Women’s Sexual & Reproductive Health: Across a Lifetime

Event Report
Aashnaa Mehta

The IMPRI Gender Impact Studies Center (GISC) orchestrated a Four-Day Immersive Online Certificate Training Course entitled “Women’s Sexual & Reproductive Health: Across a Lifetime.” This course aimed to explore the evolving discourse on gender, sexuality, and reproductive wellness, emphasizing the significance of reproductive autonomy and personal choice. Prof. Vibhuti Patel, a Visiting Distinguished Professor at IMPRI, chaired the program.

Leading the program were Dr. Manorama Bakshi, Director and Head of Healthcare and Advocacy at Consocia Advisory; Founder and Director of Trilok Raj Foundation (TRF); Visiting Senior Fellow at IMPRI, along with Dr. Arjun Kumar, Director of IMPRI, and Dr. Simi Mehta, CEO & Editorial Director of IMPRI.

Day 1

India legalized abortion through the Medical Termination of Pregnancy Act in 1971, supported by the judiciary. Despite early progress with its first family welfare program in 1952, challenges persist in ensuring universal access to abortion services due to societal constraints and bureaucratic hurdles. Ironically, those who initially championed liberal abortion laws now impose restrictions, highlighting the need for collaborative efforts among policymakers, healthcare providers, and advocacy groups to dismantle barriers.

Professor Mala Ramanathan identified these obstacles to sexual and reproductive health services for women, focusing on Medical Termination of Pregnancies (MTPs). Using National Family Health Survey (NFHS) data, she highlighted both demand-side constraints and provider-based hurdles that impede women’s reproductive autonomy.

Access to reproductive healthcare in India is influenced by socioeconomic status, education, regional disparities, and societal norms. Higher education and financial independence correlate with higher abortion rates, reflecting better knowledge and access to services. Male attitudes towards contraception and unmet family planning needs also impact abortion utilization. Promoting gender-equitable attitudes and expanding family planning programs can reduce reliance on abortion for pregnancy management.

Improving access requires a holistic approach, including raising awareness of available services, training medical professionals, and addressing institutional barriers. Enhancing provider knowledge, promoting reproductive rights, and ensuring access to safe abortion services can help India achieve comprehensive and equitable reproductive healthcare, respecting women’s reproductive autonomy.

Maternal health, encompassing pregnancy, childbirth, and postpartum care, holds paramount importance for public health. Dr. Vina Vaswani underscored the necessity of comprehensive maternal care, spanning all stages and emphasizing high-risk pregnancy management, family planning, and the roles of healthcare providers and government policies.

Socioeconomic factors, education, and cultural norms shape access to prenatal, postnatal, and postpartum care. Addressing these, alongside healthcare infrastructure gaps and rural-urban divides, is imperative for enhancing outcomes. Improving maternal healthcare in India demands innovative approaches and collaborative efforts from communities, policymakers, and healthcare providers. By prioritizing holistic care and surmounting obstacles, India can ensure improved maternal health outcomes and the welfare of future generations.

Sexual autonomy and health are fundamental human rights, profoundly impacting individuals’ social, emotional, and physical well-being. Promoting sexual health awareness and empowerment in India’s diverse cultural milieu is imperative, given the wide-ranging societal norms and attitudes towards sexuality. Dr. Padmaja Samant, Professor at KEM Hospital & G.S. Medical College, elucidated critical issues and proposed solutions in a recent session on sexual health, autonomy, and societal influences.

Persistent challenges in advancing sexual health and rights encompass entrenched cultural traditions, intricate legal structures, and deficiencies within healthcare systems. Gender disparities and patriarchal structures perpetuate numerous rights violations, while healthcare systems often lack adequate training in sexual health, primarily focusing on reproductive health and infectious diseases. Reluctance in addressing gender and sexual diversity further hampers holistic care provision.

Effectively addressing sexual health and rights necessitates a multifaceted approach involving social, legal, and educational reforms. Integrating sexual health education into medical and educational curricula, training healthcare professionals, and promoting open family communication are pivotal steps. Educating the judiciary on women’s and survivors’ perspectives ensures equitable legal proceedings. By fostering inclusivity, respect, and empowerment, we can safeguard sexual autonomy and rights for all individuals.

Day 2

Dr. Kamakshi Bhate, retired Professor of Community Medicine from KEM Hospital, Mumbai, and former Secretary of the Savitribai Phule Gender Resource Centre at BMC, provided insightful perspectives on “Guiding Adolescent Health and Nutritional Well-being.”

Dr. Bhate underscored the critical imperative of prioritizing India’s youth’s health and nutritional welfare, given that 50% of the population is under 30 years old. With approximately 250 million adolescents in India, tailored interventions are imperative to address their diverse needs influenced by gender, life circumstances, and socioeconomic factors.

