What is the procedure for Abortion?

In Indian Medical Termination of Pregnancy is legal under certain conditions. It is important for us understand the procedure for abortion.

 

For abortion or also known as Medical Termination of Pregnancy (MTP), the woman needs to fill a consent form called ‘Form C’.  Only the consent of the women is required for performing the medical termination.

The woman is provided with a medicine kit containing mifepristone and misoprostol.  These medicines are best helpful in first 12 weeks (1st Trimester of abortion).

The doctor properly explains how to utilise these medicines as it is important to take these medicines in a proper way and under the doctor’s guidance

miso-and-mife

Procedure:

  • Day 1:One 200 mg tablet of Mifepristone is taken
  • Day 3 (between 24 to 48 hours):Misoprostol pills of 200 mcg each (total of 800 mcg) are given orally or vaginally.
  • Day 14 – 15:Person returns for a post-treatment examination to affirm that a complete end of pregnancy has happened.

The doctor would recommend to come back for an ultrasound check up after 15 days. Then get an ultrasound (abdomen) done because it is important to find out if the abortion is completed and women is safe.

These medicines don’t have any side effects but should be always taken under the doctor’s guidance.  It is always better to see if the clinic has displayed the certificate for medical termination practice. One needs to be careful from quacks or unregistered doctors.

BDA 2031 Master Plan Consultation

BDA 2031 Master Plan Consultation

                                                                                                  By The Bachchao Project and Hidden Pockets Collective

Our Intention behind this

The way to build an inclusive city is to understand the diverse needs of the people interacting with the city. Every city has an governing body to draft plans, these plans essentially used to shape the work and infrastructure in the city over a period of time. Every few years when new plans are formulated, these plans are released for consultation to the citizens of the city.  These are opportunities for citizens to engage and shape their city to their needs.

When BDA released the master plan for 2031 we saw this as an opportunity to look at the gendered needs in the city and highlight the same. This is the first of our efforts to be more involved in the City Plans.

Our observations :

In our analysis of the BDA Master Plan, we realized that most of the draft of the planning is based on a concrete understanding of a city, which is focussed more on developing spaces for industrial purposes without reflecting the lived experiences of people living in these spaces.  The plan is more focussed more making the cities more functional without looking at some of the problems presently being faced by the people living in these spaces.

We have based our observations on the maps provided in the BDA 2031.  With regard to land use, there is a need for more public audits and data collection. Data is insufficient and does not accurately locate some of the spaces.

The proposed city planning does not attend to needs of all persons living in these spaces. While the BDA has considered traffic, emergencies and disasters; safety as a parameter has not received any mention in the document. Based on experience, we can identify some of the spaces in the city, which are densely populated and some of these spaces have reported several harassment incidents and are considered unsafe for eg: the petta area right in the center of the city and the city bus stand. However safety has not been considered and this has not reflected in the urban planning of some of the spaces. These are just few spaces we could easily point out but there are several such pockets in the city. While the master plan has looked at all the available data sources when it comes to emergencies, disasters and even of archaeological importance. They have failed to look at any available safety indexes and nor have initiated conversations in that direction

Similarly while considering the infrastructure of the city. In area zoning regulation there is mention of width of the road, but indicators like street lighting and footpaths for pedestrians which can be some of the markers for safety concerns in an area is missed out.

In a city like Bangalore, which has a growing concerns around migration, there is no mention of shelter homes for different communities. They have not received any place in area zoning regulation. Not just shelter homes for different communities, shelter homes for women and children were also not considered under public spaces. These spaces are important is supporting a healthy community. A city as large as bangalore should have safe spaces for survivors of abuse and people with no support systems. We thought it was odd that the plans did not consider this as a need of the city.

Bangalore is a melting point of people coming from different parts of India, who are adding to the booming economy of the city. Migration of human resources also puts onus on the city to make the city more accomodating for people who are migrating. This is often done by encroaching spaces which are allocated as public spaces.

The rising population also leads to the question of utilization of empty and open spaces to accommodate the in flow of people. We strongly suggest that the language used for interlinking open spaces and eco sensitive spaces defeats the purpose as eco sensitive spaces are not spaces meant for usage by public.

The draft mentions Public sector enterprises as lung spaces of a city, indicating that these spaces can be used by general public for purpose other than functions of public sector. This is a very limited understanding of a public space and also reduces the space which could have been accessible to general public.

There is a potential of public spaces to be point of interaction where people from different communities can interact, it can be a great space for flourishing informal sectors. There is a need to define public space with usage perspective and not just see it as empty spaces.

UNESCO defines a public space as an area or place that is open and accessible to all persons, regardless of gender, race, ethnicity, age or socio-economic level. Some of the structures can be  plazas, squares and parks.

More SDZs seemed to have been proposed which are not connected within the existing layout of the city.

The industrial and residential areas do not have a clear path of connection between the two sections. These spaces can become inaccessible and unsafe for people from different communities.

Public spaces also provide an opportunity to design sanitation as part of the urban planning and introduce several public toilets especially for women working in the informal sector who might not have access to close toilets in their work spaces.  Public toilet is another aspect, which failed to get notice of the planning process. This also gets linked to safety aspects in these public spaces. If public spaces are designed keeping in mind the needs of people from different communities, it becomes more diverse, attracts more people and provides the space with a community feeling, which also makes safety then as a community issue instead of an individual issue.

Need for additional Data

Through our work we also realised the need of city specific gender data. We released there were no public records of safety audits, nor there were enough material talking about experiences. The mapping of what makes women’s lives in the Bangalore meaningful was also missing.

Future Work

Through our work we recognised that the need for more rigorous and in detailed submission. Our comments were unfortunately limited by lack of time and readily available information to make it possible.

  • We plan to build a joint process for reviewing such plans in the future.
  • We also understand the need for establishing better communication with the city planning committees and to review the existing regulations and push for a more inclusive approach in them.
  • We understand the need of safety audits and the dearth of informations due to lack of it and we hope to support more community audits.
  • We also would like to build a larger community which can work and think of these issues in the gendered lines and we welcome any partnerships in this direction.  

References  

Our submission to the consultation are based on our broad learnings from :

  1. Phadke .S, Khan. S, Ranade .S‎ ,2011 Why Loiter?: Women And Risk On Mumbai Streets
  2. Citizen Labs Articles on Inclusive Cities :

https://www.citylab.com/amp/article/365541/

https://www.citylab.com/equity/2017/09/the-how-and-why-of-inclusive-growth/541422/

https://www.citylab.com/equity/2016/06/how-to-build-inclusive-cities/487322/

The Bachchao Project is a community effort to develop / support Open Source Technologies and technical frameworks with the following goals :

1. Prevention of Gender Based Violence.
2. Equal Rights for Women and LGBTQIA communities

Can Indian courts handle sexual pleasure?

The word ‘sex’ has been tainted, maligned and mostly misused within the legal institutions. ‘Sexual pleasure’ as a theme is yet to be explored within the legal jurisprudence. In Kamlesh Vashwani Supreme Court order (2014), the judge while delivering the order stated that “things like (porn) lead to prurient interests in the younger generation and are responsible for rising instances of sexual exploitation.” He was not referring to any established study co-relating violence and sexual pleasure. He was simply exhibiting sex negativity prevalent in the court rooms.

