I got down to widespread research on other alternatives that were available in the Indian markets and decided to go for tampons. These required lesser manoeuvring of the product and provided more fluidity of body movement. However, an abbreviation kept popping up every now and then while opening fresh packs- TSS. Toxic Shock Syndrome (TSS) is a rare but life-threatening condition caused by the overgrowth of bacteria called Staphylococcus aureus, or staph that gets stuck into the body and releases harmful toxins. It’s often found to affect those who use the super absorbent variety because a tampon, warm and soaked with blood, is an ideal place for bacteria to grow. Moreover, it was just as problematic as a pad because there were leakage issues and sleeping with tampons inside the body for too long wasn’t an option.

Digging deep into how a menstrual cup is really used, its pros and cons, different types and folds, I found myself questioning how it first came into being and why a majority of us still prefer using a sanitary pad instead. Living beings don’t adapt to changes easily because apprehension about something new and the fear of the unknown plays a massive role in it.

Evolution of the Menstrual Cup

Catamenial Sack- S. L. Hockert (1867) 

S. L. Hockert from Chicago, Illinois invented the Catamenial Sack ^[1] in the year 1867. The idea of a Catamenial Sack was the first prototype of a menstrual cup. It was a rubber pouch connected to an adjustable length wire (via a screw on the front) that was further attached to a belt worn around the waist. A string attached to the bottom of the pouch was to aid in the removal of the pouch just like a string in tampons. The wire was presumably rigid and was to help hold the cup in place and in shape to avoid it from slipping off or coming out. It often featured a small sponge for extra absorbency. There is no evidence of it being manufactured.

First Menstrual Cup Patent- McGlasson & Perkins (1932)

An early version of a bullet-shaped menstrual cup was known to be patented in 1932 by the midwifery group of McGlasson and Perkins. However, it was never commercialized and made available for the general mass.

First Commercialized Menstrual Cup Patent- Leona Chalmers (1937)

After the invention of menstrual cups in 1932, Leona Chalmers decided to take them a notch higher and make them available for the general mass. Hence Chalmers commercialized usable menstrual cups in 1937. She patented a design of a menstrual cup that was made from latex rubber, was soft as well as firm enough to not slip out. Her patent application stated that the design won’t cause “uncomfortableness or consciousness of its presence”. It also allowed women to wear “thin, light, close-fitting clothing” without belts, pins or buckles that would bother them or would show like the Catamenial Sack.

First Brand –‘TASS-ETTE’ later ‘TASSETTE’ (Latex Rubber, 1950s)

The 1930’s menstrual cup brand, “Tass-ette,” came up after Leona Chalmers designed the same. It faced hurdles during World War II as a shortage of raw material, latex rubber, occurred and the company was forced to stop production. After the war in the early 1950s, Mrs Chalmers made some improvements, modified the structure and patented a new design. Thus, it was re-launched as “Tassette” at the end of the 1950s with a bigger advertising budget. This cup was not well accepted even though women were far more progressive than in the 1930s they were somehow not ready for a menstrual cup with the idea of reusable internal protection. 

First Disposable Menstrual Cup-TASSAWAY (1966)

It was important to address problems that popped up concerning emptying or cleaning the Tassette cup. Those who were happy with the product didn’t feel the need to repurchase another since it was a reusable product. So, in the late 1960s, Tassette Inc. decided to come up with a solution to the biggest problem they were facing. They patented and began manufacturing a new disposable menstrual cup, “Tassaway,” to compete with the emerging market of disposable menstrual products. It was a big success and extremely popular in Europe. 

THE KEEPER (1987)

Reusable menstrual cups came back into the market in 1987. Another cup made out of latex rubber called ‘The Keeper’ was manufactured in the United States. The popularity picked up at a good speed as women were much more progressive and discontinuation of menstrual cups was not seen as an option thereafter. 

MOONCUP- First Silicon Menstrual Cup (2001)

The first silicone menstrual cup that became popular in the market was the UK-manufactured Mooncup in 2001. At the beginning of the 21st century a new material, medical-grade silicone, was integrated into the design which yielded great success. It ensured women a safer period cycle without latex allergies. Since Mooncup was a huge success Lunnette, Diva Cup, PeeSafe, The Women’s Company and other such brands started manufacturing the same kind of cups.

