Medical Abortion: Nurses have a Say?

Have you heard the Beatles song “Help?” or  Do you remember that song? Ever thought it along the lines of people in need for abortion and nurses?

“Help, I need somebody.

Help, not just anybody,

Help, you know  I need someone, help.

When I was younger, so much younger than today

I never needed anybody’s help in anyway

But now these days are gone, I am not so self assured

Now I find I have changed my mind and opened up the doors.

Help me if you can, I am feeling down.

And I do appreciate you being around.

Help me, get my feet back on the ground

Won’t you please, please help me.”

What would otherwise be a loved up song from the Beatles, takes on a whole new persona with innumerable interpretations during this lockdown due to COVID-19 pandemic.  For us, at Hidden Pockets, this song ran deep as the Careline services continued to grapple with the increasing distressed calls from young people who feared that they might be pregnant and were helpless about getting an abortion.

The lockdown posed a huge set of challenges to make sure abortion – an essential service declared by the Government of India in phase 2 of lockdown – is accessible and legally available for those in need. Discussions were unfolding to broaden the scope of telemedicineto include medical abortion. It is in these crisis times that all doors need to be knocked upon to make sure women have access to safe and legal abortion. One such door is the policy change to have nurses who are highly qualified and trained to be eligible to administer medical abortion pills for the pregnant persons, a possibility that was nipped in the bud in the latest MTP Amendment Bill 2020. 

The global Indian nurse

Antonia Pushpraj, a Senior Nurse Strategist with 28 plus years of experience in nursing profession said, “The entire world looks up to Indian nursing and India itself should have trust in the capabilities of the nursing professionals today. However, this is not the case and it is time that the medical professionals put the capabilities of nursing professionals to test and trust them.”

Experts say professional nurses undergo rigorous training during their years as students. While the initial years are rooted in basics such as anatomy and physiology, the latter years have diverse subjects such as gynaecology, paediatrics and more. For GNM and BSc nursing students an entire year is dedicated to maternal and child health according to the curriculum drafted by the Indian Nursing Council. In addition to this, the Indian curriculum incorporates other disciplines such as sociology which makes the nurses of India have multidisciplinary training.

“After BSc nursing, many people choose to specialize in MSc OBG. Some even go on to do their M Phils, doctoral and even post-doctoral degrees. We have a highly trained group of professional nurses in our country, who in turn can train and mentor the younger generation, ” said Antonia.

Nurses and Abortion

Many are quick to jump the gun and say a loud no at the possibility of nurses handling the medical termination of pregnancy. What is lacking in these dismissals is the patience to understand how a nurse is also as proficient as a doctor in administering and managing medical termination of pregnancy and what exactly is medical termination of pregnancy. Very often, people without understanding either are too quick to have graphic images of bleeding person, surgical tools and a foetus when they hear abortion. 

Dr Alka Barua (Abortion Theme Lead at CommonHealth) who is a medical doctor with more than 35 plus years of experience working for SRHR of women said, “ global studies have shown that nurses are capable enough to administer medical abortion pills and even WHOhas laid down such a recommendation based on these studies.” She elaborated that medical abortion is not the same as surgical abortion. In medical abortion when nurses administer pills, they are not intervening internally with the person’s body, unlike a surgical abortion. 

However, many doctors in India are not comfortable with the possibility of nurses permitted to administer the pills. One of the main reasons given by them is that in the event of ectopic pregnancy and a pregnant person takes the pill, it can lead to severe complications and that nurses are not skilled enough to detect an ectopic pregnancy. They also cite reasons such as that nurses can be careless with the pills and give the wrong drugs or wrong dosage or even give it in the wrong week of gestation. 

Anubha Rastogi, Mumbai based independent lawyer said, “ According to the existing laws under MTP Act, 1971 it is illegal for a nurse to conduct medical abortion. However, it is highly desirable to include nurses.” She elaborated that when the work around the MTP Amendment Bill 2020 was taking place, one of the key recommendations/ demands which advocacy groups had circulated to the Parliamentarians (both the Lokh Sabha and the Rajya Sabha) was to expand the service provider base for safe and legal abortions and include nurses as well. However, there was a strong backlash from medical bodies and OB-GYN bodies against such an inclusion. These bodies maintain the stand that medical abortion pills can be given only by doctors and nurses do not have the expertise to handle the complications that can arise.

Paisa, Paisa, Paisa

There is a widespread belief among many advocacy groups that doctors are indulging in a power game when it comes to abortion. They allege that doctors know a lot of money is involved in the termination of pregnancy and hence they would not want to let go of the commercial benefits that they can reap out of abortion services. This is one of the many reasons that doctors are reluctant to share their “power” of being the authorized abortion providers and thus monopolize the need by charging a hefty fee.

 A confirmed source said that a few doctors go to such an extent that, what would otherwise have been a simple and easily affordable medical abortion, is intentionally delayed by citing different reasons so that the pregnancy enters a gestation period wherein medical termination will be risky and thus a surgical termination of pregnancy will only be the option for the person who needs an abortion. This, in turn, brings in more money, especially for the corporate hospitals as well as the doctors working in the private sector. It is said that a profit cut is made for every surgical abortion in these sectors. 

