• Tuesday, Sep 29, 2020
  • Last Update : 01:37 pm

The elephants in the ob/gyn room

  • Published at 08:22 pm August 7th, 2020

Ever since the first death from Covid was announced in Bangladesh in March, doctors have regularly made the headlines, but not always for battling at the frontlines.  The range of allegations against them include: Not reporting for duty, neglect of patients, selling fake Covid negative certificates, and most recently for telling a client she ought to be “raped”.

Of the latter, I shall refrain from mentioning names and places until the due investigation has been completed. Needless to say, the incident created a social media storm, and I gathered from comments and conversations, that visiting gynecologists in this country to discuss sexual and reproductive health matters is generally an unpleasant experience for many, both unmarried and married.  I am curious, therefore, to explore why women doctors and their women clients are unable to establish a rapport -- given that in Bangladesh, female kinship ties are strong. 

Let us begin with definitions. While OB/GYN is considered one specialty, it comprises of two distinct fields: Obstetrics (the OB) which involves care during pre-conception, pregnancy, childbirth, and immediately after delivery, and Gynaecology (the GYN) which involves care of all women's health issues. 

Since gynaecology is the overall science of women, (while andrology is the science of men) and in urban settings there are qualified doctors (ob-gyns) available to address problems arising in issues of sex and reproduction, yet there is an overall dissatisfaction with their services.  From the ‘talk’, I gather that religious and cultural norms, feminism, and modernism enter a conflicting space -- which should otherwise be neutral. 

What do we mean by sexual and reproductive health? A state of physical, mental, and social well-being in matters relating to the reproductive system. Women should have safe sex, be protected from sexually transmitted diseases, and if preferable and possible, maintain the ability to reproduce, and the autonomy to decide when and how often to do so, all free from coercion, discrimination and violence. Reproductive health is also meant to reduce unintended pregnancies.

Ideally, the sexual and reproductive right of a woman demands that she have control over her own body and reproductive behaviour, and take her own decisions. However, in practice,  the cultural norms dictate that a girl’s body is considered the property of her future husband, and keeping her virginity intact is a serious preoccupation. To allow others access to her body is cheating on a future husband and giving away something that does not belong to her.

It is haram to be teaching a young girl about sex, and traditionally, it is her grandmother, an aunt or an in-law who takes the initiative in educating her about sexual matters before her marriage. As far as reproductive health is concerned, mothers-in-law are often authorized to take decisions on the daughter-in-law's behalf. Therefore, young girls are not given the education they need, nor the power, to make informed choices. Their rights are suspended under the guise of religion and culture. 

The legal age of marriage is 18, but under special circumstances, girls under 18 can be married, and statistics indicate an alarming percentage of the girls are, in fact, underage -- giving Bangladesh the distinction of having one of the highest child marriage rates in the world. 

Once married, sex is ‘legal’ -- and I refer to Section 375 of the Penal Code which states, “sexual intercourse by a man with his own wife, the wife not being under thirteen years of age , is not rape”,  and defines statutory rape as “with or without her consent, when she is under fourteen years of age”. This section also provides for marriage as a defence against rape. 

Therefore, by implication, the age of consent is 14, yet if one is married by then, then technically the husband can override the consent, and marital rape  cannot occur. 

The attitude of being able to own one’s wife’s body, along with the paradoxical legalities, is probably why marital rape is prevalent, and to avoid the violence, women become subservient and compliant. Research illustrates that once married, a woman’s status is determined by her husband’s identity, and she is expected to sacrifice herself for his needs. This has led to a vast majority of (girls) women feeling insecure about their ability to please their (future) husbands sexually, and the concern that if they cannot satisfy the man, he will go to a sex worker or have an extramarital affair. This, once again, makes the concept of consent rather indistinct. 

What of women engaging in premarital sex? Well, as with marital rape, this issue is rarely addressed in the public domain, as it is an undesirable circumstance. Consensual teenage sex leads to pregnancies and illegal marriages, and young girls are forced to marry their rapists if they become impregnated, thereby legitimising statutory rape. With these norms, it should be no surprise then that Bangladesh has the highest adolescent fertility rate in South Asia, where 1 girl in 10 has a child before the age of 15, whereas 1 in 3 adolescents becomes a mother or pregnant by the age of 19. 

And what of extra marital sex? It is known that many child brides are subsequently forced into prostitution. Consent? Her body is owned by the husband, remember, despite Section 372 and 373 declaring stringent punishment for trafficking of those under 18.  Reports state that girls as young as 11 are working in brothels, taking steroids to enhance their physical development. Prostitution is legal since the year 2000, and sex workers are supposed to have State Magistrate-approved certificates to prove they are over 18, when the reality is not all of them are. How is it, then, that engaging in sexual acts with a girl younger than 14 is not rape? Because she is a sex worker? But how can she legally be one if she is not yet 18? Or if she is married? 

Section 497 states: Whoever has sexual intercourse with a person who is and whom he knows or has reason to believe to be the wife of another man, without the consent or connivance of that man, such sexual intercourse not amounting to the offence of rape, is guilty of the offence of adultery, and shall be punished with imprisonment of either description for a term which may extend to five years, or with fine, or with both. In such case the wife shall not be punished as an abettor. This indicates that with consent and connivance, sex with another man’s wife is legally acceptable. Therefore, a young girl can be married and used for prostitution, all within legal bounds. 

Let me stop here. If I seem to be rambling, it is because I am trying to perceive the complexities of sexuality and reproduction in Bangladesh, which is fraught with ambiguities. Age, consensual sex, pregnancy, rape, prostitution, and legality have somehow become intertwined with poverty, religious norms, tradition, and education and feminism, and I am unable to grasp any clarity, much rather present it in my writing. I have, however, surmised that a woman’s body is not her own. 

Now back to the beginning. What does all this information have to do with a client discussing her sexual and reproductive issues with an ob/gyn? Everything. Women may have sexual and reproductive rights in theory, but not in practice. There are no clearly defined and delineated boundaries, and though marriage is exalted and singlehood shunned, sex and reproduction are mired in stigma and prejudice, suspicion and imposition. 

Therefore, any discussion becomes uneasy, offensive, and defensive. In the ob/gyn consulting room, the urban and rural culture overrides science and compassion to produce a very judgemental and hostile space, which leaves many women attempting to establish control over their reproductive systems feeling angry and exposed, shamed and humiliated. Unless we start having a positive and respectful approach to sexuality and reproduction, and unless we give women the autonomy they deserve, a good working relationship between ob/gyns and their clients will be few and far between. 

Chintamoni grew up in Dhaka, where she will always belong, but never quite fit in. She is an enthusiastic traveller, a compulsive procrastinator, and a contumelious raconteur.

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