Pros & Cons of Menstrual Cup

It’s rightly said that we decide which pattern we really want to break and not let it trickle down to the next generation. When I thought of giving the menstrual cup a second try my mother was apprehensive about it too. Reading up the pros and cons, watching tons of informatory videos and a lot of self-exploration helped me more than I expected to not just understand the concept but also formulate an opinion of my own. I never found a proven drawback or medical threat with regard to cups but somehow the number of women who feel comfortable using a cup is just a handful compared to the vast chunk willing to settle for sanitary pads.

A menstrual cup in its true sense is a bell-shaped silicone cup that is folded for a smoother insertion into the vagina. It slides in and pops open to form a seal against the walls of the vagina. This helps catch all the menstrual fluid and can be emptied according to one’s convenience. This is not just the ‘real game-changer’ but a life-altering experience altogether.

The blood doesn’t get a chance to flow out and spread like jam on bread, hence there are no chances of irritation, odour, infection or rashes. Concerning flexibility and mobility, one can easily spread their legs and sleep in whichever position they want because gone are those days of uncomfortable sleepless nights. It provides comfort without making one conscious about its presence inside the body. Swimming with the cup on makes life so much easier.

Emptying it according to the flow of blood depends from person to person but it can hold blood up to 12 hours at a stretch which is very convenient for someone who’s travelling, attending lectures, working long hours or even lying around like a sloth. One must note that menstrual cups don’t make the vagina dry, they keep the good bacteria intact, and are not associated with Toxic Shock Syndrome (TSS) in any way. Hence it’s a win-win situation for all! Cups are also very environment friendly and avoid adding to a lot of unnecessary waste that’s hardly biodegradable.

Sustainable Development Goals

United Nations (2015) adopted 17 Sustainable Development Goals and these SDGs are structured and well defined, in such a way that they address important problems from the health and sustainability perspective. However, Menstrual Hygiene is not explicitly mentioned in any of the SDGs but still directly linked to achieving several SDGs^[2]. SDG 3 ensures healthy lives and promotes wellbeing for all at all age; SDG 4 ensures inclusive and equitable quality education and promotes lifelong learning; SDG 5 which is all about achieving gender equality and empowering all women and girls; SDG 6 ensures availability and sustainable management of water and sanitation for all and SDG 8 that focuses on decent work & economic growth. Menstrual health and hygiene are thus intertwined with various SDGs and a slight positive change in one creates a domino effect in all the other SDGs too.

Conclusion

There are a lot of developing countries and talking about menstrual health and hygiene is a comparatively difficult task even today. Many communities are hesitant to embrace menstrual cups because of moral concerns about hymen, virginity, masturbation, and its potential to act as contraception.

Though we’ve transitioned into an advanced world there are a lot of women who still use old cloths, rags and cotton to soak their blood instead of proper products due to poverty, illiteracy, unawareness and other factors that play a crucial role which increases mortality rates and diseases day by day.

Educational institutions hardly hold menstrual awareness workshops for students in developing and underdeveloped countries. They glorify basic information in the name of awareness and certainly keep the boys away from it. That’s exactly how regressive our understanding of period blood is as a society and the role of men in menstruation remains a far-fetched dream. The stigmatized status of menstruation questions the basic menstrual needs of women hence it’s disturbing to witness how the 21st century continues to pursue a stoic silence on the issue regardless of the impact. Menstrual cups have evolved over all these years and it’s high time we consider evolving too!

References:

[1] S. L. Hockert, “Catemenial Sack,” 12-Nov-1867.

[2] International Journal of Health Sciences & Research (www.ijhsr.org) Pg- 379; Vol.8; Issue: 5; May 2018

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Autism is related to some genetic and environmental factors. Certain factors during pregnancy such as alcoholism, cocaine, etc lead to autism in newborns. Recent researches confirm multiple genetic abnormalities that can lead to autism. In addition to this, many metabolic or biochemical factors that can cause autism in children There are many environmental factors as well, which may not be much. Children with autism need constant care and protection from their family members and other caregivers.

