Abortion in Pandemic: Reality Check at the end of 2020

2020 was the Annus Horribilis. The COVID-19 pandemic shook the foundations of our world. When many world leaders equated the preparations to tackle the pandemic to a war footing and asked the public to make collective sacrifices, little did we all delve into those exaggerated declarations from the leaders to sift through and analyze how best are the leaders equipping their countries to tackle the pandemic. In the initial months of the pandemic, as different countries declared different timelines for total lockdown, there was little clarity about what is essential and not essential services. Amidst all the chaos, it came across as if the government expected that all bodily functions such as menstruation, pregnancy can all be on pause mode during the pandemic!

In India, in the first weeks of the lockdown when the whole country was brought to a standstill, when the busiest of the busy roads were as empty as a clear blue sky, when people would get out of their houses only to buy groceries and medicines, there were a group of outraged netizens and activists who brought to the leaders’ attention that basic menstrual hygiene products were not declared as essential goods! After numerous likes, shares, comments, retweets amplification in the net world, knocks on the government’s doors became so loud that eventually it was declared by the government that menstrual hygiene products are essential too! Meanwhile, numerous people in the country were being turned away from hospitals and clinics when they wanted an abortion during the lockdown. The reason for denying them abortion: not an essential service!

Well, war cry indeed, citizens, activists and NGOs made to have the abortion declared as an essential service and essential service thus it became, but how many in fact were able to get a safe and legal abortion during the lockdown and post lockdown, even though abortion was declared as an essential service?

As part of the Safe Abortion Action Fund (SAAF), in the initial weeks of the unlock in India, Hidden Pockets Collective did a tele-audit of hospitals and clinics in four districts of Karnataka viz Bengaluru Urban, Mysore, Shimoga and Ballari. We wanted to find out whether safe, legal and most importantly non-judgemental abortion especially for single women, continues to be out of bounds even during the pandemic when unplanned pregnancies are on the rise. The findings were worrisome.

With the year almost ending now, and more than 6 months have passed since the initial weeks of unlock, we set out for another round of tele-audit calls to see how have the access and availability of safe, legal and non-judgemental abortion improved/ restored in this time duration. The findings were a mixed bag!

Serial Abortionists!

Dr. A from a leading private hospital in Ballari, whom we had spoken to in the first round of tele-audits in June/ July, where she came across as very sympathetic to the challenges in accessing safe and legal termination of pregnancies and even agreed to provide MMA (Medically Managed Abortion) for single women under 7 weeks of gestation, was triggered this time when we used the word non-judgemental abortion! She blasted at us and said that she has been getting numerous cases in these last few months where women came to her for MMA pills and they keep coming back to her repeatedly, instead of taking contraceptives. She said these women are “serial abortionists” and she will not give non-judgemental abortion but give them an earful for not using contraceptives. To quote her further, “You want a non-judgemental abortion? Well, I will make sure I give these women a hard lesson when they come to me for abortion.”

When we reminded Dr. A how open and understanding she was when we last spoke to her, she said, “Agreed. But I will not want this hospital as a safe and non-judgemental space for women to get abortions. This is not a walk-in and walk-out space where they all can come, take the pill and have an abortion and keep coming back again and again.” 

At our repeated presentation of facts that the pandemic, especially the lockdown, has worsened many people’s access to contraceptives and many doctors are not helping them to get a safe and legal abortion and that  forces them to approach quacks, Dr. A had a pat reply: “These women are not dumb. They are smart enough to know where to get an abortion. If they were so worried about pregnancy, they should have made it a priority to use contraception.” She strongly said that she will not help women get an abortion and questioned us with, “Do you realize what is an abortion? It is killing a baby! You are baby killers!”

Dr. A was firm on her new stand that neither she nor the hospital that she works for will  give any abortion. As the last word she said, “If you need help and support to give women good guidance and counselling on contraceptives, they can come here. But I shall not be a party to give women abortion. They keep coming back here, again and again, with some silly excuses or the other for not taking contraceptives. I will make it a point to give them a good hearing henceforth so that they don’t come back here ever again for abortion.”

Pharmacies: the shortcut to abortion

Dr. B from a well reputed private hospital in Shimoga was far more approachable and less guarded since our last call. She said that women, married or unmarried can get a safe, legal and non-judgemental abortion at the hospital. Bracing for the second wave of the pandemic, she said that if the pregnancy is above 20 weeks, the concerned parties will need to move legally, that is through a notarized legal affidavit which needs to be filed in and abortion can proceed only through legal sanction. 

For unmarried women, she reiterated her statements from our earlier calls that it is best that her parents are involved. She again recounted numerous incidents as in the earlier calls, where women were abandoned by their male company or them creating scenes in the hospital. She also narrated a recent incident wherein a couple who were engaged to be married had come for an abortion and the fiancé had abandoned the woman. The hospital was left with no option but to inform her parents as consent was needed for surgical procedures.

When we posed the question that if women are not in a position to involve her parents, Dr B. answered that any female close relatives like a sister will be sufficient. We asked her that

even if that is not a possibility but an organization that works in SRHR is there as a patient bystander to take care of the woman, she said that is also okay, as long as the NGO is legal and the proof for registration etc are submitted when the woman needs legalized consent such as in the case of surgeries. She highlighted that the hospital has given abortion to unmarried women too in these past months, and all the hospital is aiming for by having these systems in place is that they want minimal trouble by preventing patient abandonment.

Dr. B shared with us a pattern she has seen emerge during these last few months. She said she has had numerous cases where single women self-administered medical abortion pills and developed complications in abortion. On asking these women where they got the medical abortion pills from they said that they procured it from the pharmacies. Dr. B said that perhaps these women found it difficult to approach a doctor to get abortion due to the cultural taboo, or could be that they wanted to cut the costs of medical expenses that they can incur when they get an abortion done through a doctor at a hospital. Whatever may the reason be, Dr. B said it is highly risky as women take these medical abortion pills without any medical supervision. She elaborated on various complicated cases she had to intervene because the women took the medications all wrong, sometimes even overdosing. She suggested that something needs to be done such that pharmacies do not continue dispensing medical abortion pills without medical supervision. In exasperation she explained how in the end, it is always the doctors like her, who have to handle the complications and save the women’s lives when such ill advised and non supervised usage of medical abortion pills occur.

The POCSO dilemmas and love:

Dr. C, a doctor at a government hospital in Mysore, whom we spoke to for the first time in our audits, came as a breath of fresh air. In our earlier audits in June/July we had no response from any government hospital in Mysore. However, in our December calls, we were finally able to have a breakthrough.

For Dr. C, conversations on safe, legal and non-judgemental abortion for women (single or married) were all irrelevant as she said the government hospital is the go-to place for any woman. What she wanted to bring to our notice was that in these last few months there were increasing cases of minors who had come to the hospital for abortion! She said, in many cases she was put in a difficult position due to specifics of certain cases such as two adolescents who are in love or just wanted to explore sexual matters, but she had to report the matter to the police according to the laws of the country, such as the Protection of Children from Sexual Offences (POCSO) Act. The problematic part of POCSO is that those adolescents who have had consensual sex, are in fact punishable! And to add more woe to the misery, the legal age of consent in the country is in fact 18. Dr. C opined that laws in the country should change to validate consensual sex amongst adolescents because she strongly felt that the adolescents suffer social stigma and ostracization all due to the punitive nature of the POCSO Act. 

Too hectic! Too busy?

The government hospitals in Bengaluru Urban, be it the referral hospitals or the maternity hospitals or the tertiary hospitals, must have had hectic days in these last few months because most of them still did not have responsive landlines. If at all the phone did get picked up, the receiver had no clue about abortion details that the hospital provided. And to talk to the doctor was just impossible as she/he was either in the O.T or in the ward rounds. Requests for the personal number of the doctors were met with the replies “not possible.”

Conclusion:

The second wave of infection is looming ahead. Vaccinations are planned to be rolled out on a priority basis as determined by the government. Questions are always remaining whether there will be another lockdown in the coming months, whether it will just be a night curfew. Whatever may the events be, one thing that needs to be planned well ahead of time by the government who constantly espouses war footing to tackle the pandemic is: women should have access to a safe, legal and non-judgemental abortion because abortion is a time sensitive matter. 

Writer:

Dr. Nishitha Aysha Ashraf is Programme Associate for SAAF Project at the Hidden Pockets Collective. She completed her B.A. Journalism & Communication (2010) and Bachelor of Dental Surgery (2015) from Manipal, Karnataka. She has covered the Nipah outbreak in Kerala during her stint as Health Reporter with The News Minute (2018). The reportage furthered her interest to be a key player in public health/ community health. Her internship and work at SOCHARA – Society for Community Health Awareness, Research and Action (2019) was instrumental to learn more about the People’s Health Movement. She is keen on exploring the SRHR issues of Kerala, especially those amongst the Muslim and Christian communities.

