On hope, bodily autonomy and sustainable change making: A regional dialogue on GBV and SRHR as a public health issue

Richa Sharma

Every human is entitled to live a dignified life. This right to a dignified life is enshrined in the country’s constitution, as well as the Universal Declaration of Human Rights. It’s a complex mix of ensuring a number of interdependent factors like food, shelter, health, security, bodily autonomy, education and employment. To ensure all of these factors, one inevitably has to look at how a person’s socioeconomic position in society impacts their access to these entitlements. Furthermore, it doesn’t come as a major shock that there is a significantly large set of people who are systematically denied these basic entitlements. Owing to the patriarchal society we live in, this set of population primarily consist of women and persons of gender diverse/non-gender conforming identities, including those at the intersectionality of (dis)ability, caste, class, ethnicity, religion, age, region, language, and sexual orientation. Not only is their agency undermined and dismissed, but also actively challenged, manifesting in the different forms of discrimination, gender-based violence (GBV), and in-accessibility to basic healthcare in general and sexual and reproductive healthcare in particular. 

With such discriminations and inequity prevalent to such an extent, how does one deal with these issues? The answer, I believe, lies in sustained engagement. Keeping the conversations, discussion and opposition to such forms of discrimination going is the one way to continue addressing this issue. Those of us who are privileged in terms of our socio-economic and political positioning in the society, the onus is also on us to continue the fight to resist oppression and support the movement building for change making. 

This tireless work and dedication is what is at the core of the effort that Sama has been putting consistently into movement building. Sama’s concern has been to work and build awareness and knowledge on how GBV is a public health issue. For this purpose, it has been working tirelessly with the local and regional as well as national and international partners. Through sustained engagement with these partners for the past several years, Sama has ensured to build awareness regarding it being of paramount importance that the language we use is inclusive and non-discriminatory along with having a survivor-centred rights-based approach. It is also in this spirit that a Regional Dialogue on Collective Challenges to Gender Based Violence (GBV) and Ways Forward was organized by Sama on February 20–21, 2024; over an online Zoom meeting platform. This consultation was done in Hindi/spoken language.

The Regional Dialogue on GBV: bringing diverse changemakers together

The primary focus of the two-day regional dialogue organized by Sama was not to particularly impart new knowledge which had been covered in preceding dialogues with these organisations; but rather to pause and reflect, and to provide a safe space to individuals and organizations working on issues related to GBV and Sexual and Reproductive Health and Rights (SRHR) of women and gender diverse people to come together and share their experiences and learn from each other. More than 100 participants from over 45 organizations participated in this event, working on the issues of intersectional discrimination, transgender rights, disability rights, holistic education, access to SRHR, fight against GBV, etc. For over the last two years, whatever sort of engagement (in the form of short courses, workshops, etc.) was built with the various stakeholders and individuals in the states of Jharkhand, Odisha and Bihar came together online to share their understandings, developments and suggestions/ recommendations, regarding issues of GBV, SRHR, and the challenges through their field experiences in working on them. While there were some panellists who took up specific issues of concern, the conversations among participants however, were free flowing; allowing various individuals to share their experiences and perspectives with everyone. The major themes of discussion which came up as a result of conversations among participants broadly included issues of agency of women and gender diverse people on their own body in terms of seeking SRH services along with survivor centred lens. The need of strengthening an intersectional lens while looking at issues of GBV and access to SRH, multi-sectoral response to GBV focused on health systems, police and other service providers. 

A key takeaway through indulging in the regional dialogue has been the realization that the idea and conceptualization of bodily autonomy, and the agency that women and gender diverse people should have over their own bodies is a parameter constantly touched upon during all discussions by the participants themselves. While several of the participants also shared how their understanding of dealing with GBV cases and SRHR, or their approach basically has undergone changes ever since engaging into conversations and workshops with Sama. The focus they now realize and affirm should be on the immediate needs of the survivor. The participants of our short courses/workshops, etc. and the work they are doing at the ground level with survivors of GBV, or in cases of SRHR, it is primarily through them that we can draw a tangible output of the efforts into awareness and movement building that we have been putting in. It is through the way they approach the issue—not just in discussion over pre-moderated workshops but in actual actionable terms—that we can gather a sense of growing awareness in the society. This being said, it needs to be acknowledged that the conceptions of acknowledging the bodily autonomy and needs of women and survivors of GBV were not absent from the discussions, however the sustained efforts to actively focus on survivor centred approach has led to more conscious developments.