Another confirmed source said that the money-minting is not restricted to private doctors alone and that government doctors too are in the game. According to the source, many states allow government doctors to have a private practice. Some of these doctors get the training from government training sources/ organizations for abortions and then later they divert the cases that come to the government hospitals to their private clinics which makes it possible for them to charge a higher fee.

Power Play

Nurses said that the power games of doctors do not just end there but it translates to the working spaces as well. In spite of being highly qualified and trained, many nurses constantly face the humiliation of distrust from the doctors. Very often, their skills are questioned and rebuked by the doctors. It is a public secret amongst the medical fraternity that most doctors do not trust nurses. This, in turn, translates to distrust from the management. The nurses asked that if doctors do not trust them, then how will the management trust them, who will the management listen to: doctors or nurses? The hierarchies are very well defined and often professional camaraderies and support are missing.

Experts, however, highlighted the severe shortcomings that are plaguing are plaguing the nursing training since the last few decades. The fact that there has been a mushrooming of nursing colleges throughout the country which lacks connected practice areas/hospitals with enough patient inflow needed for the nurses to hone their clinical skills point to the larger problem at the higher levels of authority. They also said that many nursing homes employ people who have education, not beyond the tenth standard, and are given rudimentary training, the coveted uniform of nurses, and are made to work as “nurses” on a pittance as salary. All of these can contribute to questioning the expertise and proficiency of nurses in the public’s eye who are unaware of the larger story and what goes into the training of a professional nurse.

Digging Deeper

Educationists said any education and training need to be done along with the KAP model (Knowledge, Attitude and Practice), be it for the nurses or be it for the doctors. This is very important especially for abortion as nurses and doctors can be thorough with the textbook knowledge on abortion but severely fall short in good attitude and practice. With respect to abortion, which still continue to hold stigma, guilt, shame amongst the larger public, it is needed that both the nurses and doctors ought to leave behind their personal prejudices, beliefs, judgements once they dorn their professional attire and tend to the patients. And for the same, the curriculum needs to have modules on training the students. 

Antonia said, “empowerment of nurses is not fighting with doctors.” Pointing to the cacophony that exists between nurses and doctors, she noted that capacity building can only be achieved through trust. “If a nurse lacks confidence in spite of her high education, doctors can be a team player and help the nurse build her/his confidence and make her/him an expert. The doctor can supervise in the beginning and gradually step back once the nurse has gained the expertise.” 

Pharma Folks at Your Service

Dr Alka elaborated on the findings of a study conducted by the Guttmacher Institute, which stated close to three in four abortions in India are achieved using MMA drugs from chemists and informal vendors rather than from health facilities. She said, “the study has said it loud and clear that a huge proportion of women in India procure medical abortion pills from sources who are not trained nor authorized according to the MTP Act. This study itself should ring a warning bell to the government that the abortions services are not being met through private or public health facilities for whatever reasons and that in such a circumstance make amendments in the MTP Act to include more service providers like nurses who are trained well.”

Experts said that if nurses are given thorough training on dosage, the required patient counselling, how to look out for complications, the necessary follow-ups and reference, any day the person who needs abortion will be far safer in the nurses’ hands than in chemists’. They say the most common objection cited by doctors on ectopic pregnancy does not hold water as it is not very frequent and doctors themselves don’t often detect it. 

Doctors are almost always put on a pedestal by our society. It is time we stop having blinders and see the desperation in pregnant people to get an abortion. Perhaps it is time we also put nurses on a pedestal such that they too can help the person in need. Or better bring the doctor down from the pedestal and have both doctors and nurses do justice to their noble profession. After all, to call a profession noble, it surely has many added human values in it. It is time the pregnant person is treated with humanity- legally and safely- to get an abortion.  

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.

Connect with us on our social media pages to get updated about Sexual and Reproductive Health and Rights.

 Twitter

#BleedingPaused

In an imaginary world, every menstruators dream of pausing their periods at least once. But, menstruation doesn’t stop for anyone. It continues its visits every month even during the lockdown!

Hidden-Pockets Collective launched a month-long campaign on May/2020 to create awareness about Menstrual Health Management (MHM) during a crisis.
It is an unnoticed global trend that women’s health concerns, especially sexual and reproductive health, and rights, are being left behind during the time of a crisis. Let it be a flood, pandemic outbreak, or even a nationwide lockdown, often the burden lands chiefly on women, doing double, triple, quadruple duty to care for children, parents, and other loved ones. It’s a global phenomenon that needs to be addressed and changed. Through the #BleedingPaused Campaign, Hidden-Pockets aims to break the widespread myths, misconceptions, and taboo around Menstruation.

Campaign Partners:

  1. Rangeen Khidki Foundation, Calcutta
  2. Mission Sanscar, Mumbai
  3. Project Khel
  4. Red is the New Green
Here are some of the contents we created for the campaign:

Posters:

Articles:

We have noticed that there is an increase in menstrual health-related queries on our website and careline during these times as stress and anxiety can affect a person’s menstrual cycle.

During the lockdown, we heard the word essential repeatedly. What are the essentials? How do you decide on the essentials? A research piece from Hidden-Pockets Collective!

