Tag Archives: women in India

A Lesson in Cultural Sensitivity: Assumptions

Last week, my team and I learned a valuable lesson in cultural sensitivity. Having traveled as much as I have and having been in many situations where I have been privy to privileged information, I considered myself to be well versed in culturally sensitivity. However, as I have learned countless times in essentially every aspect of life, there is always space for improvement and a seemingly endless stream of lessons to be learned.

Focus Group

 As I am currently in India studying a highly sensitive topic, in planning my research, I attempted to make every effort to ensure that my data collection was appropriate and inoffensive. I have spent years rearching this facinating culture but despite my research on these topics, I still had a lot to learn being on the ground interacting with women. Before leaving, I felt like I was constantly debriefing my team members on what to expect with Indian culture. We set up focus groups with Community Health Workers (CHWs) to refine our questions, piloted the final result, and asked our questions with well-educated Telugu translators. I knew that the women in villages would be too embarrassed to discuss their menstruation habits with men, so I arranged to conduct interviews with the only female translator that was available. The other members of my team, both male, interviewed CHWs and, unfortunately, had to take a male translator.


Hut in a Village

 This is where we made our first mistake–the assumption that because the CHWs interact with both male doctors and men about sensitive health information, that they would feel comfortable talking about the menstrual health habits of women in their villages with a male American medical student. However, the questions asked were still too sensitive and the situations in which they were asked brought embarrassment to the CHWs. On our first day, at the suggestion of our male translator, the male portion of our team interviewed the CHWs outside their home. The translator had a very loud and projecting voice and he spoke so loudly that I had to send my translator out from where I was interviewing to ask him to speak quietly. The next day, we realized that these questions needed to be asked in a private environment and, with the intense heat (110 F +), again at the suggestion of the male translator, this team decided to interview the CHWs in a private, air conditioned car. In making this decision, no one considered how this would appear to the villagers, and we neglected to think of having a female chaperone.    

In both of these situations, our team attracted attention to our project. As we are discussing such a sensitive and taboo topic, much of the attention that we drew was negative. In a society that is unfortunately dominated by males, the husbands of our interviewees interrogated their wives and became angry at us for asking their wives such sensitive questions. In retrospect, I see how someone might be offended if a group of men took another man’s wife into a private vehicle and asked whether she or the women in her village wore underwear… Sometimes it takes this sort incident to shift the lens and change perspective.

Some of the questions themselves that we asked were offensive. For example, we were interested in finding out about the villager’s and CHW’s general knowledge of menstruation. We quickly found that no one knew anything about the physiological process of menstruation and that this lack of knowledge made them feel uncomfortable. One question in particular, asking about the origin of menstrual blood, was extremely offensive. Even a seemly innocuous question—a question about which religion our interviewee followed–was met with extreme discomfort. Unfortunately, this question was misunderstood by the villagers, who thought that we were asking about their caste.

Unfortunately, we did not know that any of this was going on for our first two days of interviewing–we were at the mercy of our translators. We had made yet another assumption that our translators would translate the full responses, including the discomfort and the scolding that apparently went on in some of the interviews. We only learned of the trouble we caused when it was large enough to inhibit the study’s progress. One evening at dinner, we were told that the CHWs were calling each other and saying that we should not be allowed into their villages, as we were asking “bad questions”. We also were told that the husbands were particularly angry that we were asking their wives such sensitive information, and that if we proceeded with the study as is, we could be met with violence in some villages. I think that this lack of communication was due to the fact that our translators, who were also our hosts, felt obligated to proceed with our faulty and insensitive study, as they did not want to offend us. Having worked closely with people in this part of India for the last two and a half years, including one of our translators, I regretfully should have anticipated this issue and should have spoke with our translators more about giving us “bad news”.

Esther and BeBe (CHW)

 After learning this unfortunate and surprising news, we were all understandably upset. After all, we came to India in attempts to help alleviate some suffering, not to cause further discomfort and suffering. I felt (and am) responsible for the discomfort caused and couldn’t help but think that I could be responsible for episodes of domestic abuse, which is horrifyingly all too common in the villages. I retreated to my room, where, between several episodes of crying out of frustration and guilt, I began to brainstorm ways to salvage the study. After several Skype calls with friends and mentors, I was able to organize my thoughts and come up with a plan. In the period of about 16 hours (including about four and a half hours of sleep), I shifted the focus of the study, pulled the males (and with them, an important aspect of the study, as I do not have time to do in-depth interviews with all 25 CHWs on my own), and built in the mentorship and knowledge of key persons into the study, getting every question approved by multiple wise and influential women. 

