Abortion in Mysore: Part 1

Sex, pregnancy, babies: taboo subjects? Absolutely not! Not if you are married. The Indian cultures and societies validate, sanction and many even celebrate these when you are married. But, what if you are not married? All it takes is the unmarried status to make these matters into – “mooh kala kardi”- shame, dishonour and guilt. 

India has its largest ever adolescent and youth population. According to UNFPA projections, India will continue to have one of the youngest populations in the world until 2030. The Guardian reports 600 million people are under 25 years of age. That is more than half of India’s population. Do you think they all wait to get married to have sex, get pregnant and have babies? Sexuality is being explored by the youth. However, cultural and societal taboos continue to exist in many parts of India. And no surprises, it is always the unmarried women who bear the brunt of it all, especially if she is pregnant. 

Ironically, India has one of the most liberal laws in the world when it comes to termination of pregnancy. However, it is no relief when you realize the barriers that women have to overcome in accessing safe and legal abortion in India. According to reports, 56% of abortion performed in India is estimated to be unsafe. That is more than half of the estimated 6.4 million abortions that happen in India every year. If that does not worry you, then perhaps this can: unsafe abortion is the third leading cause of maternal deaths in India.

The Hidden Pockets Collective way

The collective is using technology to increase awareness of sexual and reproductive rights amongst the youth. Using multiple platforms in social media, it has been striving to increase both awareness and access for youth to address their concerns on sexual and reproductive health & well being. Collective is the first organization in India to have a real time Whatsapp Careline service where the youth can reach out for help.

SAAF (Safe Abortion Action Fund) project “Abortion is Care”

Focusing exclusively on 4 districts in Karnataka (Bengaluru, Mysore, Shimoga and Ballari) Hidden Pockets Collective has been working on SAAF (Safe Abortion Action Fund) project “Abortion is Care”.

Safe and legal abortion should no longer be a matter which is out of reach for the youth in these districts and the project is making it happen. 

Hidden Pockets Collective launched an extensive mapping and auditing of hospitals, clinics and doctors, in these four districts, who are authorized to give abortion according to the mandates of the MTP Act, 1971. 

The challenges were numerous to carry out an in-person audit during the weeks of lockdown when the country had come to a stand still. Hidden Pockets adapted to the lockdown by launching the preliminary call audits, at the same time anticipating ease in access to these 4 districts to do the in-person audits, during the lag phase of the pandemic, The call audits findings were a mixed bag. Many doctors from all the four districts, outrightly said no to take up cases of unmarried women. Some doctors, however, gave us the hope that not all roads are closed. 

Read: Abortion in the Steel City Ballari: Part 1

Read: Abortion in Shimoga: Part 1

Mysore: not a bleak picture after all!

Mysore, apart from its fame for being a sought after tourist destination in India, is an emerging hub for techies. Many youngsters from all over the country throng the place for launching their career in the Information & Technology industry. You could even say Mysore is a youthful district! When we started our call audits, we were wondering what will happen to the youth during the pandemic when they want to avail SRHR services, especially abortion services. 

Doctor A, who is a consultant OBG doctor at a few private hospitals in Mysore, revealed that in one of the private hospitals where she works, they get numerous cases of young unmarried women who want termination of pregnancy. This, of course, was in the pre-pandemic times. The hospital which provides both medical and surgical termination of pregnancy has had cases where young unmarried women have approached them and were hesitant to provide ID proofs. Doctor A revealed that some of the doctors, including her, have helped even such cases. However, she insisted to us that it is always better that women provide ID proofs.  

Doctor A came across as a person who is not very judgemental. When speaking about abortion for unmarried women, she was direct and had no qualms about giving them an abortion. This came as a surprise to us because many doctors we spoke to in Mysore were very uncomfortable about helping unmarried women.

We were impressed when Doctor A said that, for women to get the termination of pregnancy, there is no need for parents’ or partner’s signature. Doctor A added that as long as the woman is an adult, she can give her signatures wherever needed for the abortion. 

But of course, Doctor A did not open up to us so quickly to reveal all these. In the earlier part of the phone call with her, she spoke to us in a matter of fact manner as a doctor would speak to a patient. But when we went on to ask many a question, she got defensive and wanted to know who we are, what exactly we are looking for, why we are asking her so many questions. And we had to reveal to her about Hidden Pockets Collective. It was only after a lengthy disclosure which she patiently listened to, did she open up to us and gave us the needed information. 

Mysore did the unthinkable!

When we made our calls to a top private hospital in Mysore, which is part of the hospital chain spread all over India, we were very sure that there won’t be any hassle for unmarried women to get termination of pregnancy at this hospital. After all, this hospital brand stands for corporate and profit culture when it comes to healthcare delivery. But our audit calls shocked the lights out of us!

Doctor B, who works at this hospital told us that for procedures were signatures are needed, it was not enough for an adult woman to sign. The hospital wants the signatures of either the husband or the parent or any first degree relative to give consent as well. Doctor B, went onto stress that for unmarried women, her partner can give the signature and if he is not physically present with her, then the consent can be sent through fax to the hospital! We were flummoxed! “Fax? They want fax from the partner stating consent? What if the partner is nonexistent? What if the fax can be faked?” we were left wondering! We did not ask her for clarification because it was very loud and clear that the hospital was not at all helpful to unmarried women. 

Field work amidst the pandemic

As the weeks go by and we all are starting to let it sink in: the virus is here to stay, we also are looking forward to having safe access to Mysore. Our preliminary search, so far, has given us the narratives from doctors. We are eager to meet the communities and youth of Mysore and hear what they have to say when it comes to accessing sexual and reproductive health services. We are sure that having the youth with us will help us see Mysore through another lens.

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.

Abortion in Shimoga: Part 1

*This article is a part of a series exploring the abortion services in 4 districts of Karnataka. 

To read on Ballari, the first article in the series, please click here

Shimoga is a place that might not ring a bell to many. But Jog Falls for sure is that buzz word which brings adventure kicks and nature highs. Not many know that the famous Jog Falls is located in Shimoga district. Often Jog Falls gets synonymous with Karnataka. Home to many more waterfalls and splendors of green nature, Shimoga district is in the central part of Karnataka, a South Indian state. Heggodu, a tiny village in Shimoga has global standing in the world of theater. Heggodu’s pride NINASAM is a one of a kind organization that brings a communitarian approach to enrich theater, films and publishing. 

Introduction to the SAAF project: 

As part of the SAAF (Safe Abortion Action Fund) project “Abortion is Care”, we charted out a plan to travel to Shimoga, assess and map out service providers who can give safe and legal termination of pregnancy in accordance with the guidelines of the Medical Termination of Pregnancy Act, 1971. What should otherwise have been meticulous fieldwork of weeks, ended up getting shrunk to a series of telephone calls to service providers during the COVID-19 pandemic. We had to adapt as there were no other means to reach Shimoga. 

Search engines and medical termination of pregnancy

In the online spaces, Shimoga had no dearth in furnishing a list of doctors, hospitals and nursing homes which offer OBG services. For a person in distress, to find the right service providers to terminate a pregnancy, this surely comes as a quick initial relief. However, when you scratch beneath the surface, you will realize the information provided is not as accurate as it ought to be. 

When Hidden Pockets Collective reached out to the listed hospitals and nursing homes, it was found that many of them did not have OBG departments. Some of these healthcare facilities are the leading and well-reputed ones in Shimoga’s private sector. However, when it comes to OBG services they do not offer OBG consultation services and yet their organization is listed in the networld for the services. One can choose to quickly dismiss these as carelessness of the online portals/ aggregators in verifying the information and thus the wrong representation of these organizations in the public domain. But for a person, especially a young unmarried woman, who opts to use the net to find trusted, safe and legal means to access abortion services, such carelessness can prove costly when she runs from door to door of these healthcare providers, only to be told that “we don’t have OBG department here.”

Empowering abortion choices. But for whom?

In all our works at Hidden Pockets Collective, rarely have we come across doctors who trust the women to take ownership of their bodies during an abortion. Hence, it was a bit of surprise when we learned of the empowering choices doctor A gave to her patients.

Medically Managed Abortion (MMA) at home is yet to be recieved well by both medical communities and laypeople as the usual norm is to have MMA in a clinical setup. Doctor A said that she is always in support of monitored MMA at home and she offers it to her clients when possible. The hospital she works for has differently priced packages for abortion and monitored MMA at home is the cheapest. 

