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Thursday, March 14, 2024

Gender dynamics affecting maternal health services and care

  • Maternal health interventions have been successful in increasing access to and utilization of maternal health services, however, failure to address underlying gender dynamics limits the sustainability of benefits generated.
  • Gender power relations can be understood by how power is constituted and negotiated to: access to resources, division of labour, social norms, and decision-making, the intersection of which was found to affect maternal healthcare access and utilization.
  • In order to address gendered inequities affecting women’s lack of maternal health care access and utilization, interventions are needed that challenge unequal gender roles and relations that perpetuate inequities in maternal health access and utilization.

Research has shown that gender inequities have a negative effect on maternal health and maternal healthcare access and utilization in multiple ways. On the demand side, gender divisions of labour, lack of access to and control over resources (e.g. finances, information, transport, supplies), gender norms, limited autonomy, and lack of decision-making power limit women’s ability to access maternal health care services. On the supply side, societal patterns of gender discrimination are often reflected within maternal health service delivery. For example, the lack of ‘women-centred’ services, such as family planning or abortion, maternal health services being treated as ‘women-only’ spaces, and the mistreatment of women and men by health providers are all manifestations of gender discrimination. In addition, the intersection of gender with other social stratifiers, such as age, race, class, ethnicity, geography, (dis)ability and sexuality compounds the effect of gender inequities on maternal health and health care for vulnerable and marginalized women, such as poor women in rural areas. Finally, men affect women’s access to prenatal care and women’s obstetric outcomes in their roles as partners, neighbours, community leaders, and health providers due to their control over household resources and decision-making. However, progress towards engaging men in maternal and child health has been slow, despite their key decision-making roles in maternal and newborn care-seeking behaviour and family planning.

Integrating gender into maternal and child health interventions has been found to positively affect intervention outcomes. A review of gender-integrated interventions in reproductive and maternal-child health, for example, found that while the effects of integrating gender into interventions were mixed, overall the studies suggested that addressing social and structural factors within maternal and child health interventions, such as gender norms and inequalities, is beneficial for effective intervention outcomes. In particular, out of 23 interventions, those which incorporated empowerment approaches, for example, by "empower[ing] women to take actions to address health issues, […] empower[ing] adolescents and their families and chang[ing] community norms around child marriage", had the strongest evidence in support of integrating gender into maternal and child health interventions.

While maternal health interventions have been successful in increasing access to and utilization of maternal health services, failure to address underlying gender dynamics limits the sustainability of benefits generated. More needs to be done if the root causes of barriers to maternal health access and utilization are to be effectively addressed. The community discussions reveal important gender dynamics affecting maternal health access and utilization. These have laid the foundation for future interventions to address gendered power relations within intervention design, implementation, and evaluation. Gender aware interventions, particularly those which are gender transformative, are needed if access to and use of maternal health care is to be improved in the long-term.

Thursday, January 4, 2024

Nutrition Education

 Nutrition education is a critical component of public health initiatives, especially in regions like Odisha where malnutrition remains a challenge. Here are some key aspects of nutrition education that can be implemented in Odisha:

  1. Community-Based Programs: Engaging local communities through workshops and interactive sessions to educate them about the importance of nutrition and healthy eating practices.

  2. School Curriculum: Integrating nutrition education into the school curriculum to teach children about balanced diets, the importance of various nutrients, and healthy eating habits from a young age.

  3. Training Health Workers: Providing training to health workers and Anganwadi workers on nutrition so they can effectively communicate this information to the communities they serve.

  4. Mass Media Campaigns: Utilizing television, radio, and social media to spread awareness about nutrition and address common myths and misconceptions.

  5. Collaboration with Local Organizations: Partnering with local NGOs and government programs that focus on nutrition to create a more cohesive and widespread education effort.

  6. Monitoring and Evaluation: Establishing systems to monitor the impact of nutrition education programs and make data-driven decisions to improve them.


Addressing the high prevalence of anaemia in Odisha

 Addressing the high prevalence of anaemia in Odisha requires a multi-faceted approach that involves both government initiatives and community engagement. Here are some strategies that can be effective:

  1. Supplementation Programs: Strengthening iron and folic acid supplementation among targeted groups, especially women of reproductive age, adolescents, and pregnant women, is crucial12.

  2. Testing and Treatment: Regular testing for haemoglobin levels to identify anaemic cases early and providing appropriate treatment is essential12.