Adolescent Sexuality: the Age of Raging Hormones and Punishments?

Alice* was 17 years old when she discovered that she was pregnant. She was in a steady relationship and had a sexual relationship with her boyfriend. Pregnancy was the least bit of concern for Alice and her guy amidst their day to day lives of being a teenager. However, on discovering the pregnancy, both their worlds came crashing down. Alice plucked up the courage and went to a government hospital to get advice on terminating the unwanted pregnancy. She only had her best female friend, who was also 17 years old, to accompany and support her.

Chaithra* was just a few weeks short of turning 18 years old. When she discovered that she is pregnant, she did not wait for weeks to turn 18 and then get medical help. She immediately reached out to a well reputed clinic that provides medical and surgical termination of pregnancies. They did not ask for her ID proof and she had covered up the fact that she was still not yet a major. However, within a few days, her parents confronted the organization and accused the doctor of influencing their daughter -a minor- to get an abortion. The organization now makes it mandatory to show ID proof to get abortion services.

Love, Sex and Adolescence:

Every person who has passed through adolescence knows that those years are not just about the vanity of wanting to look good, but also years of wanting to get noticed, to be admired and  to be loved. A sneaked love letter or a Priya Warrier style wink from an admirer can get hearts racing during those giddy years of adolescence. The boring school lectures are a quality time to daydream about a future where you and your love interest are romancing away like the hero and heroine of the latest movie you had watched. Everything goes well until you get hit by a chalk piece thrown at you by the teacher. Everything goes well until your parents discover that you are in a relationship with a person they do not approve of. Everything goes well until you discover your partner or you are pregnant.

The Adult World & Adolescence:

India has numerous laws in place to ensure that harsh punishments are meted out to perpetrators of violence, sexual offences against children including the adolescents. What many of these laws, especially the Protection of Children from Sexual Offences (POCSO) Act, does not take into account is the agency of a child or an adolescent. Matters like consent, sexuality are clearly matters of adults and strictly adults alone, as apparent in these laws. It seems adolescents are living in a bubble wrap and only when they hit the golden number of 18, they emerge as a person capable of giving consent, taking consent and having a sexual life. Till then their bodies and minds are oblivious to sexuality! At least that is the impression given by all these existing laws which clearly does not acknowledge adolescent sexuality.

SOS messages to Hidden Pockets Careline:

Careline services run by the Hidden Pockets is the first ever Whatsapp counselling service in India for the youth on Sexual and Reproductive Health and Rights. Occasionally, the Careline do get cases where a distressed adolescent is seeking help to know about abortion and where to get an abortion. However, with the POCSO Act in place, Hidden Pockets hands are tied down to offer any direct help. In these cases, the viable solution for Hidden Pockets is to connect the adolescent to a network of NGOs working exclusively for adolescents. 

Aisha Lovely George, Executive Coordinator and Sexual and Reproductive health Counsellor at Hidden Pockets, who is also an Enfold India certified peer educator, says, “All the adolescents who have reached out to the Careline were very scared about the situation they were in. In their anguished frame of mind, they can get very guarded about giving any details, even about the SRHR crisis they are in.”

The usual portrayal of adolescents being irresponsible, careless and/or naive and ignorant do not go well with Aisha. Based on her extensive work with adolescents, she holds the opinion that adolescents are far more responsible than what the adult world can give them the credit for. She points to the fact that even adults who are in their 20’s and 30’s are very uncomfortable in approaching Hidden Pockets and healthcare service providers for an abortion, but adolescents pick up the courage and approach the necessary authorities for intervention, even at the cost of getting entangled in the POCSO initiated by the doctors who handle their cases.

“It takes time and patience to earn their trust. And only after they strongly feel that we are trustworthy, they open up to us. And once they open up, it’s a downpour!” says Aisha. She strongly feels that these adolescents were dying to talk to someone to unburden themselves of the stress they were in. And at Hidden Pockets, these adolescents are given an empathetic and non-judgemental ear. But the help ends there as Hidden Pockets can intervene directly only for adults.

Adolescents and the big big world of internet:

Hidden Pockets and Hidden Pockets Collective, both heavily use technology to make information on sexual and reproductive health, relevant and relatable to the youth. While Hidden Pockets Collective focuses on advocacy works, Hidden Pockets works as a constant presence to help the youth in accessing safe, legal, affordable and non-judgemental healthcare services on sexual and reproductive health.

The social media platforms and emails are the portals through which the youth make their first contact with Hidden Pockets. Athira Purushothaman, Digital Advocacy Manager at Hidden Pockets says, “the adolescents are very much worried about their privacy.” She explains that the taboos and cultural disapprovals which are associated with anything sexual about adolescents in our country, make them feel that they are always at risk of being discovered and humiliated. It is only because of the fact that Hidden Pockets is a safe space, and respects their autonomy and privacy that they come to Hidden Pockets in a large number. “Irrespective of the courage they have shown in taking charge of their sexual and reproductive health, they always say that they have done something wrong by being sexual,” notes Athira based on her interactions with the adolescents on digital platforms.

Jasmine Lovely George, Founder, Co-ordinator of Knowledge Production at Hidden Pockets Collective, says, “adolescents do not trust the state. When they come to Hidden Pockets instead of the state, it is very loud and clear that something is not right with the state.” Stressing on the problematic POCSO, Jasmine elaborates that an adolescent girl who is outside the parental approval of her own sexuality becomes in fact the subject of the state!

The world of the internet is often the safe space for the adolescents to feel connected, heard and supported. In an offline world where they can be judged and made to feel lesser, it is the social media platforms that offer comfort and solace. Also with search engines, churning out information on things that they want to know, adolescents who have access to technology, are far adept in understanding sexuality. However, the flip side of these is that not all adolescents can discern what is right and what is wrong in the sea of net information. Also, not all adolescents are safe from lurking sexual predators in the net world.

Athira says, “Alternative approaches, such as age verification, which is as strict as getting a Voter ID card, are very much needed in the tech spaces to prevent the adolescents from entering certain online spaces or accessing certain information.” She, however, maintains that no adolescents should be barred from the larger ecosystem of the internet as they rely heavily on tech to empower themselves through the diverse support networks. 

Laws to Protect or to Punish?

At the Karnataka consultation on ‘Rights Based Approach to Child Marriage’, co-organized by CLPR (Centre of Law and Policy Research) and CPR (Centre for Reproductive Rights), on March 9, 2019, there were first hand accounts from people and organizations that work for adolescents. From the anecdotes shared, it was clear that laws which came into existence with an intent to protect the adolescents are in fact punishing the adolescents, irrespective of the contexts.

POCSO being misused

Ashika Shetty (Enfold, CWC member) brought to light how POCSO can be misused to settle personal scores between families. She narrated an incident where a family pressed charges against a 21-year-old man for sexually assaulting their daughter. It later emerged that both the young man and the girl were in love and looking forward to getting married when the girl turns 18. However, her parents did not approve of their relationship as he belonged to a lower caste and disliked his family. And thus they manipulated the POCSO law to put the man behind the bars.

Naivety and law

K. Raghavendra Bhat (UNICEF Child Protection Project) narrated an incident which showed how the Prohibition of Child Marriage (PCMA) Act and the Protection of Children from Sexual Offences (POCSO) Act can act against naive people who are not aware of the laws and who only had best interests of their children when they solemnised the marriage. A couple with their respective parents from a North Karnataka village visited the Udupi Krishna temple to pray for the health and well being of their expecting first born. The pregnant wife developed some health problems and she was hospitalized. The doctor on taking case history realized the woman was only 17 and he alerted the police. Soon the police and the associated officers for child rights and welfare got involved. The parents of both the couple were at a loss for words and all they could do was break down in helplessness. The couple too were at their wit’s end with all the sudden influx of law and order in their otherwise blissful marital life. The officer narrated how it was a complex spot for him to be in, as none of the parties involved had no clue about the various laws and all they wanted was a happily married life.

Are Laws Alone the Way Forward?

Jasmine points to the inconsistencies in the state’s approach to adolescent sexuality. 

Rashtriya Kishor Swasthya Karyakram (RKSK) launched by the Ministry of Health and Family Welfare has provisions for adolescents to get help from the Adolescent Reproductive Sexual Health (ARSH) Clinic. The ARSH provides counselling on sexual & reproductive health issues. However, the state does not have any definitive law that validates adolescent sexuality. Under the existing laws, an adolescent can be prosecuted for having any sexual act, be it a mere kissing or  sexual intercourse, with another adolescent, irrespective of them both engaging in it consensually. 

