A training session at CINI
Sarita Santoshini is the 2016 Bitch Media Writing Fellow in Reproductive Rights & Justice.
Names have been changed to protect confidentiality.
In a small village in the state of West Bengal in India, about 40 miles away from Kolkata, I meet Salma, a giggly 17-year-old. Until two years ago, she walked to a public school about half an hour away with her friends, where about 90 other students packed into a classroom to attend lessons. After school, she’d finish household chores while her parents were at work; later, she’d lock the door of her small bedroom and dance to her favorite Bollywood tracks. “I really enjoyed studying and dancing,” Salma says, sitting cross-legged on the bed. It’s been awhile since she’s done either: In 2014, she was married to a boy in the neighborhood who, at 19 years old, now works in the coastal state of Goa and visits for three months every year. The couple loved each other but were married in a hurry against the will of Salma and her parents, who were insistent that they wait a few more years. She doesn’t have fights with her husband or in-laws and spends most of her time with her parents; but she’s been barred from going to school and remains worried about the unfamiliar changes that her body’s going through. “I don’t feel like a teenager anymore,” she complains.
Salma is just one girl among the 47 percent of girls in India who are married before the age of 18, a violation not just of their rights but also their bodies. Twenty-two percent of these girls have a child, putting their bodies at severe risk of complications during pregnancy and childbirth that could result in mortality. While these figures make it all the more important that young girls in India have easy access to reproductive healthcare facilities, the situation continues to be far from ideal. The government has opened more than 6,000 adolescent-friendly clinics across the country with the aim to increase counseling and curative reproductive healthcare services, but a study estimated that only 7 percent of young men and 3 percent of young women had ever received information regarding sexual health from a public healthcare provider. Providers are not adequately trained to address these issues with sensitivity, which means the service and information provided to adolescents is clouded by moral judgement, discomfort, and lack of privacy, more so when a girl is seeking it.
In the state of West Bengal, child marriage is extremely high: A 2011 UNICEF report stated that every second girl here was married before the age of 18. Child in Need Institute (CINI), a nongovernmental organization, set up the Adolescent Resource Centre (ARC) in 2000 to try and reach adolescents in different ways, including community intervention and TEENLINE, a dedicated telephone counseling service that has encouraged young girls living in slums, villages, and rural parts of India to ask questions regarding sexuality and sexual health without any fear or shame. Still, Indrani Bhattacharyya, who leads the ARC, believes without the involvement and support of parents, teachers, and local village bodies, adolescents won’t fully benefit from these initiatives. Monija Bibi Seth, a CINI facilitator, conducts regular awareness meetings for girls in the 10 to17 age group, but those who are married are often asked by their husbands not to attend.
Two of CINI's clients
Pulling out a few bottles of homeopathic medicine from a small cupboard, Salma tells me she’s missed her period for three months now, but she’s not pregnant; she’d asked Seth for pregnancy test kits to confirm. She has never seen her husband use a condom. Her mother-in-law had given her strips of Mala-N, a freely distributed oral contraceptive pill, but the pills made her faint, she explained, and she stopped taking them. It could be polycystic ovary syndrome (PCOS), I tell her. She listens carefully as I explain my personal experience, but she is unsure if she can make regular visits to the doctor. To get a blood test or an ultrasound (which would detect the presence of cysts in or on her ovaries) requires a trip to a private hospital about three miles away and a large sum of money out of her mother’s irregular income of about $3 per day. (Her mother assures me she’ll take her anyway.)
“My in-laws haven’t offered to pay for my medical check-ups,” Salma explains. “And I’m just scared of growing up because my husband said we’d have a baby when I’m 19. I’m not ready,” she adds hesitantly. Apparently, I learn, there were many instances of infertility among married couples in her village. As infertility is generally considered a woman’s problem, husbands and families believed that conceiving at a young age would eliminate the risk of fertility issues—a dangerous mindset that resulted from a dearth of information on reproductive and sexual health.
In the same village, I also meet 19-year-old Fatima, a mother of two who was married at the age of 15. She admits she didn’t seek prenatal care during either of her pregnancies because she feared hospitals and blood tests; likewise, she hasn’t attended the monthly meetings that are conducted to provide information to mothers. “I don’t talk about these things to my husband,” she adds. Seth begins to lecture her, but it’s hard to fault Fatima—she’s an adolescent who wasn’t taught to care for herself at home or in school, and she has little awareness about the repercussions of not paying attention to her reproductive health.
Meanwhile, young girls in urban areas with better educations face similar challenges, even with more accessible medical facilities. It can be difficult, for instance, to find doctors who won’t judge them for their sexual or lifestyle choices—a problem that Delhi-based Amba Azaad, along with three of her friends, decided to address by creating a crowdsourced list of well-trained and trustworthy gynecologists in about 30 towns and cities throughout India. Through social media, they encouraged women to fill out an extensive questionnaire about doctors they’d seen: “Will they support children and teenagers regardless of their sexual history and place their well-being ahead of their guardians’ morality?” “Will they answer all your questions without making you feel immoral, ignorant, helpless, or a nuisance?”
It’s hard not to compare the relative ease of consulting a doctor in a city to the dire situation in rural areas where adolescents are at an economical and geographical disadvantage. “When I got married and moved here, I was clueless. There was no one around to help,” notes Jorina Bibi, Salma’s mother. She points out that things are getting better for girls. It’s true: Sanitary pads and contraceptives are more easily available now, and, thanks to NGOs and facilitators, so is information. Most young women now give birth in health centers instead of homes. But there’s no denying that easy access to more clinics and healthcare services with well-trained doctors will help adolescents take care of their bodies without conforming to norms set out by men.