Shubhada Maitra

Reflecting diversity and complexity in marital sexual relationships in a low-income community in Mumbai

This paper describes findings from a study on spousal communication and sexual decision making among women and men from a low-income community in Mumbai. The study explored the link between contextual, individual and socio-economic factors, sexual behaviours and communication to highlight sexual health consequences for women and men. It utilized a combination of qualitative and quantitative methods including a community profile survey, focus group discussions, repeated in-depth interviews, pile sorting and the sequencing of sexual behaviours. Family structure and duration of marriage were found to influence the quality of marital sexual relationship. Early experiences of violence and coercive sex limited womens participation in, and enjoyment of, sex. Respondents revealed a normative sequence of pre-coital sexual behaviours; those reporting sexual violence invariably violated this sequence. Womens experiences of sexual violence revealed lower perceived equity compared with men. Respondents reporting an absence of sexual violence revealed increased satisfaction in sex and highlighted positive aspects of the marital relationship.

A Model for Translating Ethnography and Theory into Culturally Constructed Clinical Practices

AbstractThis article describes the development of a dynamic culturally constructed clinical practice model for HIV/STI prevention, the Narrative Intervention Model (NIM), and illustrates its application in practice, within the context of a 6-year transdisciplinary research program in Mumbai, India. Theory and research from anthropology, psychology, and public health, and mixed-method ethnographic research with practitioners, patients, and community members, contributed to the articulation of the NIM for HIV/STI risk reduction and prevention among married men living in low-income communities. The NIM involves a process of negotiation of patient narratives regarding their sexual health problems and related risk factors to facilitate risk reduction. The goal of the NIM is to facilitate cognitive-behavioral change through a three-stage process of co-construction (eliciting patient narrative), deconstruction (articulating discrepancies between current and desired narrative), and reconstruction (proposing alternative narratives that facilitate risk reduction). The NIM process extends the traditional clinical approach through the integration of biological, psychological, interpersonal, and cultural factors as depicted in the patient narrative. Our work demonstrates the use of a recursive integration of research and practice to address limitations of current evidence-based intervention approaches that fail to address the diversity of cultural constructions across populations and contexts.

Listening to women talk about their health: issues and evidence from India

When first published in 1994, Listening to women talk about their health: issues and evidence from India was an instant hit with health practitioners, researchers, academicians and, particularly, health activists working on women’s health in India. It was a time when shame and silence prevailed around any discussion on women’s reproductive health and the closest one got to health issues of women was to discuss ‘maternal health’. Moreover, most understanding was based on studies with female clinic attendees rather than on community-based women. Thus, an understanding of women’s health from their own perspective was missing. Several questions remained unanswered: What are the main ‘health problems’ of women as perceived by women? Whom do they talk to about their health and how do they manage their health problems? What is it that programme managers and policy makers need to know about women’s health for effective programming and policy making? The book was a step towards answering several such questions in an extremely interesting and readable manner. The book was an outcome of a Ford Foundation’s project, launched in 1990, on building social science research capacities in women’s reproductive health in India. One of the aims was to generate data on women’s reproductive health through quality interdisciplinary, empirical research in India by local researchers. The papers contained in the book were written by trainees of the various capacity-building workshops organised in the early-1990s, with the editors of the book serving as key resource persons. Thus, in some ways the book was a path-breaking publication. Not only did it generate very useful data on women’s health, it also gave a much-needed impetus to qualitative research in reproductive health in India. The second edition of this very well-received book has now been published, almost 17 years after its first edition in 1994. The content remains the same except for the ‘Preface’ and the ‘Prologue’. These two new additions capture recent developments and debates about sexual and reproductive health in the new millennium. The Preface to the second edition by Hempel and Mukherjee outlines the developments and struggles around women’s health since the UN International Conference on Population and Development (ICPD) held in Cairo in 1994. Women’s sexual and reproductive health and rights remained contentious issues even a year later at the Beijing Conference. Although the understanding of the complexity surrounding these issues has advanced considerably since then, Hempel and Mukherjee call attention to the fact that in 2000 the Millennium Development Goals (MDGs) made no mention of reproductive health and that women’s health was only seen in terms of maternal health. Following much advocacy, however, reproductive health was added to the MDGs, but the approach remained narrow, highly medical in orientation and outcomes and not comprehensive in coverage. The issues discussed in the book under review thus remain as relevant today as they were in 1994.

The Who Concept of Sexual Health Applied to An Urban Poor Community in Mumbai, India

ABSTRACT Objectives: The objectives of this study were to describe a scale that operationalizes the World Health Organization concept of sexual health and to assess factors associated with scale variation. Methods: Qualitative in-depth interviews (N = 39), sexual health interviews (N = 21), and survey data (N = 1,128) for this article are drawn from an Indo-U.S. project to reduce the incidence of HIV and sexually transmitted infections among poor urban married women (aged 18–49 years old) in Mumbai, India. Results: Lower sexual health status was significantly associated with gender inequity, marital violence, poorer marital relationships and physical health, and lower empowerment and social support. Conclusions: This work demonstrates the need to view sexual health in the broader context of community and family.

An approach to mental health in low and middle income countries: a case example from urban India.

Abstract Women in low- and middle-income countries (LMICs) facing poverty, challenging living conditions, and gender inequality often express their emotional difficulties through physical health concerns. These women seek care at primary health facilities. However, primary care providers in LMICs only treat the physical health symptoms and lack appropriate services to address women’s mental health problems. This article presents data from the counseling component of a multilevel, research and intervention project in a low-income community in Mumbai, India, whose objective was to improve sexual health and reduce HIV/STI risk among married women. Qualitative data from counselor notes show that poor mental health, associated with negative and challenging life situations, is most often expressed by women as gynecological concerns through the culturally based syndrome of tenshun. A path analysis was conducted on baseline quantitative data that confirmed the relationships between sources of tenshun, emotional status, and symptoms of common mental disorders (CMDs). Based on these findings, the authors propose a need for culturally appropriate primary care services for LMICs that would integrate mental and physical health. This approach would reduce mental health morbidity among women through early intervention and prevention of the development of CMDs.

