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“Never give up hope,” fistula survivor tells Pakistani women

“Never give up hope,” fistula survivor tells Pakistani women

2020-01-09

ISLAMABAD, Pakistan – “Helping women suffering fistula is my mission in life,” Razia Shamshad said about the maternal injury from childbirth that she thought would ruin her life. “No woman deserves to live in misery, especially when it is treatable.”

Ms. Shamshad, 29, was born in a small village in southern Punjab. Her family did not want her to go to school, so she had only received an informal religious education by age 13, when she was married off. Ms. Shamshad was already expecting her first baby within a few weeks of her wedding. Then, when she was six months pregnant, her husband died in a road accident.

Unable to afford proper medical care, Ms. Shamshad was assisted by an unskilled traditional birth attendant who was unable to manage complications. When Ms. Shamshad suffered an obstructed labour, the birth attendant did not summon medical help. Ms. Shamshad was in agony for four days, an ordeal that could have killed her.

In the end, her daughter was stillborn, and Ms. Shamshad suffered serious damage. She developed an obstetric fistula, a hole in the birth canal. Fistula leaves women leaking urine, faeces or both, and often leads to chronic medical problems.

The condition is preventable with timely access to quality medical care, such as Caesarean section. Tragically, it persists among the most marginalized women, with pregnant adolescents and undernourished women facing particularly high risks. And its sufferers are further marginalized, often facing ostracism and discrimination. 

“People would either avoid me or just make fun of me,” she said. “I never felt clean.”

A stroke of good luck

But Ms. Shamshad was able to put her life back together. Her relatives learned about free treatment available at the Koohi Goth Women’s Hospital, which specializes in treating fistula and other conditions related to reproductive health. Two years after her ordeal, her family paid for her to travel to Karachi for care. 

Ms. Shamshad’s condition was complex, and required multiple surgeries between 2010 to 2016. Even so, she has been able to regain her life. 

“Her determination was exceptional. She was resilient and strong and was able to pull through the difficult process successfully,” said Dr. Sajjad Ahmed, who was trained by UNFPA to perform fistula repair surgeries.

Ms. Shamshad went on to meet her current husband. They adopted a little girl. And though she was not expected to be able to get pregnant again, she surprised everyone by conceiving. With regular prenatal care and a C-section, she had a healthy baby girl.

Combating fistula since 2003

In many ways, Ms. Shamshad was lucky. The story is very different for many fistula survivors in Pakistan, who are unaware that there is treatment available.

And many more women and girls are at risk.  Access to reproductive health services remains a challenge for women in Pakistan. Only an estimated 52 per cent of women give birth with the help of a skilled attendant, leaving them vulnerable to complications like prolonged, obstructed labour.

“People would either avoid me or just make fun of me,” she said. “I never felt clean.”

A stroke of good luck

But Ms. Shamshad was able to put her life back together. Her relatives learned about free treatment available at the Koohi Goth Women’s Hospital, which specializes in treating fistula and other conditions related to reproductive health. Two years after her ordeal, her family paid for her to travel to Karachi for care. 

Ms. Shamshad’s condition was complex, and required multiple surgeries between 2010 to 2016. Even so, she has been able to regain her life. 

“Her determination was exceptional. She was resilient and strong and was able to pull through the difficult process successfully,” said Dr. Sajjad Ahmed, who was trained by UNFPA to perform fistula repair surgeries.

Ms. Shamshad went on to meet her current husband. They adopted a little girl. And though she was not expected to be able to get pregnant again, she surprised everyone by conceiving. With regular prenatal care and a C-section, she had a healthy baby girl.

Combating fistula since 2003

In many ways, Ms. Shamshad was lucky. The story is very different for many fistula survivors in Pakistan, who are unaware that there is treatment available.

And many more women and girls are at risk.  Access to reproductive health services remains a challenge for women in Pakistan. Only an estimated 52 per cent of women give birth with the help of a skilled attendant, leaving them vulnerable to complications like prolonged, obstructed labour.

https://www.unfpa.org/news/%E2%80%9Cnever-give-hope%E2%80%9D-fistula-survivor-tells-pakistani-women

Effectiveness of contraceptive counseling strategies

Effectiveness of contraceptive counseling strategies

January 8, 2020

Counseling strategies for modern contraception that target women initiating a method, including structured counseling on side effects, tend to have positive effects on contraceptive continuation, according to a systematic review in BMJ Sexual & Reproductive Health. But in most cases, provider training and decision-making tools for method choice did not have an effect.