Doctor A is associated with a top private hospital in Shimoga. The hospital provides MTP for both the first and second trimester. Doctor A said that upto 90% of cases they handle are MMA. For clients whose pregnancies are under 7 weeks of gestation, they offer MMA. From 7 to 12 weeks, depending on the individual case, they will opt for surgical termination. Occasionally they also get cases above 12 weeks of gestation which inevitably will be terminated through surgical procedures. The costs of termination are all presented as “packages” and monitored MMA at home is the cheapest option. As much refreshing it was to hear this, amidst the notoriety of many private hospitals wanting to fleece off the patients, we hit a wall when it came to ensuring that all options are available for unmarried women. Doctor A refused to give the cost details of the various “packages” and closed the queries on costs with a statement that everything is reasonably priced and at par with the standard market costs. 

When asked about the access for unmarried women, doctor A said that the hospital holds no difference and the services are open to all. However, she highlighted that when signatures are needed for some surgical procedures, it is mandatory that a responsible bystander, preferably a first degree relative such as a mother, be present. This, of course, is not a legal prerequisite but an individual preference. She also added that male involvement such as a brother, father is discouraged as they have had cases in the past wherein ruckus were created and directed at the patients by the male relatives.   

Parents have a say?

Many doctors who spoke to Hidden Pockets Collective said that they can provide an abortion for unmarried women. However, they insisted that parental involvement be there. It did not matter whether the woman who needed the service is a financially independent adult who has her trusted circle of people to take care of the patient bystander responsibilities. For the doctors, all that mattered is the presence of parents. According to the doctors, in events where complications can arise in certain cases of termination, it is best that parents are present to take up the responsibility of the woman and hence they insist on having parents involved. Such conditional access to termination for unmarried women is highly unhelpful, as most unmarried women will not dare to approach their parents. Premarital sex, pregnancy out of wedlock continue to be taboo subjects for most families and invariably continue to be tied to shame and guilt. It is unthinkable for many young women to bring their parents on board for their abortion. Hence the doctors’ “openness” for providing abortion services to unmarried women is null and void. 

Authorities and approval

Doctor B was above and beyond all the fuss for parental involvement. She works in a leading private hospital in Shimoga and said the hospital has both MMA and surgical abortion. According to doctor B it is usually married couples who have approached the hospital for termination and personally she dissuades them from getting a termination if it is their first pregnancy. When asked whether she will refuse abortion for unmarried women, doctor B said that the hospital does provide termination for them and that she, as a doctor, has to respect the women’s decision to get an abortion. She reasoned that it is not easy in our culture to be unwed and pregnant and that she would rather have the unwed pregnant women get a safe and legal abortion than have them go elsewhere to get an illegal and risky abortion. Doctor B was unruffled by the “parental clause” which many other doctors in Shimoga had put forward to Hidden Pockets Collective. All doctor B was concerned about is that the woman is an adult and giving consent out of her own volition. However, there were challenges to navigate as the doctor said that from the organization’s point of view, the ultimate decision to provide the abortion services for unmarried women, rests on the hospital administration. She said she can vouch for the patient’s case to the hospital administration, but she can only proceed with their approval. Doctor B was hesitant to disclose the standard costs of MMA and surgical abortion and said she can do so only after the approval from hospital authority. 

Field work amidst the pandemic

As the weeks go by and we all are starting to let it sink in: the virus is here to stay, we also are looking forward to having safe access to Shimoga. Our preliminary search, so far, has given us the narratives from doctors. We are eager to meet the communities and youth of Shimoga and hear what they have to say when it comes to accessing sexual and reproductive health services. We are sure that having the youth with us will help us see Shimoga through another lens.

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.

Age of Marriage vis-à-vis Age of Motherhood in India

History of the legal age of marriage

In India, marriage as an institution plays a major role in the development of an individual. Marriage is considered to be a sacred ceremony in some religions, and a spiritual contract in other religions. After independence, the Indian Constitution laid down in its preamble the core principle of secularism. As a result, to provide autonomy to all the religions, marriages were governed by the personal laws like the uncodified Islamic Sharia law, The Hindu Marriage Act, 1955, The Christian Marriage Act, 1872 etc and till date they do so, except that the legislature has also been taking steps to curb the societal evils like child marriages, female infanticide, and so on. Needless to say, there is much more effort to be put in,  so that there are equality and well-being in the country. 

Last year, BJP spokesperson and lawyer Ashwini Kumar Upadhyay moved the Delhi High Court filing a Public Interest Litigation claiming that the difference in the minimum age of marriage for men and women was based on patriarchal stereotypes and has no scientific backing. According to the erstwhile Sharda Act, 1929, the legal age to get married for a male is 21 and female is 18. The petition seeks to challenge the ongoing discrimination on women regarding the same. The petition further states that it is a social reality that a wife is considered to be playing a subordinate role than her husband and the said age difference deeply aggravates this power imbalance. 

In pursuance to that, the Finance Minister Nirmala Sitharaman in her speech for Budget 2020 said they will set up a task force which will dwell into the discussion of the age of marriage vis-à-vis the age of motherhood of women and look from the point of reducing maternal mortality rate which remains high in our country and increase the nutrition levels of women overall.

The Sarda Act, also known as the Child Marriage Restraint Act, 1929, was sponsored by Harbilas Sarda which mandates the legal age of marriage. This Act was introduced by the Imperial Legislative Council of India with the aim to curb the social evil of child marriages. More importantly, young daughters were married to much older males, as females were considered to be a ‘burden’ and no education was granted to them. Initially, the age of marriage was fixed at 14 and 18 years for girls and boys respectively. Later, the act was amended in 1978 to increase it to 18 and 21 for girls and boys respectively.  The provisions of the Sarda Act were enacted in continuation with the law relating to the age of consent under the Indian Penal Code, 1860. At the time of the 1949 Amendment of the Sarda Act, which raised the lowest age of marriages for girls to 15, there was also an amendment to another law, the section 375 exception 2 of the Indian Penal Code, 1860, which increased the age of cohabitation to 15. Since then the provision of Indian Penal Code didn’t change even though the Sarda Act raised the age of marriage to 18 years in later years. After a long battle, only by the Criminal Law Amendment Act, 2019, has the age of consent been at par with the age of marriage. Yet again, now there is a need to raise the age of marriage of girls to 21 to be at par with boys and establish the yearned equality in the society. This brings to notice that not only the Sarda Act should be amended but also the other penal laws regarding the age of consent so that there is no inconsistency left as it was left in section 375 exceptions 2 from 1978 to 2019. 

Child Rights

The new task force aims to raise the age of marriage of women to 21 with the aim to reduce the years of motherhood which is believed to have an indirect impact on the population. However, the government fails to understand marriages are still governed by the personal laws which support the marriage of girls at a tender age. The codification of the Hindu and Muslim laws may have granted few reliefs to the minor females, such as in the Dissolution of Muslim Marriages Act, 1939, where there are provisions for seeking a divorce in which a young girl, having been given in marriage by her father or other guardians, can repudiate the marriage before attaining the age of eighteen years, provided that the marriage has not beenconsummated. However, the practices of marrying girls as soon as they reach puberty still persist. 

The different judicial interpretations of what happens after an underage marriage have created a lot of chaos. As of today, underage marriage is not invalid, meaning the marriage still exists in the eyes of law in some states. It is considered to be voidable at the option of the minor that is not ready for the marriage to continue after they reach the age of majority. It means that once the minor reaches majority she can go to the appropriate court and request to nullify the marriage on the grounds as provided under the Act in which the marriage was solemnized. The real question remains, how many of the women have access to legal remedies so that they can divorce their current partners they forcefully were being married off. Since parents play a major role in setting up these marriages there would be no support from them and to make matters worse, the label of a divorced female is still detested in most Indian society. All these factors make a woman vulnerable and thus can socially restrict her. 

The government plans to raise the age of marriage but they should also look into the social-economic opportunities which women can avail so that the age-old belief of them being a burden does not stand true anymore. One more reason provided to increase the age of marriage is that women can attain their graduation without being pressurized to get married. However, the legal changes won’t change anything until there is an internalization of these laws as the social norms of the society. As a minor, getting married at a tender age can take away her fundamental right to education and her right to live with dignity. 