The trouble that we faced happened because we made assumptions. We made the assumption that menstruation was less taboo of a subject, the assumption that the CHWs would be comfortable talking with men about menstruation, and the assumption that our translators would translate our interviewees discomfort and inform us if our study was not well received. As painful and frustrating as this experience was, myself and my team learned important lessons in global health and cultural sensitivity that we will take with us on future endeavors. 


Post Interview


 Currently, the newly designed study is going smoothly. The women leave the interviews smiling and many wait for all the interviews to complete to take pictures with me or walk me to my vehicle with their children. The CHWs are happy and comfortable, generously offering their home and electricity so that I can have both comfortable and private interviews. So far, my findings are interesting and my mind keeps rolling with new study ideas and possible interventions. In fact, one important finding is that many of the women in the villages suffer from painful menses and cite this as a primary reason for missing work or school. Today, I was able to present information on normal menstruation as well as an intervention for painful menstruation to 22 CHWs at the quarterly CHW training. 

In closing, I learned a valuable lesson in cultural sensitivity and in making assumptions. However difficult, this experience will undoubtedly shape my approach to future work abroad. Luckily, I was able to salvage and reshape the study and look forward to sharing the results in the coming months.

Chalagamari VIllage

(A Brief) On Sanitary Napkins in Rural India

Anyone that has talked to me in the last year and a half (or anyone who has read this blog) knows that I am deeply passionate about women’s health and the improvement of women’s lives worldwide. This past year and a half, I have spent my time working on various projects involving women. From my employment on the Native CARS Study, work with survivors of sex-trafficking through Save a Survivor’s Smile, my acceptance into an MD/MPH program where I plan to pursue women’s health, to the development of my non-profit organization SHELTER International, which aims to improve the lives of widows in rural Andhra Pradesh, India, it’s a wonder I ever made it outside (but I am so thankful that I did as there is just so much to hike…)!

Today, May 28th, is Menstrual Hygiene Day. As females in the developed world, menstruation is still a pain, but we simply have to make a trip to the drug store to cheaply purchase feminine hygiene products to manage our menses. In rural India (and many other parts of the world), menstruation is a whole different fiasco. Imagine having to travel a significant distance to a town large enough to have a market where they can sell feminine hygiene products. Now imagine spending half-a-week’s (or thereabouts) salary on expensive and imported sanitary napkins. Obviously, most women in this situation spend their hard-earned cash on food or school for their children and simply do without this “luxury.”

Instead of using a hygienic product, women use bits of old cloth and sometimes even newspapers or sand to manage their menses. Due to embarrassment (as I am sure you can imagine), these cloths are rarely cleaned or sanitized and have been reported to increase the incidence of disease in the reproductive track. As these solutions can hardly be considered solutions, women and girls often have to stay home from school or work so that they can manage their menses. In turn, women have just one more reason to make less money and girls often fall behind their male peers in school.

IndiegogoSo, in an effort to help the area’s widows as well as pursue my passion for feminine hygiene (I realized feminine hygiene was a problem for many Indian women when I taught health and hygiene to girls in Tamil Nadu, India), my organization is trying to raise funds to purchase a machine to manufacture sanitary napkins. The machine will employ 10-20 widows and the low-cost product will be sold to women and girls in the area. I have wanted to get this project going for a year and a half and, after much research and planning, it is happening! We (SHELTER International) are also very fortunate to have several graduate students from Pacific University heading to the project site this summer to oversee and study the project’s implementation. I personally cannot wait to go back to India at my earliest availability to see the project in action!

Anyways, after spending so much time and energy working towards something, I am ecstatic to see a project that I am so passionate about finally coming through. Check out the Indiegogo campaign page, read about widows, learn more about the importance of menstrual hygiene, and women reading this post: be thankful that you are fortuitous enough to manage your menses in a way that doesn’t completely interrupt life!


Rape: Women and Society in India

“Senior Citizen Attempts to Rape Nine Year-Old Girl.” “Widow Gang-Raped in Uttar Pradesh.” “Delhi Gang-Rape Victim as Guilty as Her Rapists, Asarum Bapu Says.” “Two People, Including a Minor, Rape 15 Year-Old Girl.” “Puducherry Prescription: Separate Buses and Overcoats for (School) Girls.” “School Girl Raped and Strangled with Her Scarf on Way to School.” “Dalit Girl Raped by Upper Caste Boy.” “17 Year-Old Girl Repeatedly Raped by Her Father and Brother.”


