Ladakh is famous for its beautiful mountains, big monasteries and unique culture and traditions. Thousands of tourists visit every summer and I wonder if they think about what kind of life the local people have. How is it for a young girl or boy to grow up in a place like this? From the window of my house, I often see five to ten bikers riding by with their GoPros on their helmets. We are so easily attracted to the outside natural beauty and are oblivious to the inner nuances of a culture. Just beneath the surface, I wonder how many of these bikers are curious about or have any idea how challenging it is for girls and women in Ladakh.
Growing up, I barely heard the word “period” said out loud. Healthcare and access to information in Ladakh is inadequate and brings to light the economic disparity in the region. Many have to travel outside Ladakh for further medical assistance. When I was around 11 years old, studying in the living room, I heard two of my female cousins in their twenties say, “How ill-fated we are as girls!” (I assumed they meant “ill-fated” in the context of Tibetan Buddhist beliefs about karma.) I was taken aback and almost offended. I remember thinking: I am doing well in my studies, I go to a good private school where most girls are out-performing boys academically, so why are we ill-fated? I didn’t know that they were referring to having a “period.” I was a naive little girl. I thought that the world was perfect for girls just because we had access to education and I enjoyed studying. I didn’t know that soon my body would go through drastic changes and I wouldn’t have answers to many questions, and would have many doubts about my body.
Eight years later, studying in the US, I came back home for my summer holiday and was giving one of my summer project New Ladakhi Girls’ (NLG) workshops on “Sustainable Menstruation” in one of the villages in the Changthang region of Ladakh. This was our third summer in a row and we had finally decided to include men in the workshop. I remember one woman saying, “I am in my late fifties and, for the first time, I felt good about my body. For the first time, I could listen to someone talk so freely about my body sitting right next to a man.” Her face lit up and she looked so hopeful. Stressed and in the midst of our NLG work, it was easy to forget why we had started this work and her comment reminded me that there were entire generations of women before me who had no, or very limited, access to information about their bodies.
As a 24 year old woman who studied at Smith, a women’s college, I have grown far beyond mere access to information about women’s bodies, to take care of myself and admire how beautiful and capable women’s bodies are. Thousands of girls and women do not have the opportunity of discovering this at home. I am not undermining the expertise women in my grandmother’s and mother’s generation achieved from life experiences and from each other about women’s bodies. A study about women in Ladakh highlights the extraordinary bond mothers and daughters share and its significance in maternal health. There seems to be a relationship between the early demise of one’s mother (before the age of twenty-one) and having fewer live children as compared to women whose mothers survived to see their grandchildren born (Chin et al, 2004). Of course, Chin et al’s study refers to a conventional relationship, a married woman having children while her mother guides her through pregnancy and childbirth. What about teenagers in their first relationship or when they are even younger, experiencing their first period and the mental, emotional and physical changes they go through? Do they have a resourceful mother and grandmother to talk to? Unfortunately, no. The health resources available in remote villages consist merely of Primary Health Centres (PHCs). 82.86% women and children from nomadic parts of Changthang region go there for medical assistance and treatment of common diseases such as colds, fevers and high blood pressure (Dolker, et al, 2021). What about girls’ and women’s other health concerns? We have gynaecologists only in urban Leh and Kargil. In the villages, we have Auxiliary Nurse Midwives (ANMs) for child and maternal health and family planning services. However, many ANMs feel that they are not prepared for emergency or triage situations and they will often refer women to the nearest hospital which could be 50 to100 kms away (Aengst, 2011).
It was in the summer of 2015 when my friend, NLG co-founder, and I sat in a women’s health class at Smith. When asked whether we had taken the HPV vaccine, everyone except the two of us raised their hand. In those two weeks of class, I felt cheated by my education and the culture of Ladakh where young girls are not taught about their health, one of the most fundamental rights for a child. In eighth grade, my science teacher talked nervously about menstruation and had to send the boys to the library first. This is the reality of most schools in Ladakh and in India. We do not have comprehensive sexual health education. It is a highly contested topic that makes one feel like it is easier to ignore it, even though that causes so many teenagers who do not understand their body to make uninformed choices.