  3. Capacity Building: Training service providers, such as frontline health workers (ASHAs, ANMs), to effectively manage anaemia cases and promote iron supplement use3.

  4. Behavior Change Communication: Implementing social behavior change communication through information, education, and communication activities to address misconceptions and encourage healthy practices12.

  5. Nutrition Education: Educating the population about the importance of a balanced diet rich in iron, such as green leafy vegetables, legumes, nuts, and seeds.

  6. Addressing Root Causes: Tackling the underlying causes of anaemia, including malnutrition, parasitic infections, and poor sanitation.

  7. Programs like Amlan: The Odisha government has launched the ‘Amlan’ program, which encompasses many of these interventions to reduce anaemia across the state12.

For more detailed strategies and interventions, you can refer to the research article on BMC Public Health and news articles from Times of India and OrissaPOST that discuss the efforts being made to combat anaemia in Odisha. These resources provide insights into the multi-level strategies being implemented to address this public health challenge.

Gender stereotypes and its impact on health

Gender stereotypes, which are oversimplified and generalized beliefs about how members of a certain gender should behave or what traits they should have, can have significant effects on health. Here are some ways in which gender stereotypes can impact health:

  • Mental Health: Gender stereotypes can lead to psychological stress and mental health issues. For example, men may feel pressured to suppress emotions, leading to increased stress and potential mental health problems. Women may face stereotypes that limit their perceived capabilities, leading to lower self-esteem and confidence.
  • Behavioral Health: Stereotypes can influence health behaviors, such as discouraging men from seeking help for health issues or encouraging risky behaviors to conform to ‘masculine’ ideals.
  • Healthcare Access: Stereotypes can affect the quality of healthcare individuals receive. For instance, healthcare providers may have biases based on gender stereotypes that impact their treatment decisions.
  • Occupational Health: Gender stereotypes can influence job opportunities and work environments, potentially leading to occupational stress and related health issues.
  • Social Determinants of Health: Stereotypes contribute to social determinants of health by shaping societal structures and norms that can lead to unequal access to resources, education, and power, all of which are critical for health.

Combating these stereotypes involves raising awareness, promoting gender equality, and encouraging inclusive behaviors that allow individuals to express themselves freely without the constraints of traditional gender roles. For more detailed information, you can refer to resources provided by health organizations such as the World Health Organization and articles like those found on Verywell Health, which offer comprehensive insights into the development and effects of gender stereotypes on health.

Wednesday, December 27, 2023

Strengthening RMNCAH+N: Broad Strategies

 To strengthen RMNCAH+N components, some strategies can be implemented:


1. Improving Access to Healthcare:

- Enhancing healthcare infrastructure and facilities.

- Expanding the reach of primary healthcare services.

- Implementing community-based healthcare programs.

- Ensuring transportation and logistics for healthcare delivery in remote areas.


2. Enhancing Maternal and Child Health:

- Promoting antenatal and postnatal care.

- Encouraging safe delivery practices.

- Increasing access to skilled birth attendants.

- Providing immunization services for children.

- Strengthening nutrition programs for mothers and children.


3. Addressing Reproductive Health Needs:

- Expanding access to family planning methods and contraceptives.

- Offering comprehensive sexual education.

- Providing safe and legal abortion services.

- Ensuring access to quality reproductive healthcare facilities.


4. Preventing and Managing Communicable Diseases:

- Implementing vaccination campaigns.

- Enhancing disease surveillance and outbreak response systems.

- Promoting hygiene practices and sanitation.

- Providing access to diagnostics, treatment, and care for infectious diseases.


5. Integrating Nutrition Interventions:

- Promoting breastfeeding and improving infant and young child feeding practices.

- Addressing malnutrition through targeted interventions.

- Implementing nutrition education and counseling.

- Strengthening micronutrient supplementation programs.


6. Strengthening Health Systems:

- Training and capacity building of healthcare workers.

- Enhancing health information systems.

- Improving supply chain management for medicines and healthcare commodities.

- Ensuring financial protection and health insurance coverage.

- Conducting research and monitoring evaluation to inform decision-making.


7. Engaging Communities and Partnerships:

- Involving communities in planning and implementation of healthcare programs.

- Partnering with NGOs, civil society organizations, and private sectors.

- Facilitating collaboration among stakeholders.

- Advocating for policy changes and mobilizing resources.


Remember, these are general strategies, and the specific actions may vary depending on the context and country-specific needs.

