Archive for Debates

Statement on the rape and murder of Dalit woman in Kerala

kerala-rape-and-murder

Jisha’s rape and murder reaffirms how the bodies of Dalit women become sites for the most brutal forms of exercise of caste oppression accentuated by patriarchal power, where the control of and violence on women’s bodies become powerful mechanisms for upholding a Brahminical patriarchal order

By Pinjratod

On 28th April’16, Rajeshwari a daily wage labourer and a single parent, returned home to her one-room house at Kuruppampady village in Kerela at night, to find the body of her younger daughter, raped, mutilated and murdered. Her daughter, who was a Dalit student, had to discontinue her BA degree within a year due to financial constrains. However, she was not one to give up and had been enrolled as an LLB student of Ernakulum Law College since 2010. “She wants to fight for people like us, poor people, those who have been discriminated against,” says Rajeswari as she lies in the hospital, in shock and trauma, unable to accept her daughter’s sudden and tragic demise. Rajeshwari had rushed to the nearby police station on that fatal night, where not surprisingly, the police refused to file her case, “wait for the postmortem” they claimed, ensuring that any ‘crucial evidence’ would essentially be lost in the meantime. Five long days passed since the murder. There were no investigations, there were no arrests, there were no marches or media outrage. There was only a deafening silence and a disturbing apathy. This was not the first time Rajeswari had gone to the police station. She had lived in her one room state-allocated house for 40 years, and during that long period, all she and her family had faced was hostility and severe caste discrimination from their neighbours: their water pipes were destroyed and the women-only family was forced to draw water from a nearby canal, they were not allowed to build toilet in their house, stones were regularly pelted at their small home, they had received threats of murder and the two daughters were subject to constant sexual harassment from neighbourhood men. The police refused any action in all cases, despite repeated complaints.

After five days of silence, news of the rape and murder started to slowly appear in social media due to the efforts of Dalit Bahujan voices, forcing the mainstream media to respond. The mainstream media reports have been accompanied by sickening, voyeuristic and vivid descriptions of the ‘brutality’ of the rape, characteristic of the way in which Dalit bodies are denied respect and dignity even in death. “Kerala’s Nirbhaya”, screamed the media, while the Malayali savarna middle class unable to imagine such ‘barbarity’ to their kind, claimed (in typical display of their xenophobia), that the perpetrators “must be migrant workers”.

The ‘merit’ of the Dalit student had to be interrogated. ‘She had three papers left to clear”, the savarna media hinted slyly, as suspicions on her ‘character’ were raised “why did she not scream? why she did she not call out for help? how could this have happened inside her own house?”. The name and photograph of the ‘victim’ was flashed without consent across media in violation of the law

The media insensitivity that characterises this problematic act of naming, has been subsequently challenged by the emerging movement demanding Justice for Jisha by fighting against the very shaming in anticipation of which the law forbids the name of a sexual violence ‘victim’ from being revealed. However, in a context of upcoming elections in Kerela, the rape and murder of a Dalit woman has now become an ‘agenda’ for the predatory parties to capitalise on, to appropriate. The matter ‘shook’ the Rajya Sabha yesterday, where PJ Kurein, one of the primary accused in the Suryanelli rape case in Kerela, had the audacity to express his condemnation of this ‘heinous’ and ‘shameful’ crime.

The violence that was inflicted on the body of Jisha and what has unfolded thereafter, is not an ‘exception or an ‘aberration’ in Kerela’s ‘progressive’ society  whose impressive HDI (Human Development Index) credentials we are constantly reminded of. In fact,  it is characteristic of the tremendous everyday violence and oppression that is inherent to that state, and this country where Dalit lives are crushed, humiliated, maimed, killed, murdered and destroyed everyday with impunity.

Jisha’s rape and murder, like Delta Meghwal’s death, reaffirms how the bodies of Dalit women become sites for the most brutal forms of exercise of caste oppression accentuated by patriarchal power, where the control of and violence on women’s bodies become powerful mechanisms for upholding a Brahminical patriarchal order. Patriarchal and caste oppression do not operate in isolation, but inherently reinforce each other. When located in the context/history of persistent castiest and patriarchal violence faced by Rajeshwari’s family and the structural negligence of the police, the rape and murder of Jisha is not unimaginable or unanticipated, and almost constitutes the chronicles of a rape foretold. As some form of police investigation of this crime finally begins, we are met with the news of the rape of a 19yr old Dalit nursing student by three men in an auto in the coastal town of Varkala in Kerela. Our rage and anger is hence not to be limited to the ‘atrocity’ of the ‘gruesome’ nature of Jisha’s murder, but has to lead to a persistent struggle towards a structural annihilation of this Brahminical society that violently denies through innumerable everyday acts and practices, a life of dignity and equality to Dalits. 

Rajeswari’s all-women household was a ‘dangerous’ entity, a collective of women struggling and surviving and  a Dalit working class woman seeking education and entry into a profession dominated by savarna men, was a direct threat to a Brahminical and patriarchal society. The ‘outside’ streets and the neighbourhood never belonged to Rajeswari, Jisha and Deepa. But even their ‘home’ that defied the dictates of a patriarchal world which mandates male control over families, was not to have any illusion of ‘safety’. It was to be always vulnerable to stones, to abuse, to ostracisation and to attack by this disgusting casteist society, that all savarnas (including women) are complicit in perpetuating. This resistance, this deviation by Dalit women was an ‘audacity’ that was not to tolerated, it had to silenced, it had to be dismantled.

Pinjratod is an autonomous collective effort to ensure secure, affordable and not gender-discriminatory accommodation for women students across Delhi

Feminists in solidarity with JNU professor Nivedita Menon

nivedita- Menon

The attacks being carried out on Nivedita Menon by certain political groups through student bodies like the ABVP, who are filing baseless complaints with the police, and the media like Zee News, who are maligning her with footage shown out of context, is an attack on reasoned debate and informed conversation, both of which are inimical to democracy

The women’s movements and the feminist voices in India are part of the tradition of the movements that believe in pluralism in thought, action and manner of organizing. There are as many individuals and small collectives that enrich the voices within the women’s movements, as there are larger groups and even party affiliated groups. It has also the rich tradition of the academic and the activist informing each other and learning from each other.

As a serious academic and an activist, Nivedita Menon is an important voice in this plural, multifarious, diverse, political conglomeration that we call the feminist women’s movements. Her engagement with diverse issues like feminist theory, law, sexuality, technology, understanding of the body, queer theory, has helped deepen the understanding in these areas and also find new ways of campaigning on specific issues like the sex determination tests, personal laws, decriminalization of homosexuality, to name just a few. Her prolific writing and impassioned talks have made many of us, old and young, academic and otherwise, debate and discuss issues. Her commitment to academic discourse is thus not confined to the University campus alone but has extended to many spaces occupied by campaigns and activists.

As fellow travelers in these movements, we stand by Nivedita in claiming the space within the University campus to freedom of speech and debate and discussion. We find the attacks being carried out on Nivedita Menon by certain political groups through student bodies like the ABVP, who are filing baseless complaints with the police, and the media like Zee News, who are maligning her with footage shown out of context, as an attack on reasoned debate and informed conversation, both of which are inimical to democracy. Without a space for these, we do not think that the principles of equality, justice, and non-discrimination granted to us through the Indian Constitution can ever be realized.

We unequivocally condemn these attacks and this harassment of a fellow feminist activist and stand in solidarity with her.

Sisters, why should the Hindu right get to speak in our names?

