Handbook for Women with Visual Impairment - 7.

HEALTHY SEX LIFE FOR VISUALLY CHALLENGED WOMEN
  

By
Dr. Renu Addlakha

Sexual and reproductive health is a matter of global concern and human development. Over the past decade there has been a growing realisation that sexuality and reproduction are not just medical matters. Social, economic, cultural and political factors play an equally important role not only in influencing people’s sexual and reproductive behaviour but also in the success of programmes and policies aimed at population control and AIDS prevention.
  

What is Sexuality?
  

Sexuality is a multidimensional concept. Human sexuality cannot just be reduced to issues of sex, sexual intercourse and reproduction. It involves the total personality of the person from infancy to old age. Sexuality definitely centres around the anatomical, physiological, hormonal changes associated with onset of puberty, sexual intercourse, pregnancy and child-bearing but goes beyond them to encompass the way one thinks, feels and behaves as a man or woman in society.
  

Although heterosexuality is the norm, people may have other sexual orientations (homosexuality, lesbianism and bisexuality). The main elements of human heterosexuality are:
  

- How an individual feels about being a person
  

- How an individual feels about being a man or woman
  

- How the individual relates to members of the opposite sex.
  

There are many taboos associated with sexuality in our society, when it is understood in the narrow sense of just sex. Parents, teachers and other adults consider it a problem full of risks and danger, especially for women outside marriage. It is not discussed openly especially with the young and unmarried. The pleasure dimension of sexual experience is undermined. Yet on the other hand, the media is full of sexually explicit images and messages extolling the body beautiful and encouraging sexual experimentation. This paradoxical situation highlights a societal double standard in attitudes to sexuality creating a lot of confusion and uncertainty in the minds of adolescents and young people experiencing the turmoil of puberty.
  

Sexuality is an area of distress, exclusion and self-doubt for persons with disabilities. Sexuality at core is about acceptance of self and acceptance by others. Given the oppression suffered by the disabled, there is every reason to believe it is a matter of utmost importance in the movement for total inclusion of persons with disabilities in the social mainstream. The purpose of this article is to highlight the need for sexuality education for young visually challenged women, and to make some suggestions for a sexuality education programme that can be implemented in special and integrated schools.
  

Sexuality and the Visually Challenged
  

Adolescents with visual disability must cope with all physical changes, emotional anxieties and social conflicts of able-bodied adolescents, in addition to those produced by their disability. They experience the same physical changes and sex drive that is part of normal biological development, but have greater concerns about their bodies than their able-bodied counterparts. These concerns may be both realistic and irrational, but they influence their behaviour and identities in significant ways. We need to bear in mind the particular disadvantages that they, particularly girls face in this regard. Due to a range of social barriers and cultural attitudes regarding sexuality of the disabled, such persons experience more frustration in body image construction and self-esteem.
  

Furthermore, there is considerable empirical evidence to show withholding sexuality related information from young persons with disabilities has harmful consequences.
  

Consider the following:
  

Most information about sexuality is imbibed visually from childhood. Television, films, magazines, etc are replete with information about sexuality. Visually challenged persons are deprived of this important avenue of information due to their disability. Hence it is the responsibility of teachers and others to help them obtain such information in accessible formats.
  

Since most information about sex is learned quietly, covertly and is greatly influenced by peers and the media, persons with disabilities may experience great limitations in knowledge and communication about sex and sexual behaviour due to their isolation from mainstream society. Visually challenged girls may be sequestered at home or in special schools where their access to reliable information about sexuality is very limited. Over-protectiveness by their families and restrictions by school authorities may further curtail learning opportunities.
  

Girls with disabilities, including visual disability, are several times more likely to suffer sexual abuse than their non-disabled counterparts. In addition, the need for assistance in mobility renders the visually challenged woman more vulnerable to abuse. Segregation in institutions and special schools also carries the risk of sexual victimisation by institutional functionaries, and older peers.
  

Early detection and prevention of sexually transmitted diseases (STDs) including HIV/AIDS are considerably lower among disabled populations, not only because of a cultural misconception of asexuality, but more so because such persons may not have the knowledge to identify symptoms of STDs and may not have access to appropriate healthcare facilities. This does not mean that actual incidence of these conditions is lower.
  

We live in a heavily loaded visual culture of sexuality especially through the media. It is this visual imagery, which is inaccessible to the visually challenged, which calls for attention Furthermore, eye contact is an invitation to sexual communication. This is impossible to actualise by the visually challenged persons. They have to substitute one sensory modality with other e.g. auditory and tactile modes in place of the visual mode. Strategies of verbal rather than physical seductiveness may be developed to imitate sexual activity.
   

The plight of the visually challenged child is the asexual perspective of their families. There is the tendency to treat the child as innocent of sexual thoughts and feelings and yet at the same time there is an extreme fear of sexual involvement leading to over-protective behaviour. Both are counterproductive because one may lead to sexual exploitation and the other may lead to dependency and isolation, anger and resentment. The individual gets programmed into avoiding interactions with the opposite sex due to deep-seated feelings of personal inadequacy.
   

In India, visually impaired persons, especially women, tend to have late marriages. In many cases, visually impaired women face the further disadvantage of very limited opportunities for marriage. Some stay away from home and live in residential special schools where they have to take care of themselves. Visually impaired women are particularly vulnerable to sexual exploitation. In addition to lack of information about responsible sexual behaviour and safe ‘sexual practices’, recognising existence of sexual diseases becomes a problem when the symptoms are purely visual. Explaining symptoms of STDs through tactile media is useful, e.g. analogy between sores around genital area and the oozing feel of cut ladies fingers or cauliflower.
  

