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Do helplines help?

By Prabha Nagaraja

The New Delhi-based TARSHI helpline service claims to have logged over 55,000 calls over the past nine-and-a-half years, on a wide variety of issues on sexuality and reproductive health

“Ma’am, can you please explain the reproductive system to us? We have a test tomorrow and our biology teacher skipped this chapter.” -- Three school students on speaker-phone calling the helpline for information

“I am pregnant… how can it be when I only had anal sex? My boyfriend thinks I have been sleeping with someone else, but I have not! What should I do?”  -- A 21-year-old woman

“I am getting married next month… I have had sex with men before but never a woman… my wife will expect me to please her on the first night… Should I visit a sex worker for experience and practice?” -- A 29-year-old man

The need to talk about these and other issues related to sexuality is obvious and urgent. And the telephone provides an excellent medium of communication, as it promises anonymity and confidentiality whilst speaking to ‘experts’ from the privacy of one’s home/office. There’s no need to commute great distances, stand in long queues, wait in waiting rooms where there’s always the possibility of being recognised, or pay hefty consultation fees. Also, anonymity creates an instant rapport between counsellor and caller and allows the caller to share her/his most intimate concerns.

The last decade has seen the proliferation of helplines all over India. The services being provided focus on a range of issues from suicide prevention to sexuality, mental health to disability.

One such service, the TARSHI helpline service, claims to have logged over 55,000 calls over the past nine-and-a-half years, on a wide variety of issues and from people from all walks of life.

TARSHI (Talking About Reproductive and Sexual Health Issues) is a non-profit organisation based in New Delhi, India, that works with issues of sexuality and reproductive health. The organisation believes that “all people have the right to sexual well-being and to a self-affirming and enjoyable sexuality”. Established in 1996, TARSHI seeks to enhance people’s sexual and reproductive health choices. It recognises that reproductive choices cannot be isolated from sexuality, and that sexual and reproductive behaviour emerges from and impacts on a person’s life.

The TARSHI helpline, that’s manned by a team of trained counsellors, has been up and running for over nine years, three days a week (Mondays, Tuesdays and Wednesdays from 10 am to 4 pm). The service provides information, counselling and referrals on sexuality, reproductive health and related issues. It is available to everyone, regardless of age, gender, class or sexual orientation. And it’s free, confidential, anonymous and aimed specifically at women and young people.

The non-judgmental nature of the TARSHI service encourages people of all ages to call in and discuss their problems freely. The helpline’s youngest caller has been just 7 years old, and the oldest 73. Most calls, however, are from people between the ages of 18 and 35 years.

The kinds of questions people ask range from changes in the body to attraction between people of the same/ different sex, conception and contraception, to infertility, sexual pleasure enhancement to sexual problems, complex relationships to problems with body image.

Issues concerning sexuality are deeply personal and intimate, and socio-cultural restrictions preclude an open dialogue on them. This is precisely why such issues must be discussed in an open, non-judgmental manner.

The secrecy surrounding sexuality has led to a proliferation of damaging myths and misconceptions, which could lead to unsafe sexual practices. Here are a few examples that TARSHI has encountered in the course of its work with the helpline:

  • Having sex with a virgin can cure a man of a sexually-transmitted disease.
  • Having (unprotected) sex just once cannot cause infections or lead to a pregnancy.
  • Anal sex as a substitute for vaginal sex is practised for two reasons -- one, to prevent pregnancy and two, to ‘preserve’ the hymen of the unmarried partner. Since anal sex is considered safe in terms of preventing pregnancy, condoms are dispensed with, thus increasing the risk of infection.
  • The twin misconceptions that masturbation is harmful and that men have an uncontrollable sexual appetite lead men to have (unsafe) sex with casual partners or sex workers to satisfy their sexual needs.
  • Masturbation is often seen as the cause of sexual problems like erectile dysfunction and premature ejaculation in later life.
  • One common belief is that a man should be experienced before his wedding night. This means a few visits to a sex worker are required to gain experience.
  • If a woman shows any interest/initiative in sex the first time, it is assumed that she has had other sexual experiences before and is therefore ‘of loose morals’. Many marriages start out on this note of distrust.
  • Condoms reduce pleasure and sensation. This is a belief held also by those who have never had sex or used a condom before, and dissuades men from even considering using a condom.
  • Abortion is often believed to be illegal in India. This is a case of morality being conflated with legality; because a person considers it wrong, s/he also assumes that it is illegal. This leads many to seek back-street abortions, often in advanced stages of pregnancy, thereby increasing the risk of complications.
  • The silence surrounding homosexuality makes people who are attracted to others of their own gender feel lonely, isolated and grappling with issues of their sexual orientation in silence and in fear. They may not access help and medical care for fear of being judged or harassed, thus compounding their problem.
  • Regarding people with disabilities as being asexual and childlike (and consequently not needing information or experience on sexual matters) makes them vulnerable to abuse not only as children but even as adults. People with disabilities often do not have the skills or the vocabulary to communicate what they are going through.

Some challenges the helpline faces:

  • Counsellors are products of the same society that holds and reinforces the above misconceptions. They often have to overcome their own hang-ups/inhibitions in order to be comfortable with the issue of sexuality and about talking about it to callers who may be older/younger or of a different gender.
  • One of the biggest challenges has to do with adequate training in counselling skills to deal with issues like sexuality, mental illness and disability. Regular training, in-house seminars, and information and skill-refresher sessions contribute towards providing a quality service and preventing burnout.

Then there are the ethical challenges. For example, is a counsellor over-involved with a caller or asking for unnecessary details to satisfy his/her own curiosity? Other challenges include boundary issues and issues of maintaining confidentiality and anonymity. Also, maintaining confidentiality about any documentation related to calls.

There’s also the issue of using data and information for research. Again, the counsellor needs to be aware of the purpose of maintaining records -- to maintain the continuity of calls, to ensure quality service, and for research purposes. As a tele-counselling service-provider, TARSHI’s primary goal is to help the caller. If, in the process, it is able to collect data without in any way jeopardising the caller-counsellor relationship, the information can be used for research purposes.

In spite of all these challenges, being on the TARSHI helpline has been very exciting for me. I have been associated with it since its inception and the experience has been interesting, enlightening, tiring, challenging and constantly evolving. We have spoken to women, men and transgendered people, the rich and the poor, the young and the old. And even today, nearly ten years down the line, every now and again we get a call that opens a whole new vista for us to explore and learn more about.

(Prabha Nagaraja is programme officer, TARSHI, New Delhi.
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InfoChange News & Features February 2006