Hindu-nationalism

Don’t let the Hindu right speak in our names! Calling all Matas, Mummas, Mummys, Nanis, Dadis, Buas, Maasis, Mausis, Behenas, Khalas, Phuppis et all

By Aarti Sethi

Main Bharat Ki Behena
Ab Sun le Mera Kehna
I Stand With JNU

Main Bharat Ki Behena
“Suraksha” Main Nahin Rehena
I Stand With JNU

Main Bharat Ki Mata
Samajh Nahin Aata?
I Stand With JNU

Main Bharat Ki Mata
Tu Mujhe Kya Sikhata?
I Stand With JNU

Main Bharat Ki Nari
Kehti Hun Bari Bari
I Stand With JNU

Main Bharat Ki Nari
Khud Leti Zimmedari
I Stand With JNU

Main Bharat Ki Nari
Kisi Aur Ki Kar Tarafdari
I Stand With JNU

Main Bharat Ki Nani
I’m talking to you Smriti Irani
I Stand With JNU

Main Bharat Ki Nani
Irani Tu Badi Pareshani
I Stand With JNU

Main Bharat Ki Mummy
Smriti Don’t Get Chummy
I Stand With JNU

Main Bharat Ki Khala
Rajnath Tu Ganda Nala
I Stand With JNU

Main Bharat Ki Chachi
Irani tu Gand Machati
I Stand With JNU

Main Bharat Ki Mausi
Irani Don’t Get Saucy
I Stand With JNU

Main Bharat Ki Bua
Desh se Mat Khel Jua
I Stand With JNU

Main Bharat Ki Dadi
Band Karo Ye Barbadi!
I Stand With JNU

Main Bharat Ki Bijli
Beta Kya Hai Teri Khujli?
I Stand With JNU

What exactly did the JNU students leader Kanhaiya Kumar say?

Kanhaiya-Kumar

By Team FI
Last week, Jawaharlal Nehru University Students Union President Kanhaiya Kumar was arrested on charges of sedition by Delhi Police triggering large-scale protests from JNU students. JNU, known as a bastion of progressive students and teachers, is one of the most reputed Universities in Asia and its student union is headed by Communist Party of India affiliated All India Students Federation (AISF). Kumar’s arrest was based on a complaint by the ABVP, the student’s body BJP. However, a large number of students and teachers have come in support of Kumar accusing the ruling BJP of playing divisive politics in the campus.

Kanhaiya Kumar’s speech is available on YouTube and these are the main points of his speech;

1. These (RSS/ABVP are the chelas of those who had apologised to the British.

2. Their government in Haryana changed the name of the airport from Bhagat Singh to that of a Sanghi (RSS):

3. We do not want a certificate of patriotism from the RSS;

4. For us nationalism is to fight for the rights of the 80 per cent poor of India;

5. We have full faith in this country’s Constitution, if anyone raises a finger against India’s Constitution, be it of the Sanghis or anyone else, we will not tolerate that finger;

6. But the constitution that is being taught at Jhandewala or Nagpur, we have no faith in that constitution;

7. We have no faith in caste discrimination;

8. We want to uphold the rights we have been given under the Constitution of India;

9. The ABVP claims of standing for the students will be exposed if there is a debate on the basic issues of constitutional rights;

10. (Subramanian) Swamy says jihadis live in JNU, they believe in violence; we challenge the RSS and its supporters to come and debate on this.

11. They have problems when the poor ask for their rights, when the minorities, the women ask for empowerment;

12. They have difficulty in accepting when people talk of democracy and right, when along with Lal Salaam we add the Neela Salaam, when with Marx we take the name of Ambedkar;

13. Check my phone friends, my mother and sister are being abused. They talk of bharat maata but if my mother is not included in their concept I do not accept it. If the poor mazdoor woman, who works to get the Rs 3000 a month that finances my family, is being abused by them how can I or anyone accept this;

14. if you have the courage say inquilab Zindabad, Bhagat Singh, Sukhdev, Ashfaqullah Khan, Ambedkar zindabad;

15. We stand with India, with the dream that Bhagat Singh and Ambedkar wrote; we stand for the dream that all get their rights to live, to food, to expression; Rohith sacrificed his life for this dream;

16. We challenge the Central government, we will not allow you to do what you did to Rohith to JNU;

17. We have to ensure justice for all , and that will come from Parliament, from the Constitution, from democracy;

18. JNUSU is against violence, against terrorism, against anti -national activity, the unidentified persons who have shouted Pakistan zindabad slogans, we condemn this completely,

19. Look at the slogans that the ABVP raises: communist kutte, afzal guru ke pillai, jihad ke bache. if the Constitution has given me the right to live, then can you call my father a dog, is that not against our rights;

20. Don’t hate these people, recognise their reality, i feel sorry for them, they raise slogans as they think that this will get them jobs. Their desh bhakti stops at a Pakistan cricket match.

Suicidal tendencies of trans women : Links between loneliness and exclusion

Transgender- India

This is an edited version of the paper presented at the Seminar on Trans Inclusion: Implications and Challenges held on 21 and 22 January 2016 at the Periyar University, Tamil Nadu

By Prof. A Mani
It is well known that a large percentage of trans women experience social exclusion, isolation, loneliness and suicidal tendencies at various stages of their life. An alarmingly large percentage actually attempt suicide at some stage of their life. For details of the situation in the US and EU, one can refer to the surveys indicated in the references [1,2,3]. Since loneliness is a subjective internal experience, all of these surveys and much of activism has focused on social exclusion, isolation and discrimination. In this article the nature and existence of connections between loneliness, exclusion, sexualities and suicidal tendencies is explored in India and ‘developed societies’ through reference to surveys and also to personal blogs and accounts. At the end of the essay I present a research agenda as the amount of information available is inadequate to create a supportive political and social environment. However some suggestions for demands are also made at the end to address and bring down the high rate of suicide amongst trans women.

Social Isolation and Concepts of Loneliness
Loneliness (or ‘real loneliness’) is best seen as an interior, subjective experience that is influenced by external objective conditions in different ways [4,7,10]. Two different individuals do not in general generate identical degrees of response in similar loneliness inducing objective contexts. It is not the same thing as being alone and one may feel severe loneliness in the company of others.

Loneliness can have a number of negative consequences on humans that include: reduced lifespan, heath problems, lowered level of trust levels in others, feelings of social incompetence, victim mentality and self consciousness [4,5,6,9].

Stokes and Levin’1986 [8] in a couple of studies on social networks found that men may use more group oriented criteria in evaluating loneliness, whereas women focus more on the qualities of dyadic relationships. Other studies confirm similar phenomena [10], but the nature of loneliness in trans people and coping mechanisms that they may adopt is not well understood.

Research on connections between gender differences and loneliness needs to be reviewed with a feminist perspective for useful conclusions to be drawn, as the focus used in many studies seem to be unsuitable. There are many studies on loneliness in the literature ( [4--10] and some of the conclusions are used in this article.

On Suicidal Tendencies of Trans Women
People can, in general, plan their suicides in many different ways and they do kill themselves in many ways, but I will not be concerned with the suicide act as such. Here my concerns will be about the maturity level and nature of suicide plans of transsexual women during their pre-transition days or during transition. The exercise should be useful for formulating/defining concepts of reasonable social transition process and in accessing extent of damage due to social isolation and loneliness.
Of the various patterns in trans women suicides in their pre/post-transition state or transition the following are fairly prominent:

Those who have killed themselves at a relatively young age-under 25, have done so due to social oppression, persecution and inability to find the means to escape from them. The number of women in this category who actually commit suicide for reasons of wrong self-diagnosis is comparatively small. The number of people who kill themselves for their own inability to come to terms with their state may seem to be large – but blame should be put on social conditions for precipitating such a state of affairs through intersectional feminist perspectives.

All of the above also apply to the class of people who kill themselves at relatively older ages – above 30, but there are also important differences-studies of which are still insufficient. For this age-group the reasons also tend to center around problems of body transformations and insurmountable defensive adaptations of pre-transition period.

