It was May 2018 when two sisters in Karachi formally set up their dream project in a bid to help underprivileged women improve their menstrual health and hygiene. Enter HER Pakistan, a not-for-profit organisation which aims to shatter the myths and taboos surrounding menstruation through programmes that educate young girls, women and the society about a subject that is rarely ever talked about.
“I was working with a not-for-profit school network in Karachi and during a visit to one of the slums, I found out that girls were being forced to miss school, and at times, even drop out of school when they started menstruating,” says Sana Lokhandwala, co-founder of HER Pakistan. “And it wasn’t just that. I also came across a lot of myths and misconceptions around menstruation that prevail in our communities,” she adds. A communication specialist previously affiliated with the news industry, Sana now runs the project with her sister, Sumaira Lokhandwala.
During her eight years of experience as a healthcare marketeer, Sumaira says she realised how sexual and reproductive health, a major component of women’s overall health, was being largely neglected in Pakistan. “Subjects as normal as menstruation are considered taboo. Thousands of women do not have access to information and facilities in order to live a healthy and empowered life,” says Sumaira.
A research by Real Medicine Foundation in 2017, a non-profit organisation working to improve the health sector in disaster-hit regions, found that an alarming 79 percent of Pakistani women were not properly managing their menstrual hygiene due to lack of information. During their fieldwork, the Lokhandwala sisters made the same observation.
Their dream soon turned into reality and HER Pakistan was founded with an objective to improve sexual and reproductive health, particularly menstrual health and hygiene, for girls and women in Pakistan regardless of their socio-economic background. To date Sana and Sumaira Lokhandwala have successfully reached out to schools and communities in areas like Old Golimar, Rehri Goth, Machhar Colony, Kemari, Lyari, Gulbai, Moach Goth, Steel Town, Malir, Baldia Town and Qayyumabad.
The initiative is running as many as three projects simultaneously, starting with the School Puberty Education Programme, which prepares adolescents, their parents and teachers for puberty and associated changes and challenges.
“The programme takes a holistic approach by training parents and teachers simultaneously, so they can ensure a safe and healthy environment for adolescents after the sessions,” explain the Lokhandwala sisters. The basic components of the session include understanding gender and gender roles, introduction to puberty, physical, psychological and social changes during puberty, hygiene management, myths and misconceptions related to puberty, body positivity, bullying and harassment and a special focus on menstruation for girls. “The sessions are mostly tailored according to the needs of the students and the schools’ management.”
The initiative has reached out to as many as eight schools in Karachi and two in Gilgit Baltistan. The founders, however, believe that this is just the beginning. They aspire to take it to schools and communities all over Pakistan.
The community education programme, Menstrual Hygiene Drives, focuses on awareness sessions through peer-to-peer counselling and interactive teaching tools. The sessions are held in underprivileged communities in which women of all ages and backgrounds meet to discuss menstruation and it being a natural phenomenon, and its hygiene management.
The organisation has also launched a digital community group – Oh My Period! The Facebook group aims to provide a safe space for women to talk about everything related to menstruation, to be able to learn from one another’s experiences and to help each other.
“The aim is to create a friendly space where anyone can talk about their periods freely and ask questions without being judged,” says Sana.
The journey wasn’t a joy ride. It came with its set of challenges. But the Lokhandwala sisters say these challenges were not strong enough to unnerve them or shake their commitment. The sisters say that they faced harassment, bullying and even death and rape threats from men on digital platforms and in the real world.
“Everything related to a female body that does not serve the patriarchal needs of pleasure and procreation is considered a taboo. Everyone loves to objectify a woman’s body but no one wants to talk about menstruation or breast cancer or women’s other health-related problems,” says Sumaira.
She says the stigma exists because the society has attached shame to women’s bodies. “It’s these taboos that have conditioned the society to view menstruation as something shameful or as something to be ashamed about. It is because of this that the way we view menstruation is going to change very slowly because of our deeply ingrained cultural taboos,” she adds.
They acknowledge the role their families and friends have played in supporting the organisation and its work. “HER Pakistan is a community-driven initiative and we wouldn’t be where we are without the support we received from our generous supporters, volunteers, partners and donors.”
“Discussing and educating people – men, women, girls and boys – about menstrual hygiene and dismissing taboos associated with it, in a patriarchal society, are things that scare a lot of people. We would be lying if we say we weren’t scared,” says Sana. “We were. But we were adamant to change the menstrual health situation in Pakistan. And we can confidently say that the change is happening.”
The writer is a human rights reporter based in Karachi. He covers conflict, environment and culture.
WHEN I was a reporter in the mid-80s, I came across a story about a child marriage that did not see the light of day. It was apparently not newsworthy enough to be published by the newspaper (not this daily) I was working for.
It wasn’t within my understanding then that child marriage could have far-reaching effects on young girls.
A 15-year-old girl, a school dropout, was forced into marriage by her father when he could no longer support her and his other children, after his wife deserted him and the family to be with another man.
The man’s former wife suddenly appeared at the syariah court, opposing the marriage application.
A shouting match ensued between the separated couple while the girl was crying inconsolably by the side.
Her husband-to-be, a bloke twice her age, froze in fright.
The woman attacked the husband-to-be, spewing profanities at him and her ex-husband, thus drawing merciless laughter from witnesses that day.
The girl was finally given away in marriage as a second wife to the man after receiving the consent of the syariah court judge and the father, being the wali or legal guardian.
Although the incident was not published as the editors opined that the story was personal and could slander the people involved, I quietly followed up on the plight of the girl.
A year later, a divorce case was filed after the girl’s mother found out she was physically and mentally abused on a regular basis by her husband, mother-in-law and ipar-duai (sisters-in-law).
Over the years, I had come across similar disturbing stories of young brides; the parents felt it was the best option as their children had become sexually active and pregnant.
In some cases, the parents were too poor to support their children.