Bodily autonomy, safe abortion, and adolescent access to SRHR

We understand how sexuality is a core issue related to gender, GBV and SRHR. The prevalence of GBV, the root cause behind it and the challenges, all are heavily dependent upon the assertion of control over the sexuality of women and non-gender conforming people by the cis-het men and those benefiting primarily from patriarchal norms. The assertion of sexuality by non-gender conforming people including those from LGBTQIA+ communities directly challenge the patriarchal notion of sexuality i.e., to be seen strictly for reproduction. Rather, it further ‘digresses’ from that notion by promoting sexuality and the expression of it in terms of sexual identity and orientation as a fluid concept, free from patriarchal chains and focusing on agency, expression and pleasure. In context to women who are in heterosexual relationships, it is yet again the need to establish a control over their reproductive role, dismissing their agency, that more often than not is a potential cause of GBV among other causes. When one looks at GBV, they have to inevitably look at how it affects the health of the individuals- both general as well as sexual and reproductive health in particular.

Despite the diverse manifestations of GBV, efforts to address it often focused on policing and punishment, while neglecting survivors’ broader rights, including agency and decision-making. Owing to their socio-economic identity, women and gender non-conforming people of different caste, class, language, age, (dis)abilities and religion face a systemic challenge in asserting agency over their body. It is as if the body is a site of family and community honour, vulnerable to policing and decision making by everyone else, other than the person themselves. Addressing this cannot mean just focusing on medico legal aspects alone but rather delving deeper into the social context and identifying the core factors that lead to manifestation of control of sexuality in the form of GBV.

Following are some of the community voices from the regional consultation that further enrich this discussion:

Sushma who founded the Swabhimaan organization in Bokaro, Jharkhand, to work with local women and has been a frequent member of the sessions conducted by Sama for the last 5 years, shared the challenges faced by young girls in accessing SRH services, including safe abortion. She shared how the families and healthcare service providers at the local level lack any sort of gender sensitivity. Sharing an anecdote of a local woman seeking surgical contraception at the local hospital, Sushma ji mentioned how the doctor refused to conduct the procedure in the absence of the woman’s husband.

“महिला अपनी पति के बिना  कोई  सेवा नहीं ले सकती है क्या ? जब महिलाए अस्पताल में सेवा लेना चाहती है फिर भी डॉक्टर आसानी से सेवाएं नहीं देते है।”

“Can women not access any services without their husbands? When women willingly visit hospitals to get medical services even then doctors do not offer those services easily.”

The emphasis on ‘willing visit to hospitals’ is very interesting here as it often gets discussed that how women are mistreated when they affirmatively seek services and care they want; it compels us to imagine how this treatment would be when the same woman is going after facing violence, something to which she had not consented to begin with.

Nagma from Akanksha Seva Sadan in Bihar also added to this:

“महिला को बच्चा पैदा करना है या नहीं करना यह महिला का निर्णय होना चाहिए। यदि बच्चा करना है तो कब बच्चा पैदा करे कितने बच्चे पैदा करेंगी, और गर्भ निरोध साधन इस्तेमाल करना है या नहीं, यदि गर्भनिरोध इस्तेमाल करना है तो उसे यह सुविधा कहाँ से मिलेंगी इसकी जानकारी होनी चाहिए।”

“Whether a woman wants to give birth to a child or not, the decision should be hers. If she wants children, then how many; whether or not she wants to use contraception, and if she wants to use contraception then where can she access the service – all of this information should be accessible for women.”

Reflections such as these reiterate some of the pivotal discussions that Sama has led with these leaders and organisations toward collectivising a feminist stronghold on intricate issues of GBV, access to healthcare and sexual and reproductive health rights and justice (SRHRJ).

Social identity, inclusivity and intersectionality 

Women are not a homogenous category. Moreover, GBV impacts not just women but also gender non-conforming people, especially those from the marginalized socio-economic segments of the society. Despite continued discussion/work to understand the prevalence and different forms of GBV, while furthering the understanding of gender intersections and dynamics, and recognition of the struggles of different gender identities, some challenges still remain. Manifestation of GBV and structural oppression varies immensely for people from different intersections of socio-economic and cultural identity. Sharing an anecdote from their own life, one participant shared how the local hospitals are ill-equipped not just in terms of accessibility for disabled people but also further do not offer a number of services and medicines. 

