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Passport to the murky world of contraceptives for housemaids

2018-05-17 00:00:41
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Two months ago, unrest sparked across the country due to the speculation that a pill that causes infertility had been mixed with a food served in a small restaurant in Ampara.

The particle was later found to be mere lumps of flour. Nevertheless, did you know that a considerable number of Sri Lankan women, who work in the Gulf as housemaids, regardless of their race, have been unwillingly taking ‘the most dangerous contraceptive in the world’ Depo-Provera which is banned in the USA? 

The Human Rights Watch report in 2007 documented cases in which Sri Lankan female prospective domestic workers have been administered contraceptive injections without their informed consent and, in some cases, against their will. This was again reported in an article published in The Guardian on April 6, this year, making headlines in local newspapers. On the following day, the Government of Sri Lanka (GoSL) said no contraceptives were administered to Sri Lankan female migrant workers and added that only a medical check-up is conducted prior to these Sri Lankans leaving the country. The Daily Mirror investigations uncovered that the findings in the HRW report were true and the administration of the Depo-Provera injection for potential housemaids is still taking place.

Gauri Kathamuththu from Valaichchenai, Batticaloa had to become the breadwinner for her family when her husband left her just few days after their first baby was born. She was 21 years old by that time. Lack of employment opportunities in her area made her choose migration to the Gulf as the survival strategy. Deceived by the pretty image painted by local travel agents about a housemaid job, Gauri decided to fly to Saudi Arabia which is considered to be the most favoured destination of housemaids. But in reality this  nation is the hardest for housemaids to do their jobs. Gauri, who was desperate to provide education for her daughter and bear all her expenses, was thrilled by the commission worth Rs. 200,000 which she received from the sub-agent.

She said details of her passport were falsified by the travel agent in order to meet the age requirement which is 25. She was dressed with a hijab to look like a Muslim. She was given a Muslim name. She said she was told by the agent that the details were changed to portrait her as a Muslim female because many employers in the Middle East prefer Muslim domestic workers.

Gauri who was accompanied by the sub-agent to Colombo got the compulsory medical check-up done for Rs. 9,500 at a private medical centre supervised by GAMCA (Gulf Approved Medical Centers Association). In the medical certification, she was found ‘FIT’ to travel.

As per the Rules and Regulations for Medical Examination of Expatriates Recruited to work in the GCC (Gulf Cooperation Council) States, those pre-departure medical check-ups can be carried out only by a selected number of private medical centres which are under the GAMCA. That means the GoSL plays no role in pre-departure medical check-ups.

“Those medical professionals in the particular medical centre asked me to visit them once I got my menses in the same month. When I asked why, the sub-agent and the medical staff said my medical check-up had to be completed before the departure,” Gauri said.

Without her informed consent, Gauri was given a highly effective injectable contraceptive called Depo-Provera which prevented her fertility for three months. When she was given this injection back in 2000, she had no clue why it was given and how the injection works within a female body.

“They indicated that the injection was to prevent any diseases. I thought prevention is anyway better than cure. So I agreed,” she recalled.

According to Gynaecologist Dr. U.D.P. Ratnasiri, Medroxy Progesterone Acetate (Depo-Provera) is a Progestogen commonly used for female contraception. It suppresses ova production and ovulation and also causes thickening of cervical mucus in the uterus. Both these properties prevent conception and it is a highly effective method of contraception, Dr. Ratnasiri said.

He outlined that offering any method of family planning needs thorough counseling by a medical professional who’ll look into the details of why it’s required, advantages and its disadvantages.

He said this drug, which can be injected at any stage during menstruation, is effective from the day of administration for twelve weeks.

“Women leaving as housemaids to Middle Eastern countries may be susceptible for rape and sexual harassment. Yet, it is unethical and dangerous to inject Medroxy Progesterone Acetate without proper counseling and obtaining her consent. I feel it is a violation of women’s rights,” Gynaecologist Ratnasiri said.

He explained that it is always important to identify the disease condition of a woman, assess the safety of the drug and then counsel the couple about the advantages and disadvantages of the method before offering it.