So they decided to marry them off to some well-endowed middle-aged men.
Attending a wedding reception, I once asked a friend if he’d give away his 18-year-old daughter in marriage.
He quickly retorted: “Hell no, she’s still a child.”
Like many parents these days who don’t see the logic of allowing their daughters into an early marriage, he said: “I want my daughter to finish her studies first, work to earn a living, find her freedom and maybe, find her own soulmate along the way. If she can’t find any, I will find one good, pious boy for her.”
He said he had seen injustices inflicted on girls due to child marriages while living among the Indian and Pakistani community in the suburbs of Manchester, the United Kingdom back in 1980s.
They were abused regularly, both physically and mentally, besides being victims of marital rape.
“They were coerced into early marriages while they were like 16 or 17 years of age although UK law allowed such marriages with parental consent,” he said.
My late mother was given away for marriage to my father when she was 13 years old during the Japanese occupation of Malaya in the 1940s.
My mother once told me she was playing marbles under her attap-roofed house in Penang when my father’s entourage came to ask for her hand in marriage.
Whilst the decision to “force” her into marriage was understandable because of the war and the grave fear among parents those days to marry off their children quickly, I just do not understand why there are still parents these days who agree to the idea of child brides.
According to the Syariah Judiciary Department, from 2013 to June last year, there were 5,823 Muslim child marriages registered in Malaysia, with Sarawak having the highest number at 974, followed by Sabah with 877, and Kelantan with 848.
Child marriages, if they are highlighted in the press, always ignite public interest. And as far as we can see now, there is strong public opposition to child, early and forced marriages.
In July last year, it was reported that a 41-year-old man from Gua Musang married an 11-year-old girl in Thailand.
This was followed by a 44-year-old man marrying a 15-year-old girl in Tumpat in September when he received the consent of the girl’s parents and a syariah court judge.
This prompted the prime minister to issue an order to all state governments on Oct 20 to raise the legal marriageable age to 18 for both Muslims and non-Muslims.
Up to now, only Selangor has amended its enactment on family Islamic law while the Federal Territories are in the process of amending the marriageable age.
Penang, Sabah, Johor, Melaka and Perak have in principle agreed to amend their respective enactments while Sarawak, Pahang, Terengganu, Perlis, Negri Sembilan, Kedah and Kelantan have not agreed to do so. I’m curious to know why the laws in these states cannot be made uniform with others.
In a study carried out by Universiti Kebangsaan Malaysia last year, researchers pointed out that children who marry tend to have a poor understanding of sexual and reproductive health issues, besides the lack of an effective intervention support system for the parents, “which leaves many of them believing that marriage is the best solution when their children become sexually active or become pregnant”.
The sad thing about us, as the research suggests, is that community norms accept child marriage as an option. When can we start thinking that it is not a good and effective option? Period.
Let’s give some space to our children — let them enjoy their childhood, let them pursue an education to reap valuable knowledge, let them learn life experience as good as it gets. Let them decide when they want to have a soulmate. Isn’t that so difficult to grasp?
C’est la vie.
The writer is a former NST journalist, now a film scriptwriter whose penchant is finding new food haunts in the country
Having sex too soon is the biggest regret of young people losing their virginity, a survey of British sexual behaviour suggests.
More than a third of women and a quarter of men in their teens and early 20s admitted it had not been “the right time” when they first had sex.
People must be 16 or over to legally consent to sex.
The many people may not be ready at that age.
The Natsal survey, carried out every decade or so, gives a detailed picture of sexual behaviour in the UK.
For this latest work, published in BMJ Sexual & Reproductive Health, researchers at the London School of Hygiene and Tropical Medicine looked at the responses of nearly 3,000 young people who had completed the survey between 2010 and 2012.
The responses showed that nearly 40% of young women and 26% of young men did not feel that their first sexual experience had happened “at the right time”.
When asked in more depth, most said they wished they had waited longer to lose their virginity. Few said they should have done it sooner.
Most had had sex by the time they were 18 – half had done it by the time they were turning 17.
Nearly a third had sex before turning 16.
The survey also looked at sexual competence or readiness – whether a person could reasonably make an informed decision about whether to have sex for the first time. For example, they had to be sober enough to have consented and should not have been acting on peer pressure.
Around half of the young women and four in 10 of the young men who responded failed this measure.
And almost one in five women and one in 10 men said they and their partner had not been equally willing to have sex at the time, suggesting some felt pressured to have intercourse.
Founder of the Natsal survey, Prof Kaye Wellings, said the age of consent was not an indicator that someone might be ready to become sexually active. “Every young person is different – some 15-year-olds may be ready while some 18-year-olds are not.”
Co-researcher Dr Melissa Palmer said: “Our findings seem to support the idea that young women are more likely than young men to be under pressure from their partners to have sex.
“Although the survey results yielded some positive outcomes, such as nearly nine in 10 young people using a reliable method of contraception at first sex, further efforts are required to ensure that the broader wellbeing of young people is protected as they become sexually active.”
She said sex education in schools should equip young people with the right negotiating skills to enable them to have safe and positive first sexual experiences.
When is the right time?
If you think you might have sex, ask yourself:
If you answer yes to all these questions, the time may be right. But if you answer yes to any of the following questions, it might not be:
Isabel Inman from the sexual health charity Brook said: “We firmly believe that age and stage appropriate relationships and sex education (RSE) should start early in order to empower young people to make positive decisions that are right for them. We hope the introduction of mandatory RSE will provide this opportunity.”
Please Note: This article is presented for informational purposes only and is not meant to diagnose or treat any illness. If you have any health concern, see a licensed healthcare professional in person.
When we’re young, we feel like we would want to have sex forever. The sexual arousal is too strong in an adolescent period, but it’s not like that forever. In fact, people have a lesser desire to have sexual intercourse with their partner as they age.