Sex negativity remains unquestioned by courts, legislature and legal scholarship. Even activist spaces have focused more on issue of sexual violence against women and have not paid enough attention to promotion of women’s sexual rights, except in the area of reproductive rights. Indian Feminism’s engagement with law has been limited to the violence aspect of sex while losing an opportunity to enter in a dialogue with ‘sexual pleasure’. If law has been used in the past as a reformatory instrument in feminist struggles, it can also be used to redefine and re-analyse feminist relations with sex (the act) and ‘sexual pleasure’

Is there is a negative approach to the term ‘sex’ in our legal system. If there is, can we replace this approach with a sex positive framework and do we tend to benefit from this exercise?

One of the immediate effects of the December 16th incident was the increase in interest taken by the commercial enterprises around safety for women. The state machineries also displayed increased interest in the safety of the woman. Legal mechanisms also took a similar route in the form of a Criminal Amendment Act, 2013 where it resorted to criminal justice system and equated justice with legal enforcement. The new law introduced a lot many categories of crimes and new relations were created between law and sexuality. In a way, Criminal Amendment Act, 2013 created more methods to protect the idea of a woman.
The increased surveillance on the women was justified in the name of safety.

The sex negativity inherent in these different initiatives ended up curtailing women instead of providing spaces for them. The new law retained the sex negative language by evoking the notions of modesty and chastity of a woman and simply expanded the range of activities that threatened or blemished this archaic understanding of female sexuality. This new law could have been the space and time to demand sexual speech, a possibility to have a sexual choice.

Many laws in India rely on the assumption that sexual pleasure merits constraint because it is inherently negative. In Ranjit Udheshi (1968) Supreme Court judgment, it was held that “obscenity by itself has extremely “poor value in the-propagation of ideas, opinions and information of public interest or profit”. The exceptions provided to obscenity law clearly lays down that if the work comes from a scholarly, literary, artistic and political (hereinafter referred as SLAP) values it will provided with constitutional protection. However Sexual pleasure derived is not itself a good enough reason and thus is not worthy of protection.

In recent case, Aveek Sarkar judgment Supreme Court while dealing with an issue of obscenity held that we need to apply the community standards while defining obscenity. The court held that “Only those sex-related materials which have a tendency of “exciting lustful thoughts” can be held to be obscene, but the obscenity has to be judged from the point of view of an average person, by applying contemporary community standards”. This was clearly a shift from Hicklin Rule applied in Ranjit Udeshi (1968) which was more about the effect of the content. Inspite of the expansion of the definition and understanding around obscenity, courts were not willing to engage with the notion of sex in a positive framework.

Sexual pleasure is considered to have poor/negligible value. Sexual speech is not considered as speech and laws curbing sexual speech are justified in name of public order and morality. For purpose of law obscenity is no speech.

If we challenge this assumption, and commence on something like sexual pleasure is valuable, can this benefit laws engaging with sexual activities?

Sexual pleasure is mostly subjective and is achieved by individuals in different ways. Value of sexual pleasure is evident by the ends to which people go and the significant unwanted consequences they endure to achieve it. Sex positive laws are laws that perceive a certain value in sexual activity and allocate some value to sexual pleasure. Sex- positive laws are laws that inherently do not assume that sex is bad thing, and focuses on other aspects in a sexual activity instead of only focusing on the sexual act. It perceives that both men and women can experience sexual pleasure and can provide their consent for the act.
If sexual pleasure is considered to be valuable and is provided equal recognition as sexual speech, it would directly affect a lot of laws which works on the principle of sex negativity. Sex positive frameworks would question the less constitutional protection guaranteed to sexual speech than speech that promotes violence. Using this sex positive framework, the piece tries to discuss effect of it on one specific law: the obscenity laws. This law prohibits sale, circulation and display of any objects that can have a depraving effect on anyone coming in contact with it.

Whenever there is any discussion around sex in legal discourse harm principle is always cited as the main reason, instead of citing sexual pleasure as a reason for the ban. In cases of obscenity, state has to demonstrate that harm is both imminent and likely to occur as a result of that speech. However an offensive material retains constitutional protection if it contains any of the scholarly, literary, artistic and political values. The law seeks to protect not those who can protect themselves but also those whose prurient minds take secret pleasure from erotic writings. Obscenity test is based on the assumption that law needs to protect those who cannot protect themselves. Law prioritizes prevention of unlawful violence over sexual pleasure. Much of the law regulates distribution to willing consumers instead of protecting individuals from exploitation.

Also most of the times, the harm is projected to be on women. There is an unspoken assumption that sexual pleasure can lead to increase in violence against women.

Sex toys are one of these objects that are indirectly affected by these laws. The fact that sex toys/ articles and such related products ‘ carry the impression’ of being ‘obscene’, any commercial dealing in such articles always carries with it a certain element of risk of attracting obscenity laws.

Sex positive framework would help us admit that sex toys can be valuable for some and there is no immediate harm. It opens up discussions around sex toys and institutions flouring around it. This framework removes the dubious distinction between sexual and non-sexual values (scholarly, literary, artistic and political values). In a sex positive framework, one can argue that sexual pleasure is also valuable and hence would require protection. It also negates the assumption that sexual pleasure result in violence against women as woman too are seen as capable of demanding sexual pleasure.
Sex positive frameworks can also help us in dealing with emotions which can be something more than offending moral values in the case of obscenity. For example, Martha Nussbaum in her work Hiding from Humanity (2004) offers an alternative method at looking at obscenity laws. She contends that obscenity laws are catering something more than the moral values. It also deals with spaces which evokes disgust and regulates it. This factor disgust has been expressed in some of our Indian Supreme Court judgments also.
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CONCLUSIONS:
In most of the cases, sex can be a wonderful practise, and can be performed with consent of partners, without violating the consent of anyone. It is necessary to shift the focus to consent from the current practise of locating violence in sex.

This piece has only engaged with obscenity laws in sex positive framework. Similarly Rape laws, family laws and constitutional laws can also benefit from a sex positive framework. Positive value to sexual pleasure, not only provides us with a better definition of obscenity which is currently based on a narrow understanding of sexual speech, it also helps in developing a language of consent. Sex-negative framework has taken us up to a point where we locate the violence in sex. It does not mean sex only involves violence. It is necessary to focus on the right of the woman to feel sexual pleasure, which gets denied in a sex negative framework

A sex positive approach transforms the debate surrounding several areas of law and requires scholars to undertake a more honest assessment. It provides us with a framework for laws that recognizes the value of sexual pleasure. Theorists have demonstrated with increasing sophistication how categories in law form part of the social process, through which new gendered and sexualized subjectivities are created. Sex-positive framework helps us incorporating languages around different forms of sexualities and helps us in developing sensitive attitude towards different genders. The recent NALSA judgment was a step towards in this regard. It provides us with a model – a safer sex negotiations and a set of better practises.

How does a sexual offender look?

I remember reading this tweet during the #MeToo campaign, a campaign about sharing stories of survivors of sexual violence.

Zara Larsson‏Verified account @zaralarsson
“Isn’t it strange how every woman knows someone who’s been sexually harassed but no man seem to know any harasser?”

In my head I did know sexual offenders, atleast I had an idea about them and how to keep some people safe. It was discomforting and at the same time made me realise how we all have an image of a sexual offender. The abstract person who might exist in some other part of the world, but not inner personal lives.

I recently attended a workshop by Enfold India Trust by Donald Findlater who has been working with Lucy Foundation, UK on combating Child Sexual Abuse. He has worked as Probation officer with Adult Sexual Offenders on Assessment and Treatment of male Sex Offenders.