“Some of the disease conditions contraindicating this injection are migraine, headache, women at high risk of thromboembolism, active liver disease, unexplained vaginal bleeding, hypertension with cardiovascular disease and stroke,” he said.

However, it poses a serious question as to whether the so-called medical staffers in these private medical centres, which are unmonitored by the Government, comprise experts and qualified people who are tasked with evaluating these medical factors before administering the Depo injection.

Side effects of the drug 

In females, the most common side effects of Depo are acne, changes in menstrual flow, drowsiness and the causing of birth defects in the instance of being used by those pregnant. Other common side effects include breast tenderness, increased facial hair, decreased scalp hair, difficulty in sleeping or remaining asleep, stomach pain, and weight loss or gain. According to the doctor, when the injection is taken for more than two years it increases the risk of Osteoporosis which can lead to bone fractures.

Since 2000 Gauri has been travelling to Gulf countries including Saudi Arabia, Kuwait and Jordan every two years. By the time we interviewed her, it was three months since she had returned from Saudi. She has been taking the Depo injection every two years. She is now fully aware why the injection is administered and what kind of role the injection plays in her body.

“I am prepared to fly to Kuwait on May 21. Now, I am expecting my menses on May 18 and hope to visit Colombo and get the Depo injection,” she said.

Dr. Ratnasiri said that the constant use of the Depo injection, as any other contraceptive, can have a great impact on the female body. Gauri is experiencing various difficulties with regard to her health after she started taking the injection. 

“I get menses thrice during a month. Bleeding thrice during a month makes me physically weak. I am going abroad to work as a housemaid. I am responsible in looking after kids in the employer’s house, cooking, cleaning and doing all other household work. I take few hours of sleep. I don’t even get nourishing food,” she narrated her ordeal.

She said this irregular menstrual cycle has even affected her mental health. 

“At times, I suffer from depression, tiredness, anger and even experience sleep disorders. When I develop these health difficulties at work, I have to suffer more in the house because all what the employers need is work,” she said.

Gauri is now 39 years old. She is currently preparing to go to Kuwait. Her 18-year-old daughter is living with her grandmother (Gauri’s mother). Although she is still experiencing all these troubles while working as a housemaid in the Gulf, she still wants to continue working abroad.

“I don’t want my daughter to face the same situation I experienced. I will struggle to give her a beautiful future. She will not even think of flying to the Middle East to work as a housemaid,” she said.

Gauri’s is just one among many stories from Valaichchenai. Many women who have undergone the same – may be worse—experiences can be found in the area. Lakshmi is one of them. She started her career back in 1990 at the age of 28. She stopped going to the Gulf in 2012. She is now 56.

Lakshmi told the Daily Mirror that she was also given the same Depo injection repeatedly during the 22 years she was employed as a housemaid.

“I have experienced severe abdominal pains and headaches. I cannot explain in words how much I suffered due to the effects of the injection. Contraceptive options that are safe and appropriate for one woman may not work for another. Why don’t these doctors know about it? Why do these agents and even doctors play with our bodies,” she asked.

According to Lakshmi, there are several women in her area who had worked in Saudi as housemaids before getting married. Later, when they got married, they had not been able to conceive a baby. “Due to the constant use of Depo, they became sterile,” Lakshmi said.

“When they could not give a baby to their husbands, their mothers-in-law asked them to leave the house. Can anyone understand the pathetic situation these innocent women are in ?” said she.

Neither Gauri nor Lakshmi had a single document to prove the injection was given. They said it is normally not documented.

Meanwhile, the Daily Mirror spoke to Rahini Bhaskaran, Coordinator of Inayam Migrants Network, an organisation working for safe migration. She said, as an activist and also as a woman, she is very disappointed in the silent approach the GoSL is taking without punishing those who are responsible for these acts. 

She said that most of these women were not informed about what tests were being performed and why they were performed. “They were not even given their medical certificates. The travel agents attached to GAMCA Medical Centers are taking care of it. Those who perform these check-ups do not follow medical standards,” she said. 