Understanding Autism

While autism can only be treated by doctors, there are many common symptoms that parents and caregivers can look out for:

• Pragmatic Language – Most individuals with autism have difficulty communicating with other people. This particular symptom shows up during early childhood. Any delays in speech development and nonverbal communication should encourage parents to see a specialist.
• Eye Contact and Nonverbal Communication – Children with autism often have difficulty making eye-contact. Other non-verbal communication difficulties may include recognizing and using facial expressions, physical gestures, and overall body language.
• The Tone of Voice – Some people with autism may have difficulty modulating their tone of voice. As a result, they may speak too loudly, too quietly, and/or with a monotone voice.
• Repetitive Behaviors – Many people with autism may perform the same behaviours repetitively. This is also common for schizophrenic patients. This may include rocking, spinning, or flapping of the hands and arms.
• Ritualistic Behaviors – This may include eating the same food at every meal or watching the same videos repetitively. They also get upset easily.
• Self-Injury – Some children with autism tend to hurt themselves. These signs can also arise early, so a parent can notice and ask for immediate help.

Challenges Faced by Autistic Children

Children with autism go through many challenges in their lives, as do their parents and guardians. As they have many motor and communicative difficulties, they have trouble in school. A school rarely provides a good environment for an autistic child. Other kids’ success and the various challenges in a school environment often makes it difficult for the autistic child to cope. In such cases, it might make autism worse.

Autistic kids are often sensitive to loud noises and bright lights. Schools are often breeding grounds for such noises and lights which might cause discomfort among the children. This might further agitate them and make them hurt themselves. An autistic child often has problems with reading and writing. Children with autism are almost certain to be at a disadvantage, as learning how to read and write can be a major challenge. There are many other challenges that an autistic child might face in a school which would be very unpleasant and in some cases dangerous for them. 21st-century schools are in no way a fit for such children. Schools today are only designed for a specific group of students.

Researches on Autism in India

As a developing country, India has had more research articles on Autism than any others. There have been many published and unpublished articles that have helped in the advances made.

In a country as vast as India, there are no direct channels to organizations dealing with such disorders such as the National Institute for the Mentally Handicapped, in Secunderabad, and Action for Autism, New Delhi. Parents must rely on references from their paediatricians, and psychologists, on word of mouth, and newspaper articles or television broadcasts to find out about such places. By the time families of autistic children become aware that there is a national organization that specifically deals with these needs, things get worse. In the case of autism, a correct diagnosis is crucial because research has demonstrated the effectiveness of the early intervention, a specific intervention that occurs between the age of birth, and four years.

Treatments of this Mental Condition

Indians have a reputation for considering Autism as being a mental disorder. So, the vast majority of children do not get the appropriate kind of treatment. Historically, most autistic children were not even recognized until it was too late. Most people in India thought that children with autism were “slow” and best left to themselves.

Currently, many schools provide education to children with autism in the correct way. There are now autism-specific schools in India. However, considering the number of children suffering from autism, the number is not a lot. Most of these schools do not have a sufficient number of trainers.

TEACCH (Treatment and Education of Autistic and Communication Handicapped Children) is a behaviour-based treatment, for children with autism. In India, TEACCH strategies were first introduced at Open Door in Delhi in 1995, followed shortly by ASHA in Bangalore. Over the next few years, TEACCH strategies began to spread across India through various training workshops.

Family Coping

Children with autism cannot take care of themselves. They have to be under constant care by their parents. Parents of autistic children have to be specifically attentive to the children, noting the little changes taking place. Parents need to constantly educate themselves. They are advised to keep up to date on all research to help their children. Most parents have to quit their jobs to focus their attention on their children.

Conclusion

Over the last decade, there has been a dramatic increase in the number of diagnosed cases of autism in the U.S. and around the world. Experts do not know if this is because the disorder is actually on the rise, or if doctors are simply diagnosing it more effectively. We should learn more answers to questions like these over the next few years. That’s because many researchers are currently looking into autism’s origins, prevalence, and treatment.

