Towards a Culture of Reproductive Empowerment in South Asian American Communities
As a fertility specialist, when young women or couples come in for consultations, I get a firsthand glimpse into their understanding of the reproductive system. Their vocabulary, comfort using correct terminology and discussing sexuality and reproduction, and the misconceptions they hold all come to the forefront. While teaching the realities of reproductive health remains one of my favorite aspects of my job, I feel strongly that young people would be better empowered if they learned the facts from a young age. I have argued here and here that fertility counseling for adolescent women could not only help women make better informed choices and monitor their reproductive health throughout their lives, but also potentially prevent some cases of infertility.
Through this series, I also aim to dig deeper into how conversations around reproductive health vary culturally. In South Asian culture, the stigmatization of reproductive health and sexuality has been discussed frequently (see the “Women’s Health” chapter here for a detailed discussion). Many of us grew up with deeply and directly ingrained notions of shame around menstruation, sex and nudity. But how do these views get passed on from one generation to the next?
Rooted in our Childhood
Being comfortable with our bodies starts in childhood. Current pediatric literature strongly recommends using anatomically correct terms for male and female private parts, but anecdotally, this practice seems less common among South Asian families. Using correct terms can help people feel knowledgeable and comfortable about their bodies and can also help parents provide their children with safeguards against inappropriate sexual touching. Awareness of childhood sexual abuse in our community has come a long way, but we can no longer assume such violations only happen to others. On a similar note, children should not be made to feel ashamed of their nude bodies (I know many of grew up with “shame-shame” as a euphemism for nakedness). Early childhood is when we set the stage for lifelong comfort with understanding and discussing our body and its functions.'
Through Adolescent Years
The time of pubertal transition is another one fraught with landmines, and the cultural taboo against premarital sex and romantic dating remains strong. As a result, so many young South Asian American women are trapped between desi cultural expectations of modesty and American conventions of clothing and sexuality, between only dating “the right boy” and their true sexual orientation or choice of dating partner, between remaining chaste but desirable, and so on. Lost in these conflicts is what young women really need as they enter their reproductive years: 1) body positivity, 2) education around the characteristics of a normal menstrual cycle and managing periods with pads, tampons (yes, tampons, which have nothing to do with virginity and are appropriate for any menstruating woman!), period underwear or whatever methods they choose, and 3) education around consent and safe, healthy sexuality. Fortunately, we have leaders among this generation trying to open safe spaces for these conversations.
Building a Culture of Reproductive Empowerment
As a gynecologist, I see the outcomes of these missing lessons: women getting delayed diagnoses of polycystic ovary syndrome or infertility because they never understood what a normal menstrual cycle should look like, discomfort during intercourse and childbirth because of persistent embarrassment around nudity, sexuality and reproduction, and so forth. In the end, building a community of women who feel informed and confident in their choices – the full spectrum of choices – and in their reproductive health starts with positive, empowering messages from early childhood onwards. For me, the destigmatization of these conversations in the South Asian American community is both a medical and social issue, and I know we can do much, much better. Let’s start here, together.
A personal introduction to the series by Dr. Rashmi Kudesia herself!
Dr. Kudesia is Board-Certified in Reproductive Endocrinology and Infertility, practicing at CCRM Fertility Houston in Texas. She is also an Assistant Clinical Professor at Houston Methodist Hospital, and has been named a "Super Doctors Rising Star” for the past three years. Dr. Kudesia is a Fellow of the American College of Obstetricians and Gynecologists, and holds leadership roles within the American Society for Reproductive Medicine, Society for Reproductive Endocrinology and Infertility, Androgen Excess & Polycystic Ovary Syndrome Society, and American Medical Association.