Sri Lanka – Restricting sterilization: To what purpose? #Vaw #rightoabortion #reproductiverights


 

March 15, 2013,http://www.island.lk/

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I was appalled to read a recent newspaper article that reported a government ban on irreversible methods of contraception. Later I learned that the ban prohibits non-governmental organizations (NGOs) from the provision of sterilization services. According to reliable sources, sterilization services continue to be available through the public sector albeit with additional counseling requirements implemented at some points of access. As this newspaper item coincided with protests against ‘family planning’ held by extremist Buddhist factions concerned about the diminishing ‘Sinhala race’, it is surprising that neither the government nor the Ministry of Health has thus far provided clarification on this issue. In this article, I would like to highlight a few problems with the existing sterilization policy that are unlikely to be resolved through bans or other forms of restriction. Rather than restricting women’s access to contraception to accommodate the views of reactionary groups, it might be more useful to focus our efforts on addressing some of the issues outlined below.

 

General Circular No. 1586 issued by the Office of the Director General of Health Services (1988) includes the following eligibility criteria for sterilization procedures: “1) The clients should be over 26 years of age and should have at least 2 living children; the younger being over 2 years of age. Confirmation of mother’s age should be done by checking the Birth Certificate, Identity Card or any other valid document, which is available; 2) Clients who are over 26 years of age and having 3 or more living children could be sterilized at any time; 3) A client under 26 years of age, and his/her spouse insist on a sterilization, the Medical Officer concerned could use his/her discretion, and perform the sterilization provided the couple has a minimum of 3 living children. In such a situation the officer concerned should personally check the validity of the information provided, in respect of the number of living children, prior to performing the sterilization; and 4) In the event of any medical indication, which warrants sterilization, the client should be referred to a specialist in the relevant field who should make the final decision.”

 

As the subtext of the circular implies, like most contraceptive programmes offered through Ministry of Health, the criteria for sterilization target women. For instance, references to the “mother’s age” and the insistent appeal of the spouse (when the ‘client’ is under 26 years) suggest that women are primary targets of the sterilization programme. In my experience of working for the Ministry of Health, sterilization procedures were, in fact, freely available and did target women, both in terms of availability and accessibility. This is confirmed by data from the most recent Demographic and Health Survey (2006/7): 16.9 % of ‘currently married women’ were sterilized compared with 0.7% of women whose husbands were sterilized (the Demographic and Health Survey is administered to married women and specifies these categories). These statistics must also be considered in light of the fact that the sterilization procedure for men is ‘simpler, safer, easier, and less expensive’ than the procedure for women (WHO, 2007).

 

Importantly, the criteria listed on the circular do not require the ‘client’ to obtain her/his partner’s consent to undergo sterilization (although spousal insistence may add weight to requests from those who are under 26 years of age). Nevertheless, spousal consent is routinely obtained in government institutions before providing sterilization procedures to women (my experience; see also CEDAW Shadow Report, 2010). In my work, I witnessed numerous instances when women’s pleas for sterilization were rejected during Caesarean section simply because the spouse was unavailable to sign a consent form. If these women decide to undergo sterilization on a later date, they are exposed unnecessarily to a second surgical procedure. In this way, doctors take on the role of gatekeepers to contraceptives services, restricting women’s access based on their own gendered presumptions.

 

The Circular of 1988 referenced above was introduced because “[it had] been observed that a significant proportion of females who [underwent] sterilization [were] under 25 years of age, with a notable number being less than 20 years” (General Circular No. 1586). These concerns were valid in the 1980s, a time when coercive tactics were being used as part of the population control agenda imposed on the third world. In 1980, a monetary incentive of Rs. 100 per sterilization procedure was introduced and was subsequently increased to Rs. 500. Surprisingly, this monetary incentive was not omitted in the Circular of 1988 and remains in place today. In fact, another circular was introduced in 2007 in order to “streamline” the payment process so that ‘clients’ would be able to obtain this payment from the institution that provided the sterilization procedure (General Circular No. 01-09/2007). Furthermore, healthcare providers (including the surgeon, anaesthetist and assisting nurses) can still claim, if they so do wish, a negligible sum for sterilization. While Rs. 500 may seem trivial to some of us, continuing to provide incentives for sterilization is problematic and warrants omission.

