|HER WORLD||Sunday, January 25, 2004, Chandigarh, India|
still used on women
longer the only answer
THE close knit family system in India masks an alarming amount of sexual abuse of children by family members, according to the report of a recent survey by an NGO. The report notes that more and more girls are being sexually abused in their childhood.
According to the findings of the survey conducted by RAHI (Recovering and healing from incest) Foundation among capital’s college students, an overwhelming 70.5 per cent girls said that women college students "talk" about their childhood sexual abuse experiences, including incest.
"We cannot assume that all 70.5 per cent underwent abuse but this just goes to show that others have shared their experiences or they know of people with whom these have been shared," says Anuj Gupta, Executive Director, RAHI.
Incest is, by far, the most common but least talked about oppression that many young girls silently suffer and survive in the country.
"We can substantiate this fact by the findings of another survey conducted by our organisation sometime back. Out of 600 women that we spoke to as many as 40 per cent admitted to incest," Gupta says, adding according to the main findings three-quarters of upper and middle class Indian women are abused by family members — more than often an uncle, a cousin or an elder brother.
Mental Health professionals say the particular problem in India is that the concept of family is almost sacred, and abuse, if it happens is met with disbelief.
"The structure and fabric of the Indian family system is such that most of the incest cases go unreported. Even if the family members come to know about it, they try to cover it up due to fear of harming the name of the family", says Dr Jitendra Nagpal, consultant psychiatrist at Vidyasagar Institute of Mental Health and Neurosciences (VIMHANS), Delhi.
"Morever, even if the family members come to know about the abuse the most common way of dealing with it is to avoid talking about it with the child. They think that the child will forget about it if the matter is not discussed with the child or anyone else," says Gupta.
"This has the most devastating effect on the victims as whatever is suppressed will come out at a later stage of life in some other way," Dr Nagpal cautions.
Elaborating about the long-term effect of sexual abuse on the child’s growth, Dr Nagpal says: "Sexual abuse of this nature cracks the self esteem of the victim. Besides low Self-esteem and sense of helplessness, the victims also face difficulty in forming meaningful relationships when they grow up and they might even suffer from Post Traumatic Stress Disorder (PTSD). In extreme situations, the victim can even contemplate committing suicide."
Activists in the field say another problem facing victims of incest abuse in India is the complete absence of any structure outside the family to help the victim.
According to Gupta, activists often face the grimmest of choices when considering how to help the victim: "Since the crime involves those who are trusted and also loved, it makes it difficult for the child to speak out openly. And even when they do they find very little support".
Also, the law does not provide any respite to these victims. "In India incest victims hardly get support from the government. There is no specific law covering sexual abuse of children by strangers, let alone by family members.
According to law, incest falls under the provision of ‘unnatural offences’ under Section 377 of the Indian Penal Code. Unfortunately, most courts interpret this section only in case of sodomy. But incest, under the law of nature, falls in the category of unnatural offences, to find a solution to the problem, before we help the victim, we need to believe that it has happened. There is denial of reality that it can happen to my child, to someone known to us. There is need to create a social climate that incest exists."
"If a child comes forward with such problem, the situation calls for ‘crisis intervention’. First of all efforts must be made to protect the child from any further abuse and the victim should be given a patient hearing to ensure she shares the painful experience and feelings with a knowledgeable and concerned individual, within a safe and supportive environment," says Dr Nagpal.
"Personalised counselling with medication can also help in some cases and the situation also calls for long-term rehabilitation from family and support agencies," Dr Nagpal adds.
Also in the survey 92 per
cent of the respondents said that students would benefit from training
on how to respond appropriately when their friends talk about their
incest experiences; so we are also planning disclosure training
workshops for students that teach them how to help a friend who is an
incest survivor, says Gupta.
still used on women
WOMEN in rural and semi-urban areas of West Bengal continue to be guinea pigs for unsafe sterilisation methods. A recent study reveals that Quinacrine, a drug banned in India in 1998, is still in use as an intra-uterine drug for sterilisation.
Quinacrine was originally used during World War II as an anti-malaria drug. But in the 1960s, Dr Jamie Zipper of Chile discovered its anti-fertility qualities. Later, two US doctors, Stephen Mumford and Elton Kessel, collaborated with Zipper to make the semi-liquid mixture into solid pellets.
