Stigma, judgment, and misinformation: The bumpy road to sexual reproductive health in India 

If there’s one thing that instantly generates a silence and is shrouded in taboos in India, it is sexual and reproductive health. Stigma and misinformation abound, and this, combined with a lack of awareness, place significant barriers when it comes to seeking healthcare. On the eve of Sexual and Reproductive Health Awareness Day, which falls on February 12, experts have called for greater awareness, combating stigma, and a path forward to better health for all men and women.

The scope of the problem

A 2019 paper published in the Indian Journal of Community Medicine reveals that that there are about 3.5 crore sexually transmitted/reproductive tract infections in India annually. “STIs/RTIs have a direct impact on reproductive and child health through infertility, cancers and pregnancy complications, and they have an indirect impact through their role in facilitating the sexual transmission of human immunodeficiency virus (HIV), and thus, they also have an impact on national and individual economies,” the paper states. 

Infections apart, unplanned pregnancies are also an issue. According to National Family Health Suvey-5 data, the unmet need for contraception in the country stood at 9.4%.

In India, says Simi Chatterjee, a doctor who has worked in the area of family planning and women’s sexual rights in Jharkhand and West Bengal, many women do not have the autonomy to choose contraception. “Women in our country still have to give birth in order to prove their fertility after marriage. Underage marriages are still common, and they can lead to teenage pregnancies. To avoid legal action, families often give a false age for the woman at the hospital, and all of these factors can contribute to bad health outcomes for the mother and baby. In many families, it is still the husband, and sometimes the in-laws who decide if the woman can avail of contraception.”

Dr. Chatterjee also cited instances where ASHA workers — frontline healthcare workers — have faced violence from a woman’s family for allowing her to opt for contraception. Even now, she says, it is common for men to not participate in awareness drives for contraception and family planning, because reproduction is considered “a female subject,” and this hampers access to information.

For young people, the lack of access to the right kind of information can have detrimental consequences: often, teenagers undergoing hormonal changes end up making unsafe sexual choices, armed with information that is incomplete or erroneous — this can lead to unwanted pregnancies, STIs as well as mental and physical trauma, says a doctor who works in the area of teen pregnancies.

Stigma of disclosure

Doctors also point out that patients often do not disclose their STI status, and if they then have unprotected sex, the infection is transmitted to others. “None of these subjects however, are part of everyday conversations in the society we live in and this makes it harder for people to seek treatment, open up about their experiences, problems and needs, and they suffer without help,” a doctor says.

However, patients point out that even when they do access care, medical professionals sometimes do not share appropriate information or shy away from having an open conversation about sexual and reproductive health. 

A 31-year-old woman from Tripura, Kriti Roy says that when she began having issues with her menstrual cycle at the age of 18, a doctor prescribed a few medicines and assured her that the situation would get better when she gets married. “There was no discussion about my medical condition. Another time I visited a doctor, who, without any examination, was sure I was suffering from PCOD. Months later, I found out it wasn’t PCOD, but endometriosis.” 

Such experiences reflect a larger issue where patients are not provided with adequate medical information to deal with their conditions, which can lead to prolonged suffering and delayed diagnoses and treatment.

The absence of conversations about their condition apart, patients often also feel judged about their choices by medical professionals. Take the case of Julia Salgas, a French citizen working in Chhattisgarh, as a digital project manager. “I have gone to five doctors for my urinary tract infection (UTI), but most of them were judgmental about my sexual activity sans marriage and prescribed repeated antibiotics without tests, which led to added health issues,” she says. Many doctors, she adds, have even suggested to her that she should not have a partner, which led her to believe for some time that her infection was her fault. “A majority of the doctors I consulted did not give me any information on my medical condition or the correct course of action, but there was a constant shaming of my personal choices.”

Absence of non-judgemental information

Leeza Mangaldas, sexual educator and author of ‘The Sex Book’ told The Hindu that the complete absence of credible and non-judgmental sources of information about sexual health for young adults was a major cause of concern. “Pornography becomes the main source of information, which has too much information but none of it is credible or balanced. Telling fact from fiction is a problem in such cases.” 

The silence in Indian society around the topic of sex adds to the problem, she points out: this silence, she says, sends a message that this issue is taboo, and should not be spoken about in the open. This makes people more susceptible to misinformation and harm. 

Most people, she says, do not look for information on sexual and reproductive health until there is a personal crisis. It is a ‘hush-hush’ topic that is generally seen as “something that happens to others, not me.” This opens up avenues to spread misinformation, and can cause panic, trauma, and may even lead to catastrophic ends. 

The stigma and lack of awareness around sexual reproductive health in India continue to be a roadblock to proper healthcare, bodily autonomy, safe practices and life choices, point out experts, leaving people, vulnerable to multiple issues. While progressive and inclusive voices are emerging, there is a long way to go in the road to normalising conversations around this subject.