He has been focussing about the “changing nature of sexual violence”. There is a lot of focus on Child Sexual Exploitation but not really enough conversations on Child Sexual Abuse with former discussing about strangers and latter focusing on known people. Data does prove that most of the offenders are known to young people. In all of these conversations, the prevention aspects have not really received its fair share deal of focus. There is so much focus on criminizalistion aspect of it, but there does not seem to be conversations around how to keep premises and young people safe.

Some of the myths are that the perpetrator is a stranger, when in fact it is usually someone you know well and that it can’t happen to our children. Offenders could be family, friends, religious leaders or people who are part of the household.

The knee jerk reaction to any reporting of Child Sexual Abuse in India is setting up of CCTV cameras and sex offenders registry. Donald Findlater shared some of the experiences of United Kingdom where some of the programmes had been more successful that setting up of CCTV cameras.

a) Running of Helpline: Running a helpline with  a service structure in place to address the concerns. Stopitnow.org is running a helpline for adults in the UK to ensure that those people who are troubled by their sexual thoughts about young children can seek help. The program is confidential and ensures that no one seeking assistance is arrested. We hope to stop the adult before he or she abuses a child.

b) The UK has a closed sexual offenders registry where only authorities have access which basically means only people who have been convicted of the crime fall in the list. That appears to have worked far more effectively in comparison to US Sexual offenders registry which has open registry.

He also emphasised on the myth that sex offenders can’t stop. In his experience it was possible to get help and treatment and it is possible to restrain actions.

In his experience a lot of work needed to be done with the communities. There is a need for stronger community bonds with young people and lot more open conversations with young people around sexuality. In the current stream of information on internet, young people were at risk as well as advantage of meeting different people in different set ups. Young people in schools, young people in public places and young people in internet spaces were the different groups that one needed to engage with.

Mr. Findlater did focus on the aspect that most of the young people take time to come out and share their experiences of abuse. A lot of them get abused by the age of 10 years and most of them have very limited understanding around sexuality. It would be more healthy if they had trusted set of people in their lives to have conversations with, which would help them understand the changes happening in their lives. Schools had to become that space which emphasised the need for comprehensive sexuality education.

Schools instead of focusing on CCTVs and waiting for the incident happen, they can ensure that most of their spaces are designed in such a way that young people feel comfortable accessing them. There are no parts of the compounds which are secluded from rest of the space. Every person working within an institution has been trained around sexuality and has been clearly guided through child protection policy.

 

 

 

 

 

 

Inclusion of Transgender community: Status of NALSA judgement implementation?

The recent historic Supreme Court judgement declaring privacy as a fundamental right had commented on the right to sexual orientation. Members of LGBTQIA+ community across the country have been celebrating this monumental judgement as a ray of hope with respect to Section 377 that criminalises the act of homosexual intercourse.

However it is worth questioning the idea of privacy with respect to the transgender lives. The need to question this idea arises from the need to normalize their lives. In a way to include them, normalizing their lives, the Supreme Court of India acknowledged transgender as the third gender in India in its NALSA Vs.Union of India verdict in 2014. In this verdict, the Supreme Court had given directives for inclusion of transgender person including economic inclusion with reservation in public appointments and educational institutions treating them as socially and educationally backward classes of citizens (Directive 3). What happened to the directives given in the NALSA judgement 2014 by the Supreme Court? How many states have implemented all the directives issued by the Supreme Court of India? It is not clear if all Indian states have implemented these directives. There seems to be a need for a situational assessment and analysis of the implementation of these directives by the Indian states.

NALSA Vs. Union of India 2014 verdict and its implementation

It is worth noting that the Government of India has passed five centrally sponsored social welfare schemes for transgender community. This is in accordance with the directives given by the Supreme Court in 2014 (Directive 7).

  • Scheme for financial support for parents of transgender children
  • Scheme for pre-matric scholarship for the transgender students studying in Class VII to X
  • Scheme of pre-matric scholarship for the transgender students studying in classes XI and above for studies in India
  • Scheme of assistance for skill development training for transgender persons
  • National pension scheme for Transgender person

Apart from these, India has many other social welfare schemes. However, these schemes do not specifically mention the needs of gender and sexual minorities, notes Pawan Dhall, Gender and Sexuality Activist, Varta Trust.

Though theoretically there are no barriers for the adoption of these schemes by the transgender community the practice of it remains fraught with many barriers. Section 377 of the Indian Penal Code criminalises only a certain kind of sexual behavior and does not criminalise personal identification with any sexual orientation: self-identification as being gay or lesbian, is technically not supposed to deny anyone access to any social welfare schemes.Yet in practice, he notes there are barriers like:

The process to change gender and name of any individual continues to be a complex one. To identify as a woman or transgender, the person is required to make an affidavit, publish it in the gazette and then advertise in newspapers. This continues to be a deduced method of having gender and name of an individual changed considering that there is no set directive in place for this process.

“Some officials and judges understand, others refuse. There’s no guarantee. It doesn’t matter what the Supreme Court judgement says unless the officials see some directive or order of their department in their hand. They are not moved by the (NALSA) judgement,” notes Dhall speaking about the awareness levels among government officials regarding transgender inclusion in the country.

A national consultation was organised to understand the status of economic and social inclusion of Gender and Sexual Minorities in India. National Consultation on Economic Inclusion of Gender and Sexual Minorities in India organized by All Manipur Nupi Maanbi Association, Empowering Trans Ability – Manipur, SAATHII, Varta Trust and Sussex Social Science Impact Fund, University of Sussex, UK in August 2017 saw reports from representatives of different organisations and the transgender community about different initiatives undertaken in the different Indian states for social and economic inclusion of the transgender community and the gaps in its implementation.

Having worked in the states of Rajasthan, Orissa and North Eastern states on existing schemes inclusive of marginalized population with HIV – sex workers, trans individuals, MSM, SAATHII,a non-governmental organization noted that the barrier seems to be about people’s awareness about their eligibility. There seems to be a drop in the percentage of people who finally access the schemes compared to the people with access to this information. The percentage of people accessing schemes drops drastically due to the lack of correct documents required to avail schemes. Social stigma is also a concern for many who are aware yet unable to access schemes

Orissa: The state of Orissa seems to have introduced a comprehensive list of reforms for the transgender community. This includes online form for change of name and gender, inclusion in housing scheme: Biju Palla Ghar Yojana, transgender people coverage under the BPL category, and introduction of the centrally sponsored umbrella schemes, among others. However, there seem to be some challenges in the implementation of these reforms. Most of these reforms are available for transwomen but not transmen due to lack of awareness. There is lack of clarity about the inclusion of transmen under transgender in the Transgender policy introduced by the state, noted SAATHII. With respect to the online form for name and gender change, the person is expected to submit their photo, before and after transitioning. This contradicts with self-identification as being transgender without a surgery as mentioned in the NALSA judgement of 2014. A person may identify as being transgender and not choose transition.

Kerala: Sharing about the developments from the state of Kerala, a representative from the transgender community in Kerala said that the transgender policy hasn’t been implemented yet. However, the policy has included a justice board at both the district and state level. The board is to be formed by the collector, with representatives from law, education, medical and all other departments. A transman and transwomen need to be a member in each of these district boards. But in reality, finding a transman in all districts may be a challenge owing to the number of transmen who are out-of-the-closet about their gender identity. Once reviewed by the board, a gender certificate will be issued and other documents can be also changed accordingly. Though the policy came out in 2015, government officials seem to be unaware of the NALSA judgement and the Transgender policy. Gazette implementation has also not been tackled yet. Workplace inclusion has also not happened yet. It is worth noting that the Kochi metro had appointed 20 transgender employees in June 2017. However, about a third of them quit the job due to lack of social acceptance. That said, the Kerala government plans to issue a book explaining gender and sexual minorities to all government offices and departments to create awareness. The Kerala government is also looking to remove Section 377 from the state based on the recommendations of Mr Shashi Tharoor.