Quinacrine acts like a corroding agent that burns the uterine tissue and forms scabs. The inflammatory response results in the formation of scar tissues blocking the fallopian tube, leading to irreversible sterilisation. The drug was promoted in several poor countries, but by the mid-1990s
several research studies declared it was unsafe for women. The recent study, 'Quinacrine non-surgical sterilisations in West Bengal:
What we learnt from the women on the ground', claims that though the Supreme Court banned Quinacrine five years ago, its use continues on poor and illiterate women. The study was presented at a policy workshop supported by the West Bengal Women's Commission (WBWC).
The study claims that some eminent Kolkata-based gynaecologists extensively prescribed the drug in the past. A WBWC member even claimed at the workshop that a well-known city gynaecologist recently appealed to the Drug Controller of India to remove the ban on Quinacrine.
Funded by the MacArthur Foundation, the study was led by Dr Shree Mulay, Director of the Centre for Research and Teaching on Women at the McGill University, Canada, and included Indian journalist Rajashri Dasgupta and economist Navsharan Singh.
For a period of two years, starting from 2001, the team interviewed 62 women in Uluberia area, Howrah district; 32 had been sterilised with Quinacrine and 30 underwent surgical sterilisation (SS). This region was chosen after researchers heard about the widespread use of Quinacrine here. Besides, the National Family Health Survey-2 data shows that there is poor access to healthcare and a high percentage of infant mortality in the region.
Very few women interviewed reported satisfactory health after using Quinacrine. Says gynaecologist Dr Sanjib Mukherjee, who examined the women, "Most of the women revealed significant cervical problems." (Tests have revealed that Quinacrine causes mutation of cells. It can also cause tubal pregnancy and internal haemorrhage which could be fatal.)
At least 13 out of 32 women had cervix that bled on touch and some needed cervical biopsies. Women also complained about abdominal pain, dizziness, sweating and low blood pressure.
There was also one case of cervical cancer found in a woman. Half the women noticed changes in the menstrual cycles after using Quinacrine.
Why did they choose Quinacrine? "Convenient, simple and painless" were some reasons given besides fear of surgery and hospitalisation. Most of the women who used Quinacrine or SS were about 28 years old. Many were illiterate. Their husbands were wage labourers or petty traders and didn't want to bear the costs of sterilisation. Informed choice was not given to the women. Besides, there was no follow-up after the procedure to keep track of the women who used Quinacrine.
The study found that women would rather approach quacks who were community-based, than go to government doctors for SS. While SS is provided free by the government, women interviewed for the study claimed there were long waits for a bed and that they were often harassed by the hospital workers. Quinacrine appeared to be a more convenient alternative. Most women said in the study that they were approached by people posing as `health providers' for the Quinacrine treatment. Sometimes midwives used Quinacrine for sterilisation. The West Bengal study claims qualified city doctors trained unqualified rural practitioners with the Quinacrine method
and even supplied them with the pellets. Dr Zipper had visited Kolkata in 1970 to train doctors in Quinacrine.
Some people suggested in
the study that the pellets were sometimes smuggled from neighbouring
countries. Importantly, the providers were aware that Quinacrine is
banned. According to the study, the women do want to put a stop to
having more babies. One woman said she was "ashamed" to have
more children. This shows a shift in attitude and preference for smaller
families. It also indicates women's vulnerability to risky sterilisation
methods in the absence of an adequate healthcare system. In the 1960s,
the aggressive population control campaigns worldwide made women their
prime targets: the onus of birth control was put wholly on women. Not
much has changed since then. Although in 1994 the World Health
Organisation warned that the use of Quinacrine should be stopped
immediately as full laboratory and animal testing for toxicity and
carcinogenicity have not be done, in many countries it is still used
clandestinely. In 1998, the US Food and Drug Administration also called
for the 'immediate halt' of the distribution, import and manufacture of
the drug and even destroyed a stock of 290,000 pellets. But despite the
warnings, in the last decade, over 100,000 women in 25 developing
countries like Chile, China, Egypt, Iran, Pakistan, the Philippines,
Venezuela, Vietnam and India were sterilised with Quinacrine.
no longer the only answer
THE advances in the surgical treatment of gynaecological problems is truly amazing ! There is hardly any problem inside or outside the uterus which cannot be surgically corrected using the operating hysteroscope or the laparoscope. The future is now here when practically every problem has simpler ways to tackle it —balloon therapies for heavy periods and tapes to support the urinary tube if there is ' leak ' of urine on coughing or laughing. Today we can even place lower dose of medicines inside the body just where they are needed ( SAM—surgically administered methotrexate in pregnancy occurring in the tube ). Robots or 'moving machine men' are already performing surgeries on the heart ; with AESOP (automated endoscopic surgical operative positioning), the gynaecologist can perform minimally invasive laparoscopic surgeries using robots.The ultimate aim of a healer is to provide relief by surgical or medical means. Fascinating as these surgical advances are to the gynaecologist for whom minimally invasive surgeries are a passion, equally beautiful are the advances in gynaecological cures by drugs.