Coming back home from the Smith summer program, my friend and I, at sixteen, were excited to share the immense knowledge we had learned about women’s health. We compiled all the material in a Powerpoint presentation which included topics such as menstruation, puberty and contraceptives. We began our work on NLG by having our first summit with local women, where we invited doctors, teachers, counsellors and journalists to give us feedback on the content before heading to different villages and schools to share it. Their first feedback was a suggestion to remove the slides on contraceptives, saying that it was not appropriate in our culture. Instead, they wanted us to simply say, “It’s not our culture to have sex before marriage.” Their conviction while uttering those words was scary because there was a larger belief system behind them – the fear of a particular religious population taking over. Religious leaders travel to different villages to spread pro-natalist messages (Aengst, 2011). Though most local reproductive health workers support women having access to different methods of contraception and comprehensive health education, they feel that the context they work in is overtly against family planning (Aengst, 2008).
In the 2025 vision document for Ladakh, various healthcare improvements are addressed, but nowhere does it mention issues of women’s health and reproductive healthcare (Aengst, 2011). However, there are a handful of local NGOs and projects partnering with national and international organisations to help provide women’s health education in Ladakh. NLG is one such initiative. Although I loved working for and am very passionate about NLG, I do get frustrated by how ineffective it is at times. My friend and I travelled every summer between 2015-2019 and in the winter of 2021 to different villages and schools to talk about women’s health and even distributed Boodh menstrual cups and Ecofemme cloth pads. We stopped for a few hours in every village and, of course, it was meaningful to meet so many young girls and mothers and to have an open conversation about women’s bodies. Although sometimes, even one talk can be impactful, especially when it is a subject that no one touches. I remember the first time a female teacher gathered all the girls from the 7th to the10th grade together. I was sitting in the first row, and our class was the youngest of the group. When she started saying that when girls and boys grow up, we change physically, we started giggling. And she pointed to us, saying, “They have no idea what’s coming down the line.” She said now we can become pregnant and should be careful about our relationships with boys. It was a talk on morality/character rather than puberty. That talk made me feel scared, small, and vulnerable. It left a scar on me and it was only when I finally learned about my body at Smith, that I could heal that part of me, a sense of fear that I was taught to have about my body, that it was a liability. At Smith, it felt like now I have the tools and knowledge to take care of myself and that I am not a vulnerable body that can be impregnated just like that.
Having just finished my master’s degree in the International Educational Development Program at the University of Pennsylvania, I am very critical of our approach. One or two informative sessions are not enough. A sustainable program where local women and girls can access information whenever they need it is crucial because we go through so many changes and everybody’s body works differently. I remember one woman saying, “We are so used to unannounced outsiders coming in to ‘help’ us with different schemes and talks” and that’s exactly how NLG work feels to me now that COVID and our own career plans have disrupted it. We did what we could, but we, as developers, need to strengthen our approach so that we can leverage local resources and eliminate their reliance on future visits from us. In addition to this, unfortunately, many of our leaders do not understand how important sexuality education is. Therefore, without having governmental support, it is an uphill battle. I have to remember that change is slow and I am perhaps being impatient, but girls’ and women’s wellbeing cannot wait forever. Now more than ever, we need honest conversations on female sexuality and healthcare because, unlike the older generations, younger people now have access to more and more opportunities and exposure to the world. We need to figure out how to manoeuvre both modernisation and cultural beliefs; we cannot overlook sexuality education simply because it is not culturally “appropriate”.
इस लेख को हिंदी में पढ़ने के लिए यहाँ क्लिक करें।
Aengst, J. (2011) Reproductive Politics at the Border: Pronatalism, Intermarriage, and Moral Movements in Ladakh, India, ProQuest. Available at: https://www.proquest.com/
Aengst, J. (2008) Representation and Perception: Why Reproduction Matters in Ladakh, WordPress.org. International Association for Ladakh Studies. https://ladakhstudies553872937.files.wordpress.com/2018/03/ls23.pdf (Accessed: January 24, 2023).
Chin, N.P., Dye, T. and Lee, R. (2008) Women’s narrative life histories: Implications for maternal and child health in Ladakh, Brill. Brill. Available at: https://brill.com/display/book/edcoll/9789047443346/Bej.9789004167131.i-313_013.xml?language=en (Accessed: January 24, 2023).
Dolker, T. et al. (2021) Women and children health status of nomadic people of Changthang Ladakh, International Journal of Current Microbiology and Applied Sciences. Available at: https://ijcmas.com/10-4-2021/Tashi%20Dolkar,%20et%20al.pdf