 

The provision of incentives can be interpreted in many ways, especially when sterilization procedures are mostly sought by particular groups of women. Sterilization is most popular among women in the plantation sector (presumably not Sinhala contradicting the claim of extremist factions in Colombo). According to the Demographic and Health Survey (2006/7), 61% of estate women used a modern method of contraception (including sterilization, contraceptive pills, intra-uterine devices, Depo-Provera, implants, condoms and complete breastfeeding) and 41% resorted to sterilization. In contrast, 54% and 44% of rural and urban women used modern methods of contraception, while 16% and 13% resorted to sterilization (the survey used urban, rural and estate as distinct categories). This set of data completely debunks the proclamations of extremist Buddhist groups who are hell bent on protecting Sinhala women from coercive sterilization. It also makes it incumbent on us to ensure that plantation workers are not coerced into sterilization. On the other hand, the large numbers of estate women accessing sterilization may signify a lack of access to temporary contraceptive options.

 

Imposing restrictions on sterilization may have other implications for women’s health. For instance, it is likely to increase the incidence of unplanned pregnancies. According to the Demographic and Health Survey (2006/7), sterilization is popular among the following categories of women: estate women, women above 35 years of age, women with lower levels of education and women with three or more children. While these associations may point to a need to ensure that these particular groups of women are not coerced into sterilization, it also reflects on who will be most affected by restrictions on sterilization. Not surprisingly, this profile bears similarity to that of women seeking abortion services; induced abortion is most common among rural, married women with at least two children (Senanayake & Willatgamuwa, 2009). Then restrictions on sterilization could result in more women resorting to unsafe abortion, a service that has moved underground since the government led shut down of abortion clinics in 2007.

 

Religious extremism is frequently accompanied by restrictions on access to reproductive health services for women. Although the existing policy is problematic for the reason that in targeting women it burdens them with the responsibility of adopting contraceptive measures, the policy does ensure that sterilization is quite easily accessible to women through the public sector. While there is much room for improvement around health policies governing contraceptive services, such as the removal of incentives and the unofficial requirement of spousal consent for sterilization, imposing restrictions or banning sterilization altogether is hardly the solution. Such restrictions are not only an extension of policies that assume that women are incapable of making decisions concerning their health, but may well be interpreted as an attempt by the state to regulate women’s reproduction in the service of a retrograde agenda of nationalism.

 

Ramya Kumar, MBBS

 

Kandy

 

#Rape- Castration is not the right legal response #Vaw #Torture


ANUP SURENDRANATH, The indu

The view that it will deter rape is misplaced and based on a narrow, sexual intercourse-definition of the crime

There is a fascinating urban legend that Apple’s logo is dedicated to Alan Turing, who committed suicide by biting into a cyanide injected apple. A few years after he was instrumental in breaking the German Enigma code in World War II, Alan Turing was convicted in 1952 for homosexual acts in England. He agreed to the administration of female hormones when faced with incarceration. Apart from the abhorrent aim of such a measure, the scientific claim that hormone injections could alter sexuality proved to be dubious. The intuitive appeal chemical castration has as a method of drastically reducing the incidence of rape, I argue, is largely misplaced because it misunderstands the nature of rape as a crime. Rape is not about sex. Rape is about power, violence, intimidation and humiliation. Attempts to reduce the incidence of rape by controlling the sexual urge of men are bound to be ineffective because they invoke a very shallow and inadequate understanding of rape.

‘More effective’ punishment

Much before the current demand for chemical castration as a legal response to rape, Additional Sessions Judge Kamini Lau, while sentencing Dinesh Yadav in May 2011 for raping his 15-year old step-daughter for four years, called for a debate on castration as an alternative to incarceration in rape cases. Sentencing Dinesh Yadav to the minimum possible punishment of 10 years for such a crime under Section 375(2) of the Indian Penal Code, Judge Lau indicated that castration, surgical or chemical, would perhaps be a far more effective method to prevent rape. While contemplating the legal and ethical aspects of such a measure, it is important that we understand the precise terms of the suggestion, its potential to reduce the incidence of rape and its potential for abuse.

