Health and Women’s Rights

An update on the developments of Sakhi’s 11-year old Women’s Health Initiative

In his recent State of the Union Address, President Obama focused on some of the concerns surrounding the new health care law, stressing his desire to improve health care and make it more affordable. While the new law will allow legal immigrants and their dependents access to more affordable health care, it will still leave people with uncertain immigration status little choice; either continue paying for expensive health services, or not have access to healthcare. For abused immigrant women who are often dependent on their spouses, financial constraints can often serve as a barrier to seeking help from health service providers.  Sakhi believes that healthcare should not only be accessible and affordable, but that women in our communities have the right to health and a life free from violence.  As a result Sakhi has kick-started new developments in its 11-year old Women’s Health Initiative.

The Women’s Health Initiative (WHI) has worked to provide survivors of domestic violence culturally competent and affordable health services to survivors of domestic violence. Launched in 1999, the WHI has worked with survivors and healthcare providers to educate and inform them about the effects of violence on women’s mental, physical, and sexual health, and has also trained both South Asian and non-South Asian health care professionals on domestic violence in the South Asian community. In addition, the Initiative has developed a network of physicians and mental health professionals who provide Sakhi’s survivors with culturally competent and sensitive services. Through one-on-one support, workshops, focus groups, and education materials, the WHI helps survivors access doctors, manuever the complexities of insurance companies, and learn about various health issues.

Today the WHI is entering a new stage of progress. Sakhi is transforming the Women’s Health Initiative to incorporate principles of reproductive health and justice.  We are galvanizing the critical work this program does by developing it into a women’s health and justice focused program. The new project explores the links between violence and health – particularly reproductive decision-making. It will also develop a health education program that links violence to negative health outcomes, which will then be used to conduct outreach and community education.  This work is extremely important as there are hardly any resources or studies that specifically focus on the reproductive health ramifications of domestic violence among the South Asian Diaspora. There are many such resources on mental health, but little to none on reproductive health.  Through this critical work, we seek to strengthen and expand our existing programs to be relevant to coalition building and fostering change on multiple levels.

The new methodology explores details and nuances of day-to-day decision making. We ask survivors of domestic violence, what enables and limits their decision to go to a doctor, how they think of and address their concerns surrounding sex, pregnancy, childbirth and more. The data collected on the link between health and violence will be translated into advocacy and policy outcomes.  These outcomes will link the results to proactive solutions to better respond to the needs of survivors of domestic violence from the South Asian Diaspora, as well as women worldwide who are victims of gender-based violence.

At Sakhi, we see how silenced the women we work with are regarding their reproductive rights, health and decision-making power.  How control and the concept of “choice” simply does not exist for a woman living in a situation of violence.  With particular regard to the women we work with, who comprise mainly of recent immigrant, low income, limited English proficient women from the South Asian Diaspora, they face numerous other oppressions that serve to silence them from speaking up about violence, from being aware of their rights, much less being able to exercise those rights.  That is why a reproductive justice perspective, which grounds reproductive rights in a socio-economic, racial and ethnic context, is perfectly applicable to our work.  Many of the women may not even recognize the extensive impact that violence has in their lives. The ability to decide whether and when to have sex, to use contraception, to become pregnant, and to terminate or carry that pregnancy to term are all decisions that often elude women, particularly those that already are in violent relationships. The societal conditioning that many women receive – that they are to remain chaste until marriage, neither enjoying nor discussing whether and when to have sex – coupled with the social pressure to marry and to remain within that marriage often renders South Asian women more vulnerable to violent and controlling relationships. This includes reproductive control, whereby women are pressured into terminating desired pregnancies, or being forced to keep their birth control methods hidden from their partners. These forms of violence and control are hidden behind bedroom doors.

Failure to address the manner in which violence impacts women’s reproductive health can lead to detrimental health outcomes not just for a woman, but for her children as well. The consequence of an inability to negotiate sex or birth control can range from an unintended pregnancy to short spacing in between children, as well as an attendant decline in reproductive and maternal health care. Addressing this issue begins with responding to the violence and promoting a woman’s body integrity and rights over her own body. By engaging with survivors who have experienced violence – whether or not manifested as reproductive control or sexual assault – they begin to understand that they own their body, that their body is something of value, that they have fundamental human rights and finally, that they are not property passed on from their family to their husband. Consequently, we counteract numerous other societal norms that devalue a woman’s worth and promote gender equality, ultimately rendering women less vulnerable to violence.

By understanding the impact that violence has on a woman’s power to make decisions over her own body and reproductive choices, Sakhi’s Women’s Health Initiative highlights the way gender bias and societal norms limit access to health care and impinges on women’s freedoms. and gathers critical information necessary to create comprehensive and holistic change in the lives of the individuals and communities.