Autism is a sad disorder that swipes the face of Earth. Unfortunately, it usually gets unnoticed by people. Most people do not know about the issues faced by such patients and the toll it takes over the family members. In order to treat Autism in a correct way, people have to come to terms with the presence of disorders such as this and other disorders which affect the cognitive and emotional health. Only then can it be acknowledged and hence treated in its fullest sense. Many children miss out on their lives owing to Autism and many parents suffer seeing their children go through this journey. As citizens, we must all learn to deal with autistic individuals and make their surroundings loving and easy.

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There are several reasons why vaccines are not trusted, including religious and political reasons. This is exasperated by the misinformation that is spread wildly about the science behind vaccines, and the validity of such claims. Ultimately, it all boils down to how much government entities and other community leaders can propel misinformation about vaccines, and the fact that decisions about vaccines might affect the community at large.

Medical Objections Against Vaccinations

A study conducted by Andrew Wakefield in 1998 linked autism to the measles, mumps, and rubella (MMR) vaccine. It was later discredited and retracted, however, this study is still referenced as a reason to not vaccinate children, or has at least kept the idea prevalent. People often believe that vaccines are more harmful than the diseases they might prevent because of their side effects. The same sentiment is being referenced to in recent objections about a coronavirus vaccine. Pharmaceutical companies and governments are moving at record speeds to come up with a vaccine for the coronavirus. However, this is also fuelling uncertainty and hesitancy about vaccines.

The common folk is worried about compromising quality in the race for a vaccine, and some experts agree: Oksana Pyzik, who is a senior teaching fellow at the University College London School of Pharmacy says, “The fact that it’s being crunched into such a short period has been a cause for concern”. There is also a large mistrust of big pharmacy companies at play here along with a general mistrust against science and experts. People believe that the science that is provided in support of vaccines is either falsified for profit or can be proven incorrect in the future. In the case of the coronavirus vaccine, trials are being conducted one after the other without time to properly gauge the implications of the previous trial. Vaccine development can take decades; hence it is only natural that there are doubts about the safety of a coronavirus vaccine developed in less than a year.

Religious and Political Objections

Vaccines can also bring religious objections – the MMR vaccine and the rubella vaccine had been previously derived from fetal tissue. Opposition to abortion present in religions such as Hinduism, Islamism and Jewism can translate into opposition to vaccines. Religious reasons such as these are brought into play when we consider the fact that schools grant exemptions to children based on religious grounds. Schools might continue to do so even when a coronavirus vaccine comes into being, which can be a concern for overall public safety if parents want to send unvaccinated children to school citing religious objections.

Objections to a vaccine are often part of a bigger picture which includes discourse on government intervention. Opinions on a vaccine can vary along party lines, with 81% of Democrats and only 51% of Republicans keen to get vaccinated in the United States. Certain people can value individual liberty and not want the government to intervene in vaccination-related decisions, which is why Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases since 1984 said that the United States will not make a coronavirus vaccine mandatory. The idea that vaccination is increasingly becoming compulsory in order to attend school is, in turn, fuelling the anti-vaccination sentiments. People valuing freedom are interpreting this as an infringement of their rights. A study titled “The psychological roots of anti-vaccination attitudes: A 24-nation investigation” found that there is a correlation between anti-vaccination sentiments and “reactance” which is described as “the tendency for people to have a low tolerance for impingements on their freedoms”. 

Coronavirus Vaccines and Future Steps

Dr Anthony Fauci has also said that a vaccine taken by only two-thirds of the public would not create the herd immunity we want – in order for economies to get back up and running. In uncertain times such as these, one of the ways to vaccinate people is to either have governments make vaccinations mandatory. Dr Fauci’s previous comment about mandatory vaccination being unlikely in the United States could be indicative of an approach many countries could take. In such a scenario, it is important that there are discussions and discourse regarding vaccine safety. 

