by Ira Trivedi
The law only allows abortions if the pregnancy term hasn’t passed the twelve-week mark or not aborting the foetus would be a threat to the woman’s or the child’s life. If the term is longer than twelve weeks but does not exceed twenty weeks, then two doctors have to be consulted. So what happens to all the young women who come to a doctor at a later stage? What happens in situations when two accredited doctors aren’t available? Even worse, getting an abortion on the grounds of the contraception method failing is available only for married women. The wording of an explanation within the law makes this clear: ‘Where any pregnancy occurs as a result of failure of any device or method used by any married woman or her husband for the purpose of limiting the number of children, the anguish caused by such unwanted pregnancy may be presumed to constitute a grave injury to the mental health of the pregnant woman’.122
Moreover, experts believe India’s abortion policy is not based on good clinical practice. Today it is unofficially estimated that between 6.4 million and 6.7 million123 abortions take place annually versus the reported numbers of 620,472 for 2012. And two-thirds of all abortions in India take place outside the authorized health facilities.124 Approximately 63 per cent of all abortions in India have been found to be unsafe.125
‘The official estimates are an underestimate. They refer only to those abortions undertaken in registered MTP centres [so exclude all those undertaken safely or unsafely elsewhere],’ Dr Jejeebhoy told me.
This, even with the sketchy statistics, points to the increasing number of unsafe abortions and abortions in general, among young, unmarried women. What’s worse is that findings from several available studies have highlighted the vulnerability of these unmarried young abortion-seekers: delayed abortions, lack of accessible support systems and the like.
India’s public health system is restricted to cities. While on paper there is a vast network of primary health centres, community health centres and sub-centres in the rural areas, in reality, they aren’t always there. And when they do exist, as I saw recently, they are skeletal structures with a tin roof often with sporadic electricity supply—less than 20 per cent of such centres provide abortion facilities.126 So, when report says a woman in India dies every two hours because an abortion went wrong, it is believable.127
Tellingly, for a population of 1.2 billion, there are only 12,510 registered abortion facilities in India and their functionality is, at best, questionable.
♦
There is a fundamental disconnect between a rapidly evolving sexual and social landscape and the available social and physical infrastructure in India. Unsafe sex, pregnancies out of wedlock, thought-policing, unsafe abortions, sexual violence and an unstable society far outweigh available coping mechanisms. These agencies are an integral part of social infrastructure: sex education, health facilities and services, counsellors, support groups, policy dialogue. There is an unmet need; the gorge is getting deeper, the gap wider.
The void is filled by potentially erroneous sources of information and the case for peer communication is strong. Friends play a significant role in connecting young people with their partners, encouraging prenatal sex, informing each other about sexual intercourse and acting as their sex education teachers.
While peer communication is unquestionably a powerful tool to educate young people, the risk of incorrect information is pretty high, given the widespread inadequacy of sexual knowledge. Renuka Motihar, a sex education consultant, told me non-profits in India are now trying to tap into this social-network method to educate young Indians. Others like TARSHI have been hammering away about sex-ed with helplines and guides for almost a decade. For both men and women, television and films have been found to be the most popular source of information on issues related to sexual health.
Formal sex education as part of educational curricula is as good as absent in India. Without it, the media, internet, generally uncomfortable parents, or peers are makeshift ways to help young people get through the dangerous years until they are mature enough to take responsible decisions regarding their sexual lives.
In the 1990s, the government began to enhance some aspects of the country’s social infrastructure as it began the whole process of liberalization. This marked the first serious attempt to initiate a formal sex education programme as part of the curriculum. In April 1993, the Ministry of Human Resource Development organized a national seminar and invited the who’s who of academia, activists, curriculum developers, government bodies and whoever mattered to talk about sex-ed—actually ‘adolescence education’.
Eventually they came out with a report in typical Indian bureaucratic fashion. The report decided that the three areas to focus on should be adolescence, education about diseases like HIV/AIDS and drugs. This, they boasted, would be a ‘holistic’ approach. They carefully named it the Adolescent Education Programme (AEP). The suggested module became a reality in 1999 and was sent around for approval to associated organizations. A few years went by as experts deliberated on what to include and what not to include, given these were ‘sensitive elements related to sexual development in adolescents’. The chapters included basic information like the need for sex-ed, sex-related problems and so on. HIV/AIDS was not part of the curriculum yet.
Then, almost five years later, on 27 October 2004, a group of government departments met on HIV/AIDS prevention in India and there was a consensus that HIV/AIDS prevention education should be a part of the AEP. The following year, in 2005, together with the National AIDS Control Organization, another government body, the Human Resources Development Ministry, which oversees education in India, introduced the new and improved National Population Education Project. It was sent off to the state governments for implementation.
Of the educational materials developed for this savvy new programme, the most contentious was the flip chart. The flip chart, which would be placed on the teacher’s desk, had a student page (with an image) and a reference guide page, which would face the teacher, seated at the front of the classroom. This flip chart instructed teachers to talk about how girls felt when going through puberty, menstrual hygiene, erections, wet dreams and masturbation as an alternative to sex, among many other issues. It was based on the acronym ABC: A for Abstinence, B for Be faithful and C for Correct and consistent condom usage, a commonly-used approach to HIV/AIDS prevention globally.