“Every single woman has a right to decide what’s good for her body. The right to bodily autonomy and integrity guarantees the right of all individuals to refuse unwanted medical treatment. They have already faced various difficulties at their homes. Such illegal practices double their difficulties. This is unfair and inhumane. This administration of contraceptive injection has to be stopped,” affirmed Bhaskaran.

The Daily Mirror also spoke with several travel agents operating in Colombo area. Jaffer of New Kingdom Manpower in Borella said according to new rules the Depo injection is not administered.

“New rules and regulations advise not to give the contraceptive injection to housemaids anymore. Accordingly, only MMR (Measles, Mumps and Rubella) injection is given to both male and female migrant workers,” he said.

When specifically asked about the Depo injection, Jaffer said he was not aware of any medical vaccines given to migrant workers since he was not interested in the subject. He said that his only concern is to take care of recruitment procedure of the migrant workers and make sure it is done in a law-abiding manner.

“When we send a migrant worker to any of the GAMCA medical centers, it is mandatory for her to undergo the medical check-up. If its results are okay, she is given the MMR vaccine. We have nothing to do with the medical matters pertaining to workers. We don’t bother about those matters,” he said.

According to Jaffer, the main two reasons for the Sri Lankan housemaids to return before the contract expires are contracting Tuberculosis (TB) or getting pregnant.

Readers might query as to why the effect of the injection lasts for only three months? What would happen if the housemaids get pregnant after three months?
Jaffer had answers to those questions.

According to him, there is a three-months probation in the contract of employment which every housemaid is subject to. As per the contract, if a housemaid gets pregnant during the first three months of employment, the relevant travel agent will be responsible in bringing her back to Sri Lanka, bearing the travel cost. Not only the travel cost, the agent will also have to take care of the expenses in filling the job vacancy by recruiting another housemaid.

As per the contract, travel agents are bound to make sure that these housemaids will not get pregnant within the first three months. After the first three months, the responsibility of housemaids is transferred from Sri Lankan travel agent to the relevant employer.

“If they get pregnant after three months, we are not responsible in finding a replacement. It is the GCC law,” he said. Jaffer’s revelation indicated the obvious reason why agents ask housemaids to take the contraceptive injection.

Faroos Marikkar, another travel agent, spoke to the Daily Mirror regarding the Depo issue. He has been in the foreign employment field for the past thirty five years.

In another startling revelation, he said that the GAMCA had instructed agents to submit a guarantee that the migrant worker will not get physically unfit during the first three months of her contract. The loved ones of these housemaids opine that it is ridiculous how a recruitment agent can give a medical guarantee to this effect. He was of the view that the guarantee is used as a shield by the medical centers in order to avoid any payments to the travel agents in case the migrant worker is found to be physically unfit during the probation period.

Meanwhile, Faroos also explained why the Depo injection is given to housemaids. 

“A huge amount of money is paid to a housemaid as a commission before she is sent to the country. According to the GCC laws, if a woman gets pregnant while working there, she is sent back to where she came from. If this happens during the first three months, we are in trouble. When they return, it is very difficult to recover the lost money from them,” he said.

During the interview, Faroos called a Manager of a medical center known to him. The lady said Depo is no longer administrated in her medical center which is also supervised by the GAMCA.

‘Medical’ staffers unqualified 


She told Faroos that a housemaid had died of severe negative effects of Depo injection three years ago. Following this death, she said her medical center had stopped giving the injection. She did not mention about the details of this death.

Meanwhile, Faroos alleged that medical staffs working in GAMCA medical centers are neither qualified nor experienced doctors.

“Why can’t these women go to a government hospital and get the check-ups ? Government hospitals are heavens compared to these small medical centers which don’t even have proper facilities. As this is a business, these medical centers are concerned about profit and loss. Therefore, they hire cheap medical professionals,” he claimed. 

He was of the view that inaction and negligence on the part of the government had become a blessing for these private medical centers. He emphasized that the Government should take over and monitor all areas of the foreign employment field.

“These medical centers sometimes issue false medical certificates. We send women because we have confidence in the medical certification. But, we often have to face much financial losses when migrant workers are found to be physically unfit just after landing in the respective countries,” he remarked.