Age of onset of non-suicidal self-injury in Dutch-speaking adolescents and emerging adults: An event history analysis of pooled data.

OBJECTIVE Non-Suicidal Self-Injury (NSSI) has emerged as an important mental-health concern. However, epidemiological features like age of onset of NSSI have remained understudied. Therefore, the current study investigated the distribution of age of onset of NSSI in pooled sample of Dutch-speaking adolescents and emerging adults using event history analysis. METHOD Eleven datasets measuring age at first NSSI in community and clinical participants collected by researchers in the Dutch-speaking part of Belgium were pooled together. The final dataset consisted of 1973 community males, 1901 community females, and 505 clinical females. Discrete-time event history analysis was used to model the effect of gender and psychiatric disorders on the age of onset of NSSI. RESULTS Twenty-one percent of adolescents from the community samples engaged in at least one episode of NSSI by the age of 25years. Irrespective of the type of sample (community or psychiatric disorder), the probability of age of onset peaked around the age of 14-15years. A second peak was observed around the age of 20 and 24years in the community and psychiatric samples respectively. CONCLUSIONS Psychosocial interventions for prevention of NSSI should not only target adolescence through school mental health programs but also target emerging adults at the university level.

Sexual Health, Gender Roles, and Psychological Well-Being: Voices of Female Adolescents from Urban Slums of India

In India, ranked 132nd out of 148 countries on the United Nations Gender Inequality Index (2013), females face numerous challenges that pose a threat to their sexual health and psychological well-being. This chapter focuses specifically on adolescent unmarried females living in an urban slum, a particularly vulnerable segment of the population that is important to empower in order to effect change. This chapter examines psychological well-being and sexual health of adolescent girls from their own perspectives. To understand the unique perspectives of adolescent girls regarding the constructs of psychological well-being, gender roles, and sexual health, the authors analyzed focus group and interview data collected as part of the Promoting Psychological Well-Being Globally Study. Through the use of the deductive–inductive coding process, the authors identified overall themes that elucidate the perspectives of the population. Findings documented the intersection of sexual health, gender roles, and psychological well-being constructs. Additionally, the findings showed a trend of girls understanding the importance of having sexual health knowledge, but oftentimes, having limited access to this information themselves. The interactional relationships among sexual health, gender roles, and psychological well-being and the dearth of sexual health knowledge among adolescent girls elucidate the importance of designing interventions that are multidimensional. Other implications, future research directions, and limitations are discussed.

Non-suicidal self-injury and other self-directed violent behaviors in India: a review of definitions and research

The interpersonal theory of suicide suggests that most forms of self-directed violent behaviors lie on a continuum, with each behavior successively increasing the capability of committing suicide. There is increasing evidence to suggest that the continuum may begin with Non-Suicidal Self-Injury (NSSI). This theory can be important in developing interventions for suicide prevention. However, in India, consistent usage of definitions of various forms of self-directed violent behaviors is lacking. In the present study, we reviewed definitions of various forms of self-directed violent behaviors that have been investigated in India. Further, we compared the usage of these definitions with the usage by WHO. Additionally, we reviewed NSSI research in India. Thirty-eight publications were identified by a comprehensive electronic search undertaken in Indian psychiatry, psychology, and mental health-related databases. Inconsistent definitions of eight self-directed violent behaviors were observed in Indian literature. Agreement on consistent definitions of various forms of self-directed behaviors is essential. Based on the findings of the current review, it can be suggested that culturally relevant large-scale research on NSSI in India is required to confirm the limited evidence that suggests high prevalence of NSSI in India.

Association between Non-Suicidal Self-Injury, Parents and Peers Related Loneliness, and Attitude Towards Aloneness in Flemish Adolescents: An Empirical Note

Loneliness and attitude towards aloneness have been shown to be associated to depression, anxiety, and other psychiatric disorders in adolescents and they may also increase the vulnerability to Non-Suicidal Self-Injury (NSSI). Therefore, the present study investigated the association between lifetime prevalence and functions of NSSI, parent- and peer-related loneliness, and attitude towards aloneness (positive and negative). Data regarding NSSI, loneliness, and attitude towards aloneness were collected from a sample of 401 high school students from three different high schools located in the Dutch-speaking part of Belgium. Lifetime prevalence of NSSI was found to be 16.5%. Females reported a higher lifetime prevalence of NSSI than males. Higher mean scores for parent-, peer-related loneliness, and positive attitude (i.e., affinity) towards aloneness was observed in adolescents with lifetime NSSI as compared to adolescents without a history of NSSI. Finally, a positive correlation between self-related (i.e., automatic) functions of NSSI and parent- and peer-related loneliness and a positive attitude towards aloneness was also observed.

Informing sexual health intervention development in India: Perspectives of daughters, mothers, and service providers in Mumbai

In India, girls face many challenges that pose a threat to their sexual health and psychological well-being. The authors explore sexual health from the perspectives of adolescent girls, mothers of adolescent girls, and service providers. Focus groups and interview data were analyzed to understand the unique and shared perspectives of stakeholders. Through the use of the deductive-inductive coding process, the authors identified themes and differences in perspectives. The findings reveal that girls, mothers, and service providers share an understanding of the importance of girls having access to sexual health information and the value of mothers disseminating information to their daughters.