The evolving capacities of adolescents and their autonomy have little value under the existing laws. Consensual sexual activities/ sexual exploration of adolescents can turn around and be treated as matters of prosecution. The punitive nature of the laws refuses to treat adolescents as juveniles in conflict with the law. 

Aisha suggests, “POCSO is valuable when really an adolescent is sexually exploited. They need to be made aware that such laws exist so that they know whom to approach for help when they are sexually abused. However, an overarching application of the law will only deter the adolescents from getting the right information, advice and help for their sexual and reproductive health.”

Jasmine says, “The laws governing juvenile justice are far more progressive than POCSO and such an approach is needed when it comes to adolescents.” She strongly believes that restorative justice and not punitive measures should be the way forward. The existing laws such as POCSO do not take into account the scarring and trauma that an adolescent undergoes due to its punitive nature. And the reality is that adolescents can be in love, can have sexual exploration, and can even elope. 

At Hidden Pockets and Hidden Pockets Collective, all the team members stress the need to have Comprehensive Sex Education (CSE), not just for adolescents but also for parents to dismantle cultural taboos, shame and honour. The team also believes that this education should also expand to the training of lawyers and judges such that they understand the contemporary nuances of adolescent sexuality and technology. As for consent, the discussions at the policy and advocacy levels should not just be about the age of consent, but also what it means to give consent and what it means to take consent. 

*names changed to protect the privacy

Writer:

Dr. Nishitha Aysha Ashraf is Programme Associate for SAAF Project at the Hidden Pockets Collective. She completed her B.A. Journalism & Communication (2010) and Bachelor of Dental Surgery (2015) from Manipal, Karnataka. She has covered the Nipah outbreak in Kerala during her stint as Health Reporter with The News Minute (2018). The reportage furthered her interest to be a key player in public health/ community health. Her internship and work at SOCHARA – Society for Community Health Awareness, Research and Action (2019) was instrumental to learn more about the People’s Health Movement. She is keen on exploring the SRHR issues of Kerala, especially those amongst the Muslim and Christian communities.

Gendered Violence: Not Your “Circus”? Not Your “Monkeys”?

For many, gendered violence is a shocking story that they read in newspapers, a gut wrenching event that they watched in a documentary, a disturbing clip that is widely shared on platforms like Facebook. Many get affected by what they read and what they see, there is anger, sadness that how can this continue to happen even in these times when there is police, law, court whom all work to ensure that justice is delivered and help is rendered. And there are of course a few who just are not affected by any of these, choose to deal with these realities as “not my business”, “who cares”, “not my circus, not my monkeys.” Unless and until the lived realities of gendered violence are theirs, then alone perhaps can they grasp what is it like to feel powerless, what is it like to feel violated, what is it like to feel helpless. But what if the very same systems established by democracy to ensure protection and justice to all, are the ones who are doing this “not my circus, not my monkeys” act, especially when they are called upon to discharge their duties and responsibilities?

Brinda Adige, Volunteer Mentor at Global Concerns India (GCI), shared a harrowing experience with us. Mind you, this is not one isolated story but a recurrent event that merely changes form in various crises which Brinda has intervened to help.

Brinda got a call from a distressed woman Saritha*. Saritha, 5 months pregnant and HIV+, was thrown out of a house cohabited by her partner. This incident happened during the peak of the nationwide lockdown when nobody dared to step out of the house except to buy essentials. Saritha in shock had no clue what to do. She had no money, no place and no friends to call for help. Feeling utterly helpless and in shock, she walked aimlessly until she was worn out. She rested at a bus stop. Many hours had passed since she had last had any food for water and her pregnant state only made her feel all the more exhausted after the walk in the scorching heat of summer. As the last resort, she called the helpline for women set up at the Police Commissioner’s Office but received no response.

The sheer desperate state that she was in, prompted her to think of any possible way that she can get help. She remembered about the Global Concern India’s workshop she had attended and promptly dialed the saved number.

Brinda on receiving the call and grasping what Saritha’s situation is, sprung into action. She connected with a friend who took food and water to Saritha. Saritha was also instructed to keep trying 181 meanwhile. However, there was no response from 181.

Brinda also kept at 181 and finally had a breakthrough. But she was in for a rude shock as the staff who handled the call was not keen to help but give some cursory and dismissive instructions. Brinda requested them to send the rescue vehicle to Saritha and rehabilitate her to a shelter. The policewoman insisted that Brinda tell her every detail like name, address, telephone number and then alone can the police accept this reporting and do the needful. 

Many hours had passed and still no help had come to Saritha from the police. Brinda tried 181 over and over but no response was there from their end. Brinda reached out to DWCD and they promised to attend to Saritha. Time running out and night setting in and still no sight of police or DWCD reaching Saritha, Brinda was forced to call ACS. Two hours later, Saritha was picked up from the bus stop and taken to a shelter. 

Saritha is recuperating now. But she has not filed any case against her partner. As for the police staff/ helpline, no action has been taken against them for the negligence of duty. 

You might want to think this is an isolated incident, and that there are numerous cases of affirmative action from the law and order system. As part of the #16DaysOfActivism #orangetheworld campaign Hidden Pockets Collective, has been curating stories of gendered violence. And the lived realities of those who shared their stories with us show it was not the law nor the police who helped them but the alternatives set up by civil society organizations and communities. A Tweetathon  was held recently, in partnership with Youth Advocacy Network- Sri Lanka, YUWA- Nepal, Aahung- Pakistan, Global Concerns India, Rural Women’s Right Structure-Liberia, One Future Collective-India, DUKINGIRE ISI YACU- Burundi and Lend A Voice Africa, to address the gendered violence and have knowledge exchange on alternative solutions. The Tweetathon also saw active participation from activists who have been working to end gendered violence

At Hidden Pockets Collective, we never turned away anyone who reached out to us for help. If the case fell under domestic violence, we connected them to the organizations working exclusively on the matter. Many women had also reached out to us when they had no access to get medical termination of pregnancy. A consequence of intimate partner violence is unintended pregnancies. Amidst all the agonies of surviving through the violence, they also face the challenge of accessing safe and legal termination of pregnancies. We, as well as many organizations in our network, stepped up to provide alternate solutions for gendered violence during this pandemic. 

Gendered violence has emerged as the shadow pandemic during this COVID-19 pandemic. When there was vagueness or breakdown of health services, essential services, support systems, carelines, shelters, and more importantly the certainties about financial and social security of a person, all hell broke loose and gendered violence was at its peak in 2020. What we have realized through our work with the youth and partner organizations is that alternatives are the way forward. It is pointless to bank upon the mainstream, established systems for solutions. For them, you-me- all of us, are “not their circus, not their monkeys.”

Writer: 

Dr. Nishitha Aysha Ashraf is Programme Associate for SAAF Project at Hidden Pockets Collective. She completed her B.A. Journalism & Communication (2010) and Bachelor of Dental Surgery (2015) from Manipal, Karnataka. She has covered the Nipah outbreak in Kerala during her stint as Health Reporter with The News Minute (2018). The reportage furthered her interest to be a key player in public health/ community health. Her internship and work at SOCHARA – Society for Community Health Awareness, Research and Action (2019) was instrumental to learn more about the People’s Health Movement. She is keen on exploring the SRHR issues of Kerala, especially those amongst the Muslim and Christian communities.

Podcast: What is pleasure for you – Tanzila Khan

Has anyone ever asked you what is pleasure for you? Tanzila Khan gets personal with Aisha Lovely George and shares her stories on this podcast. She tries to reclaim the word “pleasure ” from the sexual connotation. For her it’s success. Tanzila discusses her idea of body, idea of sexual fantasy and what all can be done with it.

Can you get pleasure without a partner? Is it possible to have conversations about it without sex? Can it be about food? What all options do we have? Does sex restricts the idea of pleasure for some groups? Can woman talk about pleasure? Is there a guilt element that prevents women from engaging with the idea of sex? Is there a class angle, can it only be enjoyed by people from certain class? Do we all long for pleasure?

These are some of the questions with which Tanzila in this podcast asks us to expand our understanding of pleasure. A woman with disability tries to take back the idea of pleasure and fight for it.