One of many recent front-pages highlighting rape

These are just a small handful of the headlines that I have read the last few weeks in the Indian papers. It seems like every morning about ten different rape cases (all equally horrible) appear in the paper. And these are only the cases that the press finds interesting enough to write about in the fraction of rape cases that are actually reported. One of the most horrible cases I read about (besides the Delhi gang-rape case that has received international press) was about an eighteen year-old girl who was expelled from her college for being raped. Apparently, she was “following nature’s call” (there are very few bathrooms in rural India, or in all of India for that matter) with two friends when a gang of men playing cricket noticed the girls and started coming towards them. The girl’s two  friends were able to escape, leaving the girl in a vulnerable position. The girl was captured and then raped repeatedly in a field, in plain view of male administrators from her school (who did nothing to stop it). After the rape, she was expelled from her college for “behaving in-appropriately with men.” This expulsion will prevent the girl from continuing her education at another school.

After returning home that day, her parents questioned her about her injuries and tears. After much interrogation, she told her parents what had happened. She was immediately taken to a doctor who treated her for her injuries and confirmed the rape. She is now fighting the administration’s decision to expel her for being raped (the administration is still arguing their case, insisting  that this girl was acting inappropriately, even when others who witnessed the crime clearly identified it as rape). As this story was one of the few stories to get attention from the press, I hope that the administrators of this school are closely examined and replaced.

(In India, virginity is a prized possession. Women, even after being raped, are fearful to report the crime as they are afraid that their rape will tarnish their reputation and keep them from being married (some Indian men even divorce their wives after their wives have been raped!). Thus, this stigma, along with the inefficient and embarrassing process of reporting rape (in 2012 in Delhi, only 2 out of 600 reported rape cases we brought to trial and many more cases were given up after victims were treated with disrespect by the investigating officers), prevents many women and girls from taking justice against their attackers. And, perhaps most disgusting of all, policemen and family members often encourage the rape victim to marry her attacker, for she is seen as unfit to marry anyone else.)


After the brutal rape and death of the Delhi gang-rape victim, the Indian public is finally taking a stand against violence against women. Everyone from politicians, men, and women are demanding change, justice, and preventative measures against rape. Unfortunately, their solutions for the “Rape-Problem” are almost as problematic as rape itself. Politicians are demanding that women cover up more than they are already covered, insisting that women don burka-like dress and school girls wear overcoats to prevent leering eyes from feasting on those few inches of exposed skin. One, India is HOT and women are already covered up more than women in most other countries (with the exception of the Middle East and winter in Siberia). Two, “solutions” like this blame women for the misfortune and atrocity of being raped. “Solutions” such as this also avoid confronting the real issue behind rape. Furthermore, with politicians propagating such madness, women will further internalized the culturally engrained notion that rape is their fault. This will then prevent the few women that do report rape from reporting the crime, allowing more rapists to get away with it, finally resulting in an increase of rape. It is ridiculous and embarrassing that elected officials and politicians (including some women!) are spouting off such madness.


Protesters demanding death by hanging for the rapists. Credit: WSJ

While the politicians are coming up with fantastic plans to stop rape from covering up women to banning the sale of alcohol, the public is demanding stricter laws against rape including harsher punishments and swifter trials. I am in full agreement that the process of reporting and prosecuting rape should be made more agreeable to the victim (including the call for more female police officers and inspectors) and for rapists to be brought to trial within a few weeks of the incident (rather than in 10 years or not at all). However, I do not think that chemical castration or the death penalty are the solution to stopping rape.

These “solutions” miss their mark. Preventing rape has nothing to do with the way women dress or the punishments that rapists receive. Rape will continue to happen no matter what women wear and whatever the consequence as long as men continue to disrespect women. Male ego or not, women all over the world are coming up in position. We are providing for our families and working in fields that were originally reserved for men. After thousands of years of oppression and second class citizenship with ridiculous and bizarre justifications (such as women lacking reason or being deformed-and thus less than-men), women are finally beginning to live freely as they rightfully should. Perhaps this rise in progress is being met with resistance, and men feel that women are cramping their style or taking over what they feel is rightfully theirs. Perhaps this insecurity is why men feel the need to dominate women with the display of their animalistic power. While I am no expert, I am sure that men rape women for a variety of reasons, but probably all stem from insecurity.

Whatever the cause of rape, the root of the problem is not with women but with society itself. Men need to learn to love and respect women from a young age. This means that their fathers must treat women with respect, and that politicians (our leaders) need to shift the blame of rape from women to men and to the society that allows men to be brought up devoid of such values. Society must also not neglect women, but seek to raise women who are confident and believe themselves to be the equals of men. As gender inequality has deep roots in Indian culture, India’s transformation will be long and hard. I just hope that India does not require another atrocity like the death of the twenty-three year-old Delhi gang-rape victim to initiate this change.


Protesters. Credit: The Guardian