Day 12: Ensuring Access to Reproductive Choice: A Workshop || @drumaram_ram @Archytypes @swarraj @sudaroliacr @Shakthi_2016

Prepared with notes from Dr. S. Shakthi.

On the 12th day of the 2022 Prajnya 16 Days Campaign Against Gender Violence, we organised an interactive panel discussion, where Dr. Uma Ram, Dr. Prabha Swaminathan, Dr. Jaishree Gajaraj and Archanaa Sekar discussed issues related to sexual and reproductive health rights from the point of view of health care providers. In partnership with ATNRCOG and IRC India South, the 3-hour long event, Ensuring Access to Reproductive Choice: A Workshop" was conducted at Savera Hotel, Chennai.

The topics addressed in the workshop were Sexual and Reproductive Health and Rights (SRHR), Abortion, Domestic Violence and Intimate Partner Violence. The discussions aimed at focussing on how professionals in the medical field would respond to scenarios on the aforementioned themes. Dr. Uma Ram and Dr. Jaishree Gajaraj opened the workshop by discussing abortion, particularly on how to handle cases that may make the role of the doctor complicated, like cases involving minors, which may be filed under POSCO. They supplemented their discussion with several concrete examples of cases they have witnessed. The doctors, during the workshop, acknowledged that regardless of one's personal belief on topics like SRHR and abortion, it is essential for a medical professional to follow the law. The law, here, explicitly states that abortion is a right, which was emphasised throughout the discussion.

In the next hour, Archanaa Seker looked into the theme of access to contraception. She took the audience through an understanding of the ground reality of accessing contraception - in terms of the material, cultural and economic barriers. She mentioned that it is essential to shift the focus to not just look at individuals dealing with the possibility of getting pregnant, but to also look into what people's sexual practices are, what their reproductive choices are and what the overarching conditions for the same may be. The availability of Emergency Contraceptive Pills (ECPs) was also discussed. This discussion was insightful for doctors as it provided them with an understanding of what happens on-ground.

Additionally, during the course of the session, Dr. Swarna Rajagopalan (Prajnya) provided the audience with an understanding of what domestic violence is - that it goes beyond physical and sexual violence, and can also be economic and emotional violence. Dr. Prabha Swaminathan accompanied this conversation with her insights on how the medical fraternity must respond when a patient who has faced domestic violence approaches you, and reflected on the theme through her experiences as an OBGYN. The speakers also touched upon the need to be mindful of the language that is used while communicating with victims-survivors of domestic violence.

In the last hour, role plays were conducted by seven doctors:

1. A doctor and patient - A case of an unmarried woman wanting an abortion.

2. A doctor and patient - A case of a woman who comes in with two children (one of them is less than a year old), and she is pregnant again. She does not want another child, and does not want her family to know that she is getting an abortion.

3. A doctor, a patient and a husband who is abusive - Dealing with domestic violence, especially when the abuser might be in the same room as the patient.

The role plays were done in two segments where one version showed how the doctors must not respond, and all the things that must not be said/done. The other version looked into how the doctors must respond, and the importance of ensuring that their actions are empathetic and supportive.

Day 5: Twitter Takeover: "Contraceptive Violence" || @Archytypes

  On November, 29th, 2021, from 4 PM to 6 PM [IST], we had Archanaa Sekar (@Archytypes) join us to tweet about 'contraceptive violence':

Today, I (@Archytypes) am taking over this account to discuss ‘Contraceptive Violence’ as part of #Prajnya16Days of #NoSGBV (29/11/2021, 4:00PM) 

Contraception 101: A thread for #Prajnya16Days of #NoSGBV (29/11/2021, 4:00PM)

Contraception commonly referred to as Birth Control, is simply a way to prevent pregnancy. There are many methods of contraception, some more effective than others, some more accessible than others and some that suit a user better than others. #Prajnya16Days #NoSGBV (29/11/2021, 4:01PM)

#Contraception/Birth Control is actively promoted by governments, especially those of developing countries as a means of population control under #FamilyPlanning schemes. #India is the first country in the world to have launched a National Programme for Family Planning (1952) (29/11/2021, 4:06PM) 

Is #Contraception a human rights issue? YES IT IS. In The 2012 UNFPA report declares that contraception is a human right. “By Choice, Not Chance,’ goes on to stress that family planning is “universally recognised as an intrinsic right, affirmed and upheld by many other rights.” (29/11/2021, 4:10PM) 

The 2014 UN ONCHR report Reproductive Rights Are Human Rights - A Handbook For National Human Rights Institutions states that “Everyone should have access to contraception and the necessary information should also be available to marginalised groups” #Prajnya16Days (29/11/2021, 4:19PM).