Access to Reproductive Health & Women’s Rights

One of the major reasons marriages are performed is that a couple can reproduce children and provide the children with legitimacy. This leads to the added pressure women face who have already married as early as 18 years i.e. as soon as they achieve the age of majority or sometimes even earlier. Hence, teenage pregnancies of the age 15-19 pose greater health risks and result in premature babies.  With the government raising the age of marriage to 21 for women, it aims to reduce the mortality rates as the motherhood span reduces to three years. It has been constantly observed that as soon as a couple is married they are forced to reproduce a child for the sake of in-laws or with the hope to continue their family name. The age of 15 to 19 years is most vulnerable for women in terms of their reproductive health. The societal pressure of bearing a child as soon as women get married combined with child marriages results in adolescent pregnancies. To delay the age of marriage to 21 will serve an appropriate age for women to bear the child even in the first year of marriage.  In a society, where pre-marital sex is a taboo and sex education is not provided properly in schools, young couples fall prey to peer knowledge and pornography which raise expectations of their sexual experience. The lack of knowledge of contraceptives and its use results in teen pregnancies. The trauma of uncalled pregnancies, miscarriages and stillbirth are high amongst women who marry at a young age. 

From the 1970s up to 2016, there had been a spur in sterilization camps due to the government’s family planning policies. After mass deaths of women due to unhygienic environments in 2014, the Supreme Court passed a landmark judgment on the ban of sterilization camps.  Even in the sterilisation procedure, more women participation was seen than men due to social stigma such as vasectomy reducing the strength of men and making them less ‘manly’. Moreover, women’s sterilisation procedure is more complicated and riskier than men’s. The stigma to bear all the pain is a woman’s job should be removed. The responsibility should be equally shared by both the partners while seeking the right medical health. 

Conclusion

Marriage is an institution which is formed to re-create bonds and let the evolution of humankind continue. A marriage can be considered as a sacred ceremony as well as a spiritual contract as per personal religious beliefs. However, certain humanitarian values should be upheld. The age of marriage is a crucial issue as it further sends a message of what kind of society we aim to achieve. It is observed that the age of marriage should be equal for both the genders for the power imbalance to extinguish and thus remove the patriarchal stereotypes which still exist. We should aim at a society where marriage is performed between consenting adults who feel ready to take new responsibilities rather than follow a centuries-old made up path. Be it 21 or 45, marriage should be performed freely and build healthy relationships. 

About the Author: Vidhi Gada

She is a 4th-year law student from ILS Law College, Pune, who firmly believes the law can be used as a weapon of change in our country and thus began her journey in the field of law. Apart from trying her best to be updated with all the legislations, her interests lie in Human Rights & Intellectual Property Rights. The best way to connect with her is to suggest a song that sets her mood and also, dogs. No! Kidding, she loves all the animals! She really likes dancing, writing and making puns! 

Soar: Two-Child-Policy! Shrug: ICPD 1994…

On 7 February 2020, a bill on the Two-Child-Policy was introduced as a private member bill in the Rajya Sabha by the Member of Parliament Anil Desai. This is a Constitution (Amendment) Bill and seeks to bring amendments to article 47. The short title of the bill is ‘Duty of the State to promote small family norm’. The main objective of the amendment is to enforce punitive measures for those families who have more than two children. The new article is suggested to be inserted at the end of article 47 and is as follows:

“The State shall promote small family norms by offering incentives in taxes, employment, education etc to its people who keep their family limited to two children and shall withdraw every concession from and deprive such incentives to those not adhering to small family norm, to keep the growing population under control.”

The bill elaborates further in the statement of objects and reasons about the need to control population explosion and where India currently stands in the global ranking in relation to the rate of population growth, population density. The details stated further in the bill with respect to Two-Child –Policy is as follows:

‘Today, there is also a need to encourage the people to keep small family by offering tax concessions, priority in social benefit schemes and school admissions etc. And at the same time discourage them from producing more children by withdrawing tax concessions, imposing heavy taxes and by making other punitive provisions for violations.”

This is not the first time such a bill has been introduced in the Parliament.

Earlier it was the Population Regulation Bill 2019 that stirred up controversy with its draconian approach to enforce the Two-Child-Policy.  It had strong punitive measures such as people being disqualified to contest in elections to either Houses of Parliament or state legislative assembly or even bodies of the local self-government. The bill also proposed that every serving government employee ought to give an undertaking that they shall not have more than two children. The penalties for anyone who contravenes the policy will be a reduction in subsidies on loans, lower interest rates on savings schemes in banks and investments, higher interest rates for availing loans from banks and financial institutions, reduction in benefits of Public Distribution System.  Also, incentives are placed for employees of Central Government and Public Sector Enterprises under the Central Government if they or their spouses undergo sterilization.

Matters even reached the President Ram Nath Kovind way before it should have taken the defined course of bills and the Parliament. In an unprecedented move, 125 members of the Parliament (1) signed a petition for the Two-Child-Policy and had it submitted to the President, even though the President has no role in suggesting, introducing or implementing public policy in India (2). In response to the petition, the Population Foundation of India put out a statement (3) from the Advocating Reproductive Choices (ARC) – a coalition of 165 civil society organizations and individuals- and denounced the Two-Child-Policy as going against the national interest, violating basic tenets of fundamental human rights and the Indian Constitution.

A matter to be noted is the heated up interest in the Two-Child-Policy from various quarters outside the Parliament. In a span of two years, five-plus PILs (4)have been filed in the Supreme Court seeking a directive to the Centre to enforce population control through a punitive Two-Child-Policy. The Court, however, dismissed all the PILs.

Unlike all the past moves to push the Two-Child-Policy, this recent 2020 bill garnered no media attention whatsoever. One can say the introduction of this bill went off the media radar. If this bill becomes an Act it will be the unprecedented law in India that will mete out punishments for having more than two children. It can bring serious setbacks to the sexual & reproductive health and rights of women, especially those from marginalized and poor communities. 

India being a signatory to the Programme of Actions of the International Conference on Population and Development (ICPD) 1994, cannot enforce a law that prevents a couple or an individual to decide freely and responsibly the number and spacing of their children. Post ICPD 1994, India’s National Population Policy had incorporated the PoA and stated its commitment towards “voluntary and informed choice and consent of citizens while availing reproductive healthcare services and continuation of the target – free approach in administering family planning services.”  However, with the turn of events happening towards the Two-Child-Policy, it seems that India will flout the PoA of ICPD (1994) if the bill becomes a law. 

Sources:

1^ “125 MPs appeal to President Ram Nath Kovind, demand strict two-child law; Opposition suspects ‘agenda’.” Times Now, 13 Aug 2018, https://www.timesnownews.com/india/article/population-in-india-125-mps-president-ram-nath-kovind-two-child-law-bjp-congress-explosion-2-child-law-petition/269006

2^ “125 MPs Petition President, Who Has No Role in Public Policy, to Implement Two-Child Norm.” The Wire, 21 Aug 2018, https://thewire.in/government/parliamentarians-president-petition-two-child-norm

3^ “Proposed two-child policy is against human rights.” Population Foundation of India, 31 Aug 2018, https://www.populationfoundation.in/NewsEvents/view/18/106

4^ “Fresh plea in SC on population control.” The Times of India, 21 Feb 2018, https://timesofindia.indiatimes.com/india/fresh-plea-in-sc-on-population-control/articleshow/63018969.cms

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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.

Population is Exploding? Punishment Works!

In the last few decades when movies ‘Yours, Mine and Ours’’, ‘Khatta Meetha’ and shows like ‘Hum Paanch’  played out in cinemas and TVs, the amused viewers lived through the ups and downs of the reel families in laughter, joy, tears and sighs. Maybe we must have pontificated a bit on the cost and stress of running large families then. But surely we did not sound the death knell for the environment, employment and equilibrium while we enjoyed these feel-good movies. However, now with the Two-Child Policy bill on population, we might want to pooh pooh these movies and shows. Well, will we?

The chupke chupke (hush hush) act: 

The first week of February saw the Constitution (Amendment) Bill 2020 being introduced as a private member bill in the Rajya Sabha. There was not much fuss or attention. One can say it went unnoticed in the public like a hush-hush matter. If the bill ever becomes an Act, it will be the unprecedented law in India to punish families for having more than two children.  

The bill proposes that “there is also a need to encourage the people to keep small family by offering tax concessions, priority in social benefit schemes and school admissions etc. and at the same time discourage them from producing more children by withdrawing tax concessions, imposing heavy taxes and by making other punitive provisions for violations.” 

Population explosion, when? Now! Before implosion!

India currently stands at rank 2 in the global list of countries by population (1). China is first and the USA is third. With the list or without the list there is always the common comment that India is overpopulated, too crowded and “certain” religious communities are breeding as if procreation seems to be their main recreation. And when leaders, be it political or religious, continue to stress that India indeed is overpopulated, it does not need much persuasion for most Indians to fervently agree with them. But the critical questioning and critical dissection we need to do here is: is India really overpopulated? Is the Two-Child Policy needed to address the overpopulation?