Friday, December 15, 2023

Midwifery Services in India

 Midwifery services play a crucial role in providing maternal and newborn care in India, particularly in rural areas where access to healthcare is limited. Midwives are trained healthcare professionals who specialize in childbirth and the postnatal period. They provide a range of services, including antenatal care, delivery care, postnatal care, and family planning services.

In India, the role of midwives has gained recognition in recent years, with the government launching initiatives to strengthen midwifery services. The National Health Policy (2017) recognizes midwives as an essential component of the healthcare workforce and aims to increase the number of midwives in the country.

The government has also launched several programs to improve midwifery services, such as the Janani Suraksha Yojana (JSY), which provides cash incentives to pregnant women who deliver in a health facility with the assistance of a skilled birth attendant, including a midwife. The government has also launched the National Rural Health Mission (NRHM), which aims to strengthen primary healthcare services, including midwifery services.

Despite these initiatives, there are still several challenges facing midwifery services in India. One major challenge is the shortage of trained midwives. According to a report by the International Confederation of Midwives (ICM), India has only 0.2 midwives per 1,000 population, which is significantly lower than the WHO-recommended ratio of 2.5 midwives per 1,000 population. This shortage of trained midwives leads to a high burden on existing midwives and limits access to quality maternal and newborn care in many areas.

Another challenge facing midwifery services in India is the lack of recognition and respect for midwives as healthcare professionals. Midwives are often viewed as less qualified than doctors and nurses, which limits their role in decision-making processes and restricts their scope of practice. This lack of recognition and respect also affects their remuneration and working conditions, leading to a shortage of qualified midwives and a high turnover rate.

In conclusion, while initiatives have been launched to improve midwifery services in India, there are still several challenges facing this critical aspect of maternal and newborn care. The government needs to address the shortage of trained midwives by increasing investment in midwifery education and training programs. Additionally, there is a need to recognize and respect the role of midwives as essential components of the healthcare workforce and provide them with adequate remuneration and working conditions. By addressing these challenges, India can ensure that all women have access to quality maternal and newborn care through skilled birth attendants, including midwives.

Thursday, December 14, 2023

Decline in Total Fertility Rate and India at 2050

The total fertility rate (TFR) is the average number of children born to a woman during her reproductive years. In India, the TFR has declined significantly over the past few decades, from 5.0 in 1950-55 to 2.2 in 2015-20, according to data from the National Family Health Survey (NFHS). This decline in TFR is a result of various factors such as increased access to education and employment opportunities for women, improved access to family planning services, and changing social norms and attitudes towards family size.

The decline in TFR has significant implications for India's population dynamics in 2050. With a lower TFR, India's population growth rate is expected to slow down significantly. According to projections by the United Nations, India's population is expected to reach 1.7 billion by 2050, but the annual population growth rate is projected to decline from 1.3% in 2020 to 0.3% by 2050. This slower population growth rate will have several benefits for India, including reduced pressure on resources such as water, food, and housing, and lower healthcare and education costs per capita.

However, a lower TFR also presents some challenges for India. With a smaller workforce relative to the elderly population, there could be a greater burden on the working-age population to support the elderly through pensions and healthcare services. The government will need to ensure that there are enough jobs and economic opportunities for the working-age population to support this demographic shift.

Moreover, a lower TFR could also lead to a shrinking workforce relative to the dependency ratio (the ratio of dependents - children and elderly - to working-age individuals). This could put pressure on the working-age population to support a larger number of dependents, potentially leading to lower economic growth rates and higher taxes for working individuals.

In conclusion, the decline in TFR presents both opportunities and challenges for India's population dynamics in 2050. While slower population growth rates will have several benefits for India, such as reduced pressure on resources and lower healthcare and education costs per capita, there could also be challenges such as a greater burden on the working-age population to support the elderly and a shrinking workforce relative to the dependency ratio. The government will need to implement policies that cater to these demographic shifts and ensure that there are enough jobs and economic opportunities for all individuals in society.

Mental Health Counselling: An inseparable part of modern method of treatment

 Mental health counselling has become an integral part of modern healthcare, as it addresses the emotional, psychological, and social well-being of individuals. Mental health issues are becoming increasingly prevalent in today's society, with stress, anxiety, depression, and other disorders affecting people of all ages and backgrounds. Counselling provides a safe and supportive space for individuals to explore their thoughts, feelings, and behaviours, and develop coping strategies to manage their mental health.