Both the travel agents said that the administration of the Depo injection has been stopped. Even an official from the Association of Licensed Foreign Employment Agencies (established under Sri Lanka Bureau of Foreign Employment (SLBFE) Act no. 21 of 1985) also said that this practice had been stopped several years ago.

The writer contacted four private medical centers operating under the supervision of the GAMCA in the suburbs of Colombo under the guise of another desperate woman expecting to travel to Saudi in search of employment as a housemaid.

A laboratory officer of MediLab (Pvt) Ltd located in Colombo said the the administration of Depo injection is still happening at their workplace.

MediSense Laboratory (Pvt) Ltd in Battaramulla and Ohlums Clinic and Laboratories in Colombo 08 said the Depo injection is administered by their medical staff to housemaids under their informed consent. Those who are unwilling to receive the injection must submit a guarantee from their respective travel agents.

A spokesperson of Blue Cross Medical Centre (Pvt) Ltd in Rajagiriya said they only provide housemaids with MMR injections.

The HRW report in 2007 said that the labour agent or sub-agent coerced some women into getting the birth control injection. In some cases, labour agents told domestic workers that if they declined the injected contraceptive, the agency would not assist them if they became pregnant, even in the case of being raped by their employers. 

According to the HRW report, an SLBFE official confirmed that the bureau is aware that “there is a tendency” for contraceptive injections to be administered to prospective domestic workers during the compulsory medical exam, although it is not a Government policy.The SLBFE reports that it hasn’t received complaints from migrant workers regarding the administration of contraceptives. Some domestic workers reported that they didn’t complain about the administration of contraceptives because they were not aware of their right to refuse the injectable contraceptive. In some cases they did not know what medication had been administered. 

Attempts made to contact R.K. M. P. Randeniya, Deputy General Manager of the Sri Lanka Foreign Employment Bureau (SLFEB), were futile. However, another highly placed source attached to the SLFEB, speaking on terms of anonymity, said that they are fully aware of  the administration of contraceptive injection on housemaids. 

“This is not legal. This is a human rights violation. But, this practice is taking place unofficially. We have no control over the operations of the GAMCA or any of their private medical centers.

“I don’t think even the Ministry of Health is monitoring how these medical check-ups are carried out. There is no proper mechanism to address this problem. Since the GAMCA and its medical centres are controlled by the GCC specified rules and regulations, the scope for the GoSL to get involved in the issue is very limited,” the source stated.

Proving the agents’ claims, the SLFEB official said many Gulf countries demand a three-month guarantee that the housemaid will not become pregnant. In case if she is found pregnant within that period, agents take full responsibility regarding the housemaid. Agents with the support of the GAMCA are administering this injection to housemaids to avoid incurring any extra expenses in the case a pregnancy takes place,” he explained.

“A permanent visa is issued to housemaids only if they complete the three months (100 days) duration without getting pregnant. The local agents are responsible only within the 100 days,” he added. 


Seriously endangers health 

According to US media reports, over two million women around the world rely on contraception (a synthetic hormone) manufactured by a U.S.-based multinational, the Upjohn Company.

The drug’s nickname around the world is “The Shot.” Depo differs from most other contraceptive drugs in that it is injectable; one “shot” can prevent pregnancy for three months. Injected into the arm or buttock in a 150 millilitre dose, one shot of Depo-Provera lasts at least three months. Experts have stated that Depo users may be seriously endangering their health.

In the US, because of possible safety issues Depo-Provera has never been approved for use as a contraceptive. The current law prohibits the export of drugs banned or unapproved for use in the U.S. to other countries. Upjohn gets around that restriction by producing the drug in Belgium and Canada - two of about 80 countries including Sri Lanka where Depo-Provera is registered or approved as a contraceptive. 

The use of the drug as a contraceptive is prohibited in the US, the place where the drug was originated. Yet, its widespread use in Africa and other underdeveloped countries, including Sri Lanka, according to some critics, queries whether an unsafe drug is being peddled to a largely illiterate and uneducated public.


The Daily Mirror contacted the GAMCA expecting answers to all these questions. They ruled out the administration of Depo to housemaids.