"Ensuring access for all people to their preferred contraceptive methods advances several human rights including the right to life and liberty, freedom of opinion and expression and the right to work and education, as well as bringing significant health and other benefits." @WHO (29/11/2021, 4:28PM)

"Use of contraception prevents pregnancy-related health risks for women, especially for adolescent girls..." @WHO on contraception #Prajnya16Days (29/11/2021, 4:34PM)

"..., and when births are separated by less than two years, the infant mortality rate is 45% higher than it is when births are 2-3 years apart and 60% higher than it is when births are four or more years apart." @WHO  #TalkingContraception for #Prajnya16Days of #NoSGBV (29/11/2021, 4:35PM)

A user accessing contraception is making a choice about their body. When it is #MyBodyMyChoice to ensure that a pregnancy is #ByChoiceNotChance, it is just another way of saying Contraception is a #feminist issue. (29/11/2021, 4:38PM) 

 The Reality (@WHO 2017): 23 million adolescents have an unmet need for modern contraception and are thus at elevated risk of unintended pregnancy. 214 million women of reproductive age in developing regions who want to avoid pregnancy are not using a modern contraceptive method. (29/11/2021, 4:45PM)

This is contraceptive violence: When a person who needs contraception is unable to access it because of educational, financial and every other systemic barrier there is or because of the stigma attached to being sexually active, or making choices about one's own body. #16Days (29/11/2021, 4:59PM)

Why must we talk about contraceptive violence? Because it denies access and choice to users who are not cis-het men. Why must we talk about it now? Because it is sex and gender based violence. #Prajnya16Days #NoSGBV (29/22/2021, 5:05PM)

 

What People have to say about #Contraception: A Thread (Crowd sourced if you add to this!) (29/11/2021, 5:06PM)

“Many of us were the unplanned children of talented, creative women whose lives had been changed by unplanned and unwanted pregnancies. We witnessed their bitterness,..." (1/2) (29/11/2021, 5:09PM) 

"...their rage, their disappointment with their lot in life and we were clear that there could be no genuine sexual liberation for women and men without better, safer contraceptives, without the right to a safe, legal abortion.” - Bell Hooks (29/11/2021, 5:09PM)

“The technology exists for a male contraceptive pill. We have the drugs to switch off testosterone and prevent sperm production. These drugs have never gone to market because developers know that men would never take something like that..." (1/2) (29/11/2021, 5:11PM)

"...Men would never agree to switch off their hormones. They would never put up with the side effects such as depression and low libido. And, honestly, why should they put up with it? Why should women?”- Lara Briden #Prajnya16Days #NoSGBV (29/11/2021, 5:12PM)

“Mainly because as women’s education increases all around the planet, we find that family size tends to drop.” — Jane Goodall (29/11/2021, 5:13PM)

“China had managed to reduce their fertility to a large extent because of basic expansion of women’s education, not because of the one-child family.” — Amartya Sen (29/11/2021, 5:14PM)

 “The fact that 98 percent of women in [the U.S.] who are sexually experienced say they use birth control doesn’t make sex any less sacred. It just means that they’re getting to make choices about their lives.” — Melinda Gates (29/11/2021, 5:15PM)

“Contraceptive protection is something every woman must have access to, to control her own destiny.” — Ruth Bader Ginsburg (29/11/2021, 5:15PM) 

“I would think that if you understood what sex education is, you would get down on your knees and worship a condom.” — Jane Fonda (29/11/2021, 5:16PM) 

"No woman can call herself free who does not own and control her body. No woman can call herself free until she can choose consciously whether she will or will not be a mother." - Margaret Sanger, founder of Planned Parenthood (29/11/2021, 5:21PM) 

“If men had to bear the pangs which women have to undergo during childbirth none of them would even consent to bear more than a single child in his life.” - Dr. Ambedkar on 10 November 1938 to the Bombay Legislative Assembly, (29/11/2021, 5:26PM)

 

#Contraception - So much to learn: A thread #Prajnya16Days #NoSGBV (29/11/2021, 5:34PM)

There are many methods of contraception (https://who.int/health-topics/contraception#tab=tab_3) and the NHS website lists 15 of them - https://nhs.uk/conditions/contraception/what-is-contraception/ #Prajnya16Days #TalkingContraception #NoSGBV (29/11/2021, 5:37PM)