Tamil Nadu: Members of the transgender community who participated in the consultation noted that the Aravani Welfare board was setup in 2008. ID cards and free surgeries were offered. But the quality of surgery being done seems to be bad. Penetrative level of transitioning for transwomen has not been available. However, it seems that the board has been non-functioning since 2013. Transwomen have more access to the government schemes than transmen. There is still a lack of awareness with respect to transmen. Some trans rights activists have been working on it for transmen but transmen aren’t agreeable with coming out as transmen due to social stigma. Officials are allowing access to these schemes only for those who are willing to come out. There have been loan initiatives for transgender persons. Some private colleges are offering to provide them with college education and pay their fee. With respect to transitioning, the breast implant surgery is done for free for transwomen if they provide the silicon implant for the surgery. With respect to new identification documents after transitioning there seems to be a challenge. Community members seem to act as gatekeepers. It is the transwomen who are the gatekeepers and they decide who gets an ID.Whoever becomes the chella of the transwoman and joins the jama, get the support of the gatekeeper to get ID cards or surgeries,” noted a transgender community member speaking about the situation in Tamil Nadu.

Manipur: A study was conducted between August 2016-2017 – Sussex Social Science Impact Fund: Gender and Sexual Minorities Economic Inclusion Advocacy Project, to understand the economic and social inclusion of Gender and Sexual Minorities (GSM) community in Manipur. Two sensitization workshops were organized with 14 entrepreneurs and social enterprise leaders based in Manipur on gender, sexuality, elements of economic inclusion, model organizational policies and employment good practices. Entrepreneurs have come forth to offer employment opportunities to the GSM community members. Community leaders plan to follow up with these entrepreneurs to create opportunities for the community members. Efforts are also being taken to share information about these employment opportunities on an online portal, Rainbow Manipur blog for easy dissemination. Department of Information and Public Relations (DIPR) will include transgender people as trainee twice a year in their training programmes.

Developments in other Indian states:

Though attempts have been made to implement the NALSA directives, there have huge gaps and inconsistencies even among other Indian states, apart from the states discussed during the national consultation.

  • In August 2017, the union territory of Chandigarh launched a 14 member Transgender Welfare Board. Chaired by the additional deputy commissioner, the board comprises members from police department; social welfare department; law department; GMCH-32; health services; state liaison officer (education department); Registrar, Panjab University; Registrar, Birth and Death Department; SCBC Corporation, programme manager, Union Territory Child Protection Society (UTCPS); and two non-official members.
  • In the same month, a PIL was filed in Jammu & Kashmir seeking programs for the economic, social, and political inclusion and transgenders in the state.
  • In April 2017, Andhra Pradesh launched the Andhra Pradesh Hijra Transgender Welfare Board to protect the rights of the transgender community in the state.
  • In the same month, Maharashtra government announced its decision to set up the Transgender Welfare Board under the Ministry of Women and Child Welfare. However, it is not clear when the actual board will be setup.
  • Also in the same month, the transgender community in Gujarat sought to form a welfare board for the community. However, it is not clear if the board was subsequently set up
  • In September 2016, Rajasthan introduced transgender category in school admissions
  • In August 2016, Rajasthan set up the Transgender Welfare Board. However, a delay in the issue of ID cards was reported in April 2017, eight months after setting up the board
  • Also in August 2016, Manipur set up its Transgender Welfare Board.
  • In November 2015, Kerala announced its Transgender Policy for safeguarding the rights of the transgender community members in the state
  • In September 2015, Orissa government decided to implement the centrally sponsored schemes through its newly created Department of Social Security and Empowerment of Persons with Disabilities (SSEPD)
  • In March 2015, government of West Bengal set up the Transgender Welfare Development Board to function as the nodal agency to co-ordinate all policy decisions
  • In 2008, Tamil Nadu set up its Transgender Welfare Board which was also used as a model to set up such a board in other Indian states

Interestingly, the states of Meghalya and Nagaland are yet to give transgenders legal recognition. It is also not clear if all states have made any progress with respect to the NALSA judgement implementation.

Need for situational analysis of the status of NALSA judgement implementation

There seems to be lack clarity on the level of adoption and implementation of the directives from the NALSA judgment at the state level. There seems to be a lack of uniform procedural implementation of directives in the different states. There are other gaps in the implementation of different schemes and directives.

Additionally, the NDA government seems to have dropped plans to recognise transgender persons as the ‘third gender’ in the country’s labour law framework, reports The Hindu. The report notes that the Law Ministry will not be including transgender workers in all four labour codes in the pretext that transgenders fall within the definition of person in the General Clauses Act of 1897.What then happens to the NALSA judgement? It is interesting that the Labour Ministry should refuse to acknowledge transgender persons in labour law framework when a ruling government MP has criticized the draft Transgender Bill for not recognizing or addressing important civil rights such as marriage and divorce for transgender persons. In July 2017, the report by the Standing Committee on Social Justice and Empowerment headed by Ramesh Bias, a BJP MP criticized the draft Transgender Bill. Other contradictions also seem to be present with respect to the rights of Transgender persons. While the directives in the NALSA judgement of 2014 provides for self-identification as being transgender, the draft Transgender Bill 2016 has no provision for self-identification as has been permitted by NALSA judgement. What then will ensure uniform accountability across states? What is the government doing to ensure accountability? Will just a Transgender Bill suffice? What about bridging the existing gaps and making different spaces open and accessible to transgender persons? Inclusion cannot be ensured with just a law though a legal framework provides a legitimate backing.

Chennai Pride’s guide to handle online harassment for the LGBTQIA+

It is Pride month. The city of Chennai in its list of many events during this Pride also included an event on ‘Online Security, Harassment and Blackmail’ on June 11, 2017. The event was organised by Orinam collective and Nirangal, a non-governmental organisation. Vinay Chandran, Executive Director of Swabhava Trust and a counselor with over two decades of experience working with the LGBTQIA+ community led the discussion.

The focus of this session was the harassment and blackmailing faced by the people from the LGBTQIA+ community. This also sometimes includes stalking by lovers or ex-lovers. Several cases of harassment, breach of privacy and blackmail were discussed during the course of the event. There seems to be a certain pattern in these cases. Some of the regular kinds of harassment faced by the community members include:

  • One gay person outing another gay person about being HIV positive on an online dating site
  • Using compromising video or photographs to blackmail a person from the LGBTQIA community with the threat of outing them at work place or social media. Perpetrator threatens to put up a compromising photograph of a gay man from a dating site onto Facebook where friends, family and colleagues are also present and unaware of his sexual orientation
  • Gay man going on a date with a stranger and getting mugged and robbed.
  • Lesbian couples getting threatened to be out-ed to parents if they didn’t have sex with the perpetrator (usually a man).

These are just some common instances that came up during the event. Chandran addressed these issues and others highlighted by the people present at the event.

One of the key takeaways from the event was the need for you (victim) to have confidence in yourself. While it may seem scary when a perpetrator threatens to out you and tell the world about your sexuality and sexual orientation using a compromising video or an image, it is important for you to be confident. How can I be confident in such a situation?  You may ask. Here are some legal aids that were discussed that could help you have confidence. However, it is worth noting that these provisions were laid down in 1860.