Facts met myths and burst its bubbles:

Total Fertility Rate (TFR) is the rooting word to understand overpopulation and under population. TFR is the average number of children which a woman will have in her childbearing years (age 15 to age 49) according to the current birth trends. A population in an area is considered stable when the TFR is 2.1 such that no immigration or emigration has happened. The latest data shows us that most of the states in India have a TFR below 2.1 and only a few states are still above 2.1 TFR. Also, India will have an end to population growth (2) after going through ‘population momentum’ (3) following which there will be a ‘peak child’ and later ‘peak population’. So why this Kolaveri da on India being overpopulated? 

China, One-Child Policy and lessons: 

Population control and country’s development came together and weaved dreams of a better future for everyone who looked at China and wah wahed at their One-Child Policy. As China grew into one of the largest economies in the world, wielding a forceful control on her population, everyone had songs of praise for the One-Child Policy.  However, it took China 36 years to see the far-reaching consequences of the policy. 

Under population is a grave concern in China now where a high percentage of the population is elderly and non-working. The state uses its funds to give pensions while the state is having a shrinking working population. Also, the family structure takes an immense toll on the individuals, an effect appropriately termed as 4:2:1 wherein an individual has to take care of his/her parents as well as two sets of his/her grandparents in their old age. Thus the coinage 4 grandparents: 2 parents: 1 person. These family structures, where siblings are unheard of, thus cause immense financial and emotional pressure on the individual. China is a traditional society which still expects the adult children to provide for and support the ageing family members and have laws also to ensure the same. 

Patriarchal preference for a boy child added to the urgency of having that one child for a couple as a boy. Thus sex determination, even though is illegal, became rampant in China and so did sex-selective abortion. All these have resulted in a severely skewed gender ratio. 

China removed the One-Child Policy in 2015 and introduced the Two-Child Policy. However, not much hope is there for China to have a stable population even with the new policy (4).

Followers of religion & population control: wink wink?

Much anxiety looms in the country about Muslims causing the population explosion. Just going by the stereotypes of ‘hum do hamare panch’ (*us two ours five), people are quick to be stirred up by the populist view that Muslims will indeed overtake the Hindu population in the country and the WhatsApp University also does its share of spreading the “information”. What is conveniently left out is the fact that Muslims have been having a steep decline in their population growth. An article in a leading Indian newspaper (5) explains, “The 2011 Census puts the Muslim population at 17.22 crore or 14.22 per cent. The Hindu population grew in the decade of 1991-2011 at the rate of 1.55 per cent, while the Muslim population growth rate was 2.2 per cent. The fear about Hindus becoming a minority in India has the basis in this statistics. However, in the decade from 1991-2001, the growth rate of the Hindu population was 1.8 per cent and that of Muslims was 2.6 per cent. The decline in the growth rate for Hindus was 0.25 per cent and that for Muslims was 0.4 per cent. This is because of increasing literacy among all groups.” When it is easier to stir up the cauldron of hatred and fear to mobilize people why acknowledge facts that dispel the anxieties? 

Two-Child Policy: a peep into the future

Apart from the fact that policy is completely unnecessary, given how in the existing conditions India is heading to a stabilized population, enforcing this policy as a draconian law will push the poor people into a vicious cycle of poverty. Even with the law and dire consequences in place, there will be people who will have more than two children. While the rich can afford the consequences, will the poor be able to?  The limited access and knowledge to contraceptives and safe abortions, also the belief that having more children can ensure a better old age as their adult children will take care of them, will all make a poor man and a woman circumvent the policy and in all likelihood, they will have more than two children. With policy preventing them from availing benefits and schemes, they will be pushed further into poverty and thus they will end up in a vicious cycle from which they can never get out to have a better life. 

Guilty for pregnant: Blame anyone but partner and state

Women will walk on a tightrope if the Two-Child Policy becomes a law. In the currently existing conditions, it is the women who bear the brunt of (1) wanting to use contraceptives when her partner is against it (2) wanting to terminate an unwanted pregnancy when her partner is against it. Matters will be made all the grimmer for women with the Two-Child Policy as a law especially when they are victims of domestic violence. 

Contraceptives & Sterilization: We need to reflect on whether all women have access to contraceptives, whether these contraceptives are affordable and within their purchasing power, whether they are aware of all the choices they have in contraception and know how to make an informed choice on what suits them best, whether they have the negotiation power with their partners if they want their partner to wear a condom. We also need to reflect on the access and affordability they have for safe abortion, the robust public healthcare system and the legal system that will ensure that no women will be judged, discriminated or harassed for wanting to have a safe abortion. It is a valid fear that most women, especially from marginalized communities, will be forced to have sterilization after having two children. There is always the risk of giving selective information and insufficient support to enforce the law. 

Health: At the Hidden Pockets we have alarmingly seen an increase in the careless consumption of emergency contraceptive pills, commonly called as I-Pill. Many young women have one pill every week and this can be hazardous to health in the long term as the hormone balance will go for a toss and body consequently will have its reactions. Most of these women have confided to us that their partners refuse to use condoms as it interferes with pleasure. The onus for prevention of pregnancy thus falls on the women. When access and availability of oral contraceptive pills are a challenge, so also maintaining and completing the drug cycle, then emergency contraceptive pills become the quick fix.

Same story again and again:

Since decades experts have been shouting themselves hoarse that socio-economic conditions play an important role in population control. It has been ascertained census after census, how education and healthcare (6) are the factors that contribute significantly to help people decide, out of their own volition, that having a small family is indeed a good choice. What is highly problematic is the policy’s enthusiasm to make sweeping statements on the population without making any provisions to identify challenges in education and healthcare across the country and address them. Nor are there sincere efforts to address the lack of awareness on sexual & reproductive health and rights.  Experts always vouch that it is the development that can be the ultimate tool for population control and not punitive measures. We need to steer our policies towards those directions. Perhaps then we will be able to win again the nostalgia for those aforesaid movies. 

Sources:

1^ “2019 Revision of World Population Prospects.” United Nations Population Division, https://population.un.org/wpp/

2^ Ritchie, Hannah. “India’s population growth will come to an end: the number of children has already peaked.” Our World in Data, 15 January 2019, https://ourworldindata.org/indias-population-growth-will-come-to-an-end

3^ “The Inevitable Fill-Up.” Gapminder, 18 April 2018, https://www.gapminder.org/topics/population/fill-up/

4^ Kuo, Lily and Wang, Xueying. “Can China recover from its disastrous one-child policy?” The Guardian International Edition, 2 March 2019, https://www.theguardian.com/world/2019/mar/02/china-population-control-two-child-policy

5^Neelakantan, Anand. “The demographic change hoax.” The New Indian Express, 19 January 2020, https://www.newindianexpress.com/magazine/voices/2020/jan/19/the-demographic-change-hoax-2090213.html

6^Tripathi, Rahul. “Literacy leaves its mark as fertility rate goes south.” The Economic Times, 15 July 2019, https://economictimes.indiatimes.com/news/politics-and-nation/literacy-leaves-its-mark-as-fertility-rate-goes-south/articleshow/70220785.cms?from=mdr

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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.

Condoms: Are they adolescent-friendly under Indian law?

A country’s laws regarding sex, sexual orientation, sexual consent, sexual and reproductive health, access to abortion services and access to different types of contraceptives can often become autonomy-snatchers in the name of protecting children and adolescents.

Even though Indian law does not explicitly prescribe any minimum age for accessing or buying condoms, there are indirect legal barriers which might make condoms less accessible for people belonging to a certain age group. Additionally, social and cultural mentalities also make the practice of accessing condoms difficult and stressful, so much so that those affected by these often indulge in unsafe sexual activities at the cost of their physical wellbeing. 

As per the Population Council’s 2016 report, out of the 10,400 adolescents who were part of the survey from Bihar, 14.1% of unmarried boys and 6.3% of unmarried girls had engaged in sexual activity. Out of these, 28.5% girls and 22% boys had had sex before they were 15 years old. Further, condoms were regularly used only by 20.3% of unmarried boys and 8.2% of unmarried girls. The same report also revealed that adolescents, 17.2% of adolescent boys and 6.2% of adolescent girls, in Uttar Pradesh are also sexually active.

Age of consent 

In India, the legal age of consent is 18 years. This implies that anyone who engages in sexual intercourse before they are 18 years old is doing something that the law does not permit. This legal nuance can create barriers to access. Many of the adolescents who want to engage in sexual activities but are less than 18 years of age might feel intimidated by the fact that they cannot legally consent to sexual activities that they willfully wish to engage in.

