The most credible source of increasing awareness in a taboo-infested society has been reported by women to be often judgemental and dismissive of women’s sexual health.

“It is no secret that sex is a taboo in our society”, it’s been years of reading this sentence at the start of articles talking about the lack of awareness about reproductive health in India. But what about the subject being taboo in the sexual health community in India? The most credible source of increasing awareness in a taboo-infested society has been reported by women to be often judgemental and dismissive of women’s sexual health.

According to a survey conducted by Haiyya with 769 young and unmarried women in Delhi revealed that only 1% of women have received information about sexual and reproductive health as well as rights from their mothers, doctors or government campaigns. About 53% of them were unsure if their problems were serious enough to visit a gynaecologist and 18% of them were hesitant of visiting a professional for fear of being judged. They were also concerned about their confidentiality and being judged on their sexuality.

Before you start to think, "well, it's understandable that sex is a bit of a tricky subject in India and that must make the whole experience uncomfortable for the doctor", picture this-

You visit a doctor because your toe is hurting and it hurts for three days every month. The doctor asks you if your husband knows you want to get treated for the pain in your toe. Let's go a step further. Your doctor tells you your toe pain will just go away once you decide to get married. They blame you for the pain in your toe, saying it's because you just step out showing your toe to the world. Sounds absurd right?

Well, it's a very common experience for menstruators and people with ovaries to experience this treatment. And in a society that already makes a big deal about periods and period pain, your only place to have your concerns and pain acknowledged can sometimes be a professional. Except what if the professional doesn't treat you professionally?

Freeze! Show Your Marriage ID

Visual by @mayurarty of a woman being asked by a receptionist at the gynecologist's office if she is married
“When I was visiting a gynaecologist to get checked for a Urinary Tract Infection the reception staff asked me if I was married. While visiting another practitioner I was asked the same. They asked my name, contact number and then if I was married. I had visited the place to get checked for a fungal infection. I don’t know what that has to do with me being married”, says Vasu.

Women who have reached out for help because of concerns over their menstrual health are often told the problems will disappear once they get married as if marriage is the pill that suddenly fixes hormonal imbalances in your body.

It’s Not Just A Marriage Thing

The hesitancy also extends to married women as several barriers exist in India for them to even access healthcare. Socio-economic factors, financial constraints as well freedom to step out of the house are all factors that stand in the way for women to access health services. This makes it even more important to make health services more accessible and less daunting for women.

Young women living in rural areas in India are at high risk of sexual reproductive health problems and those between the ages of 15-25 form about 41% of total maternal deaths. There is also pressure to prove fertility on Indian women, often being blamed for their infertility or not choosing to give birth. Did you know 30% of women in India give birth before the legal age of 18? And 53% of women give birth before the age of 20.

For women with disabilities, the terrain of reproductive healthcare is scary and often devoid of their consent. Access to reproductive health and reproductive autonomy for all people including those with intellectual disabilities is a basic Human Right. However, despite laws, 93% of women and girls with disabilities have been and are still denied them.

Many women with disabilities are forced to undergo hysterectomies, which is the surgical removal of the womb. There have been several accounts of forced hysterectomies done on women with intellectual and other disabilities. Their menstruation cycles are considered a problem that needs to be 'managed' by removing the womb altogether. The institutional support, which is of those such as healthcare professionals and doctors is missing and often plays a part in illegal ways of doing these removals.

You’ve Had Sex No? So?

There have been several studies explaining how women are far more likely to be misdiagnosed because medical concepts of most diseases are based on understandings of male physiology. Women wait an average of 65 minutes before they receive an analgesic for acute abdominal pain compared to men waiting only 49 minutes.

Visual by @mayurarty of a woman getting a transvaginal ultrasound at the gynaecologist's office 

Mansi says that she experienced shooting abdominal pains a year ago and decided to see a gynaecologist. She was diagnosed with endometriosis, a painful disorder that can cause severe cramping during menstruation.

“I have an endometriotic cyst and they were very insensitive with the checkup. I’ve gone through a few where a vaginal checkup was involved and it hurt a lot. Once while getting a transvaginal ultrasound, I asked one of the practitioners to be gentle. She said, “you’ve had sex no, so?”.

Women’s sexual history is often used to justify the pain they are feeling. As a punishment for being sexually active before marriage women have been told to deal with the mistake they have made. Some are even told they will not be treated or will not have to bear the repercussions(whatever health issues they are having) because they chose to do this to themselves.

What's With The Paternalistic Approach At The Gynac's Office?

Reproductive health training in India is largely absent from medical school curriculums and misinformation also persists regarding the legality of abortion procedures. Patients can be given subjective assessments, varying charges and even be provided medical abortions based on the professional’s own opinions and beliefs. In many scenarios, the doctor’s biases come into play. They can be paternalistic and use a moral lens while treating young or unmarried women.  

For sexual violence survivors, the system can be especially cruel. According to a study compiled by the Centre for Enquiry into Health and Allied Themes (CEHAT) instead of being offered the care survivors are entitled to by law, private and public facilities have refused to do so via direct, indirect, or conditional means. Professionals have directly refused to provide abortions if it is the first pregnancy.

Survivors are also sometimes refused abortions beyond the 20-week mark, although the law allows termination of a pregnancy until 24 weeks. Studies have documented that practitioners sometimes perform abortions only on receiving spousal consent. This treatment can affect the patient’s health, delay their treatment, and can also lead them astray resulting in what can be unsafe or illegal procedures that survivors may resort to.

Many women report that they have been met with shock at disclosing their sex life to their gynaecologists. They say they are looked at from a moralistic lens while being treated, often even being lectured or looked down upon for their choices. The doctor seems to adorn a paternalistic hat while treating patients, often telling them about how they would not allow their children to do this or that their patient is young and does not understand how sex is bad for them.

Dr Alka, a reproductive health practitioner at a tertiary care centre says that the moral lens in the medical fraternity might be stemming from the stigma and mentality of the society. She says, “We still have not progressed to an extent where our morals have changed like those in the western cultures. All I’m trying to say is that we are in a transition phase. Both sides of the society exist even within the fraternity. Younger professionals’ perspectives might be different from those of senior professionals which we cannot change”.

So How Do We Make The Judgement Stop?

There is a gap in the healthcare requirements of unmarried women and perceptions of sexual or reproductive healthcare providers in India. Women and menstruators require stigma-free access to healthcare services where their issues can be addressed and diagnosed effectively. There exists little to no data on this gap which makes the problem a largely invisible one. There is also little and largely isolated conversations about awareness as well as reproductive health problems that women and menstruators can face owing to the stigma around menstruation and sex.

This gap results from several structural inequalities like an absence of sensitisation of sexual healthcare providers and patriarchal standards infused by educational institutions, families, and social settings at large. There is a need to empower women by making them more aware of their anatomies and providing better healthcare access.

I recall a friend telling me how she felt a lump in her breast some time ago and decided to get a breast exam. She visited a gynaecologist who told her that she should not worry about these things at such a young age. My friend is 21 and one in twenty-eight Indian women are likely to develop breast cancer. A lump in the breast is a common symptom of breast cancer. Outrightly denying a patient treatment and dismissing their concerns is unjust and speaks a lot about the perceptions held by the healthcare community in India.

Instead of moral policing patients, the responsibility of a medical professional should be taking care and actively listening to their patients without judgement. A gynaecologist’s office should be a safe space, free of societal standards where women can speak unfiltered about their problems, not a place of bad experiences. At the same time, the confidentiality of patients should be maintained at all costs.

Author's Note: The names of some of the interviewees have been changed to maintain their anonymity.