Section 384: This provision talks about the punishment for extortion. This shall be imprisonment up to 3 years or fine or both.

Section 388: This provision makes extortion a punishable offence but in addition, makes it punishable offence with life imprisonment if done using Section 377 as a threat.

“Whoever commits extortion by putting any person in fear of an accusation against that person or any other, of having committed or attempted to commit any offence punished with death, or with *[imprisonment for life], or with imprisonment for a term which may extend to ten years or of having attempted to induce any other person to commit such offence, shall be punished with imprisonment of either description for a term which may extend to ten years, and shall also be liable to fine; and, if the offence be one punished under section 377 of this Code, may be punished with [imprisonment for life].”

Section 292 A: This provision in the Indian Penal Code deals with punishment for people who print, sell, distribute etc of grossly indecent or matter intended for blackmail. The perpetrator may be punished with imprisonment up to 2 years or with fine or both.

Section 377:

Some important misconceptions about Section 377 were clarified during the event. It would be useful for people from the LGBTQIA community to know that:

  • Section 377 does not make it illegal for you to identify yourself as being gay, lesbian, bisexual, queer, trans or any other sexual identity that you identify yourself with.
  • It does not make it illegal for you to introduce a person from the same-sex as your partner or girlfriend or boy friend.
  • It does not make getting married in a religious institution illegal. That said, please note that it will not give the marriage legal recognition.
  • The law does not make it illegal to hold Pride marches.

Even with all these legal provisions, it is common for that fear to pop up. One that says, “Oh but that person has a compromising photograph/video of me.”

Here is a quick list of things you could do:

  • Perpetrator is the accused, not you: Please keep in mind that the person in possession of such a photograph or video is more likely to get into trouble for possessing such an image/video before they could out you. They can be punished under Section 292 A.
  • Why section 377 may not work: Be aware that someone threatening to use Section 377 on a video that they have of you either alone or with them may not work on two accounts. One, the video may just have you which in no way can prove anything about your sexuality. On the contrary, can get the perpetrator in trouble for having obscene content. Two, the video may have both you and the perpetrator in which case both of you are likely to get into trouble together. So the person may not eventually use Section 377 because they would be the first person to get into trouble.
  • Your confidence: If you are more confident than the perpetrator, the perpetrator becomes weaker.
  • Get help: If the intention is blackmailing for money, they wouldn’t part with the video or photo. So get help. Depending on the situation, choose to speak to someone who could help you especially a lawyer. Lawyers will be in the best position to help you in case of threats of extortion. You can also find more support here and here.

But the biggest fear for most in the community comes often from the social repercussion of being out-ed. “What if my family finds out?”

Vinay Chandran’s response to this concern was my biggest take away from the event. Having spent over two decades helping clients handle and overcome this fear, Chandran says that it is important to start engaging in simple conversations with your parents to begin with. Chandran asks you to start engaging with your parents using simple talks around boundary. Say for example, keeping your room door shut. Indian Parents aren’t too often comfortable with the idea of seeing their kids having their room doors shut. Can you engage with your parents for smaller issues like these before you get to sexuality? With time, your parents could become comfortable with discussing about sexuality and may be even your sexuality. There is always room for conversation unless your parents have already blatantly said no to discussions on homosexuality in the house. If that’s not the case, then start talking. Chandran agrees that it could take time, even years but the important thing is to engage.

All that said and done, the idea is not to keep yourself away from people because some bad experience in the past. It is important to get out, meet people and even go on dates, but with caution! Here are some quick online dating tips for the LGBTQIA+ community

  1. Tell a friend or someone close about the date and where you will be going. It is good to keep someone informed.
  2. Meet the person in a public space for the first time before you take them to your home or go to their home or to any other private space.
  3. Do not carry anything expensive or valuable with you. Carry just enough money for your date.
  4. Don’t let your date bring a friend along. It may not be a good idea. Meet them alone the first time in a public space.
  5. Be careful about how much you share with the person on your first date. You don’t want to let them know your debit/card PIN numbers or hand your wallet over to them.

Now off you go! Have some fun!

Ratnaboli Ray on sexuality of persons with psychosocial disabilities

Pleasure, Politics & Pagalpan was a conference that happened on May 13 & 14, 2017, on ‘Sexuality, Rights and Persons with Psychosocial Disability’ co- convened by Anjali and ARROW (The Asian-Pacific Resource and Research Centre for Women) with support from CREA. Speaking to Hidden Pockets about the conference, Ratnaboli Ray, Founder of Anjali shared about Anjali’s experience and understanding to do with sexuality of persons with psychosocial disabilities. Listen to a fascinating conversation with Ratnaboli Ray where she explains the deeper nuances involved in the lives of people living with psychosocial disabilities. Hope you enjoy!

 

Disclosure: Hidden Pockets is Media Outreach Partner for Pleasure, Politics and Pagalpan

Read more on Pleasure, Politics and Pagalpan

Pleasure, Politics and Pagalpan: What do those words really mean?

Pleasure, Politics & Pagalpan: Abilities, independence and consent of persons with psychosocial disabilities

“Medication for psychosocial disabilities have effect on sexuality” – Ratnaboli Ray, Anjali

“Seeking pleasure is seen as a sin and self-indulgent” – Ratnaboli Ray, Anjali

Has the sexual right of persons with psychosocial disabilities been forgotten?

 

 

 

Pleasure, Politics & Pagalpan: Abilities, independence and consent of persons with psychosocial disabilities

“I feel that people in this room are converted to their own ideologies. I have converted to what I believe in and necessarily not converted to what others believe in. When we talk to the converted, do we have common viewpoints on anything that we have talked about? When we say conversations, there are two sets of people talking and listening. We come in here and often say things like- I will tell you what I feel, why aren’t you feeling what I feel, but I cannot feel what you feel because what you are feeling is what you feel but you should feel and this goes on. And then it becomes activism versus mental health professionals’ vs somebody else.” – Pramada Menon, Co-Founder Crea; Session: Do Din Ki Chandni

These words capture the depth and seriousness of the two-day conference: Pleasure, Politics and Pagalpan which began on May 13, 2017. The opening words of Menon’s talk during the concluding session, on May 14, 2017 also highlighted the difficulty of having meaningful conversations in the public sphere as evidenced in the issue around linking PAN card to Aadhaar. During the Supreme Court hearing of this case, the Attorney General had remarked that Indians have no right over their bodies: a remark carrying serious ramifications but which did not spark any serious debate, holding up high the remark by Menon that meaningful conversations in the public sphere have become difficult .It is in this light, Pleasure, Politics & Pagalpan took place in Kolkatta as a two-day conference enabling meaningful conversations to happen around two of the most-silenced issues in the country: sexuality and psychosocial disabilities.

Most of the sessions in the conference involved social activists, psychiatrists, writers and other media practitioners to bring in different perspectives on the issues of sexuality, rights and psychosocial disabilities.

On May 13th, Chayanika Shah, a social activist and Dr.ShyamBhat, a psychiatrist curtain-raised the conference by acknowledging the silence around sexuality and psychosocial disabilities: there is suspicion and fear of sexuality; there is a tendency for human beings to repress their sexuality; breaking of any set norm allows law, medicine and society to define any act of sexuality as illegal, ill and illicit, respectively and this could lead to criminalization, medication or stigmatization with confinement being the cure for any sexual problem.