The insufficiency mentioned above is in choice of paradigms for empirical studies that pervade across age groups. It is known that problems like depression, social isolation and poor quality of life are common among “late bloomers”. These have been confirmed in recent duplication studies. It is also possible to collect large sets of data from people, but predicting failure or success is not easy because the coupling that matters may not be available for expression at all times and may also be consciously hidden by the subject of study in question. A relevant but limited study that attempts to answer some of questions is Moody and others in 2013 [17].

I am also working on the problem from a vagueness related mathematical perspective. Essentially it is about problem representation and finding multi-stage reducts (or removing the chaff). Simplified schematics have the following form:

So let us call our subject X.

X is a trans women of chronological age > 30

X wants feature sets F and maybe G as part of her transition process.

This F may be graded in various ways.

X has developed a set of adaptations S in response to loneliness (or ‘real loneliness’ if you like) connected with gender dysphoria. It should be mentioned that not all trans women feel that way.
Typically X is likely to commit suicide on realizing that critical parts of F would not be possible. In ideal situations, this and connections with S suffice to predict a “mature suicide”. But other social factors do matter and related prediction models are bound to get more complex.

Knowledge of feminism with all its intersectionality is an important life saving skill that is sometimes omitted by some trans women with terrible consequences because for them ‘feminism’ is a bad word. For people in the scope of ‘mature suicide’, there may often be no further sources of suicide mitigation.

Loneliness of the Dead
Examples for these patterns are not difficult to find, but ones with volumes of additional records are less common as in case of late Jess Phipps. Jess Shipps produced many popular you tube videos, was a moderator of few trans related subreddits, had plenty of social connections, was often vocal, expressive, positive and rarely seemed to lack empathy – all that is from her online expression and views of her friends. Yet, she was experiencing real loneliness (without social isolation), unemployment (and mentioned these as the primary reasons for her suicide) and was not really passing by her own standards (the last part is deducible from her posts in reddit). She needed wigs and makeup to pass and also believed that the “idea of a woman is distorted by mainstream media and nobody is perfect”. Maybe her suicide note was influenced by her position in trans advocacy… maybe not, but her suicide was the result of coupling of multiple factors and not just one of them.

Eventually it was the lack of material and emotional support that killed her. But it is surprising that she was actually looking forward to getting emotional support – that amounts to a tactical mistake.

Loneliness in the Living
Prof. A ManiA: Personal Experience:
Though I realized that I am a woman in my pre-teen years, my transition was well after my 30th year. I had to manage extremely high degree of loneliness in my pre-transition times – that was despite being fairly active in many academic and geek groups. The methods of adaptation included workaholism (through multiple careers), extreme degree of involvement in studies and research in solitude, cutting off people and bigots for a variety of reasons and restricting all interaction to bare essentials.

The nature of my suicidal tendencies during my pre-transition period was so mature that I had a definite plan that can be summarized in “suicide is admissible if no transition option becomes available and body has been sufficiently poisoned by testosterone”.

Physical part of my transition was very easy for me as I was already good looking, femme, healthy, athletic, response to hormones was excellent (that stabilized at estrogen level of ~360+ pg/ml (very high female range), had no complications, a partial class advantage and an Asian advantage. Details of some aspects of my transition can be found in my blog [18]. Suicidal tendencies vanished completely on commencement of HRT itself, but am yet to fully come out of the grips of loneliness related adaptations of pretransition period. Apparently this relates to a lack of open lesbian culture, prevalent transphobia and lesbophobia (am in Kolkata, India) among substantial sections of the older generation and an inhumane society. Hitting it off with women interested in women is easy for me, but not all lesbians are bold enough to break free of the patriarchy. A related aspect is that a generation of more Internet savvy urban upper class lesbians tend to be more confident in deviating from patriarchal norms in comparison to the women with far too limited opportunities to even explore themselves.

The Wikipedia articles on sex, gender and sexuality would be rated as pornography by majority of the population stuck in religion and/or conservative hetero sexist norms. No wonder the default goal of most of the whole LBT spectrum is to “emigrate”.

B: Experiences of Other Indian Trans Women
Brenda is a scientist who completed her doctorate from IMSC, Chennai before moving to Germany. Some of the issues that she faced are documented in [15]. This is what she has to say on the matter:

“1. Growing up it’s easy to assume (for myself) a hetero-normative appearance but once puberty hits, randomness + self questioning begins.

2. No matter how much I tried to hit this part, it doesn’t stay buried, if I hang out with male friends all those random comments about women bother. (not exactly misogynistic just to be clear)

3. At some point you are unable to express and process your own feelings especially sexual. (pan sexuality in my case was more than fun, just for the record)

4. Also with lack of proper sex education + information on sexual `and` gender diversity, it was hard for me to process my sexuality from gender identity.

5. Plus most of the common example of trans identity (pertaining to India) comes from media and what I see on the streets, which incidentally was almost never positive.

6. There were only two positive instances of media portrayal of trans I remember in my childhood (pardon me if my memory is not right). One – I think the movie was Sadak and Sadashiv Amrapurkar played a trans person who is in charge of a brothel (not a positive trans character but not one which was made a caricature of just for fun, which is what usually happens in Indian media). The second one was, I think, where a female infant is abandoned but adopted by a trans woman and the story revolves for the first part about their daughter and her parental relationship. I enjoyed the above two movies but rarely spoke about it with friends or family for fear of being ridiculed.

7. With dissonance in relating with real life friends, video games were easy to relate.

8. In fact this is my common observation, if I meet another younger trans person, I would say with 70% certainty that video games are a safe topic to discuss and bond with.

9. Sadly I have also seen a fraction of trans people take refugee in alcohol or weed. (I am grateful neither of them are on my list).

10.Luckily my transition to Germany was a boon since the LGBT group is a bit wide and I never felt loneliness.

11. In fact in the 4 years I made like 5 times the number of friends I have in all my 28 years in India (and bear in mind, Germans are known to be a conservative lot, in terms of personal space).”

Anamika, a student of IIT Kharagpur (as of this writing) experienced dysphoria since her early childhood. She suppressed all desired gender expression and behavior, and tried to act normal in the sense of the decadent patriarchy for much of her life. Not surprisingly she remained as lonely as ever at the institute. When she did try to explore herself, this was the result in her own words [15]:

“Amidst these feelings, changing my body to match my gender for the better seemed a far fetched reality at least in the near future and having dealt with the emotional pain and self-abuse for a decade, I didn’t see any further hope. So at the start of my 3rd semester, I cut off all my contacts and was about to attempt suicide, when a senior (who later became one of my closest friends) contacted me. I didn’t tell him anything about myself then, yet he suggested that I consider visiting the Counseling Center as an option before taking any such step (I could always go back if it didn’t help) and it seemed a reasonable bargain to me. That small decision turned out to be a life changing event. I always had very low self-esteem with almost negligible self-worth and self-love, so accepting myself as a transgender girl was a bitter experience. It took me almost 2 years of therapy to accept myself and become comfortable to open-up to others.”

C: Trans Women in Developed World
Sub-optimal conditions prevail for trans women in the so-called developed world and some quantification has been attempted through surveys. To really understand we need to look at personal writings and blogs.

Being openly trans matters a lot. Natalie Yeh agrees with this. She is an Asian American trans woman living in Los Angeles. She transitioned after 30 and her musings on her post transition loneliness suggest that she is tired of explaining herself to others to the point that she finds herself muttering, “Maybe I’ll just live out a simple, solitary life…it’s not so bad, many people do it.”

Naomi Ceder did not have suicidal tendencies despite being in the closet all through her long pre-transition years in a hostile environment. In one of her blog posts she says ,“For a trans kid in this environment self hatred was inevitable. There was literally no one I knew who was like me, no one I could dare talk to, for fear of exposure and humiliation and worse.”