Clarity on the meaning of some of the terms might be useful at this juncture. Surgical castration does not mean removal of the penis, but is instead the irreversible surgical removal of the testosterone producing testes. Chemical castration involves injecting anti-androgen drugs that suppress the production of testosterone as long as the drugs are administered.

Modern legal systems have flirted with biological control of sexual functions for a long time for a variety of reasons. Forced sterilisation of criminals and intellectually disabled people through legislation to protect the purity of the gene pool was seen as an acceptable response to the eugenics movement in Europe and the United States in the early 1900s. The United States Supreme Court inBuck v. Bell (1927), upheld the constitutionality of the 1924 Virginia statute that authorised the forced sterilisation of intellectually disabled people (‘mentally retarded’ was the term in the statute). Vehemently endorsing the eugenic aims of the statute, Justice Oliver Wendell Holmes Jr. permitted the forcible sterilisation of an 18-year old woman, with an alleged mental age of nine years and a family history of intellectual disability, with the infamous words that ‘three generations of imbeciles were enough’. Though Buck v. Bell has never been explicitly over-ruled, the U.S. Supreme Court’s decision in Skinner v. Oklahoma (1942) and the events in Nazi Germany considerably dented the popularity of forced sterilisations as part of the eugenics agenda. Forced sterilisations in the best interest of the intellectually disabled continued in the United States till the early 1980s and it was in the mid-1990s that the debates around chemical castration as a response to rape surfaced as a result of legislation in certain American States.

Once we get past the historical baggage of the term ‘castration,’ the strongest argument in favour of chemical castration is that it is a non-invasive, reversible method of nullifying the production of testosterone and thereby controlling extreme sexual urge. The use of Depo-Provera in many American States subsequent to chemical castration legislation does indicate that it reduces the risk of recidivism. However, such an approach limits the understanding of rape to the framework of sex. Irrespective of the differences in their positions on rape, influential feminists like Susan Brownmiller, Catharine MacKinnon, Andrea Dworkin, Ann Cahill, etc., agree that rape is not about the manifestation of extreme sexual urge. Violence, power, aggression and humiliation are central to understanding rape, and sex is only a mechanism used to achieve those aims.

Addressing the sexual element of rape does not address the violence and humiliation that rape is intended to inflict. Responding to a question on whether chemical castration for child molesters works, Catharine MacKinnon in an interview with Diane Rosenfeld (March 2000) captured the issue at hand by saying that “they just use bottles”. Castration as a response to rape furthers the myth that rape is about the uncontrollable sexual urge of men.

The limited role that sex has to play in understanding rape is further borne out by the fact that not all sex offenders are the same. In essence, an understanding that requires us to look at rapists merely as individuals engaging in deviant sexual behaviour is inaccurate. Rapists fall into different categories including those who deny the commission of the crime or the criminal nature of the act; blame the crime on factors like stress, alcohol, drugs or other non-sexual factors; rape for reasons related to anger, shaming, violence, etc; rape for reasons connected to sexual arousal and specific sexual fantasies, etc. Administering anti-androgens to rapists outside the last category will not be an effective response to check the incidence of rape. Mapping the long standing demand in India to reform the definition of rape (beyond penile-vaginal penetration) to include object/finger-vaginal/anal penetration on to the different categories of sexual offenders shows that a sexual intercourse-based understanding of rape is extremely narrow.

Gender violence

Even the most ardent supporters of chemical castration recognise that administration of anti-androgens without relevant therapies defeats the point of the entire exercise. Given the significant side-effects of chemical castration, a law that would require indefinite administration of anti-androgens for sex offenders is likely to be unconstitutional. Even if the argument is that governments must invest in chemical castration even if it means a minuscule effect on the incidence of rape, it would require State governments to put in place a rigorous system of providing therapy for it to be a constitutional option. Given the condition of state health care services in India, there are very good reasons to be sceptical about the feasibility of providing such therapy.

It is difficult not to succumb to the intuitive appeal of chemical castration as a response to rape. But it is an intuitive appeal that fades away on intense scrutiny. Intuition can be a great asset in politics of all sorts, but it is best avoided while contemplating a law requiring huge public investment, whose potential for abuse is immense and the benefits of which are, at best, uncertain.