The benefits of mental health counselling are numerous. Firstly, it helps individuals understand the root causes of their mental health issues and develop a greater sense of self-awareness. This understanding can lead to improved self-esteem, self-confidence, and a greater sense of control over one's life. Secondly, counselling provides individuals with practical tools and techniques to manage their mental health symptoms, such as relaxation techniques, cognitive-behavioural therapy (CBT), and mindfulness meditation. Thirdly, counselling can help individuals build resilience and develop coping strategies to manage future challenges and stressors.


Counselling is also beneficial for individuals who have experienced trauma or adversity. Trauma can have a profound impact on an individual's mental health, leading to symptoms such as anxiety, depression, and post-traumatic stress disorder (PTSD). Counselling provides a safe space for individuals to process their traumatic experiences and develop coping strategies to manage the associated symptoms.


Moreover, counselling is essential for individuals who are struggling with relationships or life transitions. Relationship issues can lead to feelings of isolation, low self-esteem, and anxiety. Counselling provides a supportive space for individuals to explore their relationship dynamics and develop communication skills to improve their relationships. Similarly, life transitions such as retirement, divorce, or the loss of a loved one can be challenging and lead to feelings of uncertainty and grief. Counselling provides a safe space for individuals to process their emotions and develop strategies to manage the associated challenges.


In conclusion, mental health counselling is an inseparable part of modern healthcare as it addresses the emotional, psychological, and social well-being of individuals. Counselling provides a safe and supportive space for individuals to explore their thoughts, feelings, and behaviours and develop coping strategies to manage their mental health symptoms. It is essential for individuals who have experienced trauma or adversity, are struggling with relationships or life transitions, or are experiencing mental health issues such as anxiety or depression. By providing practical tools and techniques to manage mental health symptoms and build resilience, counselling plays a crucial role in promoting overall well-being and improving quality of life.

Mental health: a new challenge

 Young people today face an increasing number of challenges to their mental health, and systems worldwide are insufficient to meet the large and growing demand.

Depression, anxiety and behavioural conditions are the leading cause of illness for young people and suicide is the fourth most prevalent cause of death amongst 15- to 19-year-olds. Meanwhile, around 50 per cent of mental health conditions begin by the age 14 and 75 per cent by age 24. So, if youth mental health challenges and their environmental factors aren’t addressed, they extend into adulthood. Conversely, having good mental health means being better able to cope, connect and function, leading to more fulfilling and productive lives.

Quality access to support and education remains a challenge in all countries, while stigma and discrimination prevents many young people from reaching out for support when it is available. However, access to support is not the only challenge. So too are the social determinants which influence mental health including poverty, social inequality, marginalization, exposure to war, increasing uncertainty and access to quality employment and training, with girls being disproportionately affected.

Wednesday, December 13, 2023

Low Sex Ratio at Birth: a major concern for Odisha

 Sex Ratio at Birth and Child Sex Ratio denotes the number of girls per 1000 boys, whichare considered as strong indicators of social health. The adverse sex ratios not only indicate poor social health, but also a barrier to attaining sustainable social development.

The child sex ratio of Odisha has been showing a declining trend since 1961. In the 1961 census, Odisha’s ratio was 1,035 which declined to 1,020 in 1971, 995 in 1981, 967 in 1991, 953 in 2001 and 941 in 2011.The National Family Health Survey-5 (2019-2021) had estimated Odisha's child sex ratio at 894, a sharp decline from 932 in NFHS-4 (2015-2016). The SRS statistical report estimated a fall of 23 points by Odisha in five years from 948 in 2014-16 to 925 in 2018-20. Odisha’s child sex ratio has plummeted to its lowest ever, according to the National Family Health Survey-5 (NFHS-5) that reported 894 female children for every 1000 males despite central and state government initiatives for the girl child. In 2015-16, the child sex ratio in Odisha was estimated at 932.Although, the overall sex ratio in Odisha has increased from 1,036 in 2015-16 to 1,063 in 2020-21, the child sex ratio has decreased to 894, which is the lowest it has ever been in the state.

The sex ratio at birth in Odisha in 2013 was 956 which decreased to 925 in 2020 (SRS 2018-20). The decline of SRB is a major concern for the State.  


The Department of Health and Family Welfare, Government of Odisha, in collaboration with the United Nations Population Fund (UNFPA), organized a State Level Consultative Workshop on Addressing Low Sex Ratio at Birth in Odisha on 5th December 2023 at Hotel ITC Welcom, Bhubaneswar.