The visually impaired person can visualise her body as an integrated whole, but this is often lacking when it comes to the opposite sex. Labels may be learnt but the location and functioning of various sexual parts may be distorted. Continual feedback about our own bodies and those around us provides us with a well-integrated sense of female and male physiques that visually impaired persons do not share. Life size models may be used to help them develop a holistic understanding of female and male bodies.
  

Guidelines for Sexuality Education for Visually Challenged Girls
  

Sexuality is a basic human need and reproduction a fundamental biological goal to which all living beings aspire. Consequently sexual and reproductive rights arise from human rights in general and apply to all persons regardless of age, marital status, ethnicity, race, religion, economic status, disability or other condition.
  

Sexuality is an integral part of human life. It is not a matter of shame and guilt. Adolescents and young people need correct information if they are to experience their sexuality in a positive and healthful way. Due to the social taboos associated with sexuality, parents and teachers are often unwilling or may be unable to provide such information and may actually foster a negative or inaccurate understanding through silence. Sexuality is considered socially threatening in need of control instead of encouragement and enhancement. Such issues as sexual expression, sexual intimacy, procreation and contraception are highly emotionally charged and difficult to address. There is also the assumption among adults that sexuality education will arouse insatiable aspirations, lead to over-stimulation and to uncontrollable, irresponsible sexual behaviour.
  

Ideally good sexuality education begins with the family but this may not be a practical option in our context, where sex is a highly tabooed subject. Hence it is the responsibility of school authorities to fill the gap.
  

Sexuality education is not just about body parts and reproductive education. It is equally about self-awareness, self-esteem, self-protection and relationships. It should not only equip young visually challenged people with accurate information about the physiology and psychology of sexuality but also empower them to enhance their self- esteem, forge a positive body image and develop a positive sexual identity.
  

Providing sexuality education is a difficult task even in the best of circumstances. Some suggestions for teachers undertaking it for visually challenged women are presented below:
  

1. The Teacher must have a Personal Comfort Level in Handling the Topic:
   

It is very important to acknowledge any discomfort, embarrassment and underlying prejudices at the very outset. A group discussion among teachers followed by individual introspection would help in managing such feelings.
  

2. Vocabulary of Sexual Communication:
  

Teachers should themselves become comfortable with using words connected with sexual behaviour and experience in order to impart information about these issues. These words may not be part of formal spoken and written language. They need to be desensitised to using these words in the local language as well as the slang and colloquial terms. This is necessary for effective communication, especially in the case of the visually challenged who construct the world through language. Innuendo and euphemisms may perpetuate prevailing misconceptions and misinformation and should be avoided. Indeed, when teachers show no embarrassment in naming sexual parts and acts and use the terms early on in group-process, students will also feel more comfortable in discussing these issues.
  

It is important to bear in mind that sexuality is one among several issues making up a person’s life. Family, education, career, friendships, the future, leisure and recreation are equally important concerns of young people with or without disabilities. Consequently, it is a good idea to weave in discussions on sexuality within the context of students’ other concerns, which can also serve as warm up topics before directly moving into the taboo area of sexuality.
  

3. Mixed and Disabled Friendly Instructional Media:
   

Instruction should be participatory not lecture as far as possible, i.e. emphasis should be on dialogue and question-answer methods. Role-play and dramatisation are more effective techniques for educating and testing learning involving intimate areas of life. For instance, asking a female student to enact a typical situation of sexual harassment that they may have witnessed or encountered. Case illustrations of stories in the media, movies and television are excellent ice- breakers in generating a discussion on sensitive issues. While some amount of lecturing is necessary to provide information on basic concepts, teachers should not discuss issues with a moralistic overtone. As with teaching, feedback and reinforcing the key concepts through repetition is essential.
  

Communication material has to be tailored to the needs of the target group. For the visually challenged, auditory and tactile modes of communication such as embossed charts, reading material in Braille and on cassettes, dolls, models etc. may be used. With the availability of screen reading software like JAWS and Kurzweil, very innovative ways of disseminating information may be developed tailored to the needs of the target audience.
  

4. Group Formation and Process:
  

Approaching menstruation is a good time to begin sex education, which may initially focus on reproduction and menstrual management. The composition of the group to which sexuality education is being given is as important as the contexts of the programme. There are advantages and disadvantages to giving such instruction in same-sex and mixed groups. There are also pros and cons of having a homogeneous group of only disabled persons (or those having the same disability) and a mixed group of both disabled and non-disabled persons. While comfort levels with the same sex trainer may be high in same sex groups, dual sex team may be more appropriate for mixed sex groups. Many of these group composition principles may be determined by the organisation in which participants are working. Generally it has been found in our context that more homogeneous groups work better at school level and all kinds of mixed groups work better with older adolescents and college-going students.
   

From the outset, teachers have to create a relaxed atmosphere for participants. Principles of confidentiality and non-judgementality have to be clearly communicated. Any fears, anxieties and apprehensions have to be allayed. Participants have to feel safe, comfortable and motivated to learn about sexuality and reproductive health, to express their feelings and ask questions without inhibitions.
  

CONCLUSION:
  

There are numerous modules on sexuality education for different age groups developed by international organisations like WHO, UNICEF, Population Council among others. In addition, local NGOs have also developed culturally sensitive modules. The contents of information for the non-disabled and the disabled remain the same: it is the methods of communication, which vary. The information needs of visually challenged young women are the same as those of their non-disabled counterparts. The need of the hour is to develop a cadre of teachers who can address these issues.

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