Q&A with Gayathiri Kamalakanathan from Decolonising Contraception

Gayathiri Kamalakanathan is the education lead for Decolonising Contraception (DC), a collective of Black and people of colour (BPOC) working in sexual and reproductive health (SRH), whose aim is to address the health inequalities faced by BPOC due to colonisation.

Gayathiri is a Tamil, non-binary sex and relationships educator, working with both DC and the School of Sexuality Education.

They sat down with Hysterical Women, as part of our Black Women’s Health Matters series, to talk about the racist and colonial history of sexual and reproductive health, and how it continues to impact the care that BPOC receive today.

When and why was Decolonising Contraception first created?

Dr Annabel Sowemimo is the founder and director of Decolonising Contraception, and she started the collective in 2018. DC started as a column on gal-dem, where Annabel was writing about her experience and knowledge of sexual and reproductive health, and the limitations of it for Black and people of colour in this country. She was also looking at how, throughout history, Black and brown bodies globally have been experimented on, have been tortured and mined for medical ‘advancement’. So, for example, testing the combined pill on Puerto Rican women, violating Black women’s bodies to investigate their reproductive systems.

A lot of this history is not  spoken about, not taught in medical school, and lots of medical terms are named after these white doctors who experimented on Black bodies. Our society is systemically racist, and without addressing its racism, our health, education and political systems won’t be able to serve Black and people of colour equitably.

There was such a need for a collective of BPOC sexual health experts, and we’re now a collective of around 30 people or so. We work across education and health – so we have researchers, doctors, nurses, mental health workers and sex educators. With DC we speak to our communities about decolonising sexual health, and issues related to sexuality, gender, and how a lot of the misinformation has been cemented through colonisation and white supremacy.

What kind of problems are you addressing?

So, for example, when you look at medical school textbooks, they’re looking at white bodies. I know of cases where medics were not able to diagnose jaundice in Black babies, because they were never taught to. If you’ve never learnt about how different conditions present in Black and brown bodies, you won’t be able to treat them.

Over the last two years, DC has put on panels in universities where we will invite BPOC sexual health experts, and also people like LION (Land In Our Names), which is a land justice organisation who also look at the link between reproductive justice and land justice.

I think what’s most important is that we don’t come at it from a single narrative. This single-narrative perspective is sometimes why, as a brown, non-binary person with a long-term mental health condition, some of my needs might be overlooked at the sexual health clinic.  It’s about looking at the full picture, and thinking okay, well, what about their mental health? What about housing? What about gender-based discrimination or violence? What about misinformation? How are all of these things impacting on a person’s sexual health?

Often no one consults a Black or person of colour when thinking about making sexual health services more accessible – less racist, less queerphobic. You miss a lot of the problems because you’re not asking people with lived experience about the issues they are specifically facing.

In the SRE (sex and relationships education) statutory guidance that’s come out for 2020, some of it is more inclusive. We’re talking about menstrual literacy being needed for all genders, without a segregation of ‘boys’ and ‘girls’, and also needing to teach about LGBT identities. But a really important part of that guidance also says LGBT identities should be taught at a timely point, when the school deems it appropriate – as if there is something inherently inappropriate about LGBT identities. If you’re going to teach a child about heterosexual relationships as soon as they are born, there is no reason why you can’t teach about queer identities. There’s a hyper-sexualisation of queer identities behind the suggestion that it’s not suitable for children to understand. Also importantly, if children are old enough to know they are cis and het, they are old enough to know they are queer, trans and non-binary.

You can’t look at all these issues from just one perspective – you have to talk about colonialism, you have to talk about white supremacy. White supremacy has shaped our understanding of sex and relationships; we need to talk about it so we can undo it.

How does the history of racism and colonialism impact on Black women, women of colour, and gender non-conforming BPOC today? What are the biggest barriers and misconceptions you see in your work, particularly when it comes to accessing healthcare?

I think one of the biggest things in my experience is the idea that queerness is ‘unBlack’ or ‘unbrown’; that it’s for white people. If we know our cultural history, there are lots of examples around the African and Asian continents of queer deities, queer royals, and queer people in society, who were then criminalised and erased during colonialism. We’ve absorbed this cis-heteronormativity, so it’s now deeply entrenched in our more recent history. It’s been life-affirming for me  to research and discover the frameworks that existed pre-colonisation. Queer Black and brown people have and will always exist! This is why decolonising education is so important.

What kind of external barriers are there, in terms of biases from doctors and other healthcare professionals?

What I experience and hear about is Black and brown people going to the doctor and not being believed, and their pain or side effects not being taken seriously. Say you’ve had lots of difficult side effects from one type of contraceptive pill, but you’re just being told that’s normal, you’ll get used to it – but actually it’s a year in and you don’t want to keep suffering. You should be advised by medical professionals about all the other contraceptive options available to you, because there are many others that might work better for you.

I also know of a colleague who had a particularly difficult experience. Their girlfriend was white, and she went to A&E presenting with pain around her ovaries. She was seen and it turned out she had an ovarian cyst, which could actually have caused quite a lot of issues if she hadn’t been seen for much longer.

When my colleague, who is Black, went to A&E presenting with the same pain, they were told to come back in two weeks. They are also a doctor, and so they were like ‘I bet it’s an ovarian cyst’. They went to another A&E, because they just knew they needed to be seen, and it turned out they did have an ovarian cyst. You really have to know how to advocate for yourself, because medical professionals might not advocate for you, or believe you.  In that experience, my colleague’s white girlfriend didn’t need to have that skill of persuasion. But why should you need to be able to persuade your doctor to treat you?

In our workshops we tell our communities: do advocate for yourself, do be firm about your pain. If someone doesn’t believe you, ask to be seen by another doctor. It’s not in your head. For example, Black women experience gaslighting like, “I’m sure it’s not that painful, you can take it”. You get Black people being seen as able to handle more pain than their white counterparts. Black bodies are not built to handle more pain; it’s a racist idea to think so. We are teaching our students – which includes young students, from 11 plus, all the way to our more elderly community groups – to go and say: This is my experience, this is how long I’ve been experiencing it for. Give as much detail as possible and just don’t leave until you’re seen or treated properly. This example is in a medical context, but it applies in all spaces.

How can these issues be tackled at a systematic level – whether that’s healthcare, education or policy?

In medical schools, in the House of Commons – wherever laws, services and curricula are made up – the solution is to get Black and people of colour experts to weigh in on this, to conduct surveys with specific community groups, including participants of different genders, sexualities, disabilities, neurodiversities and ask them what it is they need in order to be treated better, free of microaggressions and prejudice. Ask specific communities – for example, Nigerians, Ghanaians, Indians, Koreans, Chinese people – don’t just lump us together as ‘BAME people’. It’s so underserving of our communities when we’re called BAME, and data collection in this way doesn’t lead to constructive output. Because, for example, how a Black woman is perceived and treated by society will be different to how a South Asian person is treated. We need more specific and tailored information because we are not all the same.

For example, DC does consult on some school and university curriculums, which is great. People are realising that if you don’t have a diverse and intersectional range of voices giving input, you’re going to end up with racist, cis-heteronormative teaching.

Finally then, how can readers get involved? How can they support your work and find out more? 

There are lots of resources and information available on our website, including our Sex Agenda podcast and recordings of past panel events. These are completely free to access, and you can donate to support DC via our Patreon account (see link below). Also, anyone who identifies as BPOC, and works in sexual and reproductive health in any capacity, can get in touch and join the collective.

You can find out more and get involved with Decolonising Contraception online, on Twitter and Instagram.

You can also donate to support their work at Patreon, and listen to their Sex Agenda podcast.

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