The workshop was conducted in view of the decline of Sex Ratio at Birth (SRB) in the state to find out strategies to improve the sex ratio at birth in our State. Some of the reasons commonly put forward to explain the low levels of Sex Ratio at Birth are preference for sons, sex selective abortions, and female foeticide.

The objective of the workshop was to discuss the causes and consequences of the low SRB in the state and to develop a comprehensive action plan to improve the situation. The workshop also aimed to sensitize the district health officials and build their capacities on strengthening the implementation of the Pre-Conception and Pre-Natal Diagnostic Techniques (PC & PNDT) Act, 1994, which prohibits sex selection and regulates the use of diagnostic techniques.

The workshop was attended by around 100 participants, including the Additional District Public Health Officers (Family Welfare)-cum-District Nodal Officers, PC & PNDT and Assistant Managers-LAIS of all districts, state level health officers and concerned consultants, legal and medical experts, social scientists, members of civil societies and other stakeholders.

The workshop was inaugurated by the Mission Director, NHM Odisha in presence of Dr. Bijaya Kumar Panigrahi, Director, Family Welfare, Odisha, Md. Nadeedm Noor, Head of Office, UNFPA, Odisha, Director, I &PR Dept., Director, Social Welfare, W&CD Department, Director, Health Services of the State. The workshop generated a fruitful dialogue and paved a way to develop an action plan to address the issue of low SRB in Odisha and to ensure the survival, protection, and empowerment of the girl child.




Read more at:

https://pragativadi.com/state-level-workshop-on-low-sex-ratio-at-birth-in-odisha/ 



Tuesday, May 12, 2020

Why should I keep Social Distancing


Meaning of Social Distancing


‘Social distancing’ is actually “physical” and it’s a system. It operates in the cohesion of larger social cohort. It’s not discriminating, rather integrating the affected person, or say following certain norms of isolation, that helps in maintaining the social fabric. Reducing physical contact optimizes maintenance of social systems in long run. Distancing in an affected social set up reduces morbidity through suppression of transmission of certain killer elements like virus etc. However, the members of the given society or social system remain connected with each other and share many common social elements.

Social distancing, in other hand, may lead to loneliness, depression, reduced productivity and other benefits associated with human interactions.

WHO favours the term “Physical Distancing” as opposed to “Social Distancing”.

Counselling

COUNSELING:

Counseling is a skill. In the best of circumstances, a good Counsellor is compassionate and non-judgmental, is aware of verbal and non-verbal communication skills, is knowledgeable concerning issues, and is respectful of the needs and rights of the users. In a humanitarian situation, there is often a poor counsellor-to-client ratio, emergencies are common and the local environment is not conducive to counseling. However, at a minimum, counsellors should strive to ensure that every service user has the right to the following:
· Information: to learn about the benefits and availability of the services.·
Access: to obtain services regardless of gender, creed, colour, marital status or location.·
Choice: to understand and be able to apply all pertinent information to be able to make an informed choice, ask questions freely, and be answered in an honest, clear and comprehensive manner.·
Safety: a safe and effective service.·
Privacy: to have a private environment during counseling or services.·
Confidentiality: to be assured that any personal information will remain confidential.·
Dignity: to be treated with courtesy, consideration and attentiveness.·
Comfort: to feel comfortable when receiving services.·
Continuity: to receive services and supplies for as long as needed.·
Opinion: to express views on the services offered.

Saturday, November 24, 2018

Confusion over food and nutrition

In recent years there has been a growing concern for nutrition over food intake, which leads to thinking of developing a nutrition-sensitive food system. Growing concern over choice of food and nutrition put the semi-learned we people in confusion what to eat and what not. Even the nutritionist we meet have diversified opinion about food intake. I personally believe to go back to my grand parents' age when all my family members, my neighbours and most of my fellow villagers were healthy. I remember intake of ghee as a part of daily diet, which was denied by most of the health and nutrition specialist in a fear of chance of increasing cholesterol leading to stroke. Now, again some articles have come up with benefits of deshi ghee.

I have decided to go back to the food system I was with during my childhood.

Thanks for reading.

