For time immemorial, women’s reproductive health care has operated on a whisper network – tentative “Sorry, this may be TMI” confidences, recommendations from friends, third-hand success and horror stories, laced with the consistent, underlying wonder whether a bodily function is normal. This network is a double-edged sword: While it has helped women get care and options they may not otherwise have had over the centuries, its very existence speaks to the fact that women’s reproductive health is considered taboo, or niche, though it affects roughly half the population.

This is changing — slowly. Discussions of entrenched sexism in health care – and the resulting lack of information about and/or poor care available for women’s health issues — have proliferated lately, but in many ways the topic remains off-limits. We wanted to see how much so. While we all rely on these whisper networks to a certain extent, do we feel we can rely on the gynecological experts we have access to? How satisfied are women with their gynecological care? Do they feel their gynecologists set them up to make educated decisions in their best interest?

We surveyed 1,100 women, up to 55 years old, to find out how they experience reproductive health care in India. These women come from across the country. They are both unmarried and married, sexually active and sexually inactive.

Across the board, roughly 1 in 4 women leave interactions with their gynecologists dissatisfied. Among unmarried women, the likelihood doubles; roughly half of unmarried respondents leave an appointment with their gynecologist dissatisfied.
This may be because, 1 in 2 of all women surveyed don’t feel they can speak openly, without fear of judgment, to their gynecologist. The ratio held true regardless of whether women were unmarried or married, or whether they were sexually active. Which suggests the attitudes that have driven discussions of women’s health underground are very much alive and well.

Part of that may be the natural discomfort of maturation, of course; 75% of women under 25 feel unable to discuss sex openly, without judgment from their gynecologist. And part of it might be inhibitions built by internalized sexism; surprisingly, 80% of women aged 46-55 felt similarly.

Yet, women in the 26-35 age bracket, and 36-45, all felt roughly 50-50 about being able to discuss their sex lives free of judgment with their gynecologist. This still is far from ideal, and suggests there’s an endemic problem of gynecological professionals letting personal prejudices bleed into treatment of patients. But it doesn’t feel like coincidence that the ages of women who feel least judged by their doctors coincides with the most common ages for childbearing. Perhaps sex is easier to discuss when it is aimed at conceiving a baby. Or perhaps it’s just easier to hear if that assumption can be made.

One thing is clear: The best gynecologists are preventative or proactive in their care — but women seldom experience this. Only half of all women have doctors who gave them the thorough and proactive information they need to make an educated decision about birth control. But best-practice communication is most lacking for women who would arguably most benefit from being able to control their own fertility: 70% of all women under 25 said their gynecologist had never discussed birth control with them, or had mentioned it only in passing.

Unmarried sexually active women have a particularly hit-or-miss source of health information: 42% said their gynecologist had never or fleetingly discussed birth control with them. Roughly the same number said they left appointments feeling dissatisfied with their care.

This may be explained away by outdated and/or sexist mores around what kind of (sexual) behaviour is appropriate for women. But that’s the precise problem – and the fallout can mean not only an unplanned pregnancy, if birth control options haven’t been explained properly, but life or death. Women’s responses make clear preventative and proactive reproductive care care is not available to them, in virtually all realms: 72% of women said their gynecologist has never mentioned breast cancer screening to them, or has mentioned it only in passing. Similarly, 3 in 4 women report their gynecologist has never discussed pap smears or HPV screening with them. All three of these efforts – breast exams/mammography, pap smears, and HPV screening – are aimed at identifying the earliest abnormalities that can lead to cancer, and heading off the life-threatening disease. Which begs the question – if a woman can’t get thorough, non-judgmental information and comprehensive, proactive care from her gynecologist, where can she get it?

In the upcoming series of articles, we’ll explore this issue further. The intent is not to denigrate the gynecological profession; we assume most gynecologists are competent and well-intentioned – but also potentially overworked as well as operating within a culture that is not very friendly to women’s reproductive health and sexual empowerment. Therefore, the goal of this survey and series is to draw attention to women’s perceptions around care, support and ability to make educated decisions when it comes to their reproductive health care. It’s certainly not the whole story of gynecological care in India. But it is at least half of it.

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