While this legal barrier may stop some from having sex until they are 18, it will force many others to have unsafe sex. They might be afraid to go to a pharmacy or other stores selling condoms for a lack of certainty as to whether the pharmacist or shop-owner would sell the condoms to them. Often, the pharmacist or shop-owner might try to estimate the age of those who come to purchase condoms and if they feel, as would be the case with many people below the age of 18, that the person is a ‘child’ (WHO defines a child as any person less than 18 years old), they might refuse to sell condoms to them. 

Does the law interfere with our sexual and reproductive rights?

Although access to contraception (and to safe sex) is a basic sexual and reproductive right, our legal framework on consensual and non-consensual sex creates problems in ensuring that this right is available to people of all ages. Even though the law does not see those below 18 as capable of consenting to sexual activity, many adolescents, particularly those between 16-17 years of age, are sexually active.

Given that India has the largest number of adolescents in the world, this puts a large number of people at the risk of getting Sexually Transmitted Infections (STIs) and a large number of girls at the risk of having unwanted pregnancies and unsafe abortions.  

Law – a mirror of social and cultural beliefs?

The attitudes of healthcare providers who sell condoms might be influenced by long-standing social norms and cultural beliefs. Although we have come a long way in destigmatising pre-marital sex, we still have the limited perceptions that sex before people enter adulthood, and sexual experiences which are not to procreate, are reserved only for adults and/or married couples.

The sexual and reproductive health of adolescents below the age of 18 thus takes a backseat. People who can make contraceptives such as condoms easily available to adolescents almost always have judgmental attitudes.  Legal barriers like the minimum age for consent could be reinforced by such social and cultural mindsets. Ultimately, several of those below the age of 18 will still have sex but would be discouraged from buying condoms for a safe sexual experience. 

Public Health Programmes to improve access to condoms 

In India, the National Aids Control Programme(NACP) which is run by the National Aids Control Organization(NACO), a division of the Ministry of Health and Family Welfare, ended its phase IV in March, 2020. The programme aims to reduce and prevent the incidence of HIV transmission in the country.

As a part of its Targeted Interventions(TIs) among those who have a high risk of acquiring HIV, it focuses on “the promotion and provision of condoms to HRG(High Risk Groups) to promote their use in each sexual encounter”. Under its strategy of condom promotion, focus is on increasing demand and availability of condoms . Free condoms, called Nirodh, are procured by the Ministry and then distributed by NACO through NGOs, Anti-Retroviral Treatment(ART) centres and Integrated Counselling and Testing Centres(ICTC).

Condoms are also distributed through Social Marketing Organizations which use promotional campaigns to sell condoms at subsidized prices. Under the NACP, condoms are also marketed as private brands and sold commercially at full prices. 

The Reproductive, Maternal, Newborn Child plus Adolescent Health (RMNCH+A) programme focuses on improving maternal and child health by using a holistic approach and covering health throughout the lifecycle. Under its family planning services, free condoms are available at government health centres and are also distributed in rural areas by Accredited Social Health Activists(ASHAs). 

Shifting approaches:

We need to adopt a balanced approach when it comes to legislation that might directly or indirectly affect young people’s access to contraceptives such as condoms. Although the age of consent in India is set at 18 years with an alleged view to protect children and teenagers from sexual exploitation and abuse, such a blanket law takes away their sexual and reproductive rights. The age of consent must not be too high since that leads to many below the age of consent to have unsafe sex or to not enagage in sexual exploration at all. It should also not be too low because that increases the risk of children and young people being subjected to sexual abuse and thus other physical, emotional and social complications can arise from such abuse.

Increased access to condoms:

Condoms can be made to be more within the reach of those below 18 years of age through the setting up of  Adolescent Friendly Health Clinics (AFHCs) by health professionals who are part of the private medical factor. These clinics would have a role similar to that of the AFHCs that are set up as a part of the Rashtriya Kishor Swasthya Karyakram (RKSK), a programme led by the Ministry of Health and Family Welfare to improve the health of India’s adolescents. Since these would not be controlled by the Government, they would have the autonomy needed to provide effective and non-judgmental sexual and reproductive health services. More adolescents would be able to go to these clinics and get contraceptives like condoms and the clinics would maintain their confidentiality.

Sexulaity education:

No matter where we stand as a society in terms of openness towards and acceptance of sex among adolescnets, meaningful sex education in schools will always be of paramount importance. This education should be far from instructing those between 16-18 years of age to not have sex or to not engage in any kind of sexual activity. Rather, it should educate them on the ways in which they can have safe sex and why safe sex is important for their sexual and reproductive health.

Role of social media:

To be able to cultivate healthier attitudes towards adolescents having sex, more of us need to come out on social media and talk about why it is important to put an end to the ways in which society often tries to portray sex as wrong. However, in these present times when pedophiles are lurking in cyberspaces to groom minors, it is highly important that minors are also given the education to discern sexual exploitation as well.  Social media is a powerful tool that can be harnessed well to inform, educate and empower the teenagers such that they can make informed choices about their sexual activity. This way more teenagers might be encouraged to overcome any hesitation or fear and buy condoms. Importantly, more and more healthcare providers (pharmacists, doctors at govt. health centres) would develop friendly and non-judgmental attitudes towards teenagers having sex.

Conclusion

Although there are public health programmes in place to make condoms increasingly accessible to the people in this country, legal interventions in the form of a minimum age for consent to sexual activity might make many adolescents below the age of 18 reluctant to buy condoms before having sex. Further, for those who do go to buy condoms, service providers might not sell condoms to them based on their age. The scary part is that all this would not stop those below 18 years of age from having sex. It would only make many of them indulge in unsafe sex. 

About the Author: Navya Dawar
She is a second-year student pursuing BBA LLB Honours at Jindal Global Law School, Sonipat, Haryana. She aspires to, one day, be a part of something that helps people believe in themselves and cherish themselves for who they are while simultaneously becoming aware of their own potential for personal growth and exploiting this potential to become better versions of themselves. She loves drinking tea, playing tennis and is fond of working out. She likes to sing and read and aspires to go on long-distance solo hikes at some point in the future.

Sources:

1^ Yadavar, Swagata. “India Is Unprepared For Its Gathering Teen Sexual Revolution.” indiaspend.com, 12 Jan. 2018. http://www.indiaspend.com/india-is-unprepared-for-its-gathering-teen-sexual-revolution-23183/

2^ “Qualitative research on legal barriers to young people’s access to sexual and reproductive health services.” ippf.org, June, 2014. https://www.ippf.org/sites/default/files/ippf_coram_final_inception-report_eng_web.pdf

Abortion in the Steel City Ballari: Part 1

Ballari is not a word that rings a bell for someone new to Karnataka. For the uninitiated, the word can even morph into Bel Air, when pronounced with a rolling tongue and playfulness! Ballari and Bel-Air, however, are two worlds apart. Karnataka, a state in south India, has its trump card districts like Bangalore and Mysore which win the hearts of people as it offers them hopes and dreams to build a better future. Ballari, for many, remains that place identified as “rural”, “village”, “countryside”.The stamp of Steel City on Ballari does little to make the place a sought after one. 

Introduction to the SAAF project: 

As part of the SAAF (Safe Abortion Action Fund) project “Abortion is Care”, we charted out a plan to travel to Ballari, assess and map out service providers who can give safe and legal termination of pregnancy in accordance with the guidelines of the Medical Termination of Pregnancy Act, 1971. What should otherwise have been meticulous fieldwork of weeks, ended up getting shrunk to a series of telephone calls to service providers during the COVID-19 pandemic. We had to adapt as there were no other means to reach Ballari. 

Can the internet help me find an abortion?

For Google and smartphone-driven youth, the internet is the first place to go when in need of information. Usually, a quick search can unfold pages after pages of information on anything under the sun. However, when it comes to information on accessing medical termination of pregnancy near your place, the internet does not have it all, especially for a place like Ballari. Whatever combination of words one uses – Ballari – Abortion – MTP, the net gives either a list of gynaecologists in Ballari or a hospital/ nursing homes where gynaecologists/ or department of gynaecology are present. Questions remain: “how many youths will pluck courage and call/ go to these people/places and risk getting insulted/humiliated for asking about abortion/getting an abortion, especially if they are unmarried women? And how much of the lists on the net are accurate about providing abortion?”