Rebecca Williams has this to say on loneliness:
“I think one of the things that can trigger acute feelings of loneliness is being “different”. Being different could mean anything, in this world. …. I think people internalize this difference as sense of wrongness early on in their lives. They learn to be ashamed of their difference, of themselves. In a sense, they learn to hide that part of themselves away. It is that part, that sense of self that feels lonely. I think people are in the most part resilient, especially as children, and they learn to cope and adapt around this sense of difference. Sometimes these coping mechanisms work OK, other times they don’t…. But to foster a culture of tolerance and kindness can only be a positive thing for everyone, so everyone can learn to be more themselves, a little more different, a little bit more individual.”
Here “learn to be ashamed ” necessarily requires propaganda by bigots of various grades.

Generalities of Loneliness in Trans Women
Trans women are often excluded by way of social stigma and this has its effect on their socializing techniques and methodologies. While it is true that only a small fragment of people believe in excluding them and get actively involved in actually excluding them, much of the evil hype is sustained by lack of knowledge, misogyny and by the patriarchy. As a result of exposure to bigoted environments many trans women are likely to be predisposed to activate their self-defense mechanisms on even partial clues of bigotry. Such heightened sensitivity may not necessarily be justified in the context in question.

This means that people wanting to interact with trans women in society need to be way more sensitive to trans issues- that is for real interaction to be possible.

Based on key generalities that can be isolated/ abstracted from the nature of loneliness in trans women, loneliness in their pre-transition state may be seen as the result of the following factors:

Their own gender dysphoria inhibiting the feel of their positive interactions with people. This in turn can result in their learning of social interaction over time being less than optimal.

External anti-social actions and systemic discrimination generated by other patriarchal forces (mostly men) in response to preferred gender expression and interaction models of trans women, and Internalized social conditioning limiting their preferred gender expression and interaction models.

Trauma due to physical violence, if any, can be a factor in causing trans women to isolate themselves from situations even remotely related to the threatening situation of their experience.

PTSD (Post Traumatic Stress Disorder) due to physical and sexual violence, if any experienced by a trans women, can also be a reason for social withdrawal and impaired social function. It can be safely said that they would feel the bad effects in more severe ways than what cis women would have felt in similar situation. This is because PTSD in socially isolated people is harder to cure than in relatively less isolated people.

In an ideal tolerant environment, gender dysphoria would still kill and loneliness in pre-transition maybe the natural result of socially interacting in the wrong body. But this does not reduce the criminal responsibility of intolerant people who seek to exclude at every turn.

During physical transition, passing can affect socialization and this can happen even within LGBT groups. Further some trans women may actually believe that psychological changes from HRT is the cause of loneliness or that it intensifies the feeling of loneliness.

A related description that some trans women identify with is that whereas over time HRT improves their dysphoria and their physical appearance, they find the loneliness crushing them inside out. But this happens almost always due to their social anxiety and ideas of ‘passing’ to the point that they find the very idea of meeting people a terrifying one. Here loneliness is due to external factors, but is the feeling of loneliness actually being made deeper due to HRT? Though it is known that HRT tends to intensify emotions and improve levels of empathy in trans women, it cannot be immediately concluded that the same happens for feelings of loneliness.

Whatever the various causes, loneliness in trans women is never due to themselves alone.

Research Problems
It is clear that when we read ‘gender’ as a plural concept, then loneliness is related to it. But the concept of ‘gender identity’ is unrelated or ‘less related’. Two problems that seem to be of some interest are:
* How can we define usable concepts of ‘gendered loneliness’?
* What is the relationship of gender dysphoria to such possible concepts of ‘gendered loneliness’?

Sexuality and Related Intersections

Human beings exhibit a wide range of sexual orientation. Trans women may also have different sexual orientation and yes, it relates to their well being [2]. The largest EU survey in particular estimated that majority of the trans women were exclusively/predominantly sexually attracted to women. Survey data about preferences of trans women from countries like India are not available as most are closeted. Any talk about inclusion of trans people should also consider their sexualities in proper perspective. In this research paper, I will focus on trans lesbians from a lesbian perspective, how persecution of women who love women affects them adversely and what is required of society and socio-political economy to include them in the Indian context.

Trans women may belong to the very poor, poor, lower middle class, middle class, upper classes or super rich classes of society. They are discriminated and objectified at every turn and social progress is always an uphill task for them – this discrimination does not happen in a uniform way because of a number of reasons. In general, it can be said that objectification, discrimination and persecution applicable to women in general applies to trans women as well as they are women. Trans-ness carries its own load of objectification, discrimination and persecution, in addition, due to the patriarchy. But there are differences between the classes of trans women. Most trans women who belong to middle class and above are closeted and their lives are undocumented and less well known. While, those who are poor and part of stigmatized cultural groups are more severely persecuted and their persecution is more visible in the media.

A typical upper class trans woman in India can be expected to escape to a foreign country or a different part of the country after or before medical and legal procedures for her gender affirmation. So she would be living a new life as a cis woman and maybe a lesbian. The number of sex reassignment surgeries conducted by doctors in the country confirms the invisibility aspect. But all this requires resources and comes at substantial personal cost.

Middle and upper class societies (even in cosmopolitan Indian cities) differ a lot on their tolerance levels of human homosexuality. While religious people are predominantly bigoted, indulge in myth making to further their bigotry, irreligious people are tolerant and at least willing to learn. The bigger problem is that sex and egalitarian gender education is not compulsory and people may not be maintaining minimum standards in their relationships. This affects quality of lesbian relationships too.

An important concept in relationship to same-sex sexual relationships is that of ‘being closeted’. There are many levels of the concept ranging from ‘fully closeted’ (only the people involved in the relationship know about it), ‘open to friends’ (meaning a few friends know about it), ‘open to friends and relatives’ to ‘out and proud’. Such states are often dictated by the nature of discrimination or may be a conscious display of will to change society for the better.

If a Post-Op trans woman and a cis lesbian are in sexual relationship in India, then they are likely to be affected by the following:

Bigotry and hetero-sexist harassment from parents and relatives

Job discrimination

Absence of Community

General alienation from society

Hate and Sexual Harassment from bigots, micro aggressions from so-called friends/relatives, and
Poor medical support.

All that is trivially affected by the level to which they are ‘out’ in society. If both partners are closeted (and living together), then they are certain to feel alienated from society, indulge in deceptive acting in hetero sexist society, be at the receiving end of poor medical support. Trans women may simply avoid routine medical check ups because of the situation, while cis women may also avoid because many doctors are not knowledgeable enough on what constitutes non-discriminatory behavior. Otherwise being closeted (if it is an option) has its short-term advantages.

Most post-op trans lesbians would have left (or have abandoned) their parents and relatives – this is a common way of escaping from related problems. The same applies to cis lesbians as well, though it is also true that many parents are supportive of their daughter’s choices.

Demands
Proper rehabilitation of trans women, then requires lot more than the NALSA judgment and its implementation.
It is necessary to;
Eliminate archaic colonial laws that criminalize same-sex relations.
Provide for marriage equality.
Make feminist sex education compulsory for all.
Impose remedial courses (for discrimination-free treatment) for all medical professionals, heavily subsidize medical treatment for trans people.

Provide reservations and subsidies for trans people and women in all sectors for at least twenty years to compensate for the systemic damage and means of damage that are already in place.