 

Instagram live:

  • Future free of sexual shame with MensusWithManasa
  • Menstrual health & hygiene during the lockdown with Mission Sanscar
  • Role of sexual and reproductive health counselor during the lockdown, How are Hidden Pockets helping the young people of our country? with Indian Women Blog
  • Women’s Health, Nutrition, and PCOS with Aarathi Shanmugam (Nutrition coach at the Quad, Chennai)
  • How to manage your menstruation during the lockdown with Rangeen Khidki Foundation
  • Engaging mean and boys into menstrual health management with Project Khel

Tweetathon:

  • Access to essential Sexual and Reproductive Health products and services during the lockdown with IndiaMeToo
  • Access to essential Sexual and Reproductive Health products and services during the lockdown (In rural areas) with SHEROES
  • Discussing the structural challenges while approaching menstrual health with RESURJ, Mexico

Facebook Live:

  • Menstrual health management with Aahung, Pakistan (Supported by UNFPA, Pakistan)

Tik-Tok videos on periods with Project Khel

 

Telemedicine and Abortion: India says Yes or No?

COVID-19 has brought all of us to a standstill. It is highly unlikely that we no longer take things for granted after witnessing first hand how interconnected all our lives are. What would otherwise have been a skip, hop and jump to the pharmacy near our house to get, say a basic Paracetamol tablet, has now become desperate speed walks to all the pharmacies within 4 km radius of your house! We witness first hand, what it means when newspapers say supply chains have been affected and medicines are going out of stock. We may want to sigh, we may want to be angry at all those folks who made panic purchases earlier, who have hoarded their medicine cabinets and stayed safe in their houses with glee and satisfaction. In this case, can Telemedicine be an option to look at?

Now, what if you are to find out you are pregnant, or your partner is pregnant? What if you had not planned this pregnancy? What if this pregnancy is creating severe anxieties for you and/or for your partner given how the future looks very uncertain due to impending economic recession and thus makes you feel the pregnancy as unwanted? What if you are to find out you are pregnant while staying with your parents during this lockdown who have no clue that you are sexually active and surely will not receive well your discovery? What if this COVID-19 pandemic and the lockdown has severely restricted your access to safe abortion

India is now entering the fourth week of nationwide lockdown with 17 more days to go for the lockdown to end. Even though hospitals and pharmacies are essential services during this crisis, they are plagued with challenges. Many of the hospitals which are functional even during the lockdown, now have a dearth of Personal Protection Equipments (PPE). The staff are in the high-risk group of getting exposed to the virus and those hospitals where staff tested positive are shutting down their services. Pharmacies are facing supply chain hits and shortages of stock. Amidst all these, when you identify as one of those people mentioned in the above para, what are you to do next? 

India has a relatively liberal law on termination of pregnancy and much to the surprise/ ignorance/ confusion of many Indians: abortion is, in fact, legal in India, not as a byproduct of the liberal times, but as a legal right ensured by the Medical Termination of Pregnancy Act, 1971. Also, the recent amendments to the MTP Act 1971 passed in the Lok Sabha in March (just as the country was waking up to COVID-19 crisis), gave many the reasons to celebrate that India is moving towards more progressive abortion laws. However, there was dissonance from many quarters about the amendments being lopsided. Now, as we navigate through this lockdown, it is surprising that the necessity of timely and safe access to abortion has eluded the health sector amidst the pandemic panic and many experts and activist circles have overlooked the urgency for ensuring access to safe abortion during the lockdown. 

The lockdown is giving a tough time for scores of women to have access to safe abortions, especially for those women who do not have the convenience of distance and the privilege of a personal mode of transport. Even if they do reach the hospitals, abortion is still out of reach for them as abortions are elective procedures and most hospitals are now postponing abortions citing the risks of exposure to the virus. Almost all elective procedures including abortions are on halt at hospitals as it is highly likely to have patients who are asymptomatic and thus there can be contamination, posing a risk of infection to the hospital staff as well as the patients. 

While ‘stay home, stay safe’ is indeed the need of the hour to ‘break the chain’, many are pushing for telemedicine to address the health issues of the population such that neither the doctor nor the patient has a risk of getting exposed to the virus.  Recently the Ministry of Health and Family Welfare, Government of India issued guidelines for telemedicine practice which has solidified the acceptability of this new mode of medical intervention. These guidelines have now made it legalto practise telemedicine in a professional setting. The scope of telemedicine for Sexual and Reproductive Health and Rights (SRHR), especially for abortion, holds a lot of promise. However, there seems to be no specificity whatsoever about abortions, a much-needed service, in the existing guidelines.  

According to the experts, there is lack of clarity even though the Medical Council of India (MCI) released guidelines specifies what entails telemedicine in India, who can practice telemedicine and how e-prescriptions can be provided to clients. They explained that at present, the Government of India allows only over the counter medicines to be e-prescribed apart from some drugs like chloroquine in endemic areas while Schedule X drugs are strictly prohibited. They opined that they would discourage online prescriptions apart from what is included in list O (Over The Counter) in the telemedicine guidelines and firmly think that in any circumstances, medical abortion pill cannot be prescribed over telemedicine in India, not even during an epidemic.

