For the uninitiated, the Hindi word ‘Bolna’- the literal translation being ‘Talking’, is a common colloquial term used by women coming to our gynecology OPD to describe physical intercourse. So if you ever heard someone having a problem with talking to her husband/partner, she would be actually referring to her sexual health. The irony of using the term ‘Bolna’ is that talking about any form of reproductive health in our country, let alone coitus, is still treated as taboo.
India has the largest number of adolescents in the world with every 5th person being between the ages 10-19 yrs. This constitutes a population of about 253 million. As per a 2021 article in the International Journal of Policy Sciences and Law (IJPSL), only 15% of teenagers have access to any form of sex education. Even if you are bad at maths like me, you’d be able to understand that these numbers are abysmal and yet not surprising.
In my OPD, my approach is simple- If you can have sex, you should be able to talk freely about it. Maintaining a dialogue in a conscious yet delicate way is what the aim usually is. But at one point it's disheartening when you realize that your patient may actually have zero knowledge about reproductive health, in general.
Some may argue that not everyone has exposure to proper information. Therefore, it is a doctor's job to educate their patients. But sometimes my job entails telling an unmarried girl that she missed her period because she is pregnant. While doing so, I find myself constantly having to request parents to go out of the room. It is only then that these patients confess to being sexually active. There have been times when patients have come to me with positive urine pregnancy tests to ask me “What it Means”. This is when I question whether this is what I signed up for. Especially, when I get glared at by their parents as if it is my fault. It just means that we live in a society with a lot of “Bolna”, but no “Bolna”. Get it?
Breaking down the problems with ‘Bolna’
The same study in IJPSL found that 70% of people surveyed (1022 adolescents aged 14-19 years) agreed that medical professionals and teachers are the best to impart sex education. Among these, 21% of males and 37% of females reported feeling embarrassed talking about the sex.
In schools, the responsibility of imparting knowledge about reproduction usually lies in the hands of teachers. This is because we live in households where even television channels are changed when intimacy is portrayed. So, conversations at home regarding sex seem far-fetched. However, we forget that our teachers come from the same households. This expectation from absolute strangers to go out of the way to create safe spaces for children seems unreasonable. That too, despite being underpaid, overworked, and given very little resources to learn accurate information themselves. Some schools have started making efforts to hold well-organized workshops outsourced to agencies such as Pratisandhi, Iesha Learning, TARSHI, etc. These specialize in imparting ‘sensitive' information but their numbers are still very low.
There has been news of public backlash against sex education. Parents often feel that imparting education even in a controlled environment could corrupt their children's minds. Ironically, now with the use of smartphones at all ages, misinformation is already being consumed by these children daily. This void in accurate knowledge is not restricted to intercourse alone. Even basic information about menstruation, normal bodily changes during puberty (whether male or female), good-touch/bad-touch, contraception, and prevention of disease spread is lacking.
Furthermore, a major chunk of the statistics we are reading about are mainly from cities where information is relatively more accessible. The status in rural/semi-rural areas might actually be worse.
If you struck up a conversation with random adults about their experiences with puberty, they’d narrate hilarious yet deeply concerning stories. I’ve had friends think that they had cancer when they first menstruated. Male counterparts have talked about senior boys in school who would teach them their half-baked knowledge about masturbation. All this is now augmented with free access to an uncontrolled amount of exposure outside the school via social media, digital media, and pornography. These often glorify fetishism, promote non-consensual intimacy, and perpetuate stereotypes of physical appearances.
Doctors as sex educators
The chance for any kind of intervention by medical professionals unfortunately comes very late in India. Adolescents usually come with STIs/RTIs, irregular menstruation after wrong self-medication, and mental health disorders as a result of unhealthy relationships. The more their incidence, the more one feels that these could have been avoided if only children were just taught about their bodies in a better way.
Moreover, the population coming to seek medical advice regarding sexual health is itself very small. About 14% of pregnancies below age 20 are unplanned. 50% of maternal deaths between ages 15-19 yr are because of unsafe abortions (IJPSL). Even if the grassroots level of sex education is imparted by doctors to the community, government initiatives for the same are not very far-reaching. Additionally, they are met with a lot of resistance because of inherent societal stigma. In 2007, government-run Adolescent Education Programmes (AEPs) were suspended in several states within a year of the initiative being started. Health professionals trained exclusively in reproductive education are also very few in number and thus overburdened. In fact, had I not been a gynecologist, my own knowledge about reproductive health would have been quite poor.
Sex education for adults
With all the above facts in mind, I believe that sex education should start with adults at home. We as a society, have a problem with telling children about reproduction. We don’t want teachers to do it because it will supposedly give them ‘ideas’. We don’t want to have conversations at home because we feel embarrassed. But when children eventually explore their sexuality on their own in harmful ways, we feel ashamed of them.
The finger now should be pointed at us. What exactly do you and I, as adults, know about sex and reproductive health?
We should start with workshops and seminars targeted towards an adult audience. These would be easier to organize in terms of the stigma attached to sex education. This target group would also be more receptive to the basics of reproductive health.
If we teach adults, we could decrease the amount of misinformation likely to be passed on to teenagers and colleagues coming to them with their doubts. We would also empower them to be better prepared to help their children when they become parents. If the adult in the household de-stigmatized ‘Bolna’, sex education in the classroom would be received better. It could be discussed at home and normalized instead of perpetuating discomfort. This would also give schools a better foundation to start from. The need to enclose words related to sex or reproduction in inverted commas would finally go away.
Don’t get me wrong, sex education in school during adolescence is paramount. This is not a call to do away with it. But the process is an uphill slope. These young minds are extensions of years of familial practices of radio silence, regional myths, superstition, and religion. This further complicates reaching out to them. Also, the repercussions of misinformation are dangerously increasing in incidence. This rate is much faster than that of sexual health being promoted by governments. Therefore, it's time for adults (yes, that's you, whether you like it or not) to take the step towards breaking the dichotomy of Bolna vs Bolna by choosing to get educated. Alas, we all know that there is a lot of at least one of the two happening in India.
Edited by Christianez Ratna Kiruba.
Image by Deekshith Vodela