Financial inclusion for the disabled in India: demonetisation and beyond #makeyourcityinclusive

In the life of a disabled bank employee on the day of the demonetisation

Prem Kumar*, 55 years old, disabled bank clerk with polio, Central Office of a nationalised bank in Chennai

  • November 9, 2016, 9.30AM: Prem Kumar has Rs. 70 in his wallet enough to take him to his office by auto-rickshaw. He always withdraws only Rs. 400, never Rs. 500 or 1000 because auto drivers don’t give change.
  • 10.00AM: Prem Kumar tries to withdraw cash from the ATM in his office. The ATM is out of service.
  • 10.30AM: Prem Kumar asks his office messenger to get him cash from the bank branch next door.
  • 11.00AM: After accepting the cheque, the messenger is asked to come later to collect the cash. Cashier in the branch serves the customers first, setting aside Kumar, a colleague’s cheque.
  • 1.00PM: Prem Kumar goes back to the ATM on the ground floor during lunch break to withdraw cash. The queue is long. Unable to stand for too long, he goes back to his office to come back later.
  • 3.30PM: Kumar goes down again from his desk on the fourth floor to the ATM. The ATM door has a notice that reads, NO CASH.
  • 5:00PM: Prem Kumar’s regular auto driver comes to pick him up from the office. Kumar boards the auto without cash. Being a regular customer, the auto driver gives him a day’s credit.
  • 6:00PM: Cashier issues the cash to the messenger.
  • November 10, 2016, 10:00 AM: Prem Kumar arrives at the office in an auto, collects cash from the messenger and pays the auto driver.

Being a disabled clerk in a nationalised bank, Prem Kumar considers himself to be among the most privileged. Most other disabled citizens of India didn’t think on the days following the announcement of demonetisation. Narendra Modi, the Prime Minister of India announced the demonetisation on November 8, 2016 while the announcement for separate queues for senior citizens and the disabled was made only on November 14, 2016.

“My friend in rural West Bengal, had to go to a bank for three consecutive days along with an escort to withdraw cash. He is visually impaired,” says Anirban Mukherjee, Executive Member of the National Platform for the Rights of the Disabled (NPRD), Kolkata. “This has hit us pretty hard. Even in Kolkata, our friends are having problems. Getting the notes exchanged is also a very difficult thing. We have to fill in forms which cannot be managed without assistance. Standing in a long queue with someone escorting you, it actually becomes pretty precarious,” he adds.

Reserve Bank of India regulations to make banking accessible

In 2007, India ratified the UN Disability Convention. This Convention provides that states that ratify it should enact laws and measures to improve the rights of the disabled and also abolish laws, regulations and practices that discriminate against the disabled. Following this, the Reserve Bank of India (RBI) passed its circular in November 2007 regarding people with autism, mental retardation and other conditions while in June 2008, it passed the circular addressing the problems faced by the visually impaired customers. Subsequently, there have been multiple rounds of changes in the standards set by the RBI to improve banking access to persons with disability. This includes opening and operating accounts, ATM access for the visually impaired and physically disabled, accessible websites, ramps in ATMs and banks, among others.

Talking ATMs for the visually impaired have also been launched by several banks across India. According to TalkingATMIndia.org, as of March 31, 2016, there are 9753 talking ATMs in the country. This includes Union Bank of India (1650+ talking ATMs), Citibank (106), Bank of Baroda (167), State Bank of India and associated banks (2882), HSBC (65), Deutsch Bank (32), Corporation Bank (2), Standard Chartered Bank of India (231) and Kashi Gomti Samyut Gramin Bank.

The accessibility gap continues

Even with regulations and policies, the problems seem to continue. Being visually impaired, Anirban Mukherjee notes that it is hard to find banks that are friendly to people with disability. “This is a general statement, not just with respect to the demonetisation. If there are banks which are disabled friendly then it is purely an exception and an accident. Locating an ATM is also very difficult,” he adds.

While TalkingATMIndia.org is one platform that provides access to this information, access to information about these accessible ATMs still seems to be a big concern. This information should be available on the bank’s website.However, a website audit of nationalised banks’ websites conducted by Maxability shows that all the top ten nationalised banks have accessibility violations on their website.

Gets worse with disabled women, and disabled in the rural areas

Disabled women and others with disability in the rural areas face higher ordeals with respect to demonetisation and access to any financial services even otherwise. “Women with disability have even lesser access to services especially financial services. They find it difficult to even come out without a family member’s support. They will not be allowed to even open a bank account because the family wouldn’t think that she is productive enough or see that she would need a bank account for her personal expenses. They have a derogatory attitude towards women with disability. That is the attitudinal problem,” notes Shampa Sengupta from Sruti Disability Rights Centre.

There is also the infrastructural problem. Having worked in the field of disability rights for over twenty five years, Sengupta notes that a very large percentage of disabled people do not have bank account or even a disability certificate. ID proof like Aadhar card is often denied to them. Even getting a disability certificate is difficult for most of them considering that it requires a valid address and ID proof. “ID and address proof is not available with a large number of people with whom we work with in the community. This is not an issue for disabled people from the affluent class. But majority of them come from poor families,” adds Sengupta.

Proof of address becomes a problem for them because they live in pukka houses. Therefore, opening a bank account meeting the KYC (Know Your Customer) norms which requires a valid address and ID proof is not possible. The situation has gotten worse with demonetisation considering that most of them work in the informal sectors and get paid in cash. Most of them have a monthly family income of around Rs. 5000. Those paid with five hundred rupee notes are finding it hard to get them exchanged. Though public spaces like petrol bunks are supposed to accept the old notes, many of them take a commission in the money exchanged if exchanged without filling petrol. This makes the situation of the disabled from with lower income far worse than the rest.

The gap is real!

Reserve bank of India may have passed circulars to make financial services inclusive, may be even mandated a separate queue for the disabled. And the current demonetisation happening in the country might have brought much of the black money to light. That said, its impact on those not included in the system is far higher. The question is will the government pay the price for the cost on the lives of these affected citizens or will people continue to be the ones to bear the weight?

*Name changed for reasons of anonymity

Do people living with HIV have a right to protect their health data?

“Consequently, as new cases brought new issues and problems before the Court, the content of the right to privacy has found elaboration in these diverse contexts. These would include telephone tapping (PUCL), prior restraints on publication of material on a death row convict (Rajagopal), inspection and search of confidential documents involving the banker – customer relationship (Canara Bank), disclosure of HIV status (Mr X v Hospital Z), food preferences and animal slaughter (HinsaVirodhakSangh), medical termination of pregnancy (SuchitaSrivastava), scientific tests in criminal investigation (Selvi), disclosure of bank accounts held overseas (Ram Jethmalani) and the right of transgenders (NALSA). Early cases dealt with police regulations authorising intrusions on liberty, such as surveillance. As Indian society has evolved, the assertion of the right to privacy has been considered by this Court in varying contexts replicating the choices and autonomy of the individual citizen.” – Supreme Court, Justice K.S. Puttuswamy and ANR. Vs. Union of India (2017)

The recent historic Supreme Court judgement that declared right to privacy as a fundamental right (guaranteed under Article 21 of the Indian Constitution) with reasonable restrictions,has looked at the intersection of privacy and medical jurisprudence in cases previously dealt with by the Supreme Court of India. Interestingly, this intersection has also included HIV and the right to privacy.

Existing challenges faced by HIV High-risk groups:

This judgement becomes especially more relevant for the members of high-risk groups living with HIV. National AIDS Control Organisation (NACO) classifies Female Sex Workers (FSW), Men who have sex with men (MSM), Transgenders (TG), Injecting Drug Users (IDU) and Truckers & Migrants as the high-risk groups most susceptible to HIV. It is worth noting that members from these groups are required to fill-out group specific application forms prescribed by NACO while testing for HIV. Though the National AIDS Control Programme is in Phase IV, these high-risks groups have been facing various degrees of challenges.

Apart from social prejudice, transgender community faces issues with valid identification document due to their gender identity. Often the gender and name on their official identification documents is different from the name and gender that they identity. Though the NALSA judgement 2014 gave them the right to their gender identity, procuring valid identification documents continues to be a challenge for the community. It is worth noting that Section 377 of the Indian Penal Code criminalizes the act of homosexual intercourse.This could apply to both MSM and transgenders. Due to the social stigma associated with their identity, it becomes significantly difficult for members of the transgender group, MSM and sex workers to reveal their identity in HIV testing centres, notes PawanDhall, Gender and Sexuality activist, Varta Trust and ex-Country Director, SAATHII. There is also the challenge of negligence from the hospital or testing centre staff with respect to revealing their identity or HIV status.

“No matter how much we say or NACO says why is that a lot of people ever want to go for a test on their own? It is because of their confidentiality being compromised. There have been so many examples of people saying that the problem begins once the counsellor sends the person to the lab technician for the test. You will give your blood and go back home. If your test is positive on the day you come back you are almost at the mercy of the lab technician or the counsellor. If their mind is not in the right place, they will talk about it out loud and people all around will come to know,” notes Dhall.