Dr Ashok Kumar Devoor, Senior Gynaecologist and Advisor to Hidden Pockets Collective said, “Two important prerequisites of abortion are (1) clinical examination (2) confirmation by scanning. Scanning is very important as it helps to ascertain whether the foetus is growing within the uterus or outside the uterus, that is in the fallopian tube. Now, if one were to take medicines to abort the foetus, without knowing that foetus is outside the uterus, it can lead to serious consequences. The fallopian tube can rupture and the woman’s life will be at risk as it is a medical emergency and needs immediate surgical intervention. Hence scanning is a must to know whether the pregnancy is within the uterus.”

Specialists say that the termination of pregnancyup to 9 weeks is usually done through medicines given under medical supervision with follow up at hospitals and clinics. For pregnancy beyond 9 weeks and under 12 weeks, surgical termination of pregnancy is needed. 

Dr Shamala A. Dupte, Director Medical and PD- GCACI, Family Planning Association of India (FPAI) said, “ Access to safe abortions is a fundamental reproductive right. The mobility of staff and also the patients have been restricted during these lockdown times across the country. However, our clinical teams have braved all challenges to ensure that women continue to access these essential, time-sensitive services. We provided safe abortion services including pre and post-abortion counselling and contraception to over 200 women from 1st April to 12th April 2020.”

Countries like the UKhave already made it possible to have medical abortions within the safety of one’s own home during this pandemic. This is a temporary policy change and women need to follow a telephone or e- consultation with a doctor for abortion at home. 

Dr Ashok thinks that safe medical abortion through telemedicine is possible and much needed in India during the lockdown. However, he stressed that provisions need to be made such that if medicines are prescribed through telemedicine, it is done so only after scan results are obtained. Also, he highlighted the importance of having access to hospitals for those cases where there has been incomplete abortion. 

The possible manipulation of telemedicine for sex-selective abortion is real, especially in India where male child preference is high. However, experts said that it is the same as the one that would exist even in a clinical set up: a woman who already knows about the sex of the foetus through scanning can approach another doctor and request for an abortion in a clinical setup. 

Since the lockdown, Hidden Pockets Collective, the only real-time Careline service on sexual and reproductive health service across India, has been inundated with pleas for help from youngsters who fear that they are pregnant. What otherwise would usually be places where Hidden Pockets did not have any presence, places such as Kashmir, Nagaland, small pockets of Bihar – Uttar Pradesh – Telangana, are now emerging strongly towards Hidden Pockets during the lockdown. The SOS messages have moved beyond the metropolitan cities in the country. 

Aisha Lovely George, the Careline Counsellor at Hidden Pockets Collective, is the first point of contact for the clients who are in distress. Aisha said, “More than the fear of contracting the virus, the youth have the fear of finding out that they are pregnant and they are already panicking about safe abortion during this lockdown”. She explained that most people who reach out to Hidden Pockets have no access to pregnancy test kits as they are staying with their parents during the lockdown. When their otherwise regular periods are now unusually delayed, it sets forth a whole chain of doubt and fear that they are pregnant. To worsen their woes, they do not have the approachability to request their parents for a pregnancy test kit nor can they step out to get one on their own. Immense stress, anxiety and fear constantly swing these young people between gloom and doom. 

With the lockdown extended recently, their worries too have grown that if lockdown gets stretched further in the future, they will not be able to hide their pregnancy (if they are pregnant) as the telltale signs of pregnancy will start to show and family will realize what is happening. 

Even if necessary precautions have been taken for safe sex, the youngsters are looping in circles of worry about being pregnant only because their periods are unusually delayed. Given the drastic lifestyle changes that lockdown has brought about where sleep cycle, dietary habits and metabolic rates have all gone for a toss, the menstrual cycle is playing havoc with the youth’s anxiety levels. 

Aisha strongly felt that telemedicine guidelines, in its current form, are not addressing many challenges on the ground when it comes to access to safe abortion. She said, “the existing guidelines on telemedicine poses problems as it does not permit giving medical abortion pills. For doctors, they need scan results for abortion. Most scanning centres are non-functional during the lockdown and if they are functional the question of access during the lockdown remains.” 

With every passing day of the lockdown, the number of youngsters who reach out to Careline services of Hidden Pockets Collective is skyrocketing. As much as she wants to help them, Aisha feels her hands are tied because of the ground realities of lockdown. “Even if the government is not listening to the pleas of organizations like us and make the needed changes to the guidelines that can ensure safe access to abortion, then at least bring in as many senior doctors as possible who have vast experience to just have conversations through telemedicine with these youngsters. The reassurance these senior doctors can give to the patients can bring a lot of relief to them,” she emphatically added.

India is still making the uphill climb towards tech literacy, tech outreach and quality tech services. The dichotomy between India and Bharat are present for these tech matters too. While many continue to use these valid points as downers for supporting and promoting telemedicine, what is being forgotten is the need of the hour we are in. Young women are in distress and virgin birth might not be the best answer they can give their parents when the lockdown ends!

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.

Connect with us on our social media pages to get updated about Sexual and Reproductive Health and Rights.

