“Don’t just think of marriage.. think also about your responsibility after marrying…” says Ravi Kishan – the popular actor – chiding a bunch of young men teasing their friend about his impending marriage and sexual relations. He is acting in an advertisement by the National Health Mission, GoI.
This is one in a series of advertisements promoting equal responsibility of both partners in family planning, which is welcome. However, this is extremely limited, and the government health system’s overall record of sexual and reproductive health services on the ground, remains regressive and even harmful.
Anubhuti, a young women-led organisation based in Kalyan-Dombivali near Mumbai, has been working with communities and state service providers for ensuring equal sexual and reproductive rights through its campaign Sharir Sanvaad Abhiyan, launched in 2016. In a study the organisation conducted last year in a semi-rural community in Thane District, 91% of the women responded in the negative when asked if men were reached by health workers with information about safe sex/contraception. This was corroborated by health workers, whose top three asks from the state health system were to do with reaching more men with counselling about their responsibility towards safe sex.
The health workers also spoke about the high targets they have to follow in getting women to use invasive contraceptive measures (such as sterilisation, IUD and oral pills), which affects the quality of their health care. This discriminative attitude of the state, in almost exclusively and aggressively targeting female bodies, is exacerbated by how sexual and reproductive health care is reduced to services around contraception and maternal health. To add to this, even these existing services have been seen to be structurally violent, causing physical and emotional harm to women and girls – most of whom are from marginalised backgrounds.
Advocacy With Relevant Government Departments
Along with training women, men and youth in communities on better understanding sexuality, and related rights and responsibilities, Anubhuti feels it imperative to advocate with the relevant governments to provide dignified health services. Based on the findings of its research, few recommendations were drafted for the Brihanmumbai Municipal Corporation and the Kalyan Dombivali Municipal Corporation (KDMC). 450 people across Mumbai, Thane and Kalyan-Dombivali signed postcards endorsing these recommendations, which were sent to both the Corporations in February 2017. This was followed up by a delegation meeting the Mayor Mr. Rajendra Deolekar, Deputy Commissioner Mr. Narvekar and Head of Health Department Ms. Smita Rode of the KDMC in November 2017.
Hearing the research findings and points put forth by local youth and women who are part of the Sharir Sanvaad team, the officials agreed to take concrete steps:
- Issue circulars to ensure respectful behaviour of hospital staff towards women and girls availing sexual and reproductive health care,
- Appoint professional sexual and reproductive health counsellors in government hospitals,
- Put in a supervision mechanism to ensure that male health workers reach men with guidance about taking sexual and reproductive responsibility.
However, in these last 4 months, no steps have been taken on any of these points. In fact, the Mayor has yet not given an appointment for a follow-up meeting despite repeated attempts by Anubhuti.
Information Revealed By RTIs Filed By Anubhuti In BMC And KDMC
To substantiate the above recommendations, two RTIs each were filed with the BMC and KDMC. Information revealed by these RTIs show how important it is for the government to take the above recommendations seriously.
The RTI thus reveals how, in the year 2015-2016 in Mumbai and Kalyan-Dombivali respectively, women have undergone the invasive female sterilisation operation up from 25 to 800 times more than that of men. This is corroborated by the next response about contraceptive targets:
Despite the fact that no targets can be specified according to a Directive Order by the Central Government dated 4th October 2016, the RTI reveals that health workers were still being made to follow extremely high targets especially for invasive contraceptives used on female bodies. The RTI also reveals that despite assurances that these methods are safe, there were 11 reported failed (got pregnant despite measures) female sterilisation and copper-t insertion operations in 2015-2016 in Mumbai. In fact, 10 women in Mumbai died in the year 2015-2016, due to sterilisation-related complications. This supports Anubhuti’s research finding about the ill effects of invasive contraceptive procedures on women.
About sexual and reproductive health services available in PHCs, the RTIs revealed that these include only education about AIDS, STDs and contraceptive methods.
On whether there are any government counselling centres for sexual and reproductive health, it was revealed that for the entire 1247000 population under KDMC, such counselling is provided by one government-aided organisation, one public trust, the 2 general hospitals and 13 Urban Health Centers. During our meeting with the Head of Health Department, KDMC, Dr. Smita Rode had herself stated that such counselling is in fact provided by health workers (ASHA, ANMs, nurses, etc.) and there are no trained counsellors.
This is what the numbers say about the state’s commitment to sexual and reproductive health care: there is a huge gap, a total of Rs. 5147260 between the budgeted amount for women’s sexual and reproductive health and what was actually expended, in Mumbai.
The biggest gaps can be seen in the budgets for training, FPIS (compensation in the event of death/failures/complication), operating costs of clinics and empanelment.
Similarly, there is a big gap, a total of Rs. 1254241 between the budgeted amount and expenditure amount in Kalyan Dombivali.
There was no reply to the question on whether there are any circulars or G.R.’s regarding the required behaviour of hospital staff towards women during delivery and otherwise when they visit to avail sexual and reproductive health services.
Most surprisingly, the RTI response claims that the government health system’s target-based, female body-focused, and family planning-limited sexual and reproductive health care is based on principles laid down in international conventions such as International Conference on Population and Development (Cairo), CEDAW, IPPF, World Conference on Women (Beijing), etc. These principles support a strong case for the rights of women and men to safety, dignity, informed consent, accessibility, affordability, acceptability, free decisions, non-discrimination, privacy, protection from violence, etc. It is difficult to understand how these progressive principles translate to such a narrow delivery of sexual and reproductive health care on the ground.
The KDMC and the BMC need to take action soon to rectify their discriminative and even violent provision of sexual and reproductive health services. Without the availability of healthcare that is unbiased, universal and dignified, women shall not be able to gain their overall sexual and reproductive rights. Denying women these rights are a denial of their fundamental rights of life, dignity and expression. Providing sub-par and harmful health services to women from vulnerable backgrounds, who form the majority of women who access government health care, is outright discrimination and multiply violent towards them.
Anubhuti has till date carried out the Sharir Sanvaad Abhiyan through film screenings, focus group discussions, public meetings, workshops, corner meetings, awareness and advocacy drives, seminars and social media campaigns with 1000 people across Mumbai, Thane and Kalyan-Dombivali and has been collaborating with the Kalyan Panchayat Samiti (covering rural areas) and the Kalyan Dombivali Municipal Corporation (covering urban areas).
Do write to us with your thoughts at contact@anubhutitrust.org, and follow #SharirSanvaadAbhiyan on our facebook page at Anubhuti Trust and our twitter handle @anubhutitrust. Monetary contributions can be made here, and shall go directly to this campaign.