Aadhaar integration for HIV programme and the issues:

The government intends to establish integrated health information architecture to strengthen health surveillance, establish registries for diseases of public health importance by 2020.National Health Policy 2017 suggests exploring the use of Aadhaar for identification with heavy emphasis of privatization of healthcare in the country. Hence NACO’s website mentions initiating a project to link all PLHIV (People Living with HIV) to the Aadhaar card. It is not clear though if it has been mandatory.

However, it appears that some states (Madhya Pradesh andRajasthan)have mandated this linkage even with the Supreme Court saying that it is not mandatory to link Aadhaar. Though Aadhaar integration was expected to solve the issue of duplication of enrolment at ART centres for HIV treatment, it on the other hand, seems to have aggravated the situation. Patients have been avoiding registration with Anti-Retiroviral Therapy (ART) centres for treatment in Madhya Pradesh since this integration, notes Hindustan Times. Speaking to the India Express, about a 37 year-old sex worker diagnosed with HIV in Mumbai, PoojaWalawalkar, project manager for NGO Aditi says, “She fears that her neighbours will come to know if after linking the Aadhaar card some health worker turns up at their door.” The report also states that several sex workers get treated under a different name to conceal their identity. It is worth noting that presently (NACO Annual Report 2016-17), FSW (6,03,236), MSM (2,06,007), IDU (1,21,840), TG (29,325), Migrant (29,25,882) and Trucker (9,29,675) are under the Targeted Intervention Programme of NACO that works on preventive interventions for high-risk groups. Aadhaar linkage also aims at reducing the ‘Lost to Follow-Up’ cases who have dropped out of the ART centres and discontinued their HIV treatment.

“Aadhaar will definitely help you have unique listing but how that in itself will help in making sure that the person comes back again and again to get the medicines, that I’m not quite convinced,” notes Dhall.

Apart from privacy, there is the risk of exclusion due to authentication failures and deactivation of Aadhaar without recourse for the Aadhaar holder. So there seems to be no guarantee with respect to reaching out all that the programme is intended for.

It is worth noting that when a crime related to personal data occurs, UIDAI is not under any legal obligation to inform the Aadhaar user. Under Section 47 (1) of the Aadhaar Act, only UIDAI has the exclusive power to make complaints in case of violation of privacy or data breach.

What will change with Right to Privacy judgement?

Even prior to mandating Aadhaar, people living with HIV have been facing social stigma when their HIV status has been revealed. What is the protection assured to them against harassment, once their Aadhaar biometrics and phone numbers are also entered into the system to access healthcare? While there may be legal protection by way of the HIV Act, Medical Code of Conduct, Supreme Court’s judgement declaring right to privacy as a fundamental right, will that 37 year-old sex worker understand her legal and fundamental right to privacy as a citizen? Will the knowledge of the right to privacy be sufficient to handle the social stigma?

Addressing this concern, in its right to privacy judgement, the Supreme Court states that “elements of privacy also arise in varying contexts from the other facets of freedom and dignity recognised and guaranteed by the fundamental rights contained in Part III;”

“In State Vs Kharak Singh, the Supreme Court says right to life does not mean a mere animal existence, which means a life of dignity. In the event of intentional or unintentional disclosure of my HIV status or any other status, which might strip me of my dignity in the eyes of the society , no amount of punishment to the persecutor or compensation to me can bring that dignity back to my life for the rest of my life. This is where the state, even before saying that it should punish and compensate must put into place the process such that the citizens of India are not stripped of their dignity,” says Kaushik Gupta, lawyer and social activist explaining the impact of any breach of privacy at a personal level of any individual.

However, the consequence of the right to privacy judgement with respect to the impending Aadhaar case in the Supreme Court of India is yet to be seen. The right to privacy judgement has however taken cognizance of informational privacy especially with respect to sensitive data. It says:

“Informational privacy is a facet of the right to privacy. The dangers to privacy in an age of information can originate not only from the state but from non-state actors as well. We recommend to the Union Government the need to examine and put into place a robust regime for data protection. The creation of such a regime requires a careful and sensitive balance between individual interests and legitimate concerns of the state. The legitimate aims of the state would include for instance protecting national security, preventing and investigating crime, encouraging innovation and the spread of knowledge, and preventing the dissipation of social welfare benefits. These are matters of policy to be considered by the Union government while designing a carefully structured regime for the protection of the data. Since the Union government has informed the Court that it has constituted a Committee chaired by Hon’ble Shri Justice B N Srikrishna, former Judge of this Court, for that purpose, the matter shall be dealt with appropriately by the Union government having due regard to what has been set out in this judgment.”

However, the onus now rests on the Committee chaired by Shri Justice B N Srikrishna and the Government of India to protect the interests of the citizens. The impending petition challenging the Government’s move to make Aadhaar mandatory for social welfare schemes in the Supreme Court will be a defining judgement for the rights of Indian citizens.

Cracking HIV and COVID-19 code

I am living with HIV, how might I forestall COVID-19? This is rising stress during COVID-19 dread.

Individuals living with HIV who have not achieved viral suppression through antiretroviral treatment may have a compromised immune system that leaves them vulnerable to opportunistic infections and further disease progression. At present, there is no evidence to suggest that there is an increased risk of infection, though this can rapidly change as the virus spreads.

The guidance for individuals living with HIV is the same as for everybody. On the off chance that you are feeling unwell – you have a persevering dry cough and a temperature – remain at home and call your wellbeing specialist. They will have the option to educate you regarding the following stages. During this time, make sure you avoid close contact with others.

Tips on COVID-19 for individuals living with HIV
  • Try to stock-up on your antiretroviral treatment for at least 30 days.
  • Ensure your immunisations are up to date (influenza and pneumococcal vaccines).
  • Make sure you know how to get in touch with your health care facility and that you have a plan in place if you feel unwell and need to stay at home.
  • Make sure you are eating well, exercising as best you can (at home), and looking after your mental health.
  • If staying indoors is difficult for you, keeping in touch with people remotely, such as online, by phone or by video chat, can help you with staying socially associated and intellectually sound.
  • Keep an eye on advice from WHOPublic Health Department, and your doctor.
Can antiretroviral be used to prevent infection with the virus that causes COVID-19?

After conducting two studies, one of the studies suggested that the occurrence of MERS-CoV infection was lower among health workers receiving LPV/r (lopinavir boosted with ritonavir) compared to those who did not receive any drugs; the other study found no cases of SARS-CoV infection among 19 PLHIV hospitalized in the same ward of SARS patients, of whom 11 were on antiretroviral therapy. Again, the certainty of the evidence is very low due to the small sample size, variability in drugs provided, and uncertainty regarding the intensity of exposure. Several randomized trials are planned to assess the safety and efficacy of using antiretroviral drugs – mainly LPV/r – for treating COVID-19, in combination with other drugs. Results are expected from mid-2020 onwards.

Currently, there is insufficient data to assess the effectiveness of LPV/r or other antivirals for treating COVID-19.

Again, as part of WHO’s response to the outbreak, the WHO R&D Blueprint [8] has been activated to accelerate the evaluation of diagnostics, vaccines, and therapeutics for this novel coronavirus. WHO has also designed a set of procedures to assess the performance, quality, and safety of medical technologies during emergency situations.

If countries use antiretroviral for COVID-19, are there concerns about treatment shortages for individuals living with HIV?

If LPV/r is to be used for the treatment of COVID-19, a plan should be in place to ensure there is adequate and continuous supply to cover the needs of all individuals already using LPV/r and those who will need to begin treatment. However, a relatively small proportion of individuals living with HIV are on regimens which include LPV/r, since it is used as a second-line regimen according to WHO’s HIV treatment guidelines. Any country that allows the use of HIV medicines for the treatment of COVID-19 must ensure that an adequate and sustainable supply is in place.

Stigma, Discrimination, and Human rights

People need to realize that the coronavirus can infect any human being, but it seems to have spread a more venomous infection into certain minds dealing with racism and stereotyping. It can put everyone at risk. Many people could counterfeit not to have the infection in view of being terrified of being named as “the one with the Coronavirus”.

We all have the responsibility to correct the misconceptions.

Source:

a) https://www.avert.org/coronavirus/covid19-HIV

b) https://www.who.int/news-room/q-a-detail/q-a-on-covid-19-hiv-and-antiretrovirals

भारत में मेडिकल गर्भसमापन के लिए प्रक्रिया और लागत क्या है?

क्या हमें भारत में चिकित्सा गर्भसमापन के लिए ज्यादा पैसे का भुगतान करना होगा?