Hear hear the doctors:

Calls were made to the hospitals and nursing homes to enquire about MTP. Most often, the staff who handled the helpdesk/ enquiry/ reception were not equipped with necessary information on MTP and were quick to dismiss further questions with a reply “you can come here and get the consultation done. We don’t know much about MTP, the doctor can tell you.” Some offered the contact number of the doctors to take the conversation further while a few maintained that they cannot share the numbers due to the organization’s policy. However, the latter offered to connect the doctor through the hospital landline.

Calling the doctors was a hit or miss as very often they would either be in O.T or away for breaks. This was especially the case when the doctors were connected via the organization’s phone line. One had no option but to wait and call again later or on another day. We, at Collective, were left wondering how a young woman in distress about MTP, will handle these waiting periods, just to have a few words with the doctor! When we did get the “golden moments” to talk to the doctor, many took out time to tell us more about what was happening in Ballari and many others abruptly ended the call stating that they do not conduct MTP for single women.

The charm and pain of naivety: 

Doctor A was very empathetic to the issues single women are facing to access safe and legal abortion in Ballari. She said that she can provide MMA under 7 weeks of gestation for single women. However, for above 7 weeks, she will not be able to help as the hospital she works for, will not want to get involved in any possible complications that can arise post-termination, especially if it is a surgical termination. She explained that a single woman most often does not have legally authorized signatories for conducting the procedure nor does she have people who can take up the responsibilities in the wake of any procedure going not as planned and these put the hospital in a tough spot. 

Doctor A shared about her years at a government facility where she had seen cases of single women who came in past 12 weeks of gestation. She said it was saddening to hear the stories of these women who had no idea about anything that has to do with sex or pregnancy and are put in a position where they now need to terminate the pregnancy. By the time they seek medical help, the pregnancy has advanced and many complications could have been avoided, had they approached the doctor at an earlier gestation period. She added that most of the cases she has seen at the government hospital, filled her up with the need to go to the communities and educate them about safe sex, the timeliness in accessing the termination and the importance of taking help from doctors and staying away from quacks. 

Doctor A, however, confessed that her position as a gynaecologist in a government setting did not give her the time and the role to reach out to the community for the same. She strongly feels that if public health groups, NGOs are to take up this role, it will do immense good to the community. She highlighted that most often everyone has this notion that villagers are naive and conservative, and that they will not receive well all these information & awareness programms on safe sex, contraceptives, pregnancy and termination. But, from her experience as a gynaecologist, she believes that they are far more receptive to these informations and earnestly want interventions that will help them. 

Mushrooming nursing homes:

Doctor B who had previously worked at the only tertiary government hospital in Ballari, VIMS (Vijayanagar Institute of Medical Sciences), and now working in a private nursing home as a consultant, shed some light on what was happening in Ballari when it comes to abortion. She said that a lot of people reach out to government hospital for an abortion, given how affordable it is there. However, because of the patient load and the ensuing delay in getting a consultation, many abandon the waiting queue and resort to nursing homes to get a faster resolution. She pointed out that many nursing homes have been mushrooming in Ballari in the last decade, and most of them offer termination services. According to her, what is worrisome is that many of these nursing homes are not authorized to conduct MTP, and people are not aware of that. Doctors too partake in this and provide MTP when they are not qualified to do so. When asked about whether she can provide MTP, she said that she is only a consultant in X nursing home and that nursing home conducts only deliveries. So far, they have not provided any MTP to any women, be they single or married. She, however, suggested a few leading nursing homes in Ballari where MTP is provided but added that she is unsure whether they are single women friendly or not. 

Yes and No to abortion:

Doctor C stated as a matter of fact that she discourages abortion even in married couples. She opined that couples should proceed with pregnancy to full term and counsel for the same to any couple who approaches her for termination. 

Doctor D was not outrightly against abortion. However, she conducted abortion only for those married couples who are carrying pregnancy with foetal abnormalities that warranted abortion. 

Legal tangles in abortion:

Doctor E revealed to us that the nursing home she worked for, had a case last year wherein a minor girl had to get termination and the POCSO investigation had to be initiated. She said that currently, the nursing home is not providing termination for single women. She ascribed this change to the legal entanglement that doctors can get dragged into, the numerous court appearings for depositions, the unending dramas which the parents of a single woman can stir up when they come to know about the termination, and in worse cases, they malign the doctors’ reputation too. According to her, many doctors (including herself), even though are sympathetic to the single women’s need for abortion, are wary of taking up the issue because of the possibilities of compounded factors of medico-legal cases. She confided that a few of her friends from the medical fraternity in Ballari were embroiled in such cases and thus decided to stop providing termination for single women. She noted that many senior doctors in Ballari are adept at navigating all these red flags and have been helping single women in Ballari get a termination. However, in light of the pandemic and them being in the high risk group due to their age, they have suspended all their practice for the time being. 

Ballari in news:

We were in for a surprise when our preliminary internet search on Ballari turned up news reports about Ballari and abortion. According to the Times of India report dated 21 December 2001 ( that is almost two decades ago!) Ballari was chosen for the Safe Abortion Project. Under this Safe Abortion Project, Karnataka had three districts viz Ballari, Raichur and Bijapur. 

We also found news wherein the Supreme Court stayed the arrest of a Ballari doctor accused of terminating the pregnancy of an alleged rape victim. We realized doctors have it tough in Ballari when we found news of a husband pressing charges against his wife and the doctor for terminating a pregnancy without his permission. We were again left wondering, how cases like these can have its own ramifications within the medico fraternity in Ballari who provide termination. 

Fieldwork amidst the pandemic:

As the weeks go by and we all are starting to let it sink in: the virus is here to stay, we also are looking forward to having safe access to Ballari. Our preliminary search, so far, has given us the narratives from doctors and news from the net. We are eager to meet the communities and youth of Ballari and hear what they have to say when it comes to accessing sexual and reproductive health services. We are sure that having the youth with us will help us see Ballari through another lens. 

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.

Corona Archives: Hidden-Pockets Collective

The World Health Organization (WHO) Director General’s recent remarks on COVID-19 emphasized that “All countries must strike a fine balance between protecting health, minimizing economic and social disruption, and respecting human rights”.

When health systems are overwhelmed, we need to make difficult decisions to balance the demands of responding directly to COVID-19, while simultaneously engaging in strategic planning and coordinated action to maintain essential health service delivery. The provision of many services will become more challenging. Women’s choices and rights to sexual and reproductive health care, however, should be respected regardless of COVID-19 status.

We, at Hidden-Pockets Collective, ensured that we also are able to respond to this crisis with special focus on sexual and reproductive health.

Thought Publications : 

We ensured that sexual and reproductive health is not missed out while discussing the conversations around response to this. We produced specific articles with response to  COVID-19 crisis.

Menstrual Health Management

Pregnancy and Abortion

 

Policy focussed demands :

Social Media:

Instagram Live Sessions:

  • With Ungender Legal Advisory on Workplace Sexual Harassment: Is it still valid if you are working from home?
  • With YANSL (Youth Advocacy Network SriLanka) on Men and their support for women’s SRHR during the crisis
  • With Mission Sanscar on Menstrual health & hygiene during the lockdown
  • With The Indian Women Blog on Role of sexual and reproductive health counselor during the lockdown, How are Hidden Pockets helping the young people of our country?
  • With Sheroes on SRHR concerns during the lockdown
  • With Rangeen Khidki Foundation on How to manage your menstruation during the lockdown

Tweetathons:

  • With SAAF (Safe Abortion Action Fund) on How to ensure access to safe abortion during the COVID-19 pandemic?
  • With IndiaMeToo and Sheroes on Access to essential SRH products and Services during the lockdown
  • With Global Concerns India on Domestic violence & shelter homes during the time of COVID-19
  • With The Bachchao Project on Love in the time of lockdown (Digital privacy)
  • With YANSL (Youth Advocacy Network SriLanka) on Women’s right to choose during a crisis
  • With the Body & Data on Women, Queer Individuals and, Privacy during the lockdown
  • With Women Help Women, Safe Abortion WOmens’s Right and Gynuity Health Projects on Telemedicine and self-managed abortion: Is telemedicine the future?