Students were also given blanket guidance: you should not indulge in sexual intercourse. Safe sex was defined as any sexual exercise which did not involve semen, vaginal fluids and blood entering another person’s body or coming into contact with broken skin. Stimulating your own or your partner’s genitals (masturbation), thigh sex, massage or kissing, using a condom for vaginal or anal sexual intercourse, oral sex (mouth contact with male or female genitals) is less risky than unprotected vaginal or anal sex and no sex (abstinence) is 100 per cent safe. It seemed to use the fear tactic to push people away from sex.
Teachers were given fact sheets, also a Q&A sheet on whether touching private parts, or a man and a woman sleeping next to each other could result in pregnancy. It instructed teachers to mention ‘established methods’ of a woman getting pregnant too. The fact sheets had been distributed and were being used for a while, when a sudden political uproar derailed the progress. One state banned it and then it all went downhill. Educators say no negative side effects or repercussions of any sort had been felt or seen as a result of the materials; nothing had provoked the ban. But a parochial political class started spinning stories in order to make the changing sexual landscape more explicable to themselves. The material ‘allegedly featured offensive illustrations and classroom exercises’, and the content on contraception and STDs vexed them, Renuka Motihar told me.
Politicians—those caught having sex in their offices, watching porn in Parliament, caught having sex on camera with midwives—vehemently went at it. This was the end of innocence for our children, they said. This material, deemed ‘obnoxious’, would ignite the curiosity of students abou
t experimentation, resulting in teenage pregnancies and promiscuity. They didn’t seem to know, or if they knew they didn’t seem to care, that sexual behaviour in the country was already changing regardless of sex-ed.
Ms Motihar recalls how she went into a rural setting in Andhra Pradesh in the mid-2000s to speak to young women about the AEP. Ms Motihar says the thirty young women were ‘so openly talking about having sex, about going out into the fields’. And then she went to speak to young women in a school in Vijayawada city in the same state where ‘they were so inhibited and reserved, I remember reflecting: just look at the difference!’ The landscape had been evolving for a while and India’s government was ostensibly unaware.
By April 2007, some of the largest states of India—Gujarat, Madhya Pradesh, Maharashtra, Karnataka, Rajasthan, Kerala, Chhattisgarh and Goa—had banned sex education. ‘Sex Education Creates Storm in AIDS-Stricken India’, the Washington Post reported, ‘No Sex Education Please, we’re Indian’, other papers shrieked.
When the Indian state of Maharashtra—home to Mumbai city, unofficially India’s most cosmopolitan city—banned the curriculum, an old politician Bashir Patel declared, ‘We want our children to have good character. There is no need to give them sex education. It is done in the West and we don’t need to follow that.’ He intoned confidently, ‘Sex education will ruin our society.’ (NDTV, 2008)
Based on the bans, apparent witness interviews and field visits, the Rajya Sabha Committee on Petitions’ report boldly concluded that ‘there should be no sex education in schools’ in India. Apparently, everyone consulted ‘contended that the move to educate children about sex in the garb of HIV/AIDS prevention was quite reprehensible in view of our socio-cultural ethos’.
A few months later, two women (ironically, a teacher and a social activist) submitted a petition against this material to the Committee ‘praying for national debate and evolving consensus’ on whether or not the contentious sex-ed materials should be put into effect in central government-affiliated schools. They also wanted to stop further use of those materials till this ‘debate’ happened.
The Committee, with ten Members of Parliament from the Rajya Sabha and only one woman, examined this petition for a year-and-a-half. After deliberating on views and opinions from various stakeholders, it came out with a report with observations and prescriptive recommendations on what needed to be done about the AEP in 2009.
The exhaustive, seventy-seven-page report analysed the contentious material, what experts had to say and, apparently, what people were doing.
Amongst its various observations and recommendations, the Committee astonishingly concluded that sex before marriage was ‘immoral, unethical and unhealthy’, chapters on sexually transmitted diseases had to be removed from the curriculum, and the way ahead for India was through Naturopathy, Ayurveda, Unani and Yoga. And that was the end of the first round of debates on the sex-ed discourse.
Backward-looking, ill-informed, and retrogressive, it is instructive to let the report speak for itself. The reasons given revealed the backward and ill-informed sensibilities of those who had framed it. Here are a few lines from it:
Once sex education is introduced, there would be peer pressure amongst growing children for its experimentation, which would increase rape in society as consent below the age of sixteen years is not considered as consent in the consensual sex. Again in consequential termination of teenage pregnancies would contribute to increase of crime graph of the society. Therefore, it would add more problem than solving those. (Rajya Sabha Committee on Petitions, 2009)
While India’s central education board does prescribe an Adolescent Education Programme (AEP), a quick read through the teacher’s manual exposes the limited scope. Not only is it shockingly superficial and ill crafted but it doesn’t seem to address the real issues—what sex is and what consent means.