According to this study, the level of testosterone in the body starts to decline with age. This study shows that 6 out of 10 couples are not happy with their relationship, and one of the major reasons for relationship dissatisfaction is sexual dissatisfaction.
When there is low sex drive among people, they do not want to have more sex with their partner. However, the good news is that there are plenty of ways to enhance your sexual health and sex drive.
Are couples who have more sex happier?
Having a satisfying sex life is one of the most important factors that determine marriage success. A sexless marriage can hamper a marriage.
According to this study, some of the happiest couples have sex at least once a week. However, excessive sex, more than once a week did not have much impact on happiness, according to the results of the study.
We can say that sexual frequency is important, but excessive sex is not what determines the happiness of the couples. There are more things other than sex that determines the success of the marriage.
How to achieve more sex power?
Before jumping to the benefits of having more sex, it’s important to know something about the ways to achieve more sex power.
It’s because without enough power and stamina, it’s impossible to have more sex. Here are some of the ways to achieve more sex power.
1. Modify your diet
There are foods that are not good for sexual health and there are many foods that can boost sexual health. The foods with zinc, important vitamins and minerals can enhance the sex drive, fertility, and stamina.
Add dates, pumpkin seeds, oysters, eggs, and other foods that are capable of enhancing the sex drive and stamina. Omega-3 fatty acid found in oily fishes can also help to trigger sex desire.
2. Stay active
Staying passive won’t help in preserving energy. Be involved in regular workouts, and do not miss our cardiovascular workouts, as it helps in enhancing heart health. You will experience a tremendous boost after some time if you stay involved in regular workouts.
3. Reduce stress
Stress can impact many aspects of human health, which includes sexual health too. It can decrease the sex drive; create a problem in erection, and more.
Reducing stress helps in building a better relationship with your partner, which is key to have a better sex life. Moreover, less stress means more energy and stamina to enjoy sex.
This study shows that mental stress can take away physical endurance.
What are some of the amazing benefits of having more sex?
The people who do not have adequate sex are missing out on plenty of amazing benefits of having frequent sex. By saying more sex, I’m not talking about excessive sex, though. Let’s take a look at the benefits of having more sex.
1. Enhance brain function
There is a direct link to the brain with human emotions. The sexual desire of a person is an accumulation of various neural mechanisms, and each of them is controlled by different components of the brain. They are active at different times during sexual intercourse.
There was a study conducted by a group of researchers at the University of Pavia, Italy to find out the impact of frequent sex in the brain. The result obtained from the study showed that the people who are involved in frequent sex demonstrated an increment in cranial nerve growth.
2. Reduce stress
Are you struggling to manage your stress? The solution to your stress may be more sex. Blood pressure rises when a person is involved in sexual intercourse, but it can lower blood pressure and stress reduction in the long run.
3. Enhances the immune system
Prevention is better than cure. In order to prevent the body from various diseases, the immune system needs to be fit and strong. Having more sex may help in enhancing the immune system of a person, which will help the person in staying away from various diseases.
It’s not like a person with a stronger immune system never gets sick, but the risk of suffering from diseases significantly decrease among people with a stronger immune system.
4. Improves cardiovascular health
Cardiovascular health issue is one of the most serious health issues in the United States. According to the statistics, every 1 out of 4 deaths in the United States is caused by heart disease. The couples who maintain higher sexual frequency reduce the risk of suffering from various heart diseases.
5. Promote adequate sleep
Adequate sleep is crucial for both mind and body. Sadly, there are many people who are struggling with sleep deprivation. Sleep deprivation can lead to many unwanted health problems. Couples who have frequent sex may be more likely to have healthy sleep. The chemical called, oxytocin is released during orgasm, which helps in promoting good night sleep.
6. Fights aging
For the people who are frustrated with many signs of aging, there is good news for every one of you. This study shows that having sex at least once a week can help in reducing the rate of aging among the people. It has various positive impacts on different parts of the body, which helps in fighting various symptoms of aging.
7. Pain relief
The pleasure from sex may help in driving out pain. Having more sex may be an answer for getting relief from back pain, migraine, and pain from arthritis. The hormone released during sexual intercourse, oxytocin, increase endorphins, which helps in reducing the pain.
8. Reduce the risk of cancer
The risk of prostate cancer may be reduced among men who are involved in frequent ejaculation. It’s recommended to ejaculate at least 21 times in a month to reduce the risk of prostate cancer.
9. Improves the relationship among partners
The sex hormone oxytocin is also known as a love hormone. The release of this hormone helps in enhancing love and trust among the couple. So, it’s very natural that the more sex a couple has with each other, the better their relationship.
Now that you know about the numerous benefits of having more sex, the question is: Will you aim for higher sexual frequency? Search for the ways to improve your sex drive and do everything you can to spice up your sex life.
The study shows that the lack of frequency is one of the major causes of divorce. Have more sex; have more pleasure, and extract all the benefits of having more sex. If you’re facing serious sexual problems, then it’s better to consult with a doctor to get some valuable solutions to your problem
Stepping up in the Pacific at the expense of Pakistani women and girls
Cutting aid has a cost – and Australia should be embarrassed to take aid from other countries to give it to the Pacific.
Since coming into office in 2013, the Coalition has cut aid by 17% in nominal terms and 27% adjusting for inflation. More cuts are in the pipeline, and by 2021 aid will have been subject to a real cut of 31%.
Given that the Coalition’s justification for cutting aid was the budget deficit, you might have thought that now Australia is heading for a surplus, there might be room for increasing aid. But no – in a recent interview with the podcast Good Will Hunters, International Development Minister Alex Hawke said that the last election had been a referendum on overseas aid, that the voters had rejected Labor’s proposed aid increase, and that no aid increases were in the offing. “We’re not revisiting that envelope,” Hawke said.
The suggestion that any election is a referendum on aid is laughable. Find me a person who bases their vote on foreign aid policy. As far as I know, not a single question to either major political leader during the election campaign concerned aid.