Love after the time of 377

The unanimous verdict of the Supreme Court's five-judge constitutional bench in Navtej Singh Johar & Ors., decriminalising homosexuality and recognising the constitutional rights of LGBTI persons, has led to a massive outpouring of emotion and celebrations across the country and around the world. Reading the four opinions together, it is clear that at the heart of the verdict lies an overwhelming endorsement of the right to personal autonomy and choice. The judges have held that this right includes the right to choose one's partner, the right to sexual autonomy and agency, the right to love, to live one's life with dignity, not confined just to the privacy of the home but attaching to the body of the individual and extending to public spaces.
This expansive reading of personal autonomy-and the centrality of this right to the judges' reasoning-can be seen as an extension of the Supreme Court's own decisions after the 2013 Koushal decision, reinstating Section 377 of the Indian Penal Code (IPC) and re-criminalising homosexuality. This string of cases includes NALSA (2014), recognising citizenship rights of the transgender community; Puttaswamy (2017), upholding the fundamental right to privacy; Shafin Jahan (2018), upholding the right to be in a relationship of one's choice; Shayara Bano (2017), declaring that a law could be struck down as unconstitutional if it is manifestly arbitrary; Common Cause, recognising the right to a dignified death of those who have slipped into a permanent vegetative state; Shakti Vahini (2018), recognising the right to choose a life partner as a facet of individual liberty, where the court has opposed the practice of honour killings as a threat to the constitutional right to individual liberty.
Central to the judges' exposition of the right to personal autonomy is the right to dignity, linked to the right to privacy and the right to exercise choice without fear. What is significant, and connects to the line of cases preceding this judgment, is the court's linking of the right to dignity to the idea of fraternity. According to the judges, just as the state is bound to protect individual rights, it is equally incumbent on society to respect individual rights. Navtej Johar thus opens up further possibilities for a diverse range of situations where personal autonomy and the right to choice of individuals have been curtailed.
The second cluster of arguments that runs through the four concurring opinions in this case is a robust reading of the right to equality, both under Article 14 (the right to equality and equal protection of the law) and Article 15 (prohibition against discrimination based on religion, race, caste, sex, etc.) of the Constitution. The judges hold that the distinction made by Section 377 between 'natural' and 'unnatural' sexual intercourse is arbitrary, unsupported by scientific evidence, and does not withstand legal scrutiny. The court recognises scientific developments, including guidelines of the American Psychiatric Association, the World Health Organization and a 2018 Position Statement by the Indian Psychiatric Society, all of which state that homosexuality is no longer considered to be a mental health disorder, and cannot be altered by any 'treatment'. The court recognises homosexuality to be a natural variation of a range of sexualities found in nature.
The judges abandon a formalistic reading of the 'intelligible differentia' test, overruling an earlier decision in Air India vs Nargesh Meerza (1981), in which the Supreme Court had upheld a discriminatory rule that allowed for disparities in pay and promotion-related policies for men and women in flight cabin crew. The court based its decision on a very narrow interpretation of Article 15, and justified this step through gender stereotypical views of the roles of men and women, perpetuating the notion that the obligation of raising a family was to be borne by women. This bench, in its reading of the equality provisions, recognises that a law that is on the face of it neutral can have a disproportionately discriminatory impact on a section of society. In this specific case, Section 377 does not specifically mention homosexuals, but it has been applied overwhelmingly to target LGBTI persons.
The court not only explicitly rejects the rationale in Nargesh Meerza, but goes a step further holding that the quality provisions in our Constitution must be interpreted to challenge gender stereotypes, a heteronormative bias, binary formulations of human sexuality, and must instead, in Justice D.Y. Chandrachud's words, protect "the fluidities of sexual experience" and "plural ways of life and infinite shades of love and longing".
The judges read Article 15 expansively to read non-discrimination based on sexual orientation into the term 'sex', relying on precedents such as NALSA, as well as a plethora of international case law. In this, they reiterate the logic laid down in Naz Foundation, in which the Delhi High Court had also come to a similar conclusion. Another aspect of the judgment that strongly resonates with Naz Foundation is the judges' reiteration of the role of the courts, and their unequivocal decision that constitutional morality always trumps societal morality
Rejecting the logic in Koushal of the "presumption of constitutionality" (that the Constitution brings into force pre-colonial law unless they are expressly amended), the court says that such a presumption does not come into place in a case like this, where the petitioners have demonstrated a clear violation of fundamental rights.
The court emphasises that the role of the courts is to step in to prevent violations of fundamental rights, when the legislature and executive have failed to do so. The court has held that it is the duty of the court to protect the rights of 'discrete and insular' identities, however 'minuscule' their numbers may be. In doing so, the court recognises that Section 377 was never just about prosecutions, but about the threat of being prosecuted, about blackmail, fear and the perpetuation of a culture of silence and stigmatisation of LGBTI identities.
The judges identify the ideals of plurality, diversity, inclusiveness, equality, fraternity and liberty, among others, as being central to the character and vision of the Indian Constitution. They highlight the transformative nature of the Indian Constitution, as a document that is vibrant, dynamic and committed to social transformation.
In their powerful articulation of constitutional morality, especially through the constitutional value of fraternity, the judges are clear that they are not just speaking about state violations of rights, but also violations by other actors in society. Their judgment is a direct challenge to the values that underpin honour killings, the obstruction of inter-religious and inter-caste marriages, kidnappings, forced marriages, house arrest, and other forms of violence perpetrated by families on their own kith and kin to protect their reputation.
The court envisages this judgment as not just about guaranteeing LGBTI persons their rights, but equally as a vision of the kind of society we live in. Their articulation of constitutional morality and the value of fraternity is as much about what it means for the majority of this country as it means for its minorities
An important aspect of this judgment is its reliance on the doctrine of non-retrogression. As per this doctrine, the State should not take deliberate steps that erode or reverse rights. The court holds that if it were to accept the law laid down in Koushal, it would lead to a retrograde step in the progressive realisation of rights under the Constitution.
The judges have acknowledged the parents and families of LGBTI persons, many of whom have been intervenors in different stages of the legal challenge to Section 377. The court quotes the late Justice Leila Seth, who, in the wake of Koushal, wrote a moving article from the point of view of a mother and a judge, criticising the judgment as inhumane and profoundly cruel.
Justice Indu Malhotra, in her concurring opinion, in an extraordinary statement, states that history owes an apology to LGBTI persons and their families, for the ignominy and ostracism they have suffered through the centuries. The remorse evident in Justice Malhotra's statement sums up the mood of the court, which, in overturning the Supreme Court's 2013 decision in Koushal, has made amends for the grief, pain and rage caused by the callous words of the judges in that case.
Navtej Johar inaugurates a phase of healing and hope, a moment of joy, remembrance and gratitude, of overwhelming relief and reflection, an opportunity to pause and look back at the years of tireless activism, of countless untold stories, of intimate encounters with the law, of joyous team spirit in the face of adversity and of the contributions of people in different capacities from all over the world. This judgment is part of an extraordinary political and emotional journey and a continuing struggle for equal rights. It is a powerful indictment of the hypocrisies of society that drive the extreme violence and brutality faced by those who dare live life on their own terms.