Shilpi, who works with Aaina Organization (Odisha) and is a disability rights activist shared how oftentimes when responding to persons with disability, people often reduce their entire identity to their disability. She asserted the need to be more inclusive and accommodative to the needs of disabled people and shed away the pity perspective when talking to and about disabled people.

Disability indeed needs to be seen as it is, and much of the ableist world, societies and all of us within this struggle to do this.

Working with the Queer Collective in Jharkhand on the issue of transgender rights and LGBTQIA+ folks, Souvik shared his opinions extensively on the health, education and employment as well as the violence and discrimination faced by transgender people. Facing ostracization from sometimes their own families, transgender people face challenges in accessing health care as well as any form of redressal during instances in GBV. 

“ट्रांस व्यक्तियों के साथ परिवार, समाज, शिक्षा व्यवस्था, स्वास्थ्य व्यवस्था द्वारा हिंसा, भेदभाव हो रही है। ट्रांस लोगों के एस आर एच आर की जरूरत अन्य महिलाओं की अपेक्षा अलग होते है।”

“Trans people face discrimination from family, society, education system, and violence by the health care department. The SRHR needs of transgender people are different from other women.”

Participants of the session shared and agreed on how there is a collective need to accept that women and other gender diverse persons from different sections of the society experience GBV in varying forms and there is no ‘one solution fits all’ approach to address it. While they already face a strong challenge in getting their sexual and reproductive health needs addressed, owing to lack of agency, patriarchal control over body and decision making, etc., these challenges become further contextually difficult owing to their intersectional identity and locations. 

Multi-sectorality of the approach

This aspect lies at the core of developing a survivor centred approach – focusing contextually on the immediate needs of GBV survivors. Various stakeholders – health care service providers, police, lawmakers, employers, activists, and community members – all need to work together to address the issue of GBV and the challenges that exist in the system. Existing strategies often fail to hold systems accountable beyond policing, particularly within the health system. Participants shared the need to establish and leverage partnerships with various stakeholders in the social system in order to address the issue of GBV.

Another participant, Bandana from Akanksha Seva Sadan, Bihar shared how at the local level they have tried to leverage this partnership with the local panchayat and tried to bring across the change. 

“पंचायत, ग्राम सभा द्वारा जेंडर आधारित हिंसा का रोकथाम किया जा सकता है। हमलोग पंचायत के साथ बहुत प्रयास कर रहे है। पंचायत के साथ बातचत करके विकलांग लोगों के लिए हमने रैंप बनवायेI स्कूल में लड़कियों के लिए शौचालय और पानी की व्यवस्था कराया गया, विध्द्यालय को मजबूत किया l इसी तरह पंचायत के माध्यम से लड़कियों के लिए फुटवाल खेलने के लिए मैदान बनबाया।

“Collaborations can be made with the panchayat and Gram Sabha to stop GBV. We are making a lot of efforts with the Panchayat. Through conversations with the Panchayat, we got ramps constructed in schools for disabled kids. We ensured clean and hygienic sanitation service for school girls and strengthened schools. Similarly, we also collaborated with the Panchayat to make a football playground for the girls.”

Sujata Rani Dash from Odisha also shared her insights on the need to have a survivor centred approach when dealing with GBV and access to SRH. In her work, she pointed out how they try to ensure their support to survivors of GBV throughout the process of physical, psychological and legal aid being provided to the survivor.

“जीबीवी सर्वाइवर को राहत दिलाने की कई साझेदारों की जिम्मेदारी बनती है जैसे किसी के साथ हिंसा होने पर हिंसा को रोकने की जिम्मेदारी पुलिस की है, लेकिन अपनी जिम्मेदारी ही पूरी नहीं कर पा रहे है। सिर्फ थाने में केस दर्ज करने और कोर्ट के चक्कर काटने से कुछ नहीं मिलता है, कोर्ट से न्याय मिलने में कई साल लग जाते है। हमे सबसे पहले सर्वाइवर के प्राथमिक जरूरतों पर अधिक ध्यान देना होगा।”

“It is the responsibility of multiple stakeholders to ensure justice to GBV survivors. For instance, when violence happens with someone, it is the responsibility of the Police to stop it immediately, but this responsibility is also not getting fulfilled properly. Registering an FIR and visiting the court alone cannot bring any change. It can take years for the court to deliver any justice. We need to pay the foremost attention to the immediate needs of the survivors.”