But clearly, foreign aid is the lowest priority for the Coalition. It has been singled out. Aid has been cut by 27% since 2013, but total expenditure has increased by 18% over the same period. Answers by the Department of Foreign Affairs and Trade to the most recent Senate Estimates hearings confirmed that next year Australia’s aid-to-gross national income (GNI) ratio will fall to 0.2%, the lowest ever. Among 36 countries in the Organisation for Economic Cooperation and Development, only the much bigger United States and a few much poorer (e.g. Poland) and/or newer (e.g. South Korea) and/or crisis-ridden countries (e.g. Spain and Greece) provide 0.2% or less of GNI in foreign aid.
Because of the cuts, the Coalition has been on the defensive on aid, but that tactic is now changing. In the same podcast, Hawke noted that Australia’s aid to the Pacific was “at the highest level ever”. Likewise, at Senate Estimates last month, Foreign Minister Marise Payne stressed that the $1.4 billion Australia will be providing the Pacific this year is a “record contribution”. Hawke went further – perhaps letting the cat out of the bag, or simply saying what everyone already knows, which is that the proportion of aid to the Pacific is going to continue to “tick up”.
Under what scenario can it make sense to cut total aid, yet increase aid to the Pacific? The government has not yet been able to develop a supportive narrative. Strategic competition with China appears to be the underlying driver, but no one wants to admit it. The best that Hawke could come up with were references to the Pacific as “our backyard” and “our family”.
Given the government’s position, the opportunity cost of more aid to the Pacific is less aid to other countries. Bilateral aid to Africa has already been virtually wiped out, and aid to Asia almost halved.
I personally work a lot on Papua New Guinea and count myself as a friend of the Pacific. But the current practice of taking aid from other countries and giving it to the Pacific makes no sense.
The case of Pakistan is instructive. Australian bilateral aid to Pakistan has already been cut by half, and will be eliminated altogether next year. DFAT has no qualms in documenting that “funding in Australia’s overall aid program [to Pakistan] has been redirected to support new initiatives in our immediate Pacific region”.
What will be sacrificed by abolishing aid to Pakistan? The latest DFAT review of Australian aid noted the strong focus on gender equity of our aid to that country. Specifically, the review noted that in the last year, as a result of Australian aid, 1.7 million Pakistanis received conditional cash and food assistance (55% women and girls). In addition, nutrition supplements were provided to “117,140 women, 14,165 adolescent girls, and 212,510 children under five,” as well as “14 newly renovated, 24-hour health facilities provided reproductive health services to 12,253 women”.
Australian aid also supported 2 million more Pakistani girls going to school. All this (and much more) with only $50 million of aid – just 4% of the amount going to the Pacific.
Of course, the Pakistani government could and should do a much better job of supporting the country’s development, yet the same point could be made just as strongly of the governments of the Pacific. I challenge anyone to find benefits of a similar magnitude to those claimed in Pakistan from our much larger aid program to the Pacific. Indeed, I challenge anyone to argue that the benefits of more aid to the Pacific (already the most aid-dependent region in the world) outweigh the cost of withdrawing our support to Pakistani women and children.
One can debate whether more aid to the Pacific is warranted, but more aid to the Pacific at the expense of aid to countries such as Pakistan is a national embarrassment.
The challenge of getting family planning “right”: Professor Amy O. Tsui on sexual and reproductive health in India
With India facing a plethora of issues related to sexual and reproductive health, ranging from sex-selective abortion to rising rates of infertility, Health Issues India interviewed Professor Amy O. Tsui, PhD of the Johns Hopkins Bloomberg School of Public Health, to discuss India’s family planning, female sterilisation, infertility, female foeticide, and other issues in the field of sexual and reproductive health affecting India.
Professor Tsui, thank you for agreeing to speak with Health Issues India. First of all, could you lend an insight for our readers into the work you do?
I am a social demographer interested in population and fertility trends. As I am a faculty member based in a school of public health, I have an interest in social interventions that influence fertility levels, including marriage, abortion, and contraception. Most of my recent work has been based in Sub-Saharan African countries but I have an enduring interest in the population and fertility dynamics of South Asian countries as well. I largely collect and analyse survey data, whether of women of reproductive age, health facilities or clients.
What do you perceive to be India’s major challenges in the field of family planning?
Getting family planning care “right” at the societal level is a challenge for many countries, including the United States. Globally sexual and reproductive rights are often politicised and remain contentious even as contraceptive use becomes widespread. India faces several major challenges in family planning, the first of which is the prominence of female sterilisation as the most used contraceptive method and one promoted by the government. Although other methods are available (condoms, pills, IUDs [intrauterine devices, or the coil] and recently injectables), female sterilisation accounts for three quarters of contraceptive use. As a result, a second challenge is expanding contraceptive method choice, including vasectomy. Even though India has a history of providing the latter in the late 1970s, today while slightly over one third of married women are using female sterilisation, fewer than 0.5 percent report their spouses having a vasectomy. Other than condoms, there is relatively little use of other methods, especially for spacing births. A third family planning challenge for India is ensuring equity in couples having informed choice for all family planning decisions, whether to prevent unintended pregnancies or to achieve desired ones. Presently the more privileged segments of society enjoy access to such information and means.
Can you identify an area, or areas, where India has made progress in the field of family planning in the past few decades?
Two areas come to mind, firstly India’s progressive record in legislation on elective termination of pregnancy since 1971, amended further in 2002 and, secondly, the transition in norms around family size to where the average women of childbearing age now has just over two births (2.2) and wants just under two births (1.8). Given there are nearly 370 million Indian women of reproductive age today and each has a mother who likely had two or more times that number of births, this transformation of fertility across just two generations is quite profound. Women’s capacity to manage their reproduction has definitely improved. Regarding access to safe abortion, there is still progress to be made but the MTP [Medical Termination of Pregnancy] Act in 1971 preceded the legalisation of abortion in the US by two years. It is easier today for low-income couples to obtain medical abortion pills discreetly from private health providers in India than in the US. I suspect that with more constrained choice of contraceptive methods in India–largely condoms and female sterilisation–some women have felt it necessary to seek out abortions to end unintended pregnancies as a consequence.