The sloppily written document I stumbled upon on the CBSE website bundles sex-ed with substance abuse and HIV, already framing the discourse in a negative arena. ‘To develop healthy attitudes and responsible behaviour towards process of growing up, HIV/AIDS and Substance-Abuse’ education is one of the objectives of the AEP. And not once in the document are the words ‘sexual intercourse’ mentioned, while there are activities titled ‘Lets Celebrate Abstinence’ and ‘How to Say No’. (AEP Advocacy Manual).
Abstinence-focused sexual education doesn’t change teenage and adolescent sexual behaviour, nor does it delay the age of initiation of sexual activity.128 In a policy review, the Guttmacher Institute, a fifty-year-old American organization that works on sexual and reproductive health and rights, noted that putting a negative connotation around this topic is counter-productive. Some may argue that empirical evidence (or rather the lack of it) from these studies don’t apply to India—conservatives in India often tout its chastity and claim India is unlike the West. However, consider this: when you are told something is ‘bad’, you internalize that it is bad—like stealing, lying and being greedy.
Six years later, after the Delhi gang rape in December 2012, the Police Commissioner of Mumbai, Satyapal Singh said, ‘Sex education needs to be carefully thought out. Look at America. It has sex education as part of its curriculum, but students are simply being taught about how to have intercourse,’ speaking at a discussion on women’s safety. ‘According to a survey, rape is more common than smoking there. Countries with sex education in their curriculum only have an increased number of crimes against women.’129
Incidentally, the ABC approach and sex-ed tactics of the ‘90s were ideas that we took from President’s Bush’s era of sex education which propagated an abstinence-only outlook.
Mr Singh’s view seems rather preposterous. But it is also widely accepted, as is Bashir Patel’s. Singh is part of a system that administers information, quite literally. They choose what each young person in India should know. And while the Indian state has taken the onus of information dissemination upon itself, it has also withheld the rights of young adolescents: the right to information about their bodies and their sexual rights.
A distressed school principal from Mumbai, whose Class XII student committed suicide last year when she discovered she was pregnant, told me that even though he had tried initiating more rigorous sex-ed programmes after the unfortunate incident, many parents protested. They said they didn’t want their children exposed to these Western evils. Sex a Western evil? Given the burgeoning population of this country, it definitely doesn’t seem so.
There is no evidence from any studies or evaluations that exposing adolescents to comprehensive programmes on sexual and reproductive health leads to increased sexual risk-taking.130 Yet, globally, sex-ed is contentious for varying and seemingly coherent reasons that are in line with other laws and policies of many countries.
For instance, Indonesia, where only 20 per cent of the youth is educated about HIV, is undergoing a sexual education revolution. Activists are mobilizing to make sex-ed a part of the national curriculum. But there is opposition from the Council of Ulema in the Muslim-majority country.
The Philippines is playing a game of Church versus State. In late 2013, the Supreme Court of the country blocked a bill which had been passed by the Congress a few months earlier—to provide free contraceptives to the poor. The main opposition comes from Catholic organizations that say the bill will promote promiscuity and ‘offend the country’s values and would lead to abortion, which remains illegal in the Philippines’.131
In 2013 religious conservatives of the United States were attacking Obama’s healthcare rule that required health plans to cover birth control. Reports stated that many religious institutions filed lawsuits in twelve federal courts to challenge the President’s legislation on employees receiving ‘coverage for contraception in their health insurance policies’.132
Recently Mayor Bloomberg changed things for New York City. He overhauled twenty-year-old rules, and students in the city’s public middle and high schools were required to take sex-educ
ation classes and not just HIV education which had been the norm until then. They would be taught about condom usage and the age at which sex is appropriate. Religious communities started protesting almost immediately. The same thing happened when HIV awareness and sex-ed was sought to be introduced over three decades ago.
So change is slow the world over, but the difference is women and children aren’t getting raped every twenty minutes as in India.133
Sex talk of any kind usually gets flak from some sections of society. Elsewhere in the world, it is always on religious grounds whereas in India it is on ‘cultural’ grounds. Ironically, all this talk issues forth from the same culture that gave the world the Kamasutra and whose myths have celebrated sexuality over millennia.
Religious groups may interpret (or rather misinterpret) texts, but cultural opposition is baseless. Culture is sort of an overarching, all-inclusive term defined by traditions, language, art, food and various attributes of a particular group (be it a group of five or an entire country). India’s culture has a purely ideological adherence to ‘no sex’.
Over the years, sex-ed has been thoroughly researched and evaluated; there is now clear evidence that sex education programmes can actually help young people delay sexual activity by making informed choices and when they do start, to use contraceptives and practise safe sex.
Sex education does more than just reduce the risks of sexual activity like unintended pregnancy and sexually transmitted infections. Instead, it addresses their sexual and reproductive health and well-being ‘more holistically’, as Heather Boonstra of the Guttmacher Institute puts it.134
What works, what will work and what is appropriate for sex education will only be guided by experience and experiment. No scientific theory or formula will spit out a suitable, one-size-fits-all curriculum for a nation of 1.2 billion people, either pro-abstinence or pro-comprehensive sex-education. The social unevenness across India—the rural-urban divide, access to technology, access to the internet—makes it obvious that programme will have to be specifically designed if they are to be effective.