Adolescents in India confront a spectrum of health challenges, spanning malnutrition, noncommunicable and communicable diseases, physical and sexual violence, harmful alcohol use, and reproductive health issues. Key initiatives such as Anganwadi Khichdi-Sukhdi and Mid-Day School Meals play a pivotal role in combating malnutrition and curbing child marriage. School Health Programs are instrumental in identifying and managing various health conditions, promoting healthy behaviors, and offering mental health assistance. By prioritizing adolescent health and well-being and implementing comprehensive initiatives, India can ensure a brighter future for its youth, fostering healthier families, communities, and a more robust workforce.

Dr. Anamika Priyadarshini, Director of Knowledge Management, Research & Design at Passing Gifts Private Limited in NOIDA, India, provided a comprehensive overview of adolescent changes, spanning physical, psychological, and social dimensions. 

Dr. Priyadarshini explored how gender norms intersect with adolescents’ evolving identities, highlighting Judith Butler’s theory of gender performativity. Adolescents challenge rigid norms, seeking spaces for alternative embodiment and expression. However, societal pressures, compounded by intersectional discrimination, pose significant challenges to identity formation.

Stigma inhibits open dialogue, necessitating awareness campaigns and support systems in schools and communities. Gender sensitization and positive masculinity promotion are vital for addressing regressive norms and fostering inclusive environments.

To address adolescent mental health challenges effectively, Dr. Priyadarshini proposed awareness campaigns, gender sensitization, and the integration of sensitization programs into education curricula. Positive masculinity promotion and community engagement can further reinforce inclusive values and support adolescents’ well-being. By fostering inclusive environments and dismantling harmful stereotypes, we can empower adolescents to navigate this critical stage with resilience, ultimately building a healthier and more equitable society.

Dr. Swati Rane, CEO of SevaShakti Healthcare Consultancy and Vice-President of the Clinical Nursing Research Society shared insights from a case study on menstrual health among girls from lower socioeconomic backgrounds in Malad, Mumbai. The study uncovered gaps in menstrual knowledge and highlighted prevalent stigma surrounding menstruation. To address these issues, a peer-to-peer education model was implemented, training students to educate their peers on menstrual hygiene and related topics.

The consequences of menstrual stigma are profound, perpetuating silence, shame, and gender inequalities. It also restricts educational and economic opportunities for girls, perpetuating a cycle of disadvantage.

The session emphasized the urgent need for comprehensive menstrual health education and destigmatization efforts, particularly among lower socioeconomic strata girls in India. By empowering girls with knowledge and support, we can work towards dismantling menstrual stigma and promoting menstrual health and dignity for all individuals in India.

Day 3

Dr. Anuradha Sovani emphasized the critical need to reevaluate societal attitudes and approaches toward women’s reproductive and sexual health.  Highlighting the dichotomy between societal reverence and neglect of women, particularly in the Indian context, Dr. Sovani urged for introspection and individual reflection on women’s roles and self-perception. Despite the societal glorification of motherhood, women often face challenges and disparities in their experiences. 

Dr. Sovani also explored women’s experiences during menopause, advocating for a more inclusive and supportive approach to this life stage. She emphasized menopause as an opportunity for personal growth and empowerment, challenging stereotypes and societal pressures. The session also featured three short films presenting unique narratives exploring societal norms, gender roles, and individual agency. 

These films prompted reflection on themes of identity, autonomy, and happiness. Dr. Sovani’s insights urged a shift toward greater understanding, inclusivity, and support for women’s reproductive health. By fostering dialogue, promoting awareness, and advocating for positive societal change, she believes in creating a more equitable and compassionate society for all women.

Dr. Padma Bhate Deosthali’s session provided a detailed examination of the intricate relationship between healthcare systems and gender-based violence (GBV), offering insights into this complex issue. In addressing GBV, healthcare systems play a crucial role by providing medical treatment and psychological support to survivors. However, survivors often seek care without disclosing their experiences of violence, underscoring the need for healthcare systems to offer specialized services and support for GBV survivors.

Legal frameworks, including the Criminal Law Amendment Act of 2013 and the Protection of Children from Sexual Offences (POCSO) Act of 2012, affirm survivors’ rights to healthcare. Yet, systemic responses to GBV within healthcare systems are hindered by institutional barriers and provider attitudes influenced by misconceptions and stereotypes.

A compassionate and informed response from healthcare professionals is crucial for aiding the healing process of GBV survivors. Integrating strategies to address violence against women across all levels of the healthcare system is imperative, including prioritizing immediate treatment for physical and mental health needs and creating safe spaces within healthcare settings. Challenges such as mandatory reporting laws also need to be addressed to respect survivors’ rights and preferences.

Dr. Aqsa Shaikh emphasized the importance of understanding the diverse identities within the transgender community, including marginalized groups like the “hijra” community, as well as transgender men and non-binary individuals.