भारत में गर्भावस्था की चिकित्सय समाप्ति सिर्फ कुछ शर्तों के तहत कानूनी है जिसकी अनुमति किसी पंजीकृत मेडिकल प्रैक्टिशनर द्वारा दी गयी हो। गर्भसमापन की प्रक्रिया को समझना हमारे लिए महत्वपूर्ण है।

गर्भसमापन या जो मेडिकल टर्मिनेशन ऑफ प्रेगनेंसी (एम0टी0पी0) के रूप में भी जाना जाता है के लिये महिला को एक सहमति फॉर्म भरने की आवश्यकता होती है जिसे ‘फॉर्म‘ सी कहा जाता है। चिकित्सीय गर्भसमापन करने के लिए केवल महिला की सहमति आवश्यक है।

गर्भसमापन के लिए दवाएं एक स्त्री रोग विशेषज्ञ द्वारा लिखी जानी चाहिए।

महिला को एक दवा किट प्रदान की जाती है जिसमें मिफेप्रिस्टोन और मिसोप्रोस्टोल होता है। ये दवाएं पहले 8 हफ्तों ( पहली तिमाही में गर्भसमापन ) में सबसे अधिक सहायक होती हैं। डॉक्टर ठीक से समझाता है कि इन दवाओं का उपयोग कैसे किया जाए क्योंकि इन दवाओं को उचित तरीके से और डॉक्टर के मार्गदर्शन में लेना जरूरी है

नोटः डॉक्टर व्यक्ति को ठीक से जाँच करेगा,

गर्भावस्था की स्थिति की जाँच करेगा और फिर यह तय करेगा कि क्या करने की आवश्यकता है और उस व्यक्ति के लिये सबसे अच्छा क्या रहेगा। कुछ मामलों में सर्जिकल गर्भसमापन की आवश्यकता होगी (12 सप्ताह से पहले)। गर्भसमापन की प्रक्रिया अलग अलग व्यक्तियों पर निर्भर करती है।

प्रक्रियाः गोलियां लेने के लिए कदम गर्भसमापन की चिकित्सा प्रक्रिया

दिन 1ः मिफेप्रिस्टोन की एक 200 मिलीग्राम की गोली ली जाती है यह दवा गर्भावस्था को बढ़ने से रोकती है। मिफेप्रिस्टोन लेने के बाद कुछ लोगों को मिचली आने लगती है या खून बहने लगता है, लेकिन यह आम नहीं

है। संक्रमण को रोकने के लिए आपका डॉक्टर आपको एंटीबायोटिक भी दे सकता है। दिन 3 (24 से 48 घंटों के बीच)ः 200 मिलीग्राम की मिसोप्रोस्टोल गोलियां (कुल 800 एमसीजी) मौखिक या योनि रूप से दी जाती हैं।

गर्भसमापन की लागत/कुल खर्चा हमें ़918861713567 पर  whatsapp करें। यदि आपको अभी भी स्पष्ठ नहीं है, तो  कृपया हमें निजी सहायता के लिए व्हाट्सएप करें। यदि आप निजी अस्पताल से गर्भसमापन करवा रहे हैं तो कुल खर्चा 6 हजार से अधिक नहीं होना चाहिए। यदि आप सरकारी स्वास्थ्य क्लीनिकों में जाते हैं, तो यह आपको न्यूनतम कीमत पर प्रदान किया जाएगा। यदि हम आपको क्लीनिक से जोड़ते हैं तो

कुल खर्चा 3 हजार से कम होगा।

आप या तो मिसोप्रोस्टोल को तुरंत ले लेंगे, या पहली गोली लेने के 48 घंटे बाद तक – आपका डॉक्टर आपको बताएगा कि इसे कैसे और कब लेना है। यह गोली आपके गर्भाशय को खाली करने के लिए ऐंठन और रक्तस्राव का कारण बनती है। ज्यादातर लोगों के में, ऐंठन और रक्तस्राव आमतौर पर मिसोप्रोस्टोल लेने के 1-4 घंटे बाद शुरू होता है।

रक्तस्राव के समय खून के बडे थक्के या ऊतक के गुच्छे दिखाई देना सामान्य है। यह वास्तव में ऐंठन व अधिक रक्तस्राव के साथ होने वाली महावारी की तरह है, और गर्भसमापन की प्रक्रिया एक स्वतः गर्भपात के समान है। ध्यान देंः यदि आपको दूसरी दवा, मिसोप्रोस्टोल लेने के 24 घंटे के भीतर कोई रक्तस्राव नहीं होता है, तो डॉक्टर से सम्पर्क करें।

दिन 14 – 15ः गर्भावस्था के पूरी तरहा से समाप्त होने की पुष्टि करने के लिए एक व्यक्ति को गर्भसमापन उपरांत की जांच के लिए डॉक्टर की जरूरत होती है। डॉक्टर 15 दिनों के बाद अल्ट्रासाउंड जांच के लिए वापस आने की सलाह देंगे। फिर एक अल्ट्रासाउंड (पेट) कराएं क्योंकि यह पता

लगाना महत्वपूर्ण है कि क्या गर्भसमापन पूर्ण रूप से हो गया है और महिला सुरक्षित हैं। इन दवाओं का कोई साइड इफेक्ट नहीं है, लेकिन हमेशा डॉक्टर के मार्गदर्शन में लिया जाना चाहिए। यह देखना हमेशा बेहतर होता है कि क्लीनिक में गर्भसमापन की चिकित्सा समाप्ति करने के लिये प्रमाण पत्र प्रदर्शित किया है या नहीं। गर्भसमापन की सेवा लेने वाले व्यक्ति को झोलाछाप या अपंजीकृत डॉक्टरों से सावधान रहने की जरूरत है। आपके गर्भसमासपन के पूरा होने के बाद, जैसे जैसे घंटे और दिन गुजरेंगे आपको महसूस होने वाली ऐंठन और रक्तस्राव हल्का होना चाहिए। आपको शायद स्तन में अकड़ाहट भी हो सकता है, और उनमें से दूध जैसा पदार्थ भी स्राव हो सकता है। आरामदायक फिटिंग की ब्रा पहनने से आपको

अधिक सहज महसूस करने में मदद मिलेगी। अब तक किसी भी प्रकार की ठंड लगना, बुखार, या मतली को भी चले जाना चाहिए।  यदि आपको मिसोप्रोस्टोल (गोलियों का दूसरा सेट) लेने के 24 घंटे से अधिक समय तक मतली, उल्टी, दस्त या बुखार है तो तुरंत अपने डॉक्टर या स्वास्थ्य केंद्र पर सम्पर्क करें। यह एक संक्रमण का संकेत हो सकता है।

यह भी बहुत महत्वपूर्ण है कि 15 दिनों के बाद, एक बार स्वास्थ्य जांच के लिए जाना चाहिए,  यह सुनिश्चित करने के लिए कि गर्भ की समाप्ति पूरी हो चुकी है। इससे यह जांचने में मदद मिलती है कि गर्भाशय के अंदर कोई अवांछित तत्व तो नहीं है।

स्त्रोतः पलानड पैरंटहुड वेबसाइट

क्या भारत में गर्भसमापन कानूनी है?

हाँ।

और हां, यह कई विकसित देशों के विपरीत है जहां गर्भसमापन एक विवादास्पद विषय है जिसमें अक्सर राजनीतिक विचारधाराएं शामिल होती हैं। गर्भावस्था की चिकित्सय समाप्ति अधिनियम (मेडिकल टर्मिनेशन ऑफ प्रेग्नेंसी एम0टी0पी0) अधिनियम 1971 गर्भधारण के 20 सप्ताह तक गर्भावस्था की (एम0टी0पी0) की चिकित्सय समाप्ति की अनुमति देता है। यहाँ आपको क्या पता होना चाहिएः

गर्भावस्था के 12 सप्ताह के भीतर गर्भावस्था की चिकित्सय समाप्ति एक डॉक्टर की मंजूरी से की जा सकती है।

गर्भावस्था के 12 से 20 सप्ताह के बीच गर्भावस्था की चिकित्सय समाप्ति दो डॉक्टरों की सहमति से की जा सकती है।

एक महिला गर्भसमापन सेवा प्राप्त कर सकती है यदि-
  • गर्भावस्था के कारण यदि महिला का स्वास्थ्य (शारीरिक और मानसिक) खतरे में है।
  • यदि भ्रूण में असामान्यताएं हैं जो बाद में विकृति और जोखिम पैदा कर सकती हैं।
  • गर्भावस्था बलात्कार का परिणाम है।
  • गर्भधारण अनचाहा है और गर्भनिरोधक की विफलता का परिणाम है (गर्भनिरोधक के एक या अधिक तरीकों का उपयोग किए जाने पर भी गर्भावस्था हुई)। यह ध्यान रखना महत्वपूर्ण है कि यह खंड केवल विवाहित महिलाओं पर लागू होता है।
  • गर्भसमापन एक पंजीकृत चिकित्सिय अभ्यासकर्मी (आर0एम0पी0) द्वारा किया जाना चाहिए, जिसकी चिकित्सिय सेवाएं अधिनियम के तहत अनुमोदित हो, एक ऐसे स्थान पर जो अधिनियम के तहत अनुमोदित हो। कोई भी चिकित्सिय अभ्यासकर्मी गर्भसमापन नहीं कर सकता है।
अगर मैं 18 साल से कम हूँ तो क्या मैं गर्भसमापन करवा सकती हूँ?