References
[1]. Injustice at Every Turn – National Transgender Discrimination Survey: Full Report Sept’2012, NCTE Download Link (http://transequality.org/issues/resources/national-transgender-discrimination-survey-full-report )
[2]. EU LGBT Survey’ December’2014: Results at a Glance
EU Agency for Fundamental Rights, Dec’2014, Download Link (http://fra.europa.eu/en/publication/2014/eu-lgbt-survey-european-union-lesbian-gay-bisexual-and-transgender-survey-main)
[3]. Labia Collective: Labia Collective Survey’ April’2013. Download Link (https://sites.google.com/site/labiacollective/we-do/research/report_btb/btbReport.pdf?attredirects=0 )
[4]. Russell, D. ‘UCLA Loneliness Scale (Version 3): Reliability, validity, and factor structure’,Journal of Personality Assessment, 66, 1996, 20–40.
[5]. AIPC Article Library: July’2012, Link to Article (http://www.aipc.net.au/articles/symptoms-causes-and-effects-of-loneliness/ )(accessed on 15th June’2015)
[6]. AIPC Article Library: ‘Counseling Strategies for Dealing with the Lonely Client’, July’2012, Link to Article (http://www.aipc.net.au/articles/counselling-strategies-for-dealing-with-the-lonely-client/ )(accessed on 15th June’2015)
[7]. Aspel, Melaine, Ann. Let’s talk about feeling lonely. New York; Rosen Publishing, 2001.
[8]. Hackney, H., Cormier, S., The professional counselor – a process guide to helping. Boston: Allyn & Bacon, 2005.
[9]. Stokes J, Levin I. ‘Gender differences in predicting loneliness from social network characteristics.’ Journal of Personal Social Psychology 1986 Nov.51(5).1069–74.
[10]. Yang, J. ‘Relationship between gender traits and loneliness: the role of self-esteem’. Master’s Thesis, Brandeis University Feb 2009. 41pp
[11]. Jessie Shipps, ‘RIP : Suicide Note Discussion’ (http://www.reddit.com/r/DeadRedditors/comments/3awh7w/rip_ulumberchick/ )Jessie Shipps: Reddit Userpage (https://www.reddit.com/user/Lumberchick )
[12]. Natalie Yeh, ‘The Lonely Journey of a Transsexual Woman.’ 2013, Blog Post (https://menopausebeforepuberty.wordpress.com/2013/11/07/the-lonely-journey-of-a-transsexual-woman/ )
[13]. Naomi Ceder, ‘Thoughts on a Trans Teen Suicide.’ 2015, Blog Post (http://whataboutnaomi.blogspot.in/2015/01/thoughts-on-trans-teen-suicide.html )
[14]. Rebecca Williams, ‘Loneliness.’ 2013, Blog Post (http://rebeccakeiko.blogspot.in/2013/03/loneliness.html )
[15]. Brenda Jacks, ‘Acceptance and Denial.’ 2012, Blog Post.(http://orinam.net/acceptance-and-denial/ )
[16]. Anamika, ‘Fear Can Hold You Prisoner, But Hope Can Set You Free: Being a Transgender Girl at IIT Kharagpur.’ Blog Post (http://www.scholarsavenue.org/ga/fear-can-hold-you-prisoner-hope-can-set-you-free/ )
[17]. Moody, C., Smith, N. G. ‘Suicide Protective Factors Among Trans Adults’, Arch Sex Behaviour (2013) 42:739–752
[18]. Mani, A., ‘Femme Dialectics,’ 2014+ My Blog (http://logicamani.blogspot.in/)

Prof A. Mani is an active researcher in algebra, logic, rough sets, vagueness and foundations of Mathematics. She has published extensively on the subjects in a number of international peer-reviewed journals. Her current affiliations include the University of Calcutta. She is also a course developer, teacher, free software contributor, advocate, consultant in statistical and soft computing. As a functional feminist, she has been active in many lesbian and women’s rights groups as well. She is an active lesbian, her homepage and blog are respectively at http://www.logicamani.in and http://logicamani.blogspot.in

Why VAMP supports decriminalisation of sex work

sex-workers-rights

Any argument that seeks to define sex work as violence and exploitation forecloses discussion over the rights of people involved in sex work to pursue it as a livelihood. Law enforcement agencies, health authorities and clients often use punitive action to harass sex workers and violate their human rights. Decriminalisation will help sex workers address abusive or sub-standard or unfair working conditions instituted by state and non-state actors

By Meena Saraswathi Seshu and Aarthi Pai

Amnesty International, on 11 August, 2015, voted to recommend the full decriminalization of sex work and prostitution in order to protect the human rights of sex workers.

In the aftermath of Amnesty International’s vote, there has been a huge outcry from anti-sex work groups who contend that this move will legitimise exploitation within the sex trade industry. The critics do not agree that the intention behind Amnesty International’s resolution is to protect the human rights of sex workers and call on states to ensure that sex workers enjoy full and equal legal protection from exploitation, trafficking and violence.

Veshya Anyay Mukti Parishad [VAMP] a collective of women in sex work from western India welcomes the decision taken by Amnesty International. We support Amnesty’s assertion that states have an obligation ‘to reform their laws and develop and implement systems and policies that eliminate discrimination against those engaging in sex work’. VAMP works closely with SANGRAM a health and human rights NGO that I helped set up.

As a feminist activist for sex workers’ rights, my (Meena Saraswathi Seshu ) journey began in the movement against violence against women in India in the mid-1980s. I started working with deserted women and cases of dowry deaths in south Maharashtra. Sex workers were always ‘the other’ in every village.

In 1992 the HIV/AIDS epidemic forced Government of Maharashtra to initiate projects to work with ‘prostitutes’. SANGRAM plunged into this work and my world of the well-meaning activist was turned upside down. The involvement with this community of sex workers forced us to address the deep-rooted double standards and biases while dealing with issues related to sexuality and prostitution. It was impossible to ‘preach’ to a group of women who scorned the dominant value systems. The crying victims of the social workers’ imagination were not to be seen or heard.

As the understanding of prostitution as ‘exploitation, victimization, oppression, loose, immoral, illegal’, was broken into, it was not merely ideas and beliefs that had to be questioned but the language too had to be transformed. We had to revise our vocabulary to weed out words that reinforced the stigmatization and marginalization of women in sex work. The need to reclaim the notion of ‘womanhood’ also became necessary since this sanctified moral space refused to acknowledge the fact that the very identity (of being a woman) was obliterated by the “whore, harlot, veshya” image. If women were not “good” then they had no right to be considered women.’ It thus became a matter of claiming citizenship itself.

What caught our imagination was the notion that casual sex could be a physical act stripped of emotion, can be initiated by women, can be used in a commercial context and even be pleasurable. Besides, many adult women seemed to appear in the communities, out of ‘nowhere’ apparently, comfortable with this notion of sex within a commercial context with multiple men. This challenged our initial idea that no woman could and would enter sex work on her own and the notion that all women were forced and trafficked into sex work. It was apparent that many women were not there by force, deception or in debt bondage and were freely walking in and out of the communities.

The argument that decriminalisation will increase exploitation by legalising pimps and brothel owners is made with a very limited understanding of commercial sex

We, therefore, realised that the argument that decriminalisation will increase exploitation by legalising pimps and brothel owners is made with a very limited understanding of commercial sex. Punitive laws that criminalise and punish sex work act as instruments through which sex workers are harassed and regularly have their human rights violated by law enforcement agencies, health authorities and clients. In many countries, sex workers are a primary means by which the police meet arrest quotas, extort money, and extract information.

Police wield power over sex workers in the form of threats of arrest and public humiliation and use condoms as evidence of illegal activity, undoing years of effective public health promotion and campaigning around STIs and HIV. Forced testing for HIV is commonplace, along with breaches of due process and privacy. Sex workers in many jurisdictions are the targets of frequent harassment, physical and sexual abuse, and forced “rehabilitation”. Where sex work is illegal, sex workers often feel there is little they can do to address the violations perpetrated against them and are deterred from accessing health services for fear of further stigma and abuse.