In India, Birth Control falls under the National Health Mission's Family Planning Programme overseen by the @MoHFW_INDIA. Contraceptive services under the National Family Welfare Programme are categorised into Spacing, Permanent and Emergency Methods (https://main.mohfw.gov.in/sites/default/files/56324455632156323214.pdf) (29/11/2021, 5:43PM)

With service provision happening through Providers (ASHAs, ANMs, LHVs, SNs, and doctors) at various levels of the public health system including home delivery of oral contraceptive pills, the oldest family planning programme in the world continues to show results. (29/11/2021, 5:50PM)

But when contraception services are provided solely from the population control angle, it is 1. The state taking charge of who can make what choices - this is assuming all women want children, must have at least one child, and should stop when it's too many for the state. (29/11/2021, 5:53PM) 

2. not acknowledging that contraception, beyond saying "Enough Babies", is really for "Do I want one? Do I want one now?" and this medical/programme model of contraception takes away from the bodily autonomy of a user, also stigmatising those who do not want to/cannot be mothers. (29/11/2021, 5:57PM)

Birth control is a human rights issue. How great would it be if a well-oiled, efficiently set up system can see it as one? #TalkingContraception #Prajnya16Days #NoSGBV (29/11/2021, 6:01PM)

"Contraceptive use among married women (aged 15-49 years) was 56.3% in NFHS-3 (an increase of 8.1 percentage points from NFHS-2)," states this report: https://main.mohfw.gov.in/sites/default/files/56324455632156323214.pdf. But everybody married or not, with a child or not must be accounted for. (29/11/2021, 6:05PM)

Not ensuring information and access is available to anyone who may need contraception is violence. Not speaking about it erases the experiences of many millions of women. (29/11/2021, 6:10PM)

We are a society on blinkers when we 1. Deny that young people who are sexually active and exploring their bodies 2. Dismiss the need for contraceptives and quality sex-ed as a made up/privileged/elite/urban and indulge in whataboutery #Contraception #Prajnya16Days (29/11/2021, 6:20PM) 

As we keep silent and cut off access to information for young people in the name of honour, dignity, culture, we are only raising another generation of citizens that are poorly-informed, poorly-resourced, and unable to understand or make choices about their bodies. #Contraception (29/11/2021, 6:24PM)

 

I, @Archytypes, can attest to the following: Young people are having sex. Everyday half a dozen people reach out to me with questions on consent, contraception and sex. These young sexually active people are from all over Tamil Nadu, and sometimes from other parts of the country. (29/11/2021, 6:29PM)

I usually begin by asking if they used a condom. In most cases the reply is No. Each time I feel like running to a rooftop and yelling: "A CONDOM CAN PREVENT A PREGNANCY BUT IT CAN ALSO PREVENT STI's. WHATEVER OTHER METHOD OF CONTRACEPTION YOU ARE USING, ALSO USE A CONDOM." (29/11/2021, 6:34PM)

"Will I bleed as soon as a take an Emergency Contraceptive Pill?" is the most popular question AFTER "Where can I find an ECP?" (and mind you, requests for these come from towns and villages a good 45-90 mins away from the cities of TN). (29/11/2021, 6:38PM) 

I share this to reiterate how little information is available to people and because dozens of people create twitter accounts to communicate with me, a stranger on the internet because there is so much shame and stigma surrounding sex. #Contraception #Prajnya16Days #NoSGBV (29/11/2021, 6:40PM)

#Contraception is a #health, #humanright and #feminist issue. The state needs to look beyond family planning and make way for quality sex education, spaces where sex can be discussed without shame, non-judgemental healthcare. (29/11/2021, 6:48PM)

Till @MoHFW_INDIA, all associated central and state agencies recognise contraception as a #mybodymychoice method, “By Choice, Not Chance" will be a dream. #TalkingContraception #Prajnya16Days #NoSGBV (29/11/2021, 6:52PM)

While we work and wait for that dream to come true, I (@Archytypes) and many of my friends on the internet are here for you, whether it is to answer questions/provide support in accessing #contraception (emergency, long term)/dealing with #unwanted pregnancies. #16Days #NoSGBV (29/11/2021, 6:54PM)

I took over this account to talk about #contraception for #prajnya16days. I said a little, but there is so much more (forced contraception, #abortions, consent, big pharma, #SRHR) to think/talk about. I must sign off now, but you can reach out on my account (@Archytypes) anytime! (29/11/2021, 7:11PM)