हां, कम उम्र की लड़की गर्भसमापन करवा सकती है। जब तक कि कानून की शर्तें पूरी हो जाती हैं। इस तरह के परिदृश्य मेंहालांकि, लड़की के अभिभावक की सहमति अनिवार्यहै। एम0टी0पी0 अधिनियम अभिभावक को ‘‘एक नाबालिग या एक पागल व्यक्ति की देखभाल करने वाला व्यक्ति‘‘ के रूप मेंपरिभाषित करता है।

क्या एक अविवाहित महिला गर्भसमापन करवा सकती है?

भारत मेंगर्भसमापन, जबकि कानूनी, लेकिन महिला और भू्रण के स्वास्थ्य की चिंता से प्रेरित हैं। उदाहरण के लिए, गर्भनिरोधक की विफलता, विशेष रूप से विवाहित महिलाओं के लिए उल्लेखित एक षर्तहै। एक अविवाहित महिला, विवाहित की तरह, गर्भसमापन की सेवाएं स्वास्थ्य कारणों से प्राप्त कर सकती है और साथ ही अगर गर्भावस्था यौन उत्पीड़न के परिणामस्वरूप् है और महिला गर्भावस्था को आगे नहीं बढ़ाना चाहती है। हालांकि, वह महिला गर्भसमापन की सेवा की उम्मीद नहीं कर सकती है, अगर संभोग के दौरान कंडोम फट गया। क्या इसका मतलब यह है कि अविवाहित महिलाओं को भारत में गर्भसमापन की सेवायें नहीं मिलती है? शुक्र है कि ऐसा नहीं है।

महिला के लिए स्वास्थ्य संबंधी जोखिमों का नियम इस प्रकार हैः यदि गर्भावस्था की निरंतरता गर्भवती महिला के जीवन के लिये खतरा है या गंभीर चोट शारीरिक या मानसिक स्वास्थ्य के लिए जोखिम शामिल करेगी। इस प्रकार, यदि डॉक्टर अनचाही गर्भावस्था के मामले को देखता है, जिसमें गर्भवती महिला के मानसिक स्वास्थ्य को गंभीर चोट पहुंचे, तो वह गर्भसमापन को मंजूरी दे देगी/देगा।

क्या मुझे गर्भ समाप्त करवाने के लिए अपने पति की सहमति की आवश्यकता है?

नहीं. यदि आप 18 या अधिक वर्ष है, तो आपके किसी की भी सहमति की आवश्यकता नहीं है।

क्या 20 सप्ताह की सीमा के बाद गर्भसमापन की अनुमति नहीं है?

यह कानून के अनुसार नहीं है। हालांकि, यदि आवश्यक हो, तो आप अदालतों से संपर्क कर सकते हैं। इस तरह के अनुरोध के ठोस आधार होने चाहिए। पिछले साल, सर्वोच्च न्यायालय ने 20 सप्ताह की अवधि के बाद गर्भसमापन की अनुमति दी क्योंकि महिला को स्वास्थ्य जोखिम या भ्रूण के लिए गंभीर विकृति थी। सर्वोच्च न्यायालय ने अन्य अनुरोधों को भी अस्वीकार कर दिया था, वहां से महिला और भ्रूण के जीवन के लिए कोई जोखिम नहीं मिला।

गर्भसमापन के विभिन्न प्रकार क्या हैं?

दवाओं के द्वारा

आमतौर पर 7 सप्ताह के भीतरः एक एम0टी0पी0 किट का उपयोग किया जाता है जिसमें मौखिक रूप से लेने के लिए एक टैबलेट और योनि  द्वार में रखने के लिए चार टैबलेट होते हैं।

एक चिकित्सकीय गर्भसमापन दो हार्मोनल दवाओं के संयोजन का उपयोग करता है- एक एंटी-प्रोजेस्टेरोन और प्रोस्टाग्लैंडीन, जिसका उपयोग विभिन्न मार्गों के माध्यम से मुंह के माध्यम से, इंजेक्शन द्वारा इंट्रामस्क्युलर/नसों के द्वारा या योनि मार्ग से किया जा सकता है।

षल्य चिकित्सा/सर्जिकल माध्यम से

आमतौर पर 12 सप्ताह के भीतरःगर्भावस्था को सक्शन क्योरटेज नामक एक विधि का उपयोग करके समाप्त किया जाता है, जिसमें योनि में एक छोटी ट्यूब का डालना शामिल होता है जो एक सक्शन मशीन से जुड़ा होता है। इस विधि में गर्भावस्था को सांखकर निकाला जाता है।

आमतौर पर 12 सप्ताह और 20 सप्ताह के बीचः इस समय प्रयोग की जाने वाली विधि को फैलाव और निकासी कहा जाता है (डी एंड ई)। इसमें गर्भाशय को धीरे से खोलने के लिए गर्भाशय में गर्भाशय फैलाने वाली नलिका को डाला जाता है। एक बार जब यह गर्भाशय फैल जाता है, तो सक्शन ट्यूब और अन्य सर्जिकल उपकरणों का उपयोग करके गर्भावस्था को समाप्त कर दिया जाता है।

गर्भपात के बाद मैं क्या उम्मीद कर सकती हूं?

दर्द एक ऐसी चीज है जिसे हर कोई अलग तरह से अनुभव करता है। गर्भसमापन के तत्काल बाद खून बहता है। आपको कुछ दिनों के लिए ऐंठन हो सकती हैं। आपका डॉक्टर आपको कुछ राहत पाने के लिए दवाओं को लिखेगा।

योनि से किसी भी दुर्गंधयुक्त स्त्राव या बुखार की अनदेखी न करें ये एक संक्रमण के संकेत हो सकते हैं। थोड़ी सी भी असुविधा के लिए अपने डॉक्टर से मिलें। आप दो सप्ताह में अपने डॉक्टर से मिल सकतेहैं यह सुनिश्चित करने के लिए भी कि आप स्वस्थ्य हैं। खुद को महत्वपूर्ण बनाएं।

गर्भसमापन करवाने के बाद मैं यौन संबंध कब शुरू कर सकती हूं?

आपका शरीर आपकी जानकारी से ज्यादा स्मार्ट है। यह खुद से ठीक होगा। आपको पता चल जाएगा कि आप संभोग शुरू करने के लिए शारीरिक और भावनात्मक रूप से कब सहज हैं। कुछ डॉक्टर एक या दो सप्ताह के लिए परहेज करने की सलाह दे सकते हैं।

मुझे अगली माहवारी कब शुरू होगी?

आप गर्भसमापन के बाद तीन से छह सप्ताह के भीतर माहवारी आने की उम्मीद कर सकती हैं। गर्भसमापन के बाद अक्सर रक्तस्राव होता है, और कभी-कभी, यह रक्तस्राव एक या अधिक सप्ताह तक हो सकता है। यह रक्तस्राव आपके मासिक धर्म के समान नहीं है। गर्भसमापन के बाद आपकी पहली माहवारी आपके द्वारा अनुभव किए जाने की तुलना में अधिक गंभीर ऐंठन के साथ होने की संभावना हो सकती है।

लेखकः अनुराधा खुद को विचारक कहती है। एक कवि होने के अलावा, वह उन मामलों पर लिखती है जो उन्हें कथानक लगतें हैं। वह देहात की सह-संस्थापक हैं, जो एक आला कला ब्रांड है जो भारत की संस्कृति की सांस्कृतिक बेल्ट से कलाकारों के काम को सामने लाता है। वह चर्चा मंच लाउडस्ट के साथ भी जुड़ी हुई है और इसके पैनल चर्चाओंकोसंचालित करती है।

10 बातें जो आप भारत में कानूनी गर्भसमापन के बारे में नहीं जानते हैं।

भारत में गर्भावस्था की चिकित्सा समाप्ति अधिनियम 1973 ( मेडिकल टर्मिनेशन ऑफ प्रेगनेंसी/एमटीपी) या गर्भसमापन करने के बारे में बहुत सी गलत धारणा या स्पष्टता का अभाव प्रतीत होता है। बहुत सारी महिलाओं को यह पता नहीं है कि गर्भावस्था को समाप्त करना भारत में कानूनी है। जबकि महिलाओं के लिए यह जानना महत्वपूर्ण है कि गर्भसमापन कराने के संबंध में उनके क्या अधिकार है और क्या नहीं।