Helpline Numbers:

 

 

 

Period ही normal topic लगने लगा

उत्तम- मेरे स्कूल में Project Khel (PK) ने अप्रैल, 2013 से अपना काम करना start किया | तब मैं 10 साल का था |

संतोष- मैं जिस shelter home में रहता था, वहां पर PK ने मार्च, 2013 से काम करना start किया | तब मैं 11 साल का था |

शुरुआत में तो हम दोनों के सेन्टर में ही मज़ेदार games और sports होते थे, ताकि हमारा relationship बन सके | संतोष को sports में ज़्यादा interest था, तो उसे games और activities boring लगती थी और उत्तम को खेलना कूदना ज़्यादा पसंद नहीं था और उसे लगता था कि PK वाले sports team बनाने आये हैं, तो उसे भी अच्छा नहीं लगता था | हम दोनों उस समय मिले नहीं थे, पर हम दोनों को यह बात अच्छी लगने लगी की कैसे PK टीम के दीदी भैया लोग हमेशा टाइम से आते थे और सिर्फ अपना काम ख़त्म करने के लिए नहीं, बल्कि हमें, हमारे तरीके से life skills सिखाने की कोशिश करते थे | वैसे हम दोनों को वहाँ लगभग एक ही समय पर session दिया गया लेकिन session से हमें क्या मिला यह हम दोनों के लिए अलग था, क्योंकि दीदी भैया लोग सेन्टर के बच्चों के हिसाब से काम करते हैं |

करीब साल भर के बाद, धीरे धीरे संतोष के सेन्टर में topics और गंभीर होने लग गये | कभी-कभी हमसे मिलने के लिए दीदी भैया दूसरे संस्था से लोगों को भी लाते थे | मेरा इन सब चीज़ों में कम ही मन लगता था, लेकिन आज दीदी हमें याद दिलाती हैं कि कैसे कम अच्छा लगने के बावजूद भी मेरे behaviour में बदलाव आने लगा था | 

उत्तम 2014 में अपने स्कूल से graduate होकर दूसरे स्कूल चला गया, लेकिन उसे PK के sessions  बहुत अच्छे लगते थे, इसलिए जब भी उसके school में छुट्टी मिलती थी, वो भाग के PK के एक सेन्टर, जो की उसके घर के पास था, वहाँ चला जाया करता था |

हम दोनों को, 2015 में, दीदी भैया के साथ, अहमदाबाद में हुए एक ultimate frisbee camp में जाने का मौका मिला | उसी trip में हम दोनों पहली बार मिले | वहाँ से वापस आ कर हमे पूरे PK team को frisbee खेलना सिखाना था | यह सब इतने अच्छे से हुआ कि हम दोनों को PK के पहले 2 Youth Leader बनने का मौका मिला | Youth Leaders वो बच्चे होते हैं जो PK के 21st century  Life Skills Programme के graduate या Ultimate Frisbee के senior players होते हैं, जो Part-time facilitator बन के टीम में आते हैं | यह कैंप तो frisbee का था लेकिन इसी camp में एक session ऐसा था जिसमें हमारी अंगना दीदी और camp organizers में से एक दीदी ने periods पर एक workshop किया | उससे पहले हमें periods के बारे में थोड़ा बहुत पता था लेकिन इस workshop के बाद हमारा hesitation काफ़ी हद तक टूटा |

2016 के Global Menstrual Hygiene Day पर, Hindustan Times और Unicef के साथ मिलकर  हमने एक street carnival किया | वहाँ के जितने भी गेम्स PK चला रहे थे, सभी periods की जानकारी से जुड़े थे | हम Youth Leaders भी इस community event में facilitator के तौर पर उतरे | यह बहुत ही अच्छा experience रहा कि कैसे कुछ लोग खुल के सामने आये, और कुछ लोग हमसे बात करने में भी शरमा रहे थे | 

अगर हमारी पूरी journey को ध्यान रखते हुए हम बताये, तो सबसे ज़्यादा फायदा Youth Leaders Trainings से मिला | Feminism, Identity , consent, gender, pluralism जैसे बड़े topics समझ में आने लगे तो period उन सब में से बहुत ही छोटा और normal topic लगने लगा | Period के आस पास अपनी un-developed सोच से हमने जो हव्वा बना रखा है, वो भी समझ आया |

जब हम बच्चे के तौर पर जुड़े थे तब भी हम यह देखते थे कि first aid box में pad रखा रहता था और जब से Youth Leader के तौर पर जुड़े तो खुद भी अपने equipment kit में pad रखना शुरू कर दिया | इससे हमारे लिए pad carry करने का action बिल्कुल normal सा हो गया |

Youth Leader बनने के बाद हमें exposure के कई सारे मौके मिले | संतोष को एक बहुत ही बड़े स्कूल में जाकर लगभग अपने बराबर के बच्चों के साथ session facilitate करने का मौका मिला | उत्तम ने PK को एक MUN में represent किया और appreciation certificate भी जीता | इसके अलावा summer vacation में बड़े-बड़े स्कूल के बच्चे हमारा काम जानने के लिए लखनऊ आते थे और हम उनके साथ मिलकर action projects design और implement करते थे | हमें कई सारी  movies भी दिखाया जाता था, और movie के बाद उससे जुड़े topics पर discussion भी होता था, जिससे कि हमारे सोच का दाएरा बढ़े | अभी कुछ ही महीने पहले, जब ‘छपाक’ movie रिलीज़ हुई, तब हमें थिएटर में ले जा कर दिखाया गया, फिर उस movie से सम्बंधित discussion हमने Sheroes Cafe में किया, जहाँ हम acid attack survivors से भी मिले | मिलने के बाद हमने आपस में rape culture के ऊपर और भी बातें समझी और आपस में ध्यान भी रखने लग गये |

जनवरी 2020 में हम एक नए project में शामिल हुए, जहाँ period से जुड़े experience को ले कर  story circles करा रहे थे | अपने Female Youth Leaders और friends के real life अनुभवों को सुनना और उसके बारे में बातें करने से भी हमारे relationships में बहुत असर पड़ा | इससे हमें periods से जुड़ी अलग-अलग बातें पता चलीं, लोगों को क्या problem आती है, mood swings क्या होते हैं और कितना बुरा लगता है लड़कियों को जब उनको वाकई में किसी चीज़ पर गुस्सा आये तो लोग उसे mood swing बता के टाल देते हैं | Pain, periods से जुड़े myths का, romantic relationships पर क्या असर पड़ता है, etc पर open conversation हुए | इस में बहुत सारे लोग थे, girls और बॉयज सब एक जगह बैठ कर अपनी अपनी स्टोरी बता रहे थे और फैक्ट्स के बारे में भी बात हुई | इससे पीरियड्स हमारे लिए और भी समझाने की ज़रूरत वाली बात बन गई |

इस साल के Global Menstrual Hygiene Day के लिए, सारे Youth Leaders की मीटिंग्स करायी गयी कि हम लॉकडाउन और social media को बैलेंस करते हुए कैसे एक असरदार कैंपेन बना सकते हैं | सभी लोगों ने एक से बढ़कर एक ideas सोचे और शेयर किया | Angana दीदी ने पूरे समय, हम कितना जानते हैं और दुनिया को कितना बता सकते हैं उस हिसाब से गाइड लिया | हम लोगों ने agree किया कि tik-tok का दीवानापन अभी सबसे ज़्यादा चल रहा है, तो उसकेvideos बनiके हमने शेयर करा और podcasts भी बनाने के निर्णय लिया | इन दोनों के द्वारा, हम बहुत से टॉपिक कवर कर रहे हैं, जैसे- transman को period, एक girl जिसके period नहीं होते हैं लेकिन फिर भी वो एक ‘पूरी’ औरत है, disabled महिलाओं के periods etc | इन सबको अच्छे से बताने के लिए हमें पढ़ना भी बहुत पड़ रहा है | हम दोनों को इस campaign का manager इसीलिए बनाया गया क्योंकि हम दोनों ने सबसे ज़्यादा interest दिखाया था और अपने साइड से लगातार information ढूँढ रहे थे और दीदी से सवाल भी पूछ रहे थे | दूसरों तक बात पहुँचाने के चक्कर में हमने खुद बहुत कुछ सीखा |

फिर, इसी समय ‘Hidden Pockets Collective’ के टीम से हमारे दीदी की बात हुई और Hidden Pockets Collective  के team members  ने हमारा interview लिया और लोगों तक हमारी बात पहुंचाई | हम इन सब के लिए बहुत आभारी हैं | 

Child Marriage and Teenage Pregnancy

Playing with dolls is something most of us have done growing up. Child marriage was nowhere in our minds. We revelled in our games: to set up our own world of imagination and to have our dolls play the characters we want to. We name the dolls, we make them have doll marriages, have them set up their homes, make doll wife cook food in their doll kitchens, have her sweep and clean the dollhouses, send the husband doll away for work and even add doll babies for wife-husband doll parents! When we hit our midteens, we would have moved on from dolls to vividly conjure up a bright future for us, with us being the leading character in all our romantic movie plots: the imagination propelled us up with hope and anticipation for the future. Little did we know the realities of adult life and we naively believed in the everlasting happiness of marital bliss. We were fortunate enough to get our time to grow into adults and then enter the adult world of responsibilities and realities. We put behind our dolls and teenage imaginations. However, this COVID-19 lockdown crisis that we are living through, is making many boys and girls give up their childhood way before its time and sadly amidst the fear and panic about the virus, many of us are not seeing it. 

