Sex is fundamental to the human experience, yet for so many people it is one of the hardest things to talk about.
As a woman of colour, sex and reproduction were definitely taboo topics when I was growing up – it’s not typically discussed in most Indian households. To date, I count wading through a discussion in ‘Hinglish’ about periods and contraception with my very Indian grandma as one of my personal successes.
However, as I got older, I started to question the origin of the stigma surrounding sex in my community, which eventually led me to become a sexual and reproductive health doctor.
I now work as part of the collective Decolonising Contraception, a not-for-profit organisation formed by people of colour for people of colour.
Our members not only recognise the cultural barriers faced by people of colour in accessing sexual and reproductive healthcare, but have actually lived them too.
We know that there are huge disparities within our field. Compared to white women, lower proportions of women of colour seek contraception from their GPs, Black women have a higher rate of repeat contraception use and South Asian patients often suffer from taboo when accessing services.
The reasons for these disparities are not entirely clear. The last national survey of sexual attitudes and lifestyles by The Lancet asked whether the differences were due to deprivation, mental health or education – and the conclusion was that they are not.
There is something perhaps not measurable by research and a bit more sinister that plays a part in driving these ethnic inequalities – history.
Colonised populations have long had their reproductive freedom curtailed. For instance, Puerto Rican women were experimented on during clinical trials for the modern combined contraceptive pill, Black Americans have an extensive history of forced sterilisation and over six million Indian men were sterilised in 1976 alone.
This is just the tip of the iceberg.
Every day, I see how these events have manifested in my community. For many of my patients, our meeting is the first time they have ever seen a sexual and reproductive healthcare professional.
People of colour often seek our services only when they are at a crisis point – maybe they have symptoms, require emergency contraception or want to discuss options for an unintended pregnancy.
Many also frequently tell me that medical professionals do not have their best interests at heart – they feel as if they are characterised as irresponsible and that contraception is thrust on them with minimal explanation.
Individual communities face unique challenges around sexual and reproductive health and cultural attitudes shape patients’ journeys.
While I wasn’t raised in the exact same culture as some of my patients, I understand the challenges they face and this helps them to open up.
When a South Asian patient returns to have her implant urgently removed because her mum says it will make her infertile, I can see that the concerns may run deeper than the purely physical, and that discussion requires more time.
Contraception and fertility choices can be driven by the enmeshment of religion and culture. As an example, those that attend mosque or temple may struggle to use methods that cause irregular bleeding as some historical cultural practices state that women shouldn’t attend places of worship when on their periods.
Individual communities face unique challenges around sexual and reproductive health, and cultural attitudes shape patients’ journeys. Not all stigma is exclusive to people of colour, but if we seek to tackle poor access for those who have the worst outcomes, then we can all benefit.
We should all be striving to find more methods of contraception that cater to a wider demographic.
I welcome new developments, such as a contraceptive gel for men and online contraception prescriptions, but we need to be mindful that innovation is only part of the solution. If we are all to be empowered and lead safe, fulfilling sex lives, then the fear that has arisen in communities from previously colonised countries must be addressed.
That relationships and sex education is now part of the national curriculum is a great step forward, as more young people will become equipped to talk about these problems. However, families and communities can also impact how easily you are able to view sexual and reproductive health, so honest, non-judgemental conversations in those safe spaces are essential.
This can start as simply as mothers sharing their first period stories with their daughters, or young people asking older relatives what they think about relationships. Assumptions should be left at the door – often answers to these questions can be surprising and lead to more discussion.
Listen more, talk less, and thank people for sharing their views – even if you don’t agree with them because understanding the barriers to contraception and health care is the first step to solving them.
I hope for a world that acknowledges the historic abuse of contraception, yet recognises that contraception is about everyone, and isn’t just a women’s problem.
It can and should be liberating to provide users with the opportunity to plan their pregnancies and their lives – and to have the freedom to choose.
Tickets for Decolonise Contraception’s Pleasure and Vibes event are available at eventbrite.co.uk
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