Decriminalisation will help sex workers address abusive or sub-standard or unfair working conditions instituted by state and non-state actors

Branding decriminalisation as an attempt to legalise pimps and brothel keepers does not help sex workers in their struggles for rights, including the rights to health, and justice.

The term “third parties” used by the sex workers rights movement recognizes the diverse third party working relationships that sex workers negotiate. In contrast, the term, “pimp” is a stigmatizing racial stereotype. It posits sex workers as victims rather than as workers, denying their agency. Sex workers can be employees, employers or participate in a range of other work related relationships. Framed as targeting exploitative working relationships of sex workers, third party laws are also used to target the personal relationships of sex workers, as well as workplaces. The criminalisation of sex workers’ personal relationships amounts to the criminalisation of sex workers themselves, while the criminalisation of workplaces mitigates against sex workers ability to protect themselves from HIV and other STIs, and gain labour rights.

In environments where aspects of sex work are criminalised, for instance, soliciting, living off the earnings of a sex worker, managers. sex workers face discrimination and stigma which undermine their human rights, including to liberty, security of the person, equality, and health. Evidence suggests that sex workers’ risk of HIV infection is inextricably related to their marginalized and illegal status, which drives their work underground and increases police abuse and exploitation.

According to UNAIDS Guidance Note on HIV and Sex Work, “even where services are theoretically available, sex workers and their clients face substantial obstacles to accessing HIV prevention, treatment care and support, particularly where sex work is criminalized.” In countries where sex work is decriminalized, there is evidence that violence directed at sex workers is reduced, relations between sex workers and the police are improved, and access to health services is increased.

The reason why VAMP supports Amnesty International in the decriminalisation demand is because sex workers from VAMP want States to actively seek to empower the most marginalised in society, including through supporting the right to freedom of association of those engaging in sex work, establishing frameworks that ensure access to appropriate, quality health services and safe working conditions and through combating discrimination or abuse based on sex, sexual orientation and/or gender identity or expression. This echoes the voices of sex workers around the world who argue that states are responsible for proactively protecting fundamental rights and call on them to undertake measures that will help protect, respect, and fulfill these rights for all.

Any argument that seeks to define sex work as violence and exploitation forecloses discussion over the rights of people involved in sex work to pursue it as a livelihood. It exacerbates the lack of legal remedies to redress violence and erodes the efforts of sex workers fighting for legal and social recognition of their rights to dignity and livelihood. Sex work is work, and sex workers should not be defined as either criminals or victims, such an analysis harms not only sex workers but all women.

Meena Saraswathi Seshu is the co -founder and general secretary of SANGRAM, an organisation working with marginalised women in rural Maharashtra, India. She was instrumental in collectivising women in sex work to form VAMP (Veshya Anyaya Mukti Parishad)

Aarthi Pai is an activist and lawyer. She is the Director of Centre for Advocacy on Stigma and Marginalisation, (CASAM) a unit in SANGRAM that focuses on laws, policies and structures that impact sex workers and sexual minorities

APJ Kalam was a missile man, let us not get carried away by epithets like “People’s President”

APJ-kalam

Dr. APJ Abdul Kalam, the 11th President of India, popularly known as a ‘missile man’ passed away on Monday, after a cardiac arrest, in Shillong, North East India. He was 83. It was alleged by activists that Kalam’s nomination in 2002 by the then BJP-led NDA, was an attempt to whitewash BJP’s alleged role in the Gujarat violence which claimed over 2000 lives with several still missing. BJP ideologue Sudheendra Kulkarni described it as “an attempt to project BJP’s secularism in the aftermath of Gujarat violence.” Here is a response from feminist activist Jayashree Velankar about the tributes pouring in for a man who played a big role in the nuclearisation of the country.

This was written to share my frustrations over the tributes pouring in from all quarters for Dr. APJ Kalam. I am disturbed by some of the tributes paid by some within ‘our’ circles of friends and fellow travelers.

There is no doubt Dr. APJ Abdul Kalam was an humble man, came from a very poor family, struggled against many odds, was opposed to death penalty but the fact remains that he was a Missile Man. Kalam chose to build weapons of mass destruction. I can’t call him “People’s President” and I am not sorry I can’t pay tributes to him.

To all those, especially amongst ‘us’ – the social activists, who have said he was ‘visionary’, ‘statesman’, ‘rushitulya’ (like a Sage), ‘apolitical’ my earnest plea is to ponder over these few things:

1) Rajdeep Sardesai, in my opinion, was the first journalist to use the adjective “People’s President” for Kalam. The rationale was, unlike other presidents who kept a safe distance from people in the name of protocol, Kalam mingled with people freely and answered emails by common people, especially young people and school children. All these were welcome gestures but do they suffice for us to call him People’s President – somebody who excelled in building weapons that would kill tens of thousands of ‘people’?

Make no mistake here. Nuclear weapons will make no distinction between people from Pakistan and India. They would kill thousands, if not more on both sides of the border

2) As my comrade in peace movement, Sukla Sen pointed out, Kalam played a big role in India’s nuclearisation that has had disastrous consequences like Pakistan going nuclear within a fort night of India doing so, Kargil war, hijacking of IA plane in December 1999, Parliament attack in New Delhi in 2001 to name a few. Only hawks can think this to be ‘visionary’. Can we?

3) Yes, he opposed death penalty but again isn’t it a bitter irony? By building missiles, in reality, he signed death warrants for thousands.

4) This ‘great statesman’ kept mum when George Fernandes and others in NDA government sacked Admiral Vishnu Bhagwat in a most humiliating manner when Bhagwat exposed huge scams and Fernandes’s connections with illegal arms trade ( I haven’t found the time to cross check this part so I will stand corrected)

5) Nirmalaji Deshpande, well known Gandhian and a staunch opponent of nuclear weapons was chosen by Congress party to be the next President of India. (I think NDTV had made an announcement to this effect) but then a doubt was raised – will she allow use of nuclear weapons in case a war breaks out with Pakistan and her name was dropped like a hot potato. All those who argue that someone like APJ – a Muslim getting the highest office is a sign of maturity of Indian democracy, please rethink. His being Muslim was overlooked only because he was a Missile Man. In the eyes of jingoists, Nirmalaji lacked phallus on both accounts – being a woman and by opposing nuclear weapons. (Eventually Pratibha Patil was chosen as his successor.)

Traditional protocol demands one to be not critical of a person who is no more. But as a feminist peacenik, my conscience demands that I bring these facets to the fore.

How ‘Per Vaginal Examination’ turned into the ‘two-finger test’

two-finge-test-india

Indian laws, clearly stating the role of health professionals while carrying out examination of sexual violence survivors, do not make any reference to assessing virginity of the survivor, degree of habituation to sexual acts, status of the hymen and status of the vaginal elasticity. Despite this, and in the absence of standard medical protocols in such cases, Indian forensic medicine and medico legal bodies continue to refer to these aspects

By Sangeeta Rege

The issue of sexual violence requires a multi-disciplinary approach in order to provide comprehensive response to sexual violence. This multi-disciplinary approach requires several systems such as criminal justice system, health system, child welfare committees etc. to interact with each other. This short article focuses on the role of the health sector vis a vis sexual violence.

The Indian law has clearly laid down role for health professionals in responding to sexual violence. Sec 164A of CrPC lays down the components of medico legal examination namely seeking informed consent for carrying out examination and providing a logical medical opinion for results of the examination. It does not make any reference to assessing virginity of the survivor, degree of habituation to sexual acts, status of the hymen and status of the vaginal elasticity. Despite this fact medico legal examination continues to constantly make a reference to these aspects. These techniques have been devised and perpetuated in forensic medicine text books.