 Twitter

Abortion is Care

Abortion is Care

Every day, a minimum of 10 young women in Karnataka is looking for help to have an abortion. These women have limited information on where or how to access the services that can help them. They also have limited awareness of their sexual and reproductive health. Studies have found that unsafe abortions are the third leading cause of maternal deaths in India. And this is preventable if women have information and access to safe abortions. Hidden Pockets is running a campaign called ‘Abortion is Care’ to create awareness and provide accurate information on safe abortion in 4 cities of Karnataka (Bangalore, Bellary, Shimoga and, Mysore). By the end of this campaign, we hope to build an atmosphere where every woman will be able to access friendly, affordable and safe abortion services by involving the local communities from these cities.

Here are some of the videos we created for the campaign:

English: Abortion is Care 

Kannada: Abortion is Care

Tweetathons:

Instagram / Facebook Live:

  • Instagram live with Dakshita Wickremarathne (YANSL- Youth Advocacy Network Sri Lanka) on men and their support for women’s SRHR during a crisis.
  • Instagram live with Indian Women Blog on The role of sexual and reproductive health counselor during the lockdown, How are Hidden Pockets helping the young people of our country.
  • Instagram live with SHEROES India on SRHR concerns during the lockdown.
  • Instagram live with Rangeen Khidki Foundation on access to SRHR during the lockdown.
  • Instagram live with Good Universe NGO on Sexual and Reproductive Health.
  • Facebook Live with Dr. Rathnmala Desai, FPAI (Family Planning Association of India) on Pregnancy, Abortion and other Sexual and Reproductive Health Concerns.

Here are the Podcasts we created for the campaign:

Campaign posters:

 

Live sessions with students:

Live session with students from Christ University, Bangalore

Identified reproductive healthcare hotspots in four cities of Karnataka

In the month of September/2020, Hidden Pockets Collective run a campaign #knockingoncloseddoors where we mainly focussed on Abortion during Covid-19.

Campaign Collaborations #knockingoncloseddoors

  • Tweetathon with Pratigya Rights and Global Concerns India (Local Partners) on Impact of COVID 19 on Safe Abortion services in India.
  • Tweetathon with Lend a Voice Africa, Safe2Choose, The Wise up initiative, Rural women’s right structure, BALDSA, Global Media Foundation and COHERINET on Covid-19 and impact on safe abortion services around the world.

Tweetathon Moments

Abortion Stories

Partners

Hidden Pockets has been working both at national and international level. Some of our partners who have helped us. wgnrr_30_years_logo_final1-300x99

Women’s Global Network for Reproductive Rights(WGNRR) is an international Non-Governmental Organisation (NGO) that advocates for sexual and reproductive health and rights worldwide. Based in the global south, they are a membership-driven organization that “works within the rights, justice and feminist frameworks.” WGNRR has consultative status with ECOSOC.

For more check WGNRR’s website.

RESURJ ( Realising Sexual and Reproductive Justice)

It is a membership-based alliance of feminist activists working across generations, constituencies, and identities seeking to realize sexual and reproductive justice for all. Its justice approach encompasses an understanding of and a commitment to addressing the interlinkages between our bodies, our health, and our human rights in the context of the ecological, economic, and social crises of our times. This approach also recognizes historic injustices and systemic inequality in gender power relations.

For more check : http://resurj.org/about

FoV Logo- Hires

Fields of View is a non-profit organisation, registered under the Karnataka Societies Registration Act, 1960. Section 12AA(1)(b)(i), and Section 80G(5)(vi) of the Income Tax Act, 1961.
For More check website.

Is space available to sexual minorities for sexual expression on social media?

While social media and sexual expression is usually viewed from a popular perspective, Hidden Pockets and Point of View decided to look at the same from a different lens; from the eyes of communities usually considered to be sexual minorities. Hidden Pockets and Point of View jointly hosted a panel on Social Media and Sexual Expression during Digital Citizen Summit 2017 on September 21, 2017. The speakers on the panel included Nadika – trans rights activist and writer, Smita Vanniyar – Point of View, Mahika – Feminism in India (FII), Jasmine Lovely George – Hidden Pockets, Nipun Malhotra – Nipman Foundation and Brindaalakshmi.K – Hidden Pockets. These speakers either represented or shared their expertise on different sexually marginalized communities like women, persons with different sexual orientations and gender (LGBTQIA) and persons with different disabilities.

The panel focused on understanding how inclusive social media platforms are towards these sexually marginalized communities. Exploring the challenges posed and solutions provided by social media platforms, the panel looked into the aspects of access, challenges and privacy in relation to the different communities.

Privacy

  • With social media platforms looking to verify all profiles with identification documents, the LGBTQIA+ community faces the constant risk of their gender and sexual identities and orientation being revealed on these platforms.
  • The privacy of persons with disabilities is compromised when their disability is revealed through images shared or the community of people that they are connected to on the platform.