यहां उन 10 चीजों की सूची दी गई है, जिन्हें आप भारत में गर्भसमापन कराने के बारे में नहीं जानते हैंः

1. भारत में गर्भसमापन कानूनी है।

गर्भावस्था के बीस सप्ताह तक कुछ परिस्थितियों में गर्भावस्था का गर्भसमापन या गर्भावस्था की  चिकित्सा समाप्ति की अनुमति है। मेडिकल टर्मिनेशन ऑफ प्रेग्नेंसी एक्ट 1971 के अनुसार, गर्भावस्था को कुछ परिस्थितियों में समाप्त किया जा सकता है। जिनमें निम्न परिस्थितियां शामिल है

  • बलात्कार
  • गर्भवती महिला के स्वास्थ्य के लिए शारीरिक या मानसिक जोखिम
  • विवाहित महिलाओं के मामले में गर्भनिरोधक की विफलता
  • भ्रूण/बच्चे को किसी भी प्रकार की विकलांगता की संभावना
2. महिला को गर्भसमापन के लिए हां या ना कहने का अधिकार है।

गर्भसमापन कानूनी होने के बावजूद, एमटीपी अधिनियम गर्भावस्था को मांग पर समाप्त करने का अधिकार प्रदान नहीं करता है, महिला जबरन गर्भसमापन को ना कहने का विकल्प चुन सकती है। महिला को गर्भावस्था जारी रखने और बच्चा पैदा करने का अधिकार है। कोई भी उसे गर्भसमापन कराने के लिए मजबूर नहीं कर सकता। गर्भावस्था की चिकित्सय समाप्ति अधिनियम 1973 के अनुसार ऐसा करना एक दंडनीय अपराध है!

3. गर्भसमापन करवाने के लिए आपको केवल आपकी सहमति की आवश्यकता होती है।

यदि आप एक गर्भवती महिला हैं जो गर्भसमापन करवाना चाहती हैं, तो याद रखें कि गर्भसमापन करवाने के लिए केवल आपकी सहमति की आवश्यकता होती है। यदि आपकी आयु 18 वर्ष से अधिक है, तो आपको गर्भसमापन करवाने के लिए किसी और की अनुमति की आवश्यकता नहीं है। यदि किसी अस्पताल में डॉक्टर या अन्य कर्मचारी आपके माता-पिता या पति की सहमति के लिए पूछते हैं, तो उन्हें बताएं कि यह आपका शरीर और आपका अधिकार है।

4. गर्भावस्था के 20 सप्ताह तक गर्भावस्था को समाप्त किया जा सकता है।

गर्भावस्था की चिकित्सय समाप्ति अधिनियम किसी भी गर्भावस्था को गर्भावस्था के 20 सप्ताह के भीतर समाप्त करने की अनुमति देता है। हालांकि, जनवरी 2017 में, सर्वोच्च न्यायालय ने एक बलात्कार पीडिता को 24 सप्ताह में अपनी गर्भावस्था को समाप्त करने की अनुमति दी थी क्योंकि भ्रूण को सिर नहीं विकसित हुआ था। यह ध्यान देने योग्य है कि 2014 में तैयार एक संशोधन में गर्भावस्था की समाप्ति सीमा को वर्तमान 20 सप्ताह से 24 सप्ताह तक बढ़ाने की मांग की गई थी।

5. गर्भावस्था की हर समाप्ति भ्रूण हत्या नहीं हो सकती है।

गर्भावस्था की समाप्ति एक भ्रूण हत्या केवल तब है अगर गर्भसमापन लिंग निर्धारण परीक्षण के बाद किया जाता है। पी0सी0पी0एन0डी0टी0 अधिनियम 1994 में लिंग निर्धारण परीक्षणों के आधार पर कन्या भ्रूण हत्या को रोकने के लिए लागू किया गया था। यदि यह साबित हो जाता है कि गर्भसमापन लिंग निर्धारण परीक्षण के कारण ही किया गया है तो यह दंडनीय अपराध है।

6. 12 सप्ताह की गर्भावस्था के दौरान लिंग निर्धारण संभव नहीं हो सकता है।

यहां लिंग निर्धारण परीक्षण से जुडी बात यह है, कि पी0सी0पी0एन0डी0टी0 अधिनियम लिंग निर्धारण परीक्षण करने वाले तकनीशियन को दंडित करता है। आमतौर पर, गर्भधारण के 12 सप्ताह के भीतर भ्रूण का लिंग निर्धारित नहीं किया जा सकता है। इसलिए 12 सप्ताह की गर्भावस्था के भीतर किए गए गर्भसमापन को लिंग चयन के साथ नहीं जोड़ा जा सकता है। जो बताता है कि, एक महिला को लिंग चयन के लिए मजबूर करना एक दंडनीय अपराध है।

7. केवल एक पंजीकृत चिकित्सिय अभ्यासकर्मी (त्महपेजमतमक उमकपबंस च्तंबजपवदमत ) ही गर्भसमापन कर सकते है।

किसी भी गर्भवती महिला को गर्भसमापन एक पंजीकृत चिकित्सिय अभ्यासकर्मी द्वारा ही करवाना महत्वपूर्ण है। जब आप गर्भसमापन करवाना चाह रहे हों तो यह एक बहुत छोटी बात की तरह लग सकता है लेकिन यह एक महतत्वपूर्ण बात है जिसे बहुत गंभीरता से लिया जाना चाहिए, यह देखते हुए कि असुरक्षित गर्भसमापन कई जटिलताओं को छोड़ सकता है। एम0टी0पी0 एक्ट किसी भी डॉक्टर के लिए पंजीकृत चिकित्सिय अभ्यासकर्मी बनने की आवश्यकताओं को निर्धारित करता है। इसमें यह सुनिश्चित करने के लिए कठोर प्रशिक्षण के कई स्तर शामिल हैं कि डॉक्टर गर्भसमापन करने के लिए योग्य हैं। इसलिए यह जरूरी है कि केवल एक पंजीकृत चिकित्सिय अभ्यासकमी से ही गर्भसमापन करवाया जाए।

8. गर्भसमापन केवल एक सरकारी अस्पताल या जिला स्तरीय समिति द्वारा अनुमोदित स्थान पर ही किया जा सकता है।

गर्भसमापन करने के लिए पंजीकृत चिकित्सिय अभ्यासकर्मी की आवश्यकता के साथ ही, यह भी आवश्यक है कि गर्भसमापन सरकार द्वारा अनुमोदित अस्पताल में ही करवाया जाये। एक गर्भावस्था केवल एक सरकारी अस्पताल या इस उद्देश्य के लिए स्थापित एक जिला स्तरीय समिति द्वारा अनुमोदित अस्पताल में समाप्त करवाई जा सकती है। यदि आप गर्भसमापन कराने के बारे में अनिश्चित हैं कि गर्भसमापन कहां पर होगा तो असुरक्षित गर्भसमापन के कारण उत्पन्न होने वाली किसी भी जटिलता से बचने के लिये नजदीकी सरकारी अस्पताल में जाएं।

9. गर्भपात एक अधिकार नहीं है।

भारत में गर्भसमापन करवाना कानूनी हो सकता है, लेकिन यह एक ऐसा अधिकार नहीं है जो महिलाओं के पास है। इसका क्या मतलब है? इसका मतलब है कि आप मांग पर गर्भसमापन नहीं करवा सकते हैं, जिसका अर्थ है कि एक महिला डॉक्टर से गर्भसमापन करने के लिए नहीं कह सकती है। यह केवल ऊपर वर्णित कारणों में से किसी एक या अधिक के लिए प्राप्त किया जा सकता है।

10. डॉक्टर किसी भी महिला पर गर्भसमापन करने से मना कर सकते हैं।

यह जानते हुए कि गर्भसमापन भारत में एक अधिकार नहीं है, कोई भी डॉक्टर गर्भावस्था को समाप्त करने से इनकार कर सकता है। उदाहरण के लिए, महिला अपनी गर्भावस्था को समाप्त करने के अनुरोध के साथ ही अपनी शारीरिक या मानसिक स्वास्थ्य के लिए जोखिम का उल्लेख कर सकती है। हालांकि जब तक डॉक्टर यह नहीं देखते कि यह वास्तविक जोखिम है, वे गर्भावस्था को समाप्त करने से इनकार कर सकते हैं।

इस मुद्दे पर अधिक सुनने के लिए, हमारे पॉडकास्ट की जांच करें जहां जैस्मीन जॉर्ज, एक वकील और यौन और प्रजनन स्वास्थ्य अधिवक्ता एमटीपी अधिनियम पर चर्चा करते हैं।