According to the GAMCA, there are 14 medical centres in Sri Lanka that are registered and licensed by the Private Health Services Regulatory Council of Sri Lanka, which have been approved by the Gulf Health Council [A central organisation whose members are the Health Ministries of the GCC States working towards a common goal for health standards among the 07 GCC States] to issue pre-departure medical certification prior to granting of entry visa to GCC States for persons travelling from Sri Lanka. 

Responding to questions in an email interview, the GAMCA Colombo in its replies said that the purpose of the pre-departure health screening is to verify that persons travelling are free from certain communicable and non-communicable diseases as stipulated by the Gulf Health Council. The council believes that doing so is in the best interest of the public health of the citizens of the GCC States. 

As per the guidelines a person undergoing medical certification will be found ‘UNFIT’ under the diseases stated below.

Infectious diseases

  • HIV reactive
  • Hepatitis B surface antigen positive and Anti HCV
  • Microfilaria positive and malaria blood film positive
  • Known leprosy patient
  • Venereal diseases VDRL positive and TPHA positive
  • Tuberculosis any type
  • Pulmonary by chest X-ray showing active or past evidence of old T.B. including minimum fibrosis, calcification and pleural thickening
  • Tuberculosis pleural effusion

Non-Infectious diseases

  • Chronic renal failure
  • Chronic hepatic failure
  • Congestive heart failure
  • Uncontrolled hypertension
  • Uncontrolled diabetes mellitus
  • Known case of cancer
  • Psychiatric diseases and neurological disorders
  • Physical disability
  • Any major operation
  • Haemoglobin below 10mg/100ml

Others

  • Pregnancy

The organisation said the pre-departure screening is performed with regard to Sri Lankan nationals travelling for employment, higher studies, migration etc., to countries such as South Korea, Malaysia, UK, Australia, New Zealand and Canada by medical centers approved by relevant departments of those countries as well.

With regard to the question on the Depo injection, the GAMCA said they could clearly state that the medical screening is limited to the guidelines stated above.

The relationship between female hormones and mental health is razor-sharp. Doctors have said that the monthly menstrual cycle affects the way signals pass through female brains. After being affected by the constant use of Depo injection, women like Gauri and Lakshmi are suffering both physically and mentally.

The HRW report recommended a range of guiding principles for medical treatment, including ensuring patient autonomy in decision-making, ensuring non-discrimination, accountability and access to remedies.

Unfortunately, these Sri Lankan housemaids are considered as ‘instrumental’ to the development of the country. The significant role played by housemaids should be recognized and respected. What housemaids are vulnerable to should be recognized and proper steps should be taken to minimize such difficulties.

Desperate housemaids migrate to build a house, purchase land, pay off debts, escape from abusive spouses, pay for education-related costs for their children, pay for the care of the sick, unemployed, or elderly relatives, provide dowries for themselves or their children, meet their families’ daily needs for food and clothing, replace family resources depleted due to alcohol depending husbands, and purchase necessary equipment for micro-enterprises they planned to launch, the HRW stated in its report. 

These housemaids have already endured so much. It is vital to explore the circumstances of each woman and make her aware of the matters related to the contraceptive. What’s disappointing is how the Government authorities were quick to rule out the administration of the Depo and spoke to the media as if this practice has never existed. 

The Government authorities may be fully aware of the Depo practice, yet their hands may be tied so that they are unable to take any action against those operating within a powerful travel agents network or these medical organizations which are under the control of the ‘all powerful’ Gulf Health Council. However, it is super important that the Government and all other so-called women’s rights organizations stand up and inquire into these claims. If the inquiries expose wrongdoers, penalties must be imposed on them. It is only then that media exposure on such dangerous practices will serve a purpose.

Pix by Ram Pateriya and Kushan Pathiraja


  Comments - 3

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    Real Agent Tuesday, 22 May 2018 10:31

    It is Government fault,should make compulsory a Doctor(MBBS) should be there each recruiting agents office to be certified by the Doctor about her health. Whatever medical certificate can be obtained outside but certified by the recruiting agents Doctor.

    Reply : 0       4

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