By Ease Healthcare
Mon, 10th Aug, 2020
Accessing reliable and comprehensive sexual and reproductive health education can be a challenge. While sexual education programmes in schools and universities provide quick overviews of subjects like sexual wellness, birth control, emergency contraception and STD testing, they tend to be either superficial or highly medicalised. Only a long time afterwards do people realise how their lack of knowledge when they first became sexually active affected their ability to make informed choices and manage their health appropriately, and how informal access to the limited knowledge they had through friends, family or the internet led to misinformation and anxiety. We interviewed ten Singaporean women between the ages of 21 and 26 to understand more about their experiences accessing this type of education, the barriers they face, and the resources they rely on to stay informed.
Costly Access to Information
Questions about your sexual health and wellness can be deeply personal and lead to plenty of anxiety if left unanswered. Questions such as “why are my periods irregular?” or “why does my discharge look strange?” or “what birth control brand works for me?” and “how do I take emergency contraception?”, are doubts that many women want to get professional advice on. However, attending a consultation with a gynaecologist in Singapore can cost more than $100 which is something many women are unable to afford. F, a 23 year-old fresh university graduate explains “It’s hard to get medically approved sexual health advice in Singapore, accessing this type of knowledge is so costly”. A, a 21 year-old university student, also adds “Because I couldn’t tell my parents I was getting birth control, I had to pay for all the appointments myself”. Many of the interviewees explained that in order to access general information on things like contraceptives or STD prevention, they had had to pay a consultation fee because this kind of information is not readily available.
Face-to-face consultations in a clinic setting are often not the best space to discuss intimate questions about your sexual health and wellness. Furthermore, while medication may be easy to access it is not always accompanied by guidance and education. As A explained, “the gynaecologists I got at (clinic’s name) were very dismissive like, ‘if you want birth control, just take la’. They didn’t tell me much about the side effects and I had to Google the pill by myself”. D, a 24 year-old creative also added “I wasn't told there were other brands available for prescription, I didn't know there were different types with varying hormone levels and prices. I just accepted what the doctor wrote as the only type available. I only found out when other friends asked about BC and we realised there was a variety and we all took different types”. When exploring this issues with F a 23 year-old fresh university graduate, she explained these types of situations arise because “doctors in Singapore, (are) very MEDICAL and there’s no emotion”, which might explain the lack of guidance and support in the process of selecting a medication that works for them or the lack of comprehensive education on how to use it, what the side effects are, and what other options exist aside from what they’ve prescribed.
Informal Resources and Loads of Googling
When we asked other interviewees where they got their information on sexual and reproductive health, we received similar answers. D, a 24 year-old student and visual artist explained “I basically grew up on the internet and literally everything I know about my body I've learnt from there. I always share the information I have with those around me because I'm constantly appalled at how little women are taught about their bodies! About yeast infections and BV (bacterial vaginosis) and how to notice these things and treat them.” Other women cited social media as another source of information. D, a 25 year-old actress and educator explained “I follow a lot of influential people (on social media) who advocate birth control rights and also the effects that come with various birth control methods” She also added that her friends and colleagues are a big source of information for her and also provide her with a space to raise these issues.
Stigma Surrounding Dialogue
While some people find comfort in groups of friends or colleagues that allow them to discuss sexual and reproductive health and share information and resources, most women who were interviewed mentioned that a significant barrier to accessing this education comes from the stigma surrounding these topics. People refrain from sharing experiences or asking questions, even with people close to them, because they fear judgement. As K, a 23 year-old interior designer shared, “our culture in Singapore is way too narrow minded to be openly talking about sexual health. I have a small group of friends that are very open with this and we have chats about this as well. But other than that, there really isn't anything else in my opinion... Even till now, I don't tell certain people that I'm on the pill. Some of my closer friends think I'm more 'hoe'-like simply because I'm on the pill, despite the fact that I am, and have been in a monogamous relationship for the longest time”.
Others brought up that asking their parents for information was not even an option. As A, a 21 year-old student shared “There wasn’t any proper way I could get any information. My parents are a no-go, like ‘don’t tell me anything’”. D, a 24-year old creative shared a similar experience “My parents accidentally found out and it was a pretty rough night. They treated it as if I was damaging my body with synthetic hormones. We never spoke of it again or anything else about sex ed besides abstinence until marriage - an Asian classic!.” As V a 23 year-old summarised, “even when you tried to get information, you were just shut down.”
The provision of sexual and reproductive health services cannot be limited to just prescriptions of medication. It needs to go hand-in-hand with sufficient education to allow people to make informed decisions and take control of their health and wellness, support networks that allow women to discuss these issues and share their experiences or doubts and collectively support one another, and an ongoing care service that extends beyond the clinic door and which supports people throughout their lifetime to help take care of their health and well-being.