Source: Siddharth Narrain's article in India Today September 15, 2018

Sunday, November 18, 2018

Take action to end violence against women and girls

Violence against women and girls is a grave violation of human rights. Its impact ranges from immediate to long-term multiple physical, sexual and mental consequences for women and girls, including death. It negatively affects women’s general well-being and prevents women from fully participating in society. Violence not only has negative consequences for women but also their families, the community and the country at large. It has tremendous costs, from greater health care and legal expenses and losses in productivity, impacting national budgets and overall development.
Worldwide, approximately one in three women have experienced either physical or sexual violence in their lifetime. In the Asia-Pacific region, although 31 out of 39 countries have laws against gender-based violence, the problem of violence against women persists at varying rates. In Singapore, for example, 6 per cent of women have experienced either physical or sexual violence at some point in their lives, while in Thailand, this figure stands at 44 per cent[1]. Exposure to violence often starts early in women’s relationships, with women as young as 15 to 19 experiencing incidents of violence[2]. Under the leadership of the UN Secretary General, António Guterres, the United Nations Secretary-General’s UNiTE to End Violence against Women Campaign (UNiTE) calls for global action in order to raise awareness about the issue, increase advocacy and allow for the sharing of knowledge and innovation.

Signs of abuse

In some cases, one can be in an abusive relationship without even realizing it. Abusers may act loving and kind to their partner in order to compel the victim to stay in that relationship. However, these instances of loving behavior do not excuse abusive behavior.
The following are just some of the signs that could indicate an abusive relationship;
  • Your partner humiliates you or yells at you
  • Your partner often criticizes you and puts you down
  • Your partner blames you for their outbursts
  • Your partner monitors what you are doing at all times
  • Your partner acts very jealous and accusatory
  • Your partner restricts you from socializing, especially with members of the opposite sex or restricts you from seeing your friends and family
  • Your partner does not allow you to have a personal bank account, credit or debit card
  • Your partner tracks every dollar you spend
  • Your partner threatens to hurt you or the people in your life
  • Your partner causes you physical harm
  • Your partner threatens to harm themselves when they are upset with you
  • Your partner forces you to have sexual intercourse.