If you have not been able to conceive, there are so many drugs and combinations that give better results in each successive cycle. Combine this with artificial insemination (IUI—intra-uterine insemination) with the most motile sperms washed from fresh semen to further enhance success rates.
What to do if your husband's semen does'nt have any 'good' sperms? The sperms can be removed directly from the sperm apparatus in men and injected into the egg from the woman (ICSI—intra-cytoplasmic sperm injection). In case mature sperms are not formed at all, just the genetic material from the immature sperm will do the trick (ROSNI - round spermatid nuclear injection).This is not presently available, but certainly you could try the simple home kits for checking out your fertile days.
If you are one of those who does not want a baby, why not use good contraceptives? Contraceptives are not just for the married girls .The decision to be sexually active even without marriage has to be taken after serious thought and protection against an unwanted pregnancy is important. Some of the daily low dose pills can also control abnormal hair growth in areas which are considered 'male areas', like the moustache, beard areas, chest and back. If you are not on any regular 'pills', but are apprehensive of events the night before, the "morning after pill" as emergency contraception (two tablets 12 hours apart) is what you need. Always remember, however, that pills can effectively prevent a pregnancy, but cannot prevent sexually transmitted diseases and infections. Therefore the age-old wisdom of using both :Pills by the woman and condom by the man still holds true.
Most of the contraceptive pills, injections and patches have both the female hormones: estrogen and progesterone. If these bring on headaches, nausea or weight gain, you could try the progesterone-only pills. These, in addition to contraception, provide relief from excessive periods and period pains. If you cannot take daily pills, then a new device like the Copper-T but with progesterone instead of copper wire can be introduced in the uterus with same benefits.
If despite this there is a pregnancy, you could opt to abort it with medicines rather than a surgical procedure. Medical abortion , though safer, may require about four visits to the doctor , is best within two weeks of missed period, and may fail in 5 -10 per cent of the cases. In the event of very severe pain or bleeding (greater than four thick sanitary pads over two hours) it is wise to see your doctor.
One of the greatest fears of the pregnant woman is whether her child will be normal or not . Today, three and even four-dimensional ultrasound is available to check out the unborn baby for defects in formation and for signs like thickening at the back of the neck which is an indicator of Down's syndrome. The chances of having this very common cause of mental retardation is checked in high-risk cases by a blood test on the mother (Triple Test). Better results are available by evaluating four hormone levels in the mother (Quadruple Test) instead of three. Testing can also be done earlier than 15 weeks of pregnancy by estimation of the pregnancy associated plasma protein A (PAPPA).
As far as the delivery is concerned, painless deliveries is very routine now. What is catching the fancy and accepted the world over is 'programmed labour', wherein the day of delivery is predecided by the patient and her doctor mainly to eliminate night time and emergency hour deliveries and thereby decrease complication rates. All this, provided there is no complication of pregnancy which requires another decision.
Even as the fear of pregnancy is decreasing, the phobia of menopause still remains. Hormone replacement therapy is a big no-no today because of probable risks of breast cancer. This issue is likely to clarify by late next year. Till such time, excellent alternatives are available for all needs, be it hot flushes, porous bones and fractures and those patients who need help but have apprehension of breast cancer.
A significant decrease has been seen in cancer of the cervix (opening of the uterus) because of annual screening by the PAP smear test. This is a simple spread made of cells from the cervix onto a slide and examined under the microscope to checkout abnormal cells. Since there is a very strong association between infection of the cervix with the human papilloma virus and development of cancer several years later, it is prudent to also check for the presence of this virus in another cervical smear specially collected for this purpose (HPV DNA Hybrid Capture 2 System).
Some of the older traditions are still as good as gold but newer "gold standards" are being set rapidly in this fast-changing world. It is always wise to explore newer techniques and managements, especially if they are available at your doorstep.
(Senior gynaecologist, endoscopic surgeon)