Can you identify any current programmes targeting female empowerment, fertility, or sexual and reproductive health which are making a difference in India?
Certainly the Government of India’s national family welfare program, which is the oldest in the world, and implemented through the states has had a major impact on couples’ fertility levels, through the promotion of female contraceptive sterilisation use. While by no means perfect, the government’s universal primary education scheme, along with parents’ own investments in private schooling for their children, has led to a dramatic reduction in the proportion of women under age twenty with no schooling. In 2015, the National Family Health Survey of nearly 700,000 households found 31.0 percent of females with no schooling compared to 41.5 percent ten years before. For female welfare, education and access to birth control are powerful drivers of empowerment.
I have brought in two colleagues into this conversation. We are collaborating on analyses of the National Family Health Survey data from 1992-93 to 2015-16 — Dr. Abhishek Singh and Dr. Kaushalendra Kumar from the International Institute for Population Sciences in Mumbai. They note several government programmes, such as Beti Bachao Beti Padhao, Sukanya Samridhi Yojana and Pradhan Mantri Jan Dhan Yojana which have particularly targeted the girl child and women. BBBP focuses on states and districts in northern India where the child sex ratio at birth is very imbalanced (in favour of males) and seeks to raise awareness of gender equity. SSY encourages parents’ savings for young daughters’ education and marriage expenses. PMJDY has helped open bank accounts with no minimum deposits required to enable females and males to access modern-day financial services more readily. While these are all relatively recent initiatives under Prime Minister Modi, they have the potential to significantly improve educational opportunities for girls and women (and thus their employability) and transform their resource base. It will take time before the full impact of these schemes can be appreciated but they are steps in the right direction.
India’s sex ratio is heavily skewed, with far fewer girls and women than there should be. What drives this imbalance?
Imbalanced sex ratios, in the sense of more boys than girls being born over what is naturally expected, is a problem in China, South Korea, Taiwan and other places in Asia, although not to the extent as is observed in India. Social norms around male roles in society sustain the desire of couples to ensure a male heir among their offspring. Patriarchal customs can protect land ownership with only males having property rights. At the same time social norms evolve around female roles, such as high dowries commanded to marry daughters off, which lowers the value of females and enhance that of males.
Paradoxically, as India’s fertility rates reach replacement level (2.1 births per woman on average), the demand for sons appears to be increasing. It also appears to be strongest for first births and among the better educated females and wealthier couples. The challenge here is to reduce felt pressures by couples to bear sons and also expand opportunities to females to achieve economically and politically on par with males.
Sex-selective abortion is illegal in India but continues to be practised. What do you perceive to be gaps in the legislation allowing for this practice to continue?
This is a very difficult situation to enforce because private conversations of couples around foetal sex are impossible to monitor and health providers are not permitted to facilitate any type of prenatal sex selection decisions of clients. While authorities will need to persist in enforcement where possible, the eventual solution requires a social re-valuation of sons and daughters until parity in gender value is achieved. The norms around son preference are changing and vary geographically across India; but private decisions can still aggregate up to revealing concentrated imbalances in sex ratios at birth at the national level.
As sex selective abortions are continuing to occur despite being illegal, could factors such as providing information to the public help in reducing cases?
I suspect the public is quite aware of gender preferences and discriminations against females. It will be important for social influencers, whether in government or civil society, to promote gender equality and neutralise longstanding opinions about the lesser rights and value of females. One transformative source of influence on public beliefs and opinions is mass media, particularly television and film and their associated celebrities. Positive modelling of the value of females and their lifelong contributions can gradually and permanently alter peoples’ beliefs and behaviors. India has tremendously talented actors, actresses and film producers who could appeal to the social conscience with strong visuals, story lines and re-balance gender preferences. This and continuing education of each generation can correct misguided thinking and actions.
Unsafe abortions are commonplace in India. What are the reasons behind this?
It is very difficult to estimate the number of abortions, both unsafe and safe, in most countries. A recent study estimates nearly sixteen million abortions in 2015 with only one-fourth happening in public health facilities. Another study in nine Indian states suggests that as many as two thirds of induced abortions are unsafe. There are a number of reasons why unsafe abortions appear commonplace – the sheer number of them given unplanned pregnancies resulting from unprotected sex, the legal status of abortions and relatively easy access to abortion means outside of the public sector, and the modest levels of contraceptive use for birth spacing, driven primarily by use of condoms, which have high failure rates. If a woman is not ready for permanent contraception and has limited knowledge of and access to other birth control methods, she is likely to experience an unplanned pregnancy and seek resolution with an abortion. Medical abortion pills are readily available from pharmacies and other private retailers. However, unless proper counselling and monitoring of the use of pills are provided, which often are not, such access is considered “unsafe”.
Lastly, even though a legal procedure, induced abortion often carries social stigma. Females are embarrassed to report seeking and terminating a pregnancy which means they often resort to informal abortion care or unsafe means.
Infertility is on the rise in India. What are the factors contributing to this?
I think the apparent rise needs to be first examined in terms of whether it is voluntary or involuntary childlessness that is increasing. Possibly it is both. Infertility has as its causes both male and female factors—semen quality, uterine structural issues from pelvic inflammatory disease, exposure to environmental chemicals and toxins and stress for example. A first challenge is to properly measure the prevalence of these conditions in males and females by which careful analyses can be conducted to determine the patterns and causes.
How do you evaluate the Indian government’s approach to issues such as in-vitro fertilisation and commercial surrogacy?