What to do if you are facing abuse

If you feel that you are in an abusive relationship, it is important to know what steps to take in order to protect yourself from further harm.
The following are steps to take if you believe you are in an abusive relationship;
  • Be willing to walk away from the relationship if there is a need.
  • Do not blame yourself for the actions and choices of your abusive partner.
  • Tell someone you trust like a friend, family member, counsellor or co-worker.
  • Decide if you are in immediate danger. If you feel that your partner might harm you, go somewhere safe immediately. If you cannot get away, inform a friend or family member, or call the police.
  • Identify safe areas in the house where you can go if your abuser attacks you or starts an argument. Be careful to avoid small enclosed spaces or rooms with tools that could prove dangerous (e.g. kitchen or store-room)
  • Have important documents ready, such as birth certificates and bank records, which you can access easily should you need to leave.
  • Plan an escape route. This would involve having somewhere safe to go, such as the house of someone you trust or a women’s shelter.
Sexual violence can be committed by an intimate partner or by a total stranger.
The following are steps to take if you have been a victim of sexual assault;
  • Do not change out of your clothes as clothing may be used to collect forensic evidence.
  • If you are injured, seek medical attention in an emergency room as soon as possible. Doctors may administer a rape kit in order to preserve any forensic evidence.
  • Decide if you want to report the incident. Should you decide to report it, go to the nearest police station where the officers will take your statement.
  • Get medicine to prevent sexually transmitted infections (STIs) and unwanted pregnancies.
  • You may need to seek support from trusted individuals, a counsellor or a hotline.

What to do if someone else if being abused

When someone in your life is the victim of physical, emotional or sexual abuse, it is important to be supportive and attentive to their needs.
The following are some ways you can help someone who you think is experiencing violence.
  • Try to have an in person private conversation with them. Avoid texting, calling or leaving a voice message as this could put them in danger.
  • Listen respectfully to what they have to say. Do not press for details or ask them why they did not leave. If the person does not want to talk, simply say you will be there should they need you.
  • Before you speak to them, find services nearby that you can direct them to.
  • Offer practical support, such as accompanying them to appointments or calling a helpline.
  • Respect their decisions.
  • Never confront an abuser or do anything that may compromise your safety.
  • You may need to seek support for your own feeling through a trusted individual or a counsellor.
Source: http://asiapacific.unwomen.org/en/focus-areas/end-violence-against-women/take-action

Saturday, August 6, 2016

Response to gender based violence

The Ministry of Health & Family Welfare, India has come up with a "Protocols and Guidelines - medico legal care for survivors/ victims of Sexual Violence" in 2014 to provide coordinated response to gender based violence that includes sexual violence, domestic violence, special provisions for care of LGBT, children and disabled.

But to my dismay, the protocols and guidelines has not been adopted by many states in India. The health sector response needs to be strengthened with trained professionals, designated space for medico-legal examination of survivors and supplies. Above all privacy and confidentiality of the survivors need to be maintained and ensured, although many challanges are still to be resolved.

The protocols and guidelines is available in the MoHFW's website. 

Monday, July 8, 2013

Gender discrimination and sex selective abortion - Odisha



Sex selection is the manifestation of gender discrimination. A strong social mindset for son preference with easy availability of technology for sex determination has resulted into gender biased sex selection. The link between skewed child sex ratio and the growing trend of misuse of increasingly sophisticated diagnostic techniques for pre-conception and pre natal sex selection has been widely documented, researched and evidenced in the past few decades. Even the trend of declining child sex ratio has been spreading to rural and tribal areas in Odisha. As per the provisional data of census 2011 the child sex ratio in Odisha stands at an all time low of 934 girls for 1000 boys. In four districts namely Nayagarh, Dhenkanal, Angul and Ganjam the child sex ratio has dipped down alarmingly to less than 900. The CSR has remained below 950 in 19 districts of Odisha. According to the data of National Health Survey 2011, the sex ratio at birth (SRB) of Odisha is 905 and 12 districts have SRB less than 900. The above mentioned data indicate a bleak picture of status of the girl child and women in the State.