On the other hand, additional antenatal or postpartum counseling sessions resulted in an increased rate of postpartum contraceptive use, regardless of their timing in pregnancy or postpartum. But dedicated pre-abortion contraceptive counseling was linked to increased use only when accompanied by a broader contraceptive method provision. The review also found that male partner or couples counseling can be effective at increasing contraceptive use among non-users, or in women initiating contraceptive implants or seeking abortion.

Methods
The investigators, who were from several countries, searched six electronic databases for relevant studies of women or couples published in English since 1990: MedlineEmbaseGlobal HealthPopline, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) Plus and Cochrane Library. A total of 61 studies from 63 publications met the inclusion criteria, for which there was substantial heterogeneity in study settings, interventions, and outcome measures. However, high-quality evidence was absent for the majority of intervention types.

Findings
In summarizing the advantages and disadvantages of different counseling intervention methods, a few studies noted the increased cost of  staffing, resources, and contraceptive products when providing additional and longer patient consultations. Conversely, interventions like digital tools during waiting times prior to consultation can potentially save provider time. However, counseling satisfaction with digital tools alone was low, and best used in conjunction with face-to-face counseling.

While telephone-based interventions provide access to many women at low cost, these interventions are unable to reach women without phones and may require multiple attempts to reach participants with phones.

Counseling up to the time of birth or abortion for women who may not access services later allows for a fuller discussion of different contraceptive methods, yet some women may be reluctant to initiate contraception immediately, thus effective follow-up mechanisms are necessary. Routine postpartum counseling at 3 to 6 weeks may help some women after they have resumed sexual activity.

Including male partners in counseling sessions may also be valuable, if they are the main contraceptive decision-maker. But partner availability poses logistical challenges.

Conclusions
“Our focus on comparing counseling strategies is critical to help identify successful interventions to improve contraceptive services,” the authors wrote. “However, preventing unmet need for contraception and unwanted pregnancies (influenced by multiple other factors) is the ultimate objective from a public health standpoint, and counseling process indicators such as client participation and knowledge are also important.”

Three limitations of the review are that study quality was variable; substantial heterogeneity existed in study settings, interventions and outcomes, thereby limiting comparability of studies; and many of the included studies failed to clearly state whether the intervention targeted women initiating, switching, and/or continuing contraception, plus women switching methods were often grouped with initiators.

Nonetheless, the findings underscore that when feasible, repeated counseling throughout pregnancy and postpartum can contribute to maximum access to information and contraceptive uptake. However, interventions seeking to improve contraceptive counseling need to be tailored to patient flow, record flow, and the contraceptive methods available, while embedded within broader quality-of-care improvements, including clinical training.

The authors noted that further research is needed to determine the effectiveness of many contraceptive counseling interventions, including novel efficacious interventions, among various settings.

What Are The Best Multi-Vitamins For Women?

What Are The Best Multi-Vitamins For Women?

2020-01-06

By Staff ReporterDec 30, 2019 10:57 AM EST

Our modern society is quite unhealthy, with fast food and processed sugars available around every corner. As a direct result of the unhealthy environment they inhabit, many American women are struggling with their long-term health, especially when it comes to ensuring they have enough vitamins and a proper diet. It can be incredibly hard to find authoritative information pertaining to women’s health, too, leading many young women to simply give up altogether.

Rather than ignoring your health, you should be taking proactive steps to bolster it, like consuming healthy supplements. Which are the best multi-vitamins for women, and how else can they remain healthy? Here’s how to ensure your lifestyle is a healthy and prosperous one.

Find authoritative sources

The first thing you should do when searching for the best multi-vitamin for women is find an authoritative source that can give you valid information which you can depend upon. Many blogs exist and will tell you what supplements to take, but the truth of the matter is that these are often hosted by non-professionals who lack formal medical degrees. You should be relying strictly on valid sources of information that have science to back up their arguments. Look for websites that end in .gov, and you’ll generally know you’re in the clear when it comes to the medical data you’re reading.

The U.S. Department of Health and Human Services has anexcellent webpage provided by the Office on Women’s Health, for instance, and it should frequently be reviewed by women who want to maintain healthy lifestyles for themselves. Ensuring you have enough vitamin B9, for instance, is particularly important for pregnant women who may be deprived of valid information to rely on as they prepare for a new chapter in their lives.