Challenges

  • It was pointed out that social media primarily approaches content from a male gaze. This results in the censorship of certain categories of content on social media platforms. For instance: the body images of plus size women are filtered out while the body images of regular size women are pushed more on these platforms, thereby limiting the access to certain kinds of content on the platforms.
  • The LGBTQIA+ community faces the issue of their sexual or gender identity being revealed on social media by ex-partners or others who threaten them with extortion. Most cases of extortion go unrecorded due to the threat of IPC Sec 377. Victims gets threatens of images or videos being leaked. Unaware of their legal right against extortion, most give into these threats and pay the ransom demanded. It was noted that IPC Section 384 deals with punishment for extortion and IPC Section 388 deals with punishment for extortion using Sec 377.
  • Persons with disability find it hard to express their sexuality when their disability is visible on social media platforms.
  • Closed men-only Whatsapp groups perpetuating sexism and objectification of women, continue to exist. When asked if such women groups exist, the answer was no. Women-only groups exist. However the nature of these groups and the kind of content shared in these groups is very different from the men-only groups.

Though social media posses its own set of challenges, it’s advantages cannot be negated. Social platforms have also made Internet spaces more accessible for people from these communities to be open about their identity.

Access

  • Access becomes a challenge for person with disabilities especially those with visual impairment. How inclusive are these platforms for a person with disabilities is questionable. That said, social media platforms have also given them access, opening doors to person with other kinds of disabilities where none existed before.
  • Social platforms gave members of the LGBTQIA+ community the space to be open about their sexual orientation and gender identity for the first time in their lives by allowing them to create anonymous profiles with a different name and profile photograph.
  • Social media platforms also allow for transgender persons to be present on these platforms without disclosing their gender identity. It allows for them to come out if and when they wish to.
  • Social media platforms also provides access to create secret groups in support of different groups of people with certain challenges like the LGBTQIA+ allowing them access to a support system

In conclusion, when asked what would be the one thing that should or shouldn’t change about social media, most panelists agreed that social media may have its flaws but social media has opened several doors. However, it might be useful if these platforms become safe spaces where individuals can be themselves without worrying about any of the above mentioned issues. The onus should shift from individuals onto the platforms, governments and the Internet to make them safe for users.

Public Health : Young People in the Conversation

Hidden Pockets Collective took part in Public Consultation held by Prayasand Human Right Law Network in Bhopal in 2017. This year the theme was around Legal interventions in Sexual and Reproductive Health.

Are young people there in the National Health Policy 2017? In order to answer this question, it is important to understand the definition of young people. According to the National Youth Policy 2014, young people in India, which is people in the age group of 15-29 years of age, comprise 27.5% of the population. At present, about 34% of India’s Gross National Income (GNI) is contributed by the youth, aged 15-29 years. Government of India spends about Rs.55,000 crores on non-targeted schemes including health designed for various demographic segments of which youth are also beneficiaries.

Considering the youth contribution to the national population and Gross National Income, it becomes pertinent to understand the National Health Policy from the perspective of young people.

Areas where young people have been mentioned in the National Health Policy

It is essential to understand that though the National Youth Policy acknowledges that 15-29 years of age is the age group of the youth, the National Health Policy nowhere specifically addresses the need of this particular age group although it mentions and includes adolescents with respect to several aspects. However, taking into consideration the different aspects that pertain to the youth, following may be seen as the areas that address the needs of the youth:

If you have any queries around sexual and reproductive health, please WhatsApp us at 8861713567.

Objectives under Progressively achieve universal health coverage:

“Assuring availability of free, comprehensive primary health care services, for all aspects of reproductive, maternal, child and adolescent health and for the most prevalent communicable, non-communicable and occupational diseases in the population.”

Under Policy Thrust – Preventive and promotive health:

“an expansion of scope of interventions to include early detection and response to early childhood development delays and disability, adolescent and sexual health education, behavior change with respect to tobacco and alcohol use, screening, counseling for primary prevention and secondary prevention from common chronic illness –both communicable and non-communicable diseases.”

National Health programmes:

The policy gives special emphasis to the health challenges of adolescents and long term potential of investing in their health care.

“The scope of Reproductive and Sexual Healthshould be expanded to address issues like inadequate calorie intake, nutrition status and psychological problems interalia linked to misuse of technology, etc.”

However, this seems to only include youth between the age of 15-18 or 19.

In order to better understand the presence of youth in the National Health Policy, it becomes important to understand the policy in the light of the National Youth Policy, which was passed earlier in 2014.

Alignment between National Health Policy and National Youth Policy

Maternal health

National Health Policy 2017 and the National Youth Policy 2014, both address maternity health and the need to address the different aspects related to it for the mother and the newborn child.  It is progressive that the government acknowledges the need for expansion of reproductive and sexual health for adolescents and the need to address social determinants for maternal health. However, how it intends to implement these measures has to be seen especially with respect to National Health Policy.

Education on nutrition

Both the policy frameworks have acknowledged the need to educate the youth about the need for the education among Youth about nutrition and calorie intake

Sex education

The National Youth Policy notes the need to create “awareness about family planning, birth control, STDs, HIV/AIDS and substance abuse, especially in rural areas and (c) addressing issues concerning emotional and mental health (e.g. risk of depression and potential suicide attempts), esp. in case of adolescent youth.”

Addressing high risk groups for sexually transmitted diseases

“Enhanced capacity for detection and treatment of communicable diseases must be developed, especially for pregnant mothers and other high-risk groups.” – National Youth Policy 2014

While there are alignments with respect to several policies, there are several gaps between the policies and even otherwise. These gaps may have a far-reaching effect on the sexual and reproductive health of the youth.