This problem is further heightened when it is a woman: expression of sexual desire- which is an expression of power- by women are feared by society in general; confining women to the household and restricting their movements by ‘forced marriage or even rape’ stiffling this power. Can consent, autonomy and capacity be viewed in a way that no one gets excluded in the politics of pleasure and pagalpan?

Capacity for pleasure and its politics

“Sexuality is a grey area but in mental health, the grey area seems even more intense.” – Pramada Menon, Session: Do Din Ki Chandni

Blurring the strict boundaries of black and white, the conference opened the floor for some important issues to surface over the course of the two days delving deeper into areas that were grey. One of the first primary issues that surfaced was the acknowledgement of the need and the ability of any person ‘diagnosed’ with a psychosocial disability for pleasure. Panelists on different panels acknowledged the prevailing notion that assumes that people with psychosocial disabilities need no intimacy. ‘Just roti, kapada aur makhan’ is enough and this ignores the presence of a deep sexual need and the need for union which remains unaddressed.

“It starts with wanting to look good, go out with a gate pass (to go outside Banyan) and then flirting saying that boy looks good. Whatever the age, the women (at Banyan) desire men. They are tutored only to desire a man.” – Dr. Lakshmi Ravikanth, Psychologist & Visiting Faculty at Banyan Academy of Leadership in Mental Health (BALM); Session: Ajeeb Dastan hein Yeh, Kahan shuru Kahan Khatam

The need for intimacy of people living in institutions was acknowledged and so were the social stigmas associated with them finding a partner. The decision-making ability of people with psychosocial disability also raised questions around their capacity to be married.

Often, a person with any form of disability can only marry a person with disability. There are exceptions but are far and few. People with psychosocial disabilities are abandoned on disclosing their disability. This gets further intensified for women with any form of disability. Families aren’t too open or willing to let the daughters find a partner or be married. While marriage is looked at as a panacea for any issue faced by a man, it does not seem to be the case with women.

Non-acknowledgement of the need for intimacy and relationship results in viewing any effects of medication on people with psychosocial disabilities as ‘normal’. The loss of libido or any other side effects due to medication is often normalized or never discussed by persons under medication.

Privacy is also an issue with persons with any disability, physical, intellectual or psychosocial, be it at home or inside institutions. Their need for space or privacy is not is never heeded, because they are not looked at as beings capable of understanding or making informed decisions. There is no privacy even to masturbate. This again stems from the medical model that looks at them as beings who need care. While the medical model only takes into consideration the right to care, the model built around psychosocial disabilities, moves away from the notion of care and towards the environment being accommodative for all. This also led to questions around homosexuality with respect to persons with psychosocial disabilities.

Is heterosexuality the only normal way in the practice of sex? When institutionalized, can and do people explore same sex relationships and intimacy? How is it viewed or dealt with inside institutions? How is it outside institutions? What about transgenders? How are they treated in institutions? Is there a policy at all for their institutionalization?

“Pursing a man is a sin and a woman pursuing a woman is not even in their imagination. If they are isolated for a long time then they crave touch. But we pathologise it and prohibit it for both, men or women in mental institutions. This may cause other issues or give rise to other mental issues.” – Ratnaboli Ray, Founder – Anjali; Session: Ajeeb Dastan hein Yeh, Kahan shuru Kahan Khatam

“I think we live in better times now. When I was an undergraduate student, homosexuality was seen as being pathological. By the time I was finishing college, homosexuality was to be treated only if the person who identified as homosexual wanted to no longer have it.” – Ajith Bhide, psychiatrist, psychotherapist and Vice President – Indian Psychiatric AssociationSession: Ajeeb Dastan hein Yeh, Kahan shuru Kahan Khatam

 Independence of persons with psychosocial disabilities

Understanding the ability of person with psychosocial disabilities requires the understanding of their independence and the power structures that control them, be it institutions, psychiatrists or even their families.

While institutions exercise their power in terms of administering medication, defining privacy of the patients and the capacity of the patients; among others, family as an institution also seems to wield its power in decisions around several issues. Psychiatrists acknowledged the requests often made by parents for their adolescent child going through puberty: the parents do not want their children to have sexual desires; they may also decide on the ability of their children to love or be married, especially if it is girl,and may even choose to institutionalize them without their consent.

Several psychiatrists, both speakers and audience, acknowledged the power that therapists hold in decision making for persons with psychosocial disabilities. Some also said that it appears to be so but the reality is quite different. There was also honest admission to the lack of answers to all questions or problems of all their clients. The psychiatrists have dilemmas too. Owing to the cultural factors at play, they are often unsure about the best possible route to take to handle a certain situation for their clients. There is also a certain power and gender dynamics that exists within the world of mental health practioners:

“Psychiatrist is usually a man and counselors are mostly women. It is still happening. In the advocacy (mental health rights advocacy) world, it still exists. There are very few ‘user’ (persons with psychosocial disabilities) advocates. There are very few of us (persons with psychosocial disabilities) even in the international space as well. In fact, very few psychiatrists want to sit in the same space as us. We are looked at as threats,” – Reshma Valliappan, Schizophrenist and Artist (As audience in the Session: Do Din Ki Chandni)

With institutions, psychiatrists and families deciding the ability of persons with psychosocial disabilities to seek sexual pleasure or companionship, what power do they hold? This steps into the terrain of consent.

Consent of persons with psychosocial disabilities

Consent is a conscious and unforced decision made by any individual to an offer to enter into a relationship or for sex with another human being. It includes her decision to say yes or no to invitations.

The conference then questioned the understanding of consent. What is consent to a person with psychosocial disabilities? Do they have a right to consent? Is their consent acknowledged? The speakers and audience delved deeper into these questions in an attempt to find some answers. Be it the ICD – 10 (Classification of Mental and Behavioural Disorders), the Mental Health Bill 2017 or UNCRPD (United Nations Convention on Rights of Persons with Disabilities), none acknowledge persons with psychosocial disabilities as sexual beings capable of desire and pleasure.

With this background, defining consent for persons with psychosocial disabilities becomes a complex issue especially with adolescents with psychosocial disabilities. What is the right age to educate them about contraceptives, safe sex and other concepts around consent and abuse? Consent also becomes tough for people with certain other physical disabilities like visual and hearing disability. There is also the need for clarity about valid consent and concerned protectionism. There have been boundary violations, both as abuse and denial of rights.

“Even if they (persons with psychosocial disabilities) give consent, in case of psychosocial disabilities it is not taken as consent and that is the problem.” – Ratnaboli Ray, Session: Ajeeb Dastan hein Yeh, Kahan shuru Kahan Khatam

“Even if a person (with psychosocial disabilities) gives consent, it is not considered valid. Competence to give consent is important. Incompetence to give consent should be proven. Unless proven, all are competent. So most inmates (in mental health institutions) are competent.” – Anirudh Kala, Intercourse-Outercourse-Discourse

Questioning these issues of ability, independence and consent, led to more questions over the course of the two days. Some of them were:

What do we want out of safe spaces?

What is an institution? What happens when you question it?

Whose story are we telling? How much of it is eligible to be talked about?

How do we start looking at sexuality in a way that it includes everything, all the intersectionality – caste, class, gender, religion etc.?

Is there any mechanism to prevention of abuse and right to pleasure simultaneously?

What is to be done about assisted masturbation for people with physical disabilities like cerebral palsy?