I am not knowledgeable enough about the Indian government’s approaches but certainly a comprehensive national family planning program will address couples’ reproductive intentions, whether to space, limit or have desired births. This includes addressing infertility issues. Denmark’s public health system, for example, supports assisted reproduction services (in vitro fertilisation) for women irrespective of marital status and sexual orientation and the proportion of births assisted with IVF is rising.
In regard to family planning, is there a disproportionate focus on sterilisation, and female sterilisation in particular, as the primary method of family planning in India?
I would say yes. One finds few countries in the world, particularly with populations as large as India’s, where permanent contraception occupies such a prominent role as a means of birth control. Female sterilisation is favoured in Central America and China, but women there also use other methods. While female sterilisation is a terminal use status for many Indian women, they appear not to access other contraceptive choices as readily if they wish to space births. Striking is the extent to which female sterilisation has become the birth control option for less educated and low-income women.
Do you feel the emphasis on sterilisation occludes access to other mechanisms of family planning such as contraceptive devices (e.g. condoms)?
The government’s Family Welfare program has recently introduced two spacing methods – Chayya, a once a week oral contraceptive pill, and Antara, a three-month injectable contraceptive. These offer protection against unplanned pregnancies to breastfeeding women and require minimal attention to use. These help complement the other government-sponsored methods. In addition, the government has been promoting immediate postpartum IUD insertions so that women can leave the birth facility protected with a highly effective method. With major surveys such as the National Family Health Survey conducted every few years, it will be possible to monitor the uptake of the new methods and observe how the family planning intentions of couples are being realised.
Finally, do you have anything you wish to add?
Nearly one in every five women on this planet is Indian (seventeen percent). Each of them deserves to be born a wanted daughter, be educated, live a healthy productive life and be a contributing member of society. India should not squander this human resource, which can potentially help accelerate the country’s future economic growth.
Amy O. Tsui, PhD is a Professor in the Department of Population, Family and Reproductive Health of Johns Hopkins Bloomberg School of Public Health and a senior scholar of the Bill & Melinda Gates Institute for Population and Reproductive Health.
Her research interests include family planning, fertility, and related health issues in developing countries and her current research is on the effects of various family planning and health service delivery models on contraceptive, fertility, and sexual health outcomes in sub-Saharan African and other low-income countries. She obtained an MA degree from the University of Hawaii in 1972 and her PhD from the University of Chicago in 1977. Among her honours are the Champion of Public Health award from the Tulane School of Public Health and Tropical Medicine, 2005; the AMTRA Award, JHSPH, 2006-07; the Golden Apple Award, JHSPH, 2009; and the Carl S. Schulz Lifetime Achievement Award, Population, Reproductive and Sexual Health Section from the American Public Health Association, November 2010.
If you were a girl: Men, this is what you need to understand about women and violence
The body swap is an old Hollywood trope: Boy meets girl, boy swaps bodies with girl, boy has epiphany about love, life and patriarchy. Too bad that in 2019, this kind of empathy is still just the stuff of movies
The brutal rape and murder of 19-year-old Uyinene Mrwetyana by Luyanda Botha, a post office clerk, in August this year left us all shaken, battling to make sense of our excruciatingly violent world.
Mrwetyana went to collect a parcel from her local post office on Saturday morning and never made it out alive. The sheer banality of the circumstances sent shockwaves through social media.
She was wearing brown corduroy pants and a white t-shirt. She was not drunk. She was not walking home late at night. She hadn’t been at a shebeen or a club. There was nothing about the circumstances that could be used to “victim shame” her.
Nevertheless, on social media, many commentators suggested what women could do to “avoid” being raped, for instance — taking self-defence classes, carrying pepper spray, sending live locations to friends when they leave a venue.
A tweet, posted on the official Government of South Africa account, read: “Violence and abuse against women have no place in our society. Govt is calling on women to speak out, and not allow themselves to become victims by keeping quiet. Women who speak out are able to act, effect change and help others.”
It received widespread backlash on social media. Black Twitter acted fast to offer a correction to the tweet, much like a schoolteacher would take a red pen to a student’s exam paper.
This was the correction: “Violence and abuse by men have no place in our society. Govt is calling on men to speak out, and not allow themselves to create victims. Men who speak out are able to act, effect change and help others.”
The post went viral.
Some years back there was a film called “What Women Want”, a romantic comedy which body swapped the male character and his female love interest so he could understand what she wanted from him as a lover and a partner.
While this would be great, it will sadly remain in the land of Hollywood.
However, if men listened closely to the outpouring of women’s grief, fear and frustration after yet another act of violence, they would hear not only what we want, but also what we urgently need.
Women do not have the power to stop rape. We cannot simply break our silence or act in certain ways to effect change.
What we need is for men to speak out boldly in public and private spaces.
We need all men, from all walks of life, to call out their male friends, family and colleagues whenever they say or do anything that condones or excuses rape.
When men do speak out against rape, they should counter the narrative that they are doing so because women are their mothers, wives, sisters or friends.
We want men to speak out because they believe women are people who have a value in society equal to that of themselves.
Fathers must teach their sons what enthusiastic and continuous consent means and that it is non-negotiable in all their interactions with the girls and women in their lives.
Today, begins the annual 16 Days of Activism against Gender-Based Violence campaign, which runs from 25 November, also known as the International Day for the Elimination of Violence Against Women until International Human Rights Day on 10 December. This year, the United Nations Secretary-General’s UNiTe campaign against gender-based violence has run the theme: “Generation equality: stand against rape!”
But we need 365 days of sustained action in order to eliminate gender-based violence.
Gender-based violence is directed at an individual based on his or her biological sex or gender identity. It includes physical, sexual, verbal, emotional, financial and psychological violence or abuse, in public or private life.
Rape is rooted in the notion that women are inferior to men and motivated by the rapist’s violent need for power and control.
Women who are raped are more likely to contract HIV, less able to exercise their sexual and reproductive health rights and more likely to be exposed to other forms of gender-based violence throughout their lifetime than those who are not.