Many women have a vitamin B-12 deficiency, too, which is a helpful reminder to talk to your medical professionals about what your body might need that it’s naturally lacking. It’s important to remember thatnutritional supplements are only one source of these vitamins – many people often get enough in their regular diets, though some dietary restrictions may impede your ability to ingest enough of them in your food. When it comes to B-12 deficiencies, for instance, you can try to amend them by increasing the amount of fat-free milk, eggs, poultry, and nutritional yeast you consume on a regular basis.

Many women find themselves suffering from calcium deficiencies, and these can’t always be amended by eating more food groups that are rich in calcium. Young girls who are still growing may be in particular need of calcium supplements because they can be very important when it comes to bone growth and hitting your appropriate height.

Learn about multi-vitamin trends

To find the best multi-vitamins and to determine which are popular and which are fading, it can be helpful to familiarize yourself with multi-vitamin trends across the nation. The past few years have seen ageneral decline in the number of multi-vitamins consumed by American adults, for instance, though it’s not yet clear why people are taking fewer and fewer of them. Americans are taking more vitamin D, for instance, but overall the total amount of supplements they’re taking is going down.

It’s important to speak with your medical providers to ensure that you’re not following national trends which may be popular but nevertheless unhealthy when your specific body is considered. Women of reproductive age in particular are taking fewer supplements,according to data made available by the CDC, though this is often impacted by the age and ethnicity of the individuals in question.

Vitamins A, C, E, and D remain some of the most popular supplements with women even in light of this decline, however. Calcium is also particularly important for developing women of a younger age. Before ingesting any supplements, ensure their sourcing is authentic and that there are no regulatory embargos on the substance you’re consuming. By finding authoritative and well-regulated providers of supplements, you can bolster your health, but taking shady supplements from lackluster sources is highly inadvisable. Never be afraid to talk to your medical professional about taking certain multi-vitamins or a particular supplement you’ve encountered online.  

The biggest wins for LGBT+ rights in the 2010s – and all the battles yet to be won

The biggest wins for LGBT+ rights in the 2010s – and all the battles yet to be won

As the decade ends, we take a look back at the rights won by LGBT+ people across the UK in the 2010s, and the fights that continue on.

1. Legal protections against transphobic discrimination

At the start of the decade, on October 1, 2010, the Equality Act came into force, giving trans people explicit protection against discrimination. Under the law, “gender reassignment” is a protected characteristic, a move that James Morton  of the Scottish Transgender Alliance said has been”really effective in terms of encouraging employers and also service providers to take into account the needs of trans people.”

In 2016, Morton gave evidence for a Parliamentary inquiry on transgender equality, which indicated that protections for trans people “are not universally seen as legally complete and many trans people still face discrimination in employment and in other aspects of their lives.” It called for the act to be updated with a a broader definition of trans identities, one which uses more considerate language.

2. Same-sex couples in Northern Ireland can adopt children.

Same-sex couples in England and Wales have had the right to adopt since 2002, with LGBT+ people in Scotland given their rights in 2009. In Northern Ireland, same-sex adoption wasn’t introduced until 2013, after the ban was ruled to be unlawful.

In 2018 it was reported that just 30 same-sex couples had applied to adopt in Northern Ireland, with just two approved. This makes the success rate one in 15, compared to one in two for the rest of the UK. The Department of Health said that lower success rate may be because the adoption process can take several years to complete.

3. Equal marriage.

While same-sex couples have been able to enter into civil partnerships since 2004, giving them the most of the same rights as married mixed-sex couples, it took another 10 years for full marriage equality to be introduced – and even then, it wasn’t universal.

England and Wales were the first parts of the UK to allow men to marry men and women to marry women, with the first such unions taking place on March 29, 2014.

Scotland followed suit on New Year’s Eve that same year, while Northern Ireland will see its first same-sex weddings take place on Valentine’s Day 2020 after an intervention by the House of Commons.

4. Married trans people can legally transition without having to divorce.

Historically, married people who wanted to change their legal gender marker were forced to divorce in order to do so.

The introduction of same-sex marriage corrected this wrong, meaning that trans people are now able to legally transition while remaining in their marriage. But – and this is a big but – they must have the consent of their spouse before a gender recognition certificate can be awarded, creating an effective ‘spousal veto‘.

5. Men convicted for their sexuality were pardoned.

In 2017, MPs passed the Alan Turing law to right an historic injustice and pardon the thousands of queer men who were convicted for “buggery” and other archaic, homophobic offences.

