CM Karunanidhi this week to show him the certificate and medal.

She says that back in 1996, she had a female infanticide map of Tamil Nadu drawn up to find out how much and how widely prevalent this practice was. And it was a revelation as well as evidence of the practice. While the rest of Tamil Nadu showed a gender differential of 4.6, Dharmapuri showed 61.8, Madurai showed 31.1 and Salem showed 28.3. Female infanticide cases which were 3,004 in 1994 had gone up to 3,417 in 1998.

The strategy, she says, was to destroy the social legitimacy of the practice. A traveling street theatre was formed and 3,000 performances over 40 days were held. “The dramas not only flayed the practice of female infanticide but also opposed practices like a son lighting the funeral pyre.” This awareness campaign combined with improved health care facilities including 24 hour health care delivery facilities resulted in female infanticide coming down to 64.

A Feisty Collector
The illegal extraction of sand whether from the sea or river poses grave environmental dangers and therefore what Jothi Nirmala, currently collector in Kanyakumari, did was daring as well as beneficial. Her fight against illegal sand quarrying and illicit arrack as a Revenue Divisional Officer in Padmanabhapuram Revenue Division, Kanyakumari district, back in 1995 fetched her the Kalpana Chawla Award – a citation, gold medal and cheque for Rs 5 lakhs – at the hands of CM Karunanidhi on Independence Day.

“It was just like in the movies. My team chased down country-made wooden boats carrying sand,” says Nirmala. Despite threats – in fact her response to threats was to carry out raids – Nirmala seized 175 boats and 250 lorries used to transport the sand. Her allies were also women, suffering at the hands of alcoholic husbands, who would tip her off about illicit brewing. “Sometimes they even helped me seize bombs and lethal weapons,” she says. Who says honest officials are not given recognition?