India has made significant progress in recognizing and protecting transgender rights over the past decade. Landmark judgments like the 2014 National Legal Services Authority vs. Union of India case acknowledged a third gender and affirmed the right of transgender individuals to self-identify. However, the implementation of the Transgender Persons Act has faced criticism, highlighting the need for ongoing dialogue and amendments. To address healthcare disparities, comprehensive reforms are essential, including prioritizing menstrual health for transgender men and tailored interventions for STIs, HIV, and mental health challenges.

Improving the availability and quality of gender-affirming care and revising medical curricula to include transgender health needs are crucial steps. Legal reforms, such as outlawing conversion therapy and unnecessary surgeries on intersex children, are also necessary to ensure equitable healthcare for all individuals. Involving transgender communities in decision-making processes is vital for developing inclusive policies and programs.

Day 4

Dr. Sangeeta Rege, Director of CEHAT and Visiting Senior Fellow at IMPRI discussed the stigma surrounding Medical Termination of Pregnancy (MTP), particularly for young adults, highlighting societal prejudices against unmarried and teenage pregnancies, which often lead to honor-related violence.

Dr. Rege debunked myths about rapid population growth in India, emphasizing that the total fertility rate does not support this notion. She also challenged the assumption that family planning initiatives inherently improve women’s reproductive health, arguing against the necessity of incentives for contraceptive use.

Highlighting the gender-blind approach in healthcare, Dr. Rege stressed the importance of gender-sensitive care, which considers biological, social, and cultural factors. She criticized practices like contraceptive counseling without consent and advocated for personalized care based on individual needs.

Dr. Rege’s session emphasized the need for enhanced access to reproductive healthcare and dispelled misconceptions about population growth and family planning. She called for a gender-sensitive healthcare approach to ensure equitable and respectful care for all, empowering individuals to make informed decisions about their reproductive health.

Dr. Amar Jesani, an independent consultant and bioethics expert, discussed the historical context of reproductive health ethics, noting how societal and religious norms have stigmatized reproduction. Dr. Jesani identified societal morality, patriarchal norms, religion, and stigma as significant contributors to this stigma.

Dr. Jesani explored the religious perspectives on abortion in Christianity, Hinduism, Judaism, and Islam, highlighting Pope Pius IX’s declaration in 1869 regarding abortion in Catholicism. He addressed conscientious objection, advocating for caregivers’ right to provide abortion services based on their conscience. He criticized laws that fail to protect providers and contribute to the stigma surrounding abortion.

Drawing from Lisa Harris’s work, Dr. Jesani proposed recognizing abortion provision as a conscientious act and emphasized the importance of protecting caregivers who choose to provide abortion services. He called for a nuanced approach that respects individual rights, religious beliefs, and the ethical obligations of healthcare providers. 

Dr. Anant Bhan, a medical doctor with a master’s degree in bioethics, discussed Assisted Reproductive Technologies (ARTs). ARTs encompass various medical procedures aimed at addressing infertility and helping individuals or couples conceive. These techniques include In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), Intrauterine Insemination (IUI), surrogacy, donor sperm or eggs, embryo donation, and gestational surrogacy.

Infertility stigma is a significant burden, particularly for women, leading to feelings of shame, isolation, and inadequacy. Societal pressures and misconceptions contribute to this stigma, with infertility often wrongly perceived as solely a woman’s problem. Open conversations and awareness can help challenge this stigma and create a more supportive environment for those facing infertility.

ARTs raise several ethical considerations, including equitable access, safeguards for egg donors and surrogate mothers, concerns about designer babies, and the societal impact of ARTs in India. While ARTs offer hope for infertile couples, they also present complex ethical, social, and economic challenges.

Dr. Sanjida Arora, a public health researcher at CEHAT, explored Reproductive Tract Infections (RTIs) and cancer risks in women during her session. RTIs, encompassing infections of the female reproductive system, can be transmitted sexually or non-sexually. Factors contributing to RTIs include Gender-Based Violence (GBV), limited access to medical facilities, and stigma surrounding seeking medical assistance. Adolescents, particularly girls, encounter obstacles in seeking help due to societal taboos, insufficient education, and myths about reproductive health.

The session shed light on the challenges faced by women, especially those in rural areas, in accessing reproductive healthcare due to various social and cultural factors. Lack of awareness, education, and support systems contribute to poor reproductive health outcomes. Additionally, gender biases and discriminatory practices in the healthcare sector worsen the situation.

Dr. Arora advocated for an intersectional feminist approach that acknowledges the diverse realities and needs of women. She highlighted the significance of researching risk factors, training healthcare providers to provide comprehensive care, and raising community awareness about early symptoms and disease recognition. Overall, the session emphasized the importance of addressing structural barriers and advocating for women’s health rights to enhance reproductive health outcomes.

Acknowledgement This article was written by Aashnaa Mehta, Research Intern at IMPRI, who is currently pursuing her Bachelors in Political Science.

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