Written by Eileen McDougall

Persisting prejudice in India toward pre-marital sex means unmarried women face stigma by medical providers when trying to access sexual health services.

Societal norms are indeed changing in the country as increasingly more women choose to delay marriage. India is now the world’s fourth-largest user of online dating apps. However, despite the developing social and sexual landscape, attitudes in the medical profession on sexual issues, even in India’s largest cities, are still enmeshed with conservative thinking.

Over the last four years, a campaign called Health Over Stigma ran by Delhi-based youth organization Haiyya, has been challenging this system by linking unmarried women with sexual health and reproductive services — and changing the views of India’s gynecologists.

In February 2020, I met with Sreejani Malakar, the Health Over Stigma campaign manager, who explained:

If you are sexually active, the precondition is that you are married. If you are not married, and having sexual relationships, you are considered impure and the doctor will not treat you. It is a social stigma; doctors and medical professionals are products of the social system. And the level of shame involved is so great that women often cannot bring themselves to seek the services they need.

Traditionally, in Hinduism, sex before marriage is seen as a source of pollution, and stigmatized outside of marriage; in Islam, it is forbidden. These attitudes among doctors, Malakar says, lead unmarried women to de-prioritize their sexual health needs and refrain from accessing the appropriate services.

In a survey of unmarried women living in Delhi, conducted throughout 2018, Haiyya found only 5 percent of respondents took their information about sex or contraception from medical professionals. Most, they found, relied on the internet or friends.

Other statistics reveal the consequence of this vacuum. The same survey discovered that only 20 percent of the women surveyed understood their rights relating to abortion. Meanwhile, a 2018 YouGov India survey revealed that 15 percent of women thought that emergency contraception was not suitable as a regular method of contraception; 49 percent were not sure.

‘The man at the pharmacy pretends to mishear me’

Sapna Devi (not her real name), a young, unmarried woman, shared her experience with me last February in an interview in her home city of Jaipur. “I was 18 when I met my last boyfriend on Facebook. We dated for two years, and would meet in hotels, where no-one could see us,” she recounted.

Sapna described how the first gynecologist refused to treat her as an unmarried woman. She tried again, this time pretending to be engaged, and managed to receive the contraceptive injection. She bled irregularly in the following months, but felt she couldn’t go back to the doctor. In the end, she resorted back to condoms and emergency contraception.

At 1.50 USD per dose, the emergency contraceptive pill is by far one of the most accessible options of contraception for women in India, with one pre-pandemic survey finding 77 percent of single women use it as a regular means of contraception, despite the uncertainties over the side-effects of long-term usage.

“The man at the pharmacy always pretends to mishear me, making me ask twice. But I don’t care; it is the easiest option,” said Devi.

Building networks

It was stories like Devi’s that pushed Haiyya to start the Heath over Stigma campaign back in 2017.

At that time, Haiyya ran a set of meet-ups called the “Vagina Dialogues”, where unmarried women were encouraged to talk about their sexual health experiences. The dialogues revealed the extent of the problem and Haiyya decided to scale up the movement by going to the streets and asking women to share their stories.

Haiyya has found, for example, that many doctors refuse to perform internal examinations on unmarried women; requests for safe contraception are rejected; and those needing abortions are referred to expensive, often illegal, clinics, despite terminations being legal in India up to 20 weeks, regardless of marital status.

Low public provision and failure to regulate private providers mean abortion charges, particularly for the unmarried, are beyond the spending power of most patients.

#MyGynaecStory, the campaign’s hashtag, features the testimonies highlighting some of the grave consequences — both physical and mental — of a healthcare system shaped by a highly sexually conservative society.

Writer, singer and feminist Asmita tweeted in 2019:

And writer Manjima Misra said:

hers like her.

The original article can be found here