Sujata’s reflections as a human rights lawyer to broaden the discourses of justice to include services and affirmative pathways for GBV survivors, going beyond the legal rulings and judgments is manifesting of the discussions built together with them.

The politics of language

Language, particularly when it comes to feminist discourses, and the role it plays in order to ensure that conversations do not take a backseat due to lack of right terminologies plays a significant role as an agent of agency and power. In this regard, it becomes even more important to be mindful that the language we use to address these issues is inclusive and has a rights-based lens. This is something that Sama has ensured in all the sessions conducted with participants.

For example, the importance of using ‘जेंडर’ आधारित हिंसा instead of literal Hindi translation that goes as ‘लिंग’ आधारित हिंसा ensures the conceptualization of gender remains intact, instead of losing essence due to strong binary gendered nature of regional languages like Hindi.

गर्भ समापन is yet another term mindfully chosen to refer to termination of pregnancy, instead of the other informal terms which might carry pejorative connotations. Not only does this ensure that the focus on keeping the needs of the survivor remains central but also indirectly informs popular opinion on issues of gender sensitivity. One thus realizes the role that language plays also in centring a rights-based approach. The complexity of the global discourse on disability rights, or reproductive health and rights as well as the influence it has on politics of these issues is very telling of the need to be conscious of the language that forms these discourses.

A similar point was raised by one of the panelists of the session. Shilpi from Aaina foundation started her conversation by asking the question on what comes to everyone’s minds when they hear the words विकलांग or दिव्यांग and how these terms dictate how we think about disabled people. She emphasized on how it often has an effect of reducing the entire identity of disabled folks to their disability, fully dehumanizing their personhood which is completely against the principles of respect and equity. This also raises the continuing debate on ‘disabled people’ or ‘persons with disability’ – which is a far more nuanced debate on ‘person first’ vs. ‘identity first’.

Hope, activism and sustainable changemaking

It is in light of these discussions that were undertaken by participants of this regional dialogue, that further reinstate my belief in the fact that ‘hope’ is a necessity for attempting to create sustained change. While working on issues of gender, health and rights; it gets fairly easy to lose sense of progress in the absence of immediate results. But this is where the fruit of sustained engagement can be seen which reignites the faith and hope to continue working to challenge the status quo and question the oppressive systems. This regional dialogue with various participants and stakeholders from diverse sections of society, which came together with a varying spectrum of issues discussed, is a testimony to how feminist efforts and conversations are continuing to create a change in dialogue.
These discussions are integral to the way sexuality is operationalized; conceptualizing gender, GBV and health within a reproductive justice framework. The pointers highlighted by various participants also reflect how constant awareness and leadership building is happening at ground level to keep furthering the need to accept the agency of women over their own bodies. 

The intent of such engagements is to ensure that there are active changemakers at every point on ground, composed of people from within the communities of engagement so that survivors of GBV have people who can make services approachable as well as more accessible to them. GBV has long term implications on the health and wellbeing of individuals and caring for their SRH requirements becomes an immediate need. The role that interventions like this play in the broader movement to address GBV and SRHR as a public health issue is to build and sustain a local pool of networks. This, in turn also aids in leveraging their participation and role in addressing these issues to build pressure on other stakeholders to acknowledge the immediate need to build a more survivor centric lens in order to address this issue.

There were many more voices and names all of whom cannot be brought to the limited text of my blog; however they do appear in this section as the hope of continuity of reflections, feminist affirmations and being change agents that are very well ongoing long after the conclusion of this online dialogue itself.

Richa Sharma works as a Program Associate with Sama. She is an intersectional feminist, who believes in unlearning and learning at every opportunity. She tends to engage in higher emotional capacity for the things that are impactful, hence dissociating comes difficult. She believes in advocating for equity on as many occasions as possible and will happily provide a well researched perspective on any social issue over a cup of perfect Chai.
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