The problem is further compounded by the lack of standard protocol for medico legal care of survivors. Health professionals across the country continue to assess the hymenal status of survivors, determine laxity of vagina by carrying out a finger test, look for marks of resistance on her genitals or body, record physical attributes like built, height, weight etc.

To add to this confusion, the Delhi health department put out an advisory stating that finger test can be conducted in some instances such as to determine internal injures for rape survivors. The advisory confused the term “finger test” with the clinical examination term “ Per Vaginal (PV) Examination”.

Let us decode these confusions:

• Finger test – Finger test emerged from forensic medicine as a way of determining whether a person is habituated to sexual violence. It is done by inserting one or 2 fingers inside the vagina of a woman . If more than 1 finger passes without difficulty , the woman is said to be habituated to sexual activity . Such a test is unscientific and is rooted in biases and stereotypes about rape and misconceptions about virginity. Several High Courts and Supreme Courts have already called it an unscientific test and have asked health professionals to refrain from it. It also contravenes Section 146 of the Indian evidence act of 1872.

• Other unscientific tests – Just like the finger test, Forensic medicine has also developed methods of recording old tears to the hymen to state that the woman is habituated. They ask providers to measure height – weight to argue that if she is well built than the perpetrator, she could not have been over powered . These comments too are in complete contravention of the Section 146 of the Indian Evidence Act (IEA), 1872.

• Overemphasis on injuries – Forensic medicine in India further essentialises the presence of genital and physical injuries on the survivor . Absence of such injuries makes the doctors suspicious about whether the survivor is reporting the “ truth” or was it a consensual act . It is important to lay down facts about absence of injuries . Aspects like fear, threat to life, being too shocked / numbed by the attack , being rendered unconscious etc prevents the survivor from resisting the perpetrator.

However doctors do not take in to account circumstances in which sexual violence occurs and so are unable to understand the lack of injuries on bodies of survivor . Evidence from WHO multi country study 2003 also shows that only 1 in 3 survivors have chances of sustaining any injury . The changes in the law especially CLA 2013 in its explanation (2) to section 375 IPC has clarified that lack of injuries should not be understood as consent to the sexual act . However these changes have still not found its way in the medico legal practices across the country

• Overemphasis on presence of medico legal evidence – Medical professionals , police as well as the Judiciary believe that medico legal evidence is the most clinching form of evidence in the form of semen , blood traces , sperms , saliva , etc which will help in conviction of a perpetrator of sexual violence . In fact in a case of child sexual abuse , the judge allowed an acquittal for lack of medical evidence in the form of seminal stains , despite the fact that the 8 year old child had given the history of fingering in the vagina . This is the extent of how misplaced the understanding on medical evidence is even with the highest echelon in the justice system . What is gravely missed is that medico legal evidence rapidly erodes with time as well as activities such as washing , bathing , gargling, urinating etc . A survivor often needs time to come to terms with the assault , consult family members and reach a hospital or police station . So in many instances evidence of semen , blood etc is not found . But this is misinterpreted as sexual violence did not take place by doctors and thus they are unable to explain the lack of positive forensic medical evidence.

There is a need to correct the biases and prejudices related to understanding of medical evidence

• If a survivor has reported peno- vaginal assault or there are clinical signs / symptoms such as vaginal pain, bleeding , discharge etc. they indicate a need for internal examination only then a Per Vaginal Examination (which should not be confused with finger test ) is done . This is done with the purpose of identifying clinical causes underlying a specific medical condition. This examination requires fingers to be inserted in the vagina but to assess a clinical condition and is followed up with a treatment plan. Here too consent for Per Vaginal Examination should also be sought from the woman/ girl.

• Second, it is important to understand components of medical evidence. Medical evidence is:
 Trace evidence in the form of semen, spermatozoa, blood, hair, cells, dust, paint, grass, lubricant, fecal matter, bbody fluids, saliva.
 Injuries either on the body / genitals
 Presence of sexually transmitted infection that the perpetrator has passed to the survivor in the form of HIV, Hepatitis, Gonorrhea, and also unwanted pregnancy.
 It is important to understand that the possibility of finding forensic evidence decreases significantly after 96 hours after the incident. Even within these 96 hours after the incident, the extent of medical evidence found is subject to activities undertaken by the survivor in the form of bathing, urinating, gargling, defecating etc. Also possibility of finding semen evidence is based on whether perpetrator ejaculated or not. These activities should be recorded by the doctor and explained in the court when asked about lack of medical evidence .

 Most importantly the possibility of finding any forensic evidence depends on circumstances of the sexual violence and also nature of sexual violence , therefore the dependence on forensic evidence is misplaced

• Third, it is important to state that a health professional, in this case doctors, has dual responsibility – forensic and therapeutic. The therapeutic role though often ignored, has now been made mandatory by the changes in the law(Section 357C CrPC and Rule 5 of POCSO). No hospital and health provider private or public can refuse treatment to survivors of sexual violence. Refusal to provide treatment is now punishable by law (section 166 B IPC).

• Fourth, MOHFW (Ministry of Health and Family Welfare, Govt of India) in April 2014 recognizes dual role of doctors therapeutic and medico legal and provides specific directions to doctors for responding to not just women and children but also transgender and other marginalized communities. It also equips doctors to understand the scope of medical evidence and steps in interpreting medical evidence. Besides the state health departments, civil society organisations must also be informed about this practice and must push for a comprehensive health care response to survivors of sexual violence.

• MOHFW (Govt of India) established a multi disciplinary committee of experts and developed gender sensitive and uniform protocol for responding to sexual violence survivors. This is the first national directive by the Union health ministry in 2014 to all states to adopt such a protocol. These guidelines have been drafted under Sec 164A of CrPC and must be adhered to uniformly across the country.

This article is based on CEHAT’s collaborative program with the MCGM hospitals in Mumbai on implementing a comprehensive health care response

Govt shows interest in Depo Provera again

HPV-Vaccine

For the past three decades women’s groups in India have been fighting against the inclusion of Depo-Provera, the injectable contraceptive into the country’s family planning programme. With signs of a renewed interest from the government on the inclusion of this drug, it is imperative that activists discuss and articulate their views on this issue of grave importance to women and public health

By Sarojini N and Priya Ranjan

After the London Summit- FP2020, a renewed interest is being witnessed, amongst funders, foundations, NGOs, UN agencies and Ministry of Health and Family Welfare (MOHFW), in Depot medroxyprogesterone acetate (Depo), an injectable contraceptive.
Many international organizations/agencies/foundations are advocating that the Government of India introduce Depo-Provera (the brand name of DMPA) into the national family planning programme.

In fact, the Ministry of Health and Family Welfare (MOHFW) had recently recommended Depo’s inclusion in the Family Planning Programme (FPP) ostensibly to provide an alternative choice to women seeking to plan their families. However, the Drugs Technical Advisory Board (DTAB), the highest decision-making body on technical matters in MOHFW, has refused to give its nod on the recommendation of the department of family welfare for the introduction of Depo-Provera in FPP and has asked the Department to “examine the matter in consultation with the leading gynaecologists of the country for examining the effects of the use of the drug (Depo Provera) under National Family Planning Programme of the Government of India”.(Pharmabiz April 16, 2015).

There are a few NGOs and other international agencies who are working on issues related to Family planning, contraception and reproductive and maternal health that are in favor of Depo. They argue that injectables and implants provide better contraceptive options particularly for the poor and powerless women to exercise control over their own bodies and lives (since the contraceptive is injectable, neither husbands, nor in-laws would come to know of the contraceptive method used by women). Those who are in favor of injectables are also of the opinion that women should have freedom to choose the kind of contraceptives they want. They believe that the idea of offering injectables as a method of contraception is to widen the choices available to women and that the risk of morbidity and mortality associated with unwanted pregnancies must always be weighed against the side effects of contraceptive methods. There are also suggestions to introduce Depo initially at district level assuming it is equipped to ensure the screening and follow-up care for this method.