Exact numbers of rape and sexual assaults are difficult to estimate due a culture of impunity for perpetrators, stigma towards survivors and their resulting silence.
UNAids’ latest global report shows that around 30% of women in South Africa, Uganda and the United Republic of Tanzania have experienced violence at the hands of an intimate partner in the last 12 months, according to surveys.
There are structural changes that we need make to achieve meaningful and sustainable gender equality, access to justice and human dignity. These will take some time and we will continue to advocate for changes in laws and policies in the eastern and southern African region that will help us reach our goal.
What we can do in the next 365 days, though, is write a scene in the script of our own Hollywood romcom, where this time next year, through simple and deliberate changes, we are living in a world a less violent than it is now.
Catherine Sozi is Director of the UNAids Regional Support Team for Eastern and Southern Africa. Follow them on Twitter at @UNAIDS_ESA.
Does Sexual Wellbeing Lead to Better Life And Leadership Skills? This Sextech Company Wants To Find Out
The connection between sexual well-being and mental and physical health has been recently attracting more interest. Sexual wellness brands -many of which endure constant advertising censoring– advocate to position sexual health and wellness as part of the health conversation, to make it more accessible to all.
A rich body of research confirms that sexual satisfaction affects relationship satisfaction, which is key to earning potential. For example, in one longitudinal Harvard study, the data revealed that fulfilling relationships are the key to happiness, health and longevity. And not only that: Those with the most fulfilling relationships earned an average of $141,000 a year more at their highest earning point.
This study, however, was focused exclusively on male subjects, and it inspired a recent study conducted by sexual wellness company Womanizer (WOW Tech) in partnership with The What Collective, a women-centered organization founded by dot com entrepreneurs Gina Pell and Amy Parker. The former co-founders of Splendora (acq. by JOYUS) recently hosted a gathering called The What Summit at the secretive and exclusive Skywalker Ranch. The survey was completed by over 200 high-earning attending women. 80% of respondents were ages 35-64 and in director, management and C-suite positions.
The preliminary results showed some interesting insights: More than 50% of respondents perceived that having a healthy fulfilling sex and relational life would positively impact all other aspect of their lives, including their careers.
The Deficit in SexEd Addressed By Wellness Brands
When it comes to sexuality only 3% of respondents said they had learned at school or with their families. The majority cited the following sources of sex education: peers and friends (34%), magazines and books (28%), and the Internet (10%). In fact, 77% of women who received some sex education stated that it never mentioned that sex should be pleasurable and 70% say there was no discussion about consent. Additionally, 62% state that they have experienced shame around sex and sexuality.
Global expenditure on wellness products and services is on the rise, highly driven by women, and the women’s empowerment movement has added to the conversation issues such as the orgasm gap between men and women, and the right to body autonomy and pleasure of women. This context creates an opportunity for Sextech and Femtech businesses to create innovative solutions to educate and offer resources in underserved categories for people of all ages. Both industries have been estimated at $30 and $25 billion, respectively.
Stephanie Keating, Head of Marketing of WOW Tech, which comprises Womanizer and We-Vibe, said: “Womanizer partnered with The What Summit to facilitate conversations amongst women about pleasure and all that it brings our lives. For many women, experiencing self-pleasure builds confidence, comfort, and agency – yet 75% of us were not taught that sex should be pleasurable. Traditional sex education has failed us. For too many women, pleasure is associated with shame. That limits us in so many other aspects of our lives. The conversations that Womanizer and our experts are having with women free us to talk to each other about this essential part of our lives.
Personal Fulfillment As A Source Of Confidence And Wellbeing
When asked about the impact of their personal sexual wellness in other areas of life, the majority of women believed that feeling fulfilled positively impacted how they showed up in other areas of their lives. Specifically, 51% stated that this translated into a positive impact on their professional lives. Many respondents pointed to the correlation between fulfillment and “confidence”, “lowered stress”, increased overall “happiness and motivation”, feeling “empowered” and “powerful”, and the positive correlation with overall “well-being”.
Emily Morse, Doctor of Human Sexuality, relationship therapist and author, says “Sexual wellness impacts body image, confidence, … These factors can put a strain on our mental health. If you are not connecting with your partner, it is going to affect your day to day life. Additionally, being able to ask for what you want is a skill that translates into other areas of life.”
Sexologist and relationship expert, Dr. Jessica O’Rielly, PhD, said: “Sexual fulfillment, relationship fulfillment and life fulfillment are all positively correlated. It follows that investing in your relationships and sex life (however you define it) and fulfilling those needs leads to greater self-assurance, improved mood, increased motivation and even greater assertion skills — all of which can benefit your career.”
Educators, researchers, entrepreneurs… The business of sexual wellness is a growing one and the merger of Womanizer and We-Vibe, which is about to become the largest sexual wellness toy manufacturer, approaching $100 million in sales, wants to push forward a healthier narrative around sexuality: “ Our flagship products were created to help women achieve personal sexual fulfillment and their pleasure potential. WOW Tech’s mission is to be the premier provider of sexual health and wellness products — products that enable people all over the world to increase the satisfaction of their personal and sexual well-being,” concludes Keating.
Positive Pregnancy Test: “But, I Am Not Sexually Active!”
I can still recall her young face overcome with concern as she learned of her positive pregnancy test. She was just 16 years old and a relatively new patient at the time. Her situation was complicated by the fact that her grandmother, her legal guardian, was sitting in the waiting room. Grandma had met me prior to the appointment and clarified that, although she respected the fact that I wanted to see her ward alone, she absolutely did not want me “putting ideas into the child’s head” by offering her any form of birth control. Grandma further stated that she would not be here with her granddaughter today if someone had not talked about “these things” with her own teenage daughter 16 years ago.