Almost 50,000 were posthumously pardoned, while those who were living were invited to apply for a statutory pardon through the Home Office’s disregard scheme, introduced in 2012. However in September 2019, it was reported that fewer than 200 wrongful convictions had been erased – a failure rate of 71 percent.

6. LGBT-inclusive education.

The most recent win for Britain’s LGBT+ community is the legal enshrining of an LGBT-inclusive school curriculum.

In March, MPs voted overwhelmingly to introduce new relationships and sex education guidelines which mean that from September 2020, every child in the UK will learn about LGBT+ people, relationships and families

Stonewall’s director of education and youth Mo Wiltshire said that such lessons “have the potential to deliver real change in how LGBT families, people and relationships are taught about. This will help foster greater inclusion, acceptance and understanding in our classrooms, playgrounds and school corridors.”

LGBT+ rights that need to be won in the 2020s

1. Full and free access to PrEP.

Currently, PrEP is only available in England through a limited trial. In Wales, Scotland and Northern Ireland, it can be prescribed by any NHS sexual health clinics.

Debbie Laycock, head of policy at the Terrence Higgins Trust, told PinkNews that restricted access to the drug is putting some men at increased risk of acquiring HIV.

“In parts of the country PrEP trial sites have closed to gay and bisexual men due to being oversubscribed,” she said, calling for a full roll-out of the drug.

Labour, the Liberal Democrats and the Green Party have all committed to giving universal access to PrEP in their election manifestos. The Conservatives and the Brexit Party both failed to make any mention of the drug in theirs.

2. Reform of the Gender Recognition Act.

When the Gender Recognition Act was introduced in 2004, it was a ground-breaking, trail-blazing piece of legislation. But 15 years on, it’s no longer fit for purpose.

In 2018 the government conducted a public consultation on reforms to the act, with most sensible people recommending the introduction of self-identification and legal recognition for non-binary people, among other measures.

Yet, more than a year after the consultation closed, we’re yet to see any results or official response. Again, the Conservatives failed to mention this crucial area of the law in its manifesto, while Labour, the Liberal Democrats and the Greens have all backed reform.

3. A ban on conversion therapy.

In July 2018, then-Prime Minister Theresa May vowed to outlaw the “abhorrent” practice of so-called gay conversion therapy. However such a ban is yet to materialise.

None of the major parties mention the practice in their manifestos, however spokespeople for the Conservatives, Labour, Liberal Democrats and the Green Party have all confirmed that they would end the practice.

4. An end to the blood ban.

In England, Wales and Scotland, men who have sex with men can only donate blood if they have been celibate for three months. In Northern Ireland, the deferral period is still 12 months.

This effectively amounts to a ban for men who are sexually active. Stonewall says that while it is statistically true that “men who have sex with men face higher rates of blood-borne infections, it’s simply untrue to say that every gay and bi man is a high-risk donor.”

The charity is calling for a system based on individualised risk assessment, rather than the current, discriminatory policy.

5. Changes to surrogacy laws

For gay men, the route to parenthood is fraught with complications.

While same-sex couples are able to adopt, the laws around surrogacy are somewhat more complicated. Commercial surrogates – a popular option in the US – is illegal in the UK.

Altruistic surrogacy is permitted, but the birth mother remains the child’s legal parent until a court grants a paternal order, a process which can take months and leaves all parties exposed to the risk that one or the other will change their mind.

It also means that if the child is taken ill after being born, only the surrogate mother is able to make decisions. NGA Law, which has campaigned for surrogacy reform since 2007, wants the law to change so that the intended parents are the child’s legal parents from birth, along with clarifications that surrogates can be financially compensated.

Breaking silence on menstruation

Breaking silence on menstruation

2019-11-26

Ebad AhmedSpecial ReportNovember 24, 2019

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.

Child marriage not good option

Child marriage not good option

By Rohiman HaroonNovember 23, 2019

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

What is the right age to lose your virginity?

What is the right age to lose your virginity?

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 findings

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.

Equally willing

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:

Source:

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.”

10 Benefits Of Having More Sex

10 Benefits Of Having More Sex

The good news is that there are plenty of ways to enhance your sexual health and sex drive.

November 24, 2019 by Kathy Mitchell Leave a Comment

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.

Conclusion

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

Stepping up in the Pacific at the expense of Pakistani women and girls

Young girl doing her school-work in Karachi.

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

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. 

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