On the other hand, many women’s organizations and health groups have consistently opposed the introduction of injectables and implants for many years. Women’s groups have raised concerns regarding serious health risks and adverse effects of Depo on women along with the unequipped public health system to ensure the screening and follow up at all levels. Several studies have shown that the use of Depo leads to loss of bone density in young women. In fact, the US FDA in 2004 asked Pfizer to put black box warning on Depo’s label highlighting potential medical complication associated with the drug. The findings of more recent studies conducted in Africa demonstrated that the use of Depo-Provera may also increase the acquisition risk of HIV infection.

There are also other proven measures to reduce maternal (and infant) mortality besides preventing pregnancy.

Unfortunately, there has been hardly any discussion/debate on injectables and implants in recent years. It is important to speak to women who have used and are using Depo as a method of family planning. It is available in the private market and used extensively in regions such as Jharkhand. Data from this experience needs to be compiled and analysed. From anecdotal evidence it seems that the discontinuation rate appears to be high among the users of Depo. At the same time we should clearly articulate the other alternatives, as women do need safe contraceptive methods.

Given the fact that there is a renewed attempt to introduce it in FPP, it is imperative to discuss and articulate our views on this very important woman’s and public health issue.

History of Depo-Provera
Depo-Provera (Depo) is a synthetic hormonal drug with medroxy-progesterone acetate (MPA) manufactured by Upjohn Pharmaceuticals which was later acquired by Pfizer. In 1963, it was sold in the US as a treatment for incurable, inoperable cancer of the en-dometrium (lining of the uterus).

In 1967 Upjohn decided to sell DP as a long-term contraceptive and applied to FDA (Food and Drug Administration) authorities. As per news reports, two animal trials – mandatory for FDA approval—a seven-year long beagle dog trial and a ten-year long rhesus monkey trial began. DP was granted a conditional approval for use by those who could not use other methods of contraception.

In 1973 the FDA’s Advisory Committee on Obstetrics and Gynaecology recommended the Depo-Provera drug, DMPA, for use as a contraceptive.

In 1975 the FDA convened a joint meeting of its Advisory Committees on Obstetrics and Gynecology and on Biometric and Epidemiologic Methodology. The Committees in turn jointly constituted a sub-committee task force which, after open hearings, recommended that the FDA approve Depo as a contraceptive.

Following the implication of Depo in cervical cancer, the US Congress objected and in March 1978, the FDA stayed the issuing of the license to sell DP as a contraceptive in the US. By then Upjohn had already begun selling the drug especially in third world countries with a large amount of sales going to the International Planned Parenthood Federation (IPPF) which had begun distributing it in 12 countries, the World Health Organisation and the US Agency for International Development (AID).

The irony is that even before the US authority could register the drug, it was being used extensively in third world countries, or rather being ‘tested’ on large numbers of women

Following an appeal from the management, and a groundswell of opinion against the injectable contraceptive that in July 1979 the FDA appointed a Board of Inquiry. TheUS FDA was forced to hold a public enquiry, only the second time in its history, to decide on whether the drug should be licensed. Its verdict held that there was insufficient material to show that the drug was safe. This Board convened in January 1983 and a report was issued in 1984. The report stated that there was not enough evidence to prove that the drug was safe for women as a long term contraceptive.

The US FDA did not license Depo for use as a contraceptive until 1990. This was in the context of the resurgence of anxiety about the population explosion especially in the Third World and the fact that the latter had increasingly become cautious about licensing a drug which had not been registered in the country of origin.

Depo Provera had reached India in 1974 and the Indian Council of Medical Research trials had begun testing the contraceptive. However, the trials were soon cancelled apparently due to women dropping out of the trials and so there was no trial report put out. By 1984, the drug was said to be used in a few health projects, though as per news report in the EPW “several professionals and professional bodies have been, after a long silence on the subject, issuing statements urging the government to allow Depo in the Indian market.”

The early 1980s saw women and health groups in India taking a stand against contraceptives especially in the government family planning programmes. In late 1993, India decided to issue Upjohn with the license to market DP for contraceptive use which would be manufactured and sold by Max India. Depo-Provera was approved without the mandatory Phase 3 trials. It was to be sold on prescription, individually, not through the family planning programme. Its price was reportedly, Rs 120 per dose. The company issued a statement saying that they would be doing a Post Marketing Surveillance but they would be doing this on their own without the involvement of the ICMR or the Indian drug control authorities.

In 1993, women’s groups filed a case in the Supreme Court against the introduction of injectable contraceptives into the country’s family planning programme. The court ordered a stay on the drug’s use on the grounds that there was insufficient research on its suitability for Indian conditions.

In 2000, a study conducted by SAMA Resource Group for Women and Health (Unveiled reality: a study of women’s experiences with Depo-Provera, an injectable contraceptive. SAMA, Delhi, 2000) found that in Delhi at public health centers, women were being given injectable contraceptives without informed consent which meant they were not informed of the adverse side effects of the drug.

The potential of abuse, the incomplete mandatory trials and lack of control of government agencies over pharmaceutical agencies that sell the contraceptives were some of the grave concerns of the women, health, and human rights groups. Women’s groups again met with officials from the Health Ministry in 2000 to fight against the government’s intention to incorporate the drug into its family planning programme, though allegedly it had already begun doing so in Uttar Pradesh.

In 2005, a national workshop in October 2004 organised by Parivar Seva Sanstha along with the government of lndia, UNFPA and the Packard Foundation through the Population Foundation of India. The topic at hand was the introduction of injectable contraceptives. Following this a letter signed by 62 individuals and health organisation in India wrote a letter to the then Union Minister for Health and Family Welfare – A Ramadoss. An article based on the letter appeared in the Indian Journal of Medical Ethics written by N B Sarojini of SAMA and Laxmi Murthy of Saheli with title ‘Why Women Group’s Oppose Injectable Contraceptives.

The article stated that the relaxation of Indian drug regulations and the introduction of long-acting hormonal contraceptives such as injectables (Net En and Depo Provera) and sub-dermal implants (Norplant) would cause irreversible damage to the women and their progeny’s health.

According to the article, “administration requires ruling out contra-indications and close monitoring over long periods. Such monitoring is totally absent in this country. Poor women who visit government hospitals where injectables would be offered in the family planning programme would be treated as ‘living laboratories”.

The article pointed out that a five year post-marketing surveillance study was to have been done in place of the final stage of clinical trials. However, this report has not been made public. As per the article, several factors were revealed studying the post marketing surveillance study which had failed to address several serious concerns such as the potential side-effect of bone density loss and subsequent increased risk of osteoporosis, cancer risk, assessment of return of fertility, the effect of Depo on progeny conceived immediately after stopping the use of the drug, amenorrhea, irregular bleeding, generalised weakness and lethargy, migraine headaches, pain in the abdomen and severe abdominal cramps were relegated as “non-serious” medical events by researchers. The article stated that after scrutinisng many studies which favoured the use of DP, women’s groups have found no “scientific/medical justification for the introduction of injectable contraceptives like Depo-Provera or Net-En.”

The above information about the history of Depo Provera was aggregated by the FI Team from the following articles; Why women’s groups oppose injectable contraceptives by N B Sarojini, Laxmi Murthy

http://www.issuesinmedicalethics.org/index.php/ijme/article/view/702

‘Contraceptives: Case for Public Enquiry’, EPW, April 9, 1994
‘Retreat on Depo-Provera?’ by Padma Prakash, December 8, 1984