Were all these and other questions answered? Abhijit Nadkarni, in his concluding remark during Pleasure, Politics & Pagalpan, summed the answers to all those questions:

“I don’t know if I have got any answers but I have got a lot of questions for which we have few answers. We have got fewer answers that will satisfy all of us. Some answers will satisfy some of us and there are some that will satisfy others. If we keep the dialogue going between the different stakeholders then we will find answers to many more of these questions. As we know, a lot of these things happen in small incremental steps. This conference is one such step and mostly the first step is hugely the most important step.” – Abhijit Nadkarni, an addiction psychiatrist Session: Do Din Ki Chandni

Disclosure: Hidden Pockets is Media Outreach Partner for Pleasure, Politics & Pagalpan

National Health Policy 2017: What’s in it for sexual and reproductive health?

After a gap of 14 years since the National Health Policy of 2002, the cabinet approved the National Health Policy 2017 in March 2017. As an organisation working in sexual and reproductive health, Hidden Pockets has attempted to look at the policy from the lens of sexual and reproductive health of the population in the country. The policy has set targets for several parameters relating to sexual and reproductive health including family planning, HIV/AIDS, antenatal care coverage, newborn immunization, neo-natal mortality, infant mortality, among others. In a way to achieve these targets, several programmes and steps have been outlined in the policy. Some of the key highlights in the policy affecting sexual and reproductive health are:

National Health Programmes

In terms of National Health Programmes with respect to sexual and reproductive health, the policy includes:

  • RMNCH+A (Reproductive, Maternal, Newborn, Child, and Adolescent Health) services would address factors affecting maternal health and child survival by addressing – “the social determinants through developmental action in all sectors.”
  • With respect to children and adolescent health, it acknowledges the need to expand the scope of reproductive and sexual health in order to address issues like

“inadequate calorie intake, nutrition status and psychological problems interalia linked to misuse of technology, etc.

  • Increase the proportion of male sterilization from less than 5% currently, to at least 30% and if possible much higher.
  • Focused interventions on the high risk communities like MSM (Men who have Sex with Men), Transgender, FSW (Female Sex workers), etc. and prioritized geographies for control of HIV/AIDS

Our take:

  • It is progressive that the government acknowledges the need for expansion of reproductive and sexual health for adolescents and the need to address social determinants for maternal health. However, how it intends to implement these measures has to be seen.
  • Linking of psychological problems due to misuse of technology to sexual and reproductive health, could also lead to curbing of access to technology, especially for girls. It is already happening in some parts of India. How does the government intend to balance between gender equality with respect to access to technology/opportunity and healthcare?
  • It is also interesting that the policy includes MSM as a high-risk community. Sec 377 criminalizes carnal intercourse against the order of nature (which includes homosexuality). It would be interesting to see the government’s initiatives to target this group.

Primary, secondary and tertiary healthcare

  • The government will be introducing Health and Wellness Centres to provide “larger package of comprehensive primary health care.” To access these services, every family would be given a health card linking them to these facilities and making them eligible for a “defined package of services anywhere in the country”. The government intends to do this by using digital health to link primary, secondary and tertiary levels of healthcare.
  • At the secondary care services, even “caesarian section and neonatal care would be made available at least at the sub-divisional level in a cluster of few blocks.”
  • At the tertiary level, referral mechanisms will be operationalized to private institutions with deserving patients being admitted at a designated fee/subsidized beds.
  • Also, select tertiary services will be purchased from non-government sector hospitals to assist the poor

Gender based violence:

The section on Gender based violence notes that public hospitals need to be made women-friendly and the staff need orientation to gender sensitivity issues. It also states that healthcare to survivors and victims of gender based violence needs to be provided free and with dignity in the public and private sector.

Our take:

  • Gender violence also affects the transgender community, going beyond just women. However, the policy limits the scope to women.
  • Even with respect to women, the policy does not qualify or define gender violence or gender sensitivity issues.

Women’s health and gender mainstreaming:

The policy notes,

There will be enhanced provisions for reproductive morbidities and health needs of women beyond the reproductive age group (40+) This would be in addition to package of services covered in the previous paragraphs.

Healthcare for transgender:

Apart from control of HIV, there is mention of transgenders only with respect to research –

Research on social determinants of health along with neglected health issues such as disability and transgender health will be promoted.”

There is no mention of transgender community in the list of vulnerable groups that the government intends to target with the new policy.

Our take: Apart from being vulnerable to sexually transmitted diseases, the transgender community continues to face discrimination in terms of access to basic healthcare. This is often due to lack of clarity regarding the hospital-ward of admission for members of the third gender. This continues to be the case even with provisions in the Transgender Persons (Protection of Rights) Bill and the NALSA judgement  that criminalizes denying of services to them.

The government recently issued a guideline to the SwachhBharath Mission (Gramin) stating that the third-gender community may be allowed to use public toilets of their choice.  Can we expect more such guidelines to make healthcare inclusive for the transgender community?

Some of the other highlights in the policy that could also have an effect on sexual and reproductive health are:

Partnerships with non-governmental/private organisations:

  • There is heavy emphasis on government-private partnerships in the policy including capacity building, skill development, disaster management, mental health programmes, disease surveillance, health information system, Corporate Social Responsibility (CSR), among others.
  • The policy also suggests government collaboration with the private sector for ‘Health and Wellness centres’ to set up fully functional primary healthcare facilities.
  • Private organisations have not been defined properly. In some cases, the term ‘non-government’ has been used for both ‘profit’ and ‘not-for-profit’ organizations. Two senior bureaucrats have clarified that non-governmental organisations meant both NGOs as commonly understood as charitable organisations – as well as private for-profit organisations as indicated by a Wire report.
  • The policy recommends a Health Information Exchange involving the private sector also pooling in data. With such high involvement of the private sector in healthcare, will they also be subjected to the regulations of the Right to Information Act? What guarantees accountability?

Financing and cost of healthcare:

  • The government intends to finance its health policy by increasing health expenditure from the existing 1.5% of GDP to 2.5% by 2025 and increase state sector health spending to >8% of state budgets by 2020.
  • The policy also notes that finance will be allocated by targeting specific population sub groups, geographical areas, health care services and gender related issues.
  • It also suggests timely revision of National List of Essential Medicines (NLEM) along with appropriate price control mechanisms for generic drugs in a way to decrease cost for patients seeking healthcare in the private sector.
  • The policy recommends the setting up of a medical tribunal to address disputes/complaints regarding different issues including prices of services.
  • The policy states that only few states have adopted the Clinical Establishment Act of 2010: Advocacy for adoption of this Act by other states will be undertaken.
  • Primary healthcare in urban areas would involve a cost for the middle class as against vulnerable groups.They will also be privatized.
  • It states that at the tertiary level, in the geriatric and chronic care segments, both for in & out-patients, most drugs and diagnostics would be free or subsidized with “some co-payments for well-to-do”.
  • It also notes that to encourage private sector participation, private sector would be incentivized through reimbursement/fees

Our take:

  • Would 2.5% of GDP for health expenditure by 2025 be sufficient to cover all plans mentioned in the policy? Sujatha Rao, former Union Health Secretary explains why this allocation could be too little too late
  • Which are the population sub groups, geographical areas and gender related issues? How will they be prioritized? On what basis? There seems to be a lack of clarity.
  • The policy has mentioned cost control measures only for medicines in the private sector. Though the policy talks about a medical tribunal with respect to pricing of services, it is not clear if services provided by the private sector would fall within the ambit of this tribunal. According to the data released by the Health Ministry for the year 2013-14, Indians spend 8 times more on private hospitals compared to government hospitals.