Gaps between both policies and otherwise

Addressing sex ratio

Along with maternal health, the National Youth Policy also addresses the need to bring down female feticide to improve child sex ratio

“There is a need to pay special attention to health issues concerning women youth. This would entail greater pre-natal and post-natal care for women in vulnerable age group of 14-18 years, need to bring down maternal and infant mortality rates, campaign against female feticide to improve child sex ratio, etc.”

Marginalized and disadvantaged youth

The National Youth Policy 2014 acknowledges the need to support “a few segments of the youth population require special attention. These include economically backward youth, women, youth with disabilities, youth living in conflict affected regions including left wing extremism, and youth at risk due to substance abuse, human trafficking or hazardous working conditions.”

This is not the case with the National Health Policy. Except women as a group, the intersectionality of young people with other groups of people has not been dealt with in detail in the National Health Policy 2017. There seems to be a gap in understanding the impact of an individual being subject to multiple challenges due to the intersectionality.

For example: A person may be disabled, transgender and HIV positive

Disability

  •      Equity: Reducing inequity would mean affirmative action to reach the poorest. It would mean minimizing disparity on account of gender, poverty, caste, disability, other forms of social exclusion and geographical barriers. It would imply greater investments and financial protection for the poor who suffer the largest burden of disease.
  •      Health Status and Programme Impact: Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of burden of disease and its trends by major categories by 2022.
  •      “Research on social determinants of health along with neglected health issues such as disability and transgender health will be promoted.”

Transgender violence:

  •      Unfortunately, both policies do not focus on the needs of sexual minorities going beyond the ambit of HIV/AIDS with focused interventions on the high risk communities like MSM (Men who have Sex with Men), Transgender, FSW (Female Sex workers), etc. and prioritized geographies for control of HIV/AIDS. It is worth noting though that the National Youth Policy was passed in January 2014 much before the NALSA judgment of 2014 that recognised transgenders as the third gender in the country.
  •      Gender violence also affects the transgender community, going beyond just women. However, the policy limits the scope to women.

Gender based violence:

  •      The section on Gender based violence notes that public hospitals need to be made women-friendly and the staff need orientation to gender sensitivity issues. It also states that healthcare to survivors and victims of gender based violence needs to be provided free and with dignity in the public and private sector.
  •      Gender violence also affects the transgender community, going beyond just women. However, the policy limits the scope to women.
  •      Even with respect to women, the policy does not qualify or define gender violence or gender sensitivity issues.

Universal Health Coverage and Right to Health

The 12th Plan seeks to extend the outreach of public health services for moving towards the goal of Universal Health Coverage (UHC) through National Health Mission. – National Youth Policy 2014

National Health Policy 2017 has reiterated the same. It advocates an “incremental assurance based approach”. The policy tries to understand Right to Health from two perspectives.

The policy mentions that the medical tribunal will also be responsible for resolution of disputes related healthcare and also the need for protection of patients including right to information, access to medical records, confidentiality, privacy, among others. Information related to health is of sensitive nature especially sexual and reproductive health. This could include details about HIV and AIDS patients, abortion data (both married and unmarried women), individuals affected by other STDs, among others. What happens if there is a data leak? The government recently admitted to Aadhaar data leak.  Several state governments including Madhya Pradesh have mandated linking Aadhaar to HIV treatment. News reports note a drop in registration at ART centres since the announcement of this integration.

Right to privacywas recently declared as a fundamental right. However, there is no law protecting the privacy of Indians. It is worth noting that the verdict on mandating Aadhaar is expected in November 2017.

The consultation was an excellent initiative to bring people working in the public health sector under one umbrella and discuss issues affecting various different communities. We shared our concerns regarding young people and their role in the public health sector.

 

Note : Brindaalakshmi had attended and presented on behalf of Hidden Pockets Collective.

 

How safe is SG Palya in Bangalore for women?

With Gender Equality at No.5 in UN’s list for things to improve, India starts the year with women safety as a widely discussed subject in all directions. Considered to be one of the safest spaces until now, has Bengaluru started drawing parallels with Delhi?

In light of the recent incident in Bangaloreon New Year’s eve, it becomes pertinent to explore and understand different areas with high concentration of female population. Suddagunte Palya or S.G.Palya located in South of Bangalore is a home to thousands of girls who come from the different parts of the country for education and jobs. ‘None of the city, be it Bengaluru or any place in India is safe enough for a girl to walk freely during night hours and be absolutely safe,’ says a Social Work student from Christ University who resides in SG Palya for the last two years. That said, another management student from Christ University who also lives in a PG in the area disagrees. ‘No, I don’t think so, there have been many days in my life when I had a late night walks and have roamed around on bikes.’ The recent incident that happened on New Year’s night, has indeed changed the existing notions about places and pleasures but that will not stop the new force, who are coming out much prepared for these challenges.

The uniqueness of SG Palya is its dynamics and ethnicity. ‘The area used to be a barren land earlier with very few people residing.’ Tells a local resident who runs their old condiment shop near Christ School. As the population grew things changed and those who had small land or a property turned it into four storey buildings occupied mostly by the students and job employees.