Any meaningful attempt to protect women against rape must engage with gendered notions of power entrenched in our families, our marriages, our workplaces, our educational institutions, our religions, our laws, our political parties and, perhaps, worst of all, in our minds. There are many violent manifestations of these entrenched patterns of power in our society and while rape is certainly one of them, it would be a great disservice to empowerment of women in this country to not attach the same kind of urgency and significance to gender violence beyond rape.

(Anup Surendranath is an Assistant Professor of Law, National Law University, Delhi, and doctoral candidate at the Faculty of Law, University of Oxford.)

 

WHO- contradictions- Gag order on Reproductive Health and Guidance for hormonal contraceptive


Invitees who attended back-to-back World Health Organization (WHO) consultations at the start of February were required to sign confidentiality agreements prohibiting them from talking about the meetings. They had to promise not to divulge anything that was said during the three days — not to colleagues, not to their networks, and especially not to journalists, who might misreport the facts. The world health body explained that journalists often exaggerate, and the UN doesn’t want to induce panic. The media will be informed when WHO holds an additional meeting of UN insiders on February 15, behind closed doors, and prepares a carefully worded public statement for release the next day.

The highly classified topic of discussion wasn’t a nuclear threat or a new virus that can kill within days. It was birth control.

WHO’s gag order is just the latest in a years-long effort by the United Nations’ AIDS apparatus to limit how much women know about possible links between HIV and injectable hormonal contraceptives. The UN appears to have forgotten that its job is not to control women’s sexual and reproductive decisions, but to inform them.

Here’s what the UN knows: In July 2011, researchers led by Renee Heffron at the University of Washington in Seattle presented findings from studies involving 3,790 sero-discordant couples (one HIV-negative and one HIV-positive partner) in east and southern Africa.1 The data compared women who had and women who had not used hormonal contraceptives during the research periods: twice as many HIV-negative hormonal contraceptive users acquired the virus. The rates of transmission from HIV-positive women to their male partners was also two times higher for users of hormonal contraceptives. (The findings focused on injectables because very few study participants took hormonal contraceptives in pill form, making the higher rates of HIV infection and transmission in that group “statistically insignificant.”)

In laypersons’ terms, hormonal contraceptives are products that adjust a woman’s hormone levels to prevent ovulation and pregnancy. In the east and southern African countries where the research was carried out, injectable hormonal contraceptives (“depot medroxyprogesterone acetate,” or DMPA) are the top choice of women who use contraceptives, and the Depo-Provera brand owned by pharmaceutical giant Pfizer, Inc. is the most widely used. Despite common side effects, popular features of the method are that one injection lasts three months, and a woman’s sex partner need not know that she is using a contraceptive.

The findings by Heffron and colleagues weren’t definitive; it would take years of additional research to determine beyond a doubt whether or not hormonal contraceptives actually double women’s risks of acquiring or transmitting HIV during unprotected sex. But the research team was concerned enough last July to say: “Our findings argue for policies to counsel women about the potential for increased HIV-1 risk with hormonal contraceptive use, especially injectable DMPA use, and the importance of dual protection with condoms to decrease HIV-1 risk.”

Read Original Artical here

and GUESS WHAT ?, WHO has just declared that “hormonal contraceptives are safe to use for women with or at risk of HIV” based on the meetings discussed below.

WHO upholds guidance on hormonal contraceptive use and HIV

Geneva, 16 February 2012. WHO has concluded, on the advice of its Guidelines Review Committee, that women living with HIV or at high risk of HIV can safely continue to use hormonal contraceptives to prevent pregnancy. The recommendation follows a thorough review of evidence about links between hormonal contraceptive use and HIV acquisition.

Current WHO recommendations in the Medical eligibility criteria for contraceptive use (2009 edition) therefore remain: there are no restrictions on the use of any hormonal contraceptive method for women living with HIV or at high risk of HIV. Couples seeking to prevent both unintended pregnancy and HIV should be strongly advised to use dual protection – condoms and another effective contraceptive method, such as hormonal contraceptives.

Read more here

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