Health Information Exchange:

The government intends to establish integrated health information architecture to strengthen health surveillance, establish registries for diseases of public health importance by 2020. It intends to set up a Health Information Exchanges and National Health Information Network by 2025. This includes exchange of information even from private hospitals and non-government hospitals.

The policy suggests exploring the use of “Aadhaar” (Unique ID) for identification. Creation of registries (i.e. patients, provider, service, diseases, document and event) for enhanced public health/big data analytics, creation of health information exchange platform and national health information network, use of National Optical Fibre Network, use of smartphones/tablets for capturing real time data, are key strategies of the National Health Information Architecture.”

The government also intends for private sector participation in developing and linking systems into a common network/grid, which can be accessed by both public and private healthcare providers.

Our take: The policy mentions that the medical tribunal will also be responsible for resolution of disputes related healthcare and also the need for protection of patients including right to information, access to medical records, confidentiality, privacy, among others. Information related to health is of sensitive nature especially sexual and reproductive health. This could include details about HIV and AIDS patients, abortion data, among others. What happens if there is a data leak? The government recently admitted to Aadhaar data leak.  Note that the government is already running a pilot to link PLHIV to Aadhaar number in Delhi. There is no privacy law in India yet.

In case of vulnerable groups (as mentioned in the policy) like sex workers, the government intends to provide them with better healthcare. With linking of phone numbers to Aadhaar number being mandatory, the phone numbers and biometrics of sex workers could be susceptible to misuse. What is the protection assured to them against harassment, once their Aadhaar biometrics and phone numbers are entered into the system to access healthcare?

Right to Health as a fundamental right:

Right to Health is not a fundamental right promised by the constitution of India. National Health Policy 2017 has reiterated the same. It advocates an “incremental assurance based approach”. The policy tries to understand Right to Health from two perspectives.

Questions that need to be addressed are manifold, namely, (a) whether when health care is a State subject, is it desirable or useful to make a Central law, (b) whether such a law should mainly focus on the enforcement of public health standards on water, sanitation, food safety, air pollution etc, or whether it should focus on health rights- access to health care and quality of health care – i.e whether focus should be on what the State enforces on citizens or on what the citizen demands of the State?

Our take: Focus on public health standards (sanitation, water, food safety etc) alone may not be sufficient in terms of ensuring sexual and reproductive health standards in the country. Considering the cost involved in privatized healthcare especially in sexual and reproductive healthcare, it already is quite difficult for all to access good and affordable healthcare. Even without Right to Health as a fundamental right, access to healthcare could become a problem with (mandatory) Aadhaar integration if authentication failures continue to persist, as has been the case with several states in the country. There is also the concern regarding deactivation of Aadhaar number without any recourse for the Aadhaar holder. How will this affect a person’s access to primary healthcare or health and wellness centres, as the policy calls it? How does the government intend to tackle this? It is appreciable that the policy highlights the need to improve the healthcare standards in the country before Right to Health is made a fundamental right. However, it does not mention a timeline for the implementation of this “incremental assurance based approach”. What is the vision for Right to Health as a fundamental right?

Implementation Framework:

The policy also envisages an implementation framework to be put in place to deliver on the policy commitments.

“A policy is only as good as its implementation.”

Will you visit a government hospital to get health check up?

My first association with a big government hospital was when Amma asked me to go meet a doctor. She wanted someone senior to talk to me, so that I will eat my dinner properly. That was my first memory. Big hospital and lots of people. I was excited, running around looking for a specific room and this all seemed like an adventure. I still don’t have any memory of what exactly did my doctor say, but I retained the visuals. They stayed on and that was what government hospitals meant for me, for the longest time.

I grew up among Malayali nurses, and right next to my house there was one of the biggest government hospitals in Delhi. With time, I realised nobody really liked going to a government hospital and it was always crowded, no matter what. If god forbid, we had to meet a doctor, we really had to depend on our Malayali roots; we all knew how much it mattered to have one Malayali nurse aunty, who could get us to the right doctor and will save us the torture of waiting in line. The visuals of lines and crowd stayed on, and memories of government hospitals become more murkier in my mind.

With college, there seemed to be a plethora of hospitals around us. Everyone knew the swankiest private hospitals and everybody seemed to have a medical insurance. Amma again coaxed me into  getting a medical insurance and again thought talking to a senior doctor will help, so that I will live my life properly. I had my war against insurance going on, in those years ( it still persists), and I ended up never having a medical insurance. But slowly the narration of government hospitals started disappearing from my family, my aunts were getting transferred to private hospitals. Everyone talked about the private hospitals being the saviour of lives, people even started making separate accounts just for private hospitals, lest one day one might need it.

“We are paying for the convenience”- they said

“ Nature will save me”- I said.

Nature did not save me, and it did not really help that I was a city bred girl who genuinely for the longest time thought milk comes from mother dairy booth. The only hospital I knew was AIIMS, because now I had friends there and that too was a place I never wanted to visit. I no more had any visual memory, I no more had any experience. I was told, government hospitals were crowded and dirty.I believed and continued living in my naturopathy bubble.

When Hidden Pockets started mapping government hospitals, as a researcher it was very difficult to start visiting the government hospitals. All these hearsay, the images I had seen floating in media, and all that reportage, I was not really sure what was I was looking for in these hospitals. The big chunk of my country was using these services, and I was on my journey of finding what was really happening in these hospitals. The aspiration of the burgeoning of middle class and the daily life of lower income group was providing me with enough existential crisis.

Even before accessing the services, I had to wage off another ideological war in my head. Shush all the images of the government hospitals I already had in my mind. I had to give government hospitals another chance. I had to convince myself that government hospitals were just not meant for poor people. My health was not a luxury for which I needed to save, it was my right. My government had to take care of my health too. Too many battles I say.

So I started with my favourite battle:the battle to reclaim beauty narrative, the battle to reclaim all the images I had of government hospitals. I had to go to these hospitals and witness some of these hospitals, sit there, commit to bird watching and look at the bodies that come there.

“Nobody likes a mess” said Aisha, but I was sure, there was something else was happening in our visits to these government hospitals. There were crowds, which I had seen in private hospitals also, but the crowd looked different, the staff felt different, something which reeked of something crude. It did not feel like the parallel city I believed I was living in. Poverty was too stark.

Yes, there are plenty of people who went to government hospitals, it is the only source for solace for poor people and they still believed government will help them. There are huge lines in these places.

One of my biggest shock came, when I realised that OPD fee ranged from Rs 2 to Rs 50. I was used to hearing from Rs 200- Rs 1500. The economic value of my health could be that affordable, was a question that played in my mind for sometime.

With time, our visits became more regular, we have visited government hospitals in various cities of India. Delhi, Chandigarh, Chennai, Cochin, Jaipur, Mumbai, Bangalore and Ahmedabad and plenty more cities to visit. With time, we were less and less apprehensive about government hospitals. We started understanding the process of government hospitals and in most of the cases, even liked the facilities provided. Most of these services were pretty good and there were plenty of options within the government services. I did not have to invest all my life savings in a private clinics to get basic services.

The visuals stayed and the crowd persisted. But with time, I started getting used to the images and realised maybe I had been living in a sanitized version where people of certain groups were not to be interacted. Most of the places were clean, they were not as swanky and clean as a private hospital, but they were clean.

At Hidden Pockets, we are trying to make the process of accessing Sexual and Reproductive health services easier; by finding the exact building where services can be located, by finding out the kind of services availability and by checking if the service providers are friendly. We have even surveyed the places for cleanliness and access with public transportation. The Vision behind this mapping venture was to make the experience as comfortable as possible.