Child marriage has been steadily increasing during the lockdown and this is extremely worrisome. Even in pre lockdown years, the number of child marriages in India was problematic. Girls Not Brides states that 27% of girls in India are married before their 18th birthday and 7% are married before the age of 15 and according to UNICEF India has the highest absolute number of child brides in the world – 15,509,000. Now with the lockdown in place, the numbers are expected to shoot up. 

Childmarriage: livelihood and security

As COVID-19 lockdown continue to increase the uncertainties, many are losing their livelihood. People are staring at a blank future and don’t know how to make sense out of a crisis when they don’t have any money coming in. As days go by, and whatever little savings are getting fast depleted in procuring food and essentials, they fear about the future when hunger will overpower them to do things that they would not do otherwise. 

John Roberts, Programme Head, Southern Region, C.R.Y (Child Rights and You) says, “In the lockdown, the livelihood scenario is hit so badly. There is greater stress, indebtedness and desperation. Famish and poverty have become worse. There is a huge connect between livelihood stress and pushing children into marriage.” 

Vasudev Sharma, Executive Director, CRT-Child Rights Trust, says, “Economic factors are the primary reason for most of the child marriages. I see child marriages at two levels – one, families want free labour (younger the girl, more obedient and subservient she is); second, the son of the family will come back to the house every evening (and will not go in search of love outside).”

Vasudev adds that there may be some social pressure that may operate on the families, wherein relatives, matchmakers and neighbours may motivate/persuade the parents with adolescent girls to marry her off at the earliest. John also notes how patriarchy, culture all have a role in fuelling child marriage, especially during a crisis. 

Child marriage and shut schools

When schools were functional, it kept the children in schools. Most parents and communities would not dare to get the children married, as it would bring in trouble for them with the alert and responsible school authorities reporting the plans or the marriage itself to the child protection services. However, with the lockdown in place and schools shut, many contriving parents and communities are making the most out of it. Also, with uncertainties about livelihood looming large for parents, many are forced to go back to the relatively secure and comfortable lives of their native place and communities living there. As parents move, so will their children move with them. Many children who otherwise would have been safer and secure in schools and hostels are now thus put in a situation where their rights as children will have no value whatsoever, especially when parents and communities do not ensure children’s security.  

Vasudev, says, “As we see and understand that there is a long holiday (till September schools would not start). This long period may work against the interest of the children, particularly girl children – pushing them into marriage or child labour or such victims of crimes.” He also adds, “When some of the families have to return to their workplaces, maybe in urban areas, they may consider the adolescent girls as a burden and may think of getting them married.”

Child marriage, SRHR during lockdown:

Every phase of the lockdown has posed huge challenges to ensure sexual and reproductive health and services are accessible and available to all. Unmarried girls, especially, were hit hard when they discovered that they are pregnant. When living with parents and having neither cultural sanctions to be an unwed mother nor get a safe medical termination of pregnancy, they took up the “only option” put forward or rather forced upon them by their parents viz a marriage, even though it meant that they are marrying as minors.

For the already married minor girls, the lockdown not only pushed them into a hurried marriage but is also pushing them into early pregnancy. They have little choices on contraception and abortion services during the lockdown. They have limited access to transport and even if they do reach the places they are turned away by the service providers who are working in limited capacities amidst the fear of asymptomatic virus carriers. It is anticipated that this lockdown will have a long term impact on minors due to the unwanted and unintended pregnancies. The teenage girls are being forced to be mothers when they are not ready for it. 

John says, “evidence gathering studies which we, at CRY, have conducted in the past in Tamil Nadu and Karnataka have shown us that teenage pregnancies occur. Young girls who are forcefully married end up in a miserable marriage. Spousal abuse happens, husband abandons wife or husband and wife live separately. Early and child marriages ruin the lives of girls.”

Report and Rescue:

The lockdown has posed challenges to the prevention of child marriages. With the initial weeks having no clarity from the government about the dos and dont’s of lockdown, many parents took advantage of the absence of the Child Marriage Protection Officers. Though some instances were reported to the ChildLine 1098 and the police, most of the time such child marriages have gone unnoticed and unreported before the marriage. With the breakdown of civil registration systems at many places during the lockdown, many child marriages have escaped the scrutiny of the law and its subsequent course. Vasudev explains, “You get to know about a large number of child marriages only when the daughter-in-law arrives at the husband’s house and the worse situation when the below 18 daughters-in-law reaches the PHC and the AWC.” 

To prevent and to protect:

Vasudev suggests immediate measures that need to be done to prevent child marriages, “The urgent need is that the local Govt (Grama Panchayats) take a census/count of all the children in their vicinity and jurisdiction and particularly adolescent girls from a protection perspective.”  He explains that though the local school or AWC may have the count of the children who were otherwise in the same village all the while, the count of the new arrivals (migrants who have returned, girls who have come back from hostels and such arrangements) need to be recorded. This can help in assessing the needs of the children during the lockdown – their nutrition, medical help, protection.

He stresses on the importance of conducting intensive public education/warning about dire action if any child marriages are attempted and thinks it is highly needed to educate all girls and boys, adolescent boys and men about the legal actions that they have to face if they attempt child marriages and child abuse. And to respond according to the COVID-19 times, he suggests considering any child abuse in the form of child marriage or sexual abuse under the Disaster Management Act.

John draws attention to the need for more inclusive packages from the government that keeps the children also as a major focus. He says that if one looks at the budget allocation or resource allocation so far, and also especially of the lockdown, it appears that children do not exist at all. “There is very little from a child’s perspective.” With schools closed and uncertainties looming about when the reopening shall be, many children are losing out on their mid-day meals that kept their tummies full and hunger at bay. Anganwadis which used to be the go-to place for many adolescents for nutrition and supplements now stays shut at the blank faces of these youngsters. And so far, it appears that the government has not opened its eyes to the perils of children during this lockdown. “ As long as parents are hungry, as long as children are hungry, there will be always the desperation. The hunger will push people into all kinds of other situations. The state must look into far more comprehensive responses, especially from the point of view of the poor.” 

Experts suggest that the state and NGOs need to collaborate and work together to ensure the safety, nutrition, health, education of the children. Especially during this pandemic, it is imperative that the needs of the children are met appropriately, such that the trauma and stress of children too find a place in the discourse to solutions in the times of lockdown. Many children are not aware of the “whys” of the lockdown. They are silent spectators to this unprecedented time, unable to comprehend the tectonic shifts that are happening to their little world they are in. While urban and rural boys and girls may experience lockdown differently, one thing is sure that they are all suffering in their own worlds. 

For the young readers benefit, who are not well versed with the government’s role and mechanisms in place to report and prevent child marriage, Vasudev Sharma, Executive Director, CRT-Child Rights Trust, elaborates on how the system works:

“The Prohibition of Child Marriages Act (PCMA) 2006 empowers everyone to complain if they come to know about any possible child marriages. The local authorities – School Head Masters, ANM, Grama Panchayat PDOs, Supervisors of the AWCs are the CMPOs (Child Marriage Prohibition Officers). All police sub-inspectors and above rank are also CMPOs. There are hundreds of other officers at taluk and district who have the authority to prevent and file cases if they get to know about child marriages.

One can reach out to police or ChldLine 1098 about the possible child marriages (anybody, adult or children – the victim or any child). All are assured of maintaining anonymity. Their identity will not be revealed.

But we urge that the information should reach the authority at the earliest. Don’t wait for the marriage day. We are not supermen or women to appear in a jiffy to stop the marriage as it happens in Indian films! We too require time to prepare, plan and arrive at the village to take up action.

The ChildLine 1098 representatives or police or DCPU would visit the site on receipt of the information and conduct their own inquiry and take necessary measures.

If the child requires to be rescued from the location, she would be provided shelter under the state care after producing the child before the Child Welfare Committee. The girl’s education would not be affected and she can always go back to her family once the situation subsides.  The family would be counselled to prevent child marriages and the authorities may even file a case against the perpetrators.

If the marriage is performed, filing the case becomes inevitable under various sections – PCMA, IPC and even as per the POCSO.

If there is any adult hand in instigating the girl to elope, that will be considered as kidnap and further measures will be taken along with POCSO and IPC provisions.”

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.

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