Confidentiality in our pediatric and adolescent practices
is often the key to engendering confidence and trust within our patients. In their article published in the October issue of Pediatrics in Review, Drs Maslyanskaya and Alderman discuss the need to educate both adolescents and caregivers about the importance of confidential care to ensure the patient’s emotional and physical wellbeing. This applies particularly in the sensitive domains of sexual health, substance use, and mental health. Research has shown that adolescents, if not guaranteed privacy, are less likely to access health services for reproductive and substance use issues. The authors further describe that physicians should consider multiple factors when weighing the ability of the adolescents to interpret health information and make health care decisions autonomously.
Laws regarding confidentiality and consent may vary drastically from state to state, especially with regards to consent for reproductive health needs (including abortion). Maslyanskaya and Alderman advise that pediatricians faced with these dilemmas understand the limits of confidential care for adolescent patients and provide resources relevant to different states in the United States. Physicians should be aware that minors may gain legal status as adults under certain state and federal laws, including the concepts of “mature” and “emancipated” minors. The authors emphasize that federal laws like HIPPA, Title X , SAMHSA and MEDICAID override state laws and, thus, familiarity with both is essential to the provider. Pediatricians should also be aware that there are instances when they must “break” confidentiality, in the best interest of the patient, as in cases of child abuse or when there is a risk of suicide or homicide. For public health reasons, sexually transmitted infections (STIs) also must be reported to the local health department to ensure that partners are treated and to prevent the spread of the disease.
Finally, the authors discuss that, with the increased use of electronic records, pediatricians should ensure that they are careful to protect confidential information. Strategies may include blocking sensitive information from after-visit summaries and advocating for institutional policies restricting the use of internet portals by parents of teenagers.
In our case, the teenager chose to continue the pregnancy and consented to her grandmother being included in the conversation and planning for the future. She was also made familiar with different long-acting reversible contraceptive methods that are available to prevent future pregnancies.
Nupur Gupta, MD, MPH, Editorial Board Member, Pediatrics in Review November 25, 2019
A staggering one-in-three women, experience physical, sexual abuse
Here is the grim reality, in numbers: A third of all women and girls experience physical or sexual violence in their lifetime, half of women killed worldwide were killed by their partners or family, and violence perpetrated against women is as common a cause of death and incapacity for those of reproductive age, as cancer, and a greater cause of ill health than road accidents and malaria combined.
The prevalence of the issue, “means someone around you. A family member, a co-worker, a friend, or even yourself” has experienced this type of abuse, Secretary-General António Guterres said in his message to mark the Day.
“Sexual violence against women and girls is rooted in centuries of male domination”, he added, reminding the world that stigma, misconceptions, under-reporting and poor enforcement of laws perpetuate impunity in rape cases.
“All of this must change…now”, the UN chief urged.
Damaging flesh, imprinted in memory
To spotlight the scale of the problem, on this year’s International Day of the Elimination of Violence against Women, the United Nations is sharing the many ways in which the scourge manifests itself in physical, sexual and psychological forms, and the organisation is underscoring the life-altering, adverse consequences women suffer as a result.
sexual violence and harassment (rape, forced sexual acts, unwanted sexual advances, child sexual abuse, forced marriage, street harassment, stalking, cyber- harassment);
human trafficking (slavery, sexual exploitation);
female genital mutilation
The Declaration on the Elimination of Violence Against Women, issued by the UN General Assembly in 1993, defines violence against women as “any act of gender-based violence that results in, or including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life”, the UN highlighted on the Day.
Rape isn’t an isolated brief act. It damages flesh and reverberates in memory.–Executive Director of UN Women
UN Women’s Executive Director, Phumzile Mlambo-Ngcuka, expressed her concerns when it comes to rape specifically.
She said the end of the horrendous act would mean eliminating a “significant weapon of war from the arsenal of conflict”, the absence of a daily risk assessment for girls and women who actively work to avoid an incident that could leave them scarred.
“Rape isn’t an isolated brief act. It damages flesh and reverberates in memory. It can have life changing, unchosen results – a pregnancy or a transmitted disease”, Ms. Mlambo-Ngcuka stressed, adding that consequences of a one-time act can sprawl into damaging long-term effects.
“It’s long-lasting, devastating effects reach others: family, friends, partners and colleagues”, she continued.
In addition, research by the World Health Organization (WHO), details disturbing impacts of violence on women’s physical, sexual, reproductive and mental health:
Women who experience physical or sexual abuse are twice as likely to have an abortion, and the experience nearly doubles their likelihood of falling into depression. In some regions, they are 1.5 times more likely to acquire HIV, and evidence exists that sexually assaulted women are 2.3 times more likely to have alcohol disorders.
More women abused than not, in US
Some national studies examining incidents in the United States show that up to 70 per cent of women have experienced physical and or sexual violence from an intimate partner, according to UN Women.
The agency cited that nearly a quarter of female college students reported having experienced sexual assault or misconduct in the US, but harm targeting women and girls knows no bounds.
Multi-country investigations by WHO show partner violence to be a reality for 65 per cent of women in some parts of sub-Saharan Africa, and around 40 per cent of women in South Asia, as well as Andean parts of Latin America.
Meanwhile, even in regions where incidents are less likely, as in East Asia and Western Europe, more than 16 per cent and 19 per cent of women have experienced intimate partner violence, respectively.
Psychological violence is another layer to the problem, with some 82 per cent of women parliamentarians in a recent study, reporting having experienced remarks, gestures, threats, or sexist comments while serving – most often via social media.
While gender-based violence can happen to anyone, women who identify with the LGBTI community, migrants and refugees, indigenous minorities, and those living through humanitarian crises, are particularly vulnerable to gender-based harm.
“Almost universally, most perpetrators of rape go unreported or unpunished”, Ms. Mlambo-Ngcuka explained. “For women to report in the first place requires a great deal of resilience to re-live the attack…In many countries, women know that they are overwhelmingly more likely to be blamed than believed.”