My parents have always told me to not travel alone after evening time because of the mixed population in the area.’ says Akansha, a local resident who works in a MNC. But she also adds ‘I usually come back late from my office and I just try not to go out alone after the initial dark hours, otherwise I have always found this place happening and full of life.’ She believes that women have to travel daily because of their work and they can’t quit going out and traveling by local transport simply because these cases are happening and suggests that this area has lot of things to do. Women’s accommodation in the area is usually expensive than men’s and differs based on the facilities and location. A two or three sharing is more feasible than a single sharing. There are enough medical and healthcare centres in the area, which are function throughout the day although it was hard to find any government woman help center in the area.

Photo credit: Ashish Kumar

Equipped with both north-Indian and south Indian delicacies from Shawarma counters to happy meals all over the place, the area has several dining options including cafes like Mécaf Multicuisine and Eat n DrinkChristites addais the new Malabar Café, which is always serving tea and fries to students’ crowd. The best of thing about this area is that there are three single screen theatres, Srinivasa, Laxmi and Balaji theatres. When asked, many girls say that they don’t prefer going to these theatres because they don’t seem women-friendly. Comparing the prices with luxurious PVR cinemas in Forum, these theaters offer much cheaper viewing but appealing only to the male audiences.

Tavarekere Park is another fun spot in the area. It has a running track for walkers and runners. Women prefer going to this park during early morning and evening time. According to the locals, the park needs maintenance and stop the miscreants from polluting the tranquillity of the area. They also say that there have been few cases of theft and assault but the effort has been put in to prevent such incidents. Most of the parts of the park is under surveillance and along these lines to find some personal space would be not so easy. But places like Soho St., Little Italy, Malabar Bay and Forum mall are always there to have a good time.

Photo credit: Ashish Kumar

‘This city is considered to be one of the most advanced, in terms of education and work culture but it’s not about just education. It’s all about the attitude towards womenand it is about time that we bring back the chivalry culture,’ says an employee from one of the famous cafes in the area, when asked if the recent incident would affect their establishment. This small pocket in south of Bangalore has motivated to maintain positivity in the hearts and minds of all gender and the recent events will only help in empowering women to fight against the growing menace and live out loud without any fear.  ‘Modernisation is not just of spaces but also of thoughts.

Author profile:

Ashish Kumar is a Media and Communications post-graduate from Christ University, Bangalore. He is a freelance writer and is passionate about films, politics, and new age journalism. Previously, he has worked with Jagran Prakashan Ltd, NetworkingEye.com, Web Cyonix, and interned with Hindustan Times, Patna. His sources of inspiration are writers Charles Bukowski and Eric Hobsbawm.

Volunteer

                                                                                   Intern Profiles

Do you believe in being inclusive and also claiming your space even in the crowd? Yes? Then you need to be a college student looking for an internship to read on because we are looking for interns with these qualities.

Basically, we are a bunch of women who got tired of complaining about what a rotten place the world is and decided to get to do something about it, instead. We are looking for interns for a whole, cool bunch of things – journalism, technology and music! This is an unpaid position.

Hidden-Pockets is an early-stage Feminist startup based out of Delhi and Bangalore (India). We work on spaces, pleasures, inclusiveness and everything in between.

 

HK Icons-03 (16)

Intern journalists

  • Should write at least 1 pieces every week
  • Needs to pitch new ideas for stories
  • Stories should also include images

What do interns get?

  • Hand-holding in understanding and working in a digital environment as a journalist
  • A portfolio of articles
  • Freedom to work on interesting ideas. You may not always get to do that in your job 😉

Duration: 3 months

Location : Anywhere

 

HK Icons-03 (6)

Tech Interns

Requirements:

  • A student interested in front-end developing work
  • Willingness to experiment on working on a bot
  • Candidates with Html, CSS, and JavaScript knowledge – preferred

What do interns get?

  • An exciting portfolio
  • Places to go to on your next date
  • Freedom to work on interesting ideas. You may not always get to do that in your job 😉

Duration: 3 months

Location : Anywhere

 HK Icons-03 (10)Podcast Intern:

Requirements:

  • University student who loves music (preferably someone who wants to be a DJ)
  • Interested in curating music
  • Candidates with interest in different generes of music and music in different languages preferred

 

What do interns get?

 

  • A taste of what it would be like to be a DJ
  • May be even your own show! You never know 😉
  • Places to go to on your next date
  • Freedom to work on interesting ideas. You may not always get to do that in your job 😉

Duration:3 months

Location : Anywhere

 

 

Students who are Interested and have any queries kindly mail us your CV or biodata at aisha.george@hidden-pockets.com

Camera and Girls, Revert the gaze for a person living with HIV.

DSCN0298DSCN0302
DSCN0303
DSCN0305P1050075

P1050088P1050121Hidden Pockets Collective conducted a workshop with young positive girls using cameras. It was really exciting to talk to the photographers who covered the event, from the idea of “reverting the gaze” to muses becoming the photographer.

It was an interesting insight into the world of photography. Check out the podcast link below.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DSCN0306

 

 

These images were taken by the young girls.