People often do not rely solely on doctors for medical advice, or at least have different sources than can influence their medical decisions. There needs to be a coming together of leaders in the community – religious leaders, celebrities and politicians – in order to combat misinformation and to encourage people to get vaccinated. Secondly, it is important to address religious concerns. Though most religious organizations do not actively oppose vaccination, there is sometimes opposition to vaccination in certain religions. Religious leaders could be instrumental in combating vaccine hesitancy – against coronavirus and other preventable diseases. 

Such a sentiment on discourse about vaccines is best represented by Dr Mike Ryan’s quote. Dr Ryan, who is executive director of World Health Organisation’s health emergencies programme, said that people need to be allowed to have conversations about vaccines – “It’s not a one-way street. It’s not about shoving things down people’s throats. It’s about having a proper discussion, good information, good discussion on this and people will make up their own minds,” he was quoted saying.

Properly publishing information on how vaccines are developed and how safe they are can quell medical objections to vaccines. Propelling rumours and misinformation is important – despite the sped-up process, vaccines are still going through required checks and tests before being made available to the public. Moreover, data from trials is being verified from other sources too. People often have worries about the authenticity of medical equipment. For example, the WHO says that 1 in 10 medical products are either fake or below a certain standard. This is all a part of the mistrust people have of “big pharma”, and even the government. Conspiracy theories have cropped up saying the government might inject microchips in the vaccines. Such rumours increase vaccine hesitancy and need to be combated by emphasising the importance of vaccines in public safety.

Conclusion

All efforts and resources including medical personnel, money and infrastructure that is being put into the development of a coronavirus vaccine will be in vain if people refuse to get vaccinated if and when a vaccine becomes available. Making the vaccine mandatory is something a lot of countries might be unable to do. In this situation debunking conspiracy theories and having trust in public safety experts and doctors is crucial. In fact, it is important to trust medical experts in all matters related to vaccines. Even the WHO has included vaccine hesitancy in its list of top 10 global health threats and that goes on to show how important it is for discourse to happen on the importance and safety of vaccines. 

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“Medicine is a science of experience; its object is to eradicate diseases by means of remedies. The knowledge of the disease, the knowledge of remedies and the knowledge of their employment, constitute medicine”

– Samuel Hahnemann

THE INDIAN PHARMACEUTICAL INDUSTRY

The Indian pharmaceutical industry is an effective, high-innovation based industry that has seen reliable development in the course of recent decades. The current industry players involve a few exclusive Indian organizations that have caught a generous offer in the domestic pharmaceutical market because of variables, for example, great government arrangements and restricted rivalry from overseas. However, the advancement of the Indian economy is upsetting Indian ventures as they rise out of household markets and apparatus up for international competition. 

PATENT LAW IN INDIA 

In India Patent right were introduced in 1856, and the Patent Act 1970 (The Patent Act) repealed all the previous enactments. India is additionally a signatory to the Paris Convention for the assurance of mechanical property, 1883, and the Patent Cooperation Treaty, 1970. The Patents Act provides that any invention that satisfies the criteria of newness, non-obviousness and usefulness can be the subject matter of a patent. A portion of the non-patentable developments under the Patents Act incorporate methods of agriculture or horticulture, processes for the medicinal, surgical, curative, prophylactic or other treatment of human beings, animals or plants or substances obtained by a mere admixture, resulting only in the aggregation of the properties of the components, etc. Concerning pharmaceuticals, on account of substances planned for utilizing or equipped for being utilized as food, medications or drugs or substances created by synthetic procedures, licenses are allowed distinctly for the procedures of assembling of such substances and not for the substances themselves. Henceforth, pharmaceutical items are right now not allowed patent insurance under Indian law. India had a product patent regime for all innovations under the Patents and Designs Act 1911. In the year 1970, the government came up with a new Patents Act, which excluded pharmaceuticals and agrochemical products. This exclusion was introduced to lower the dependency of India on imports for drugs and create a self-reliant indigenous pharmaceutical industry.

The absence of product patents in pharmaceuticals and agrochemicals significantly affected the Indian pharmaceutical industry and brought about the advancement of extensive ability in figuring out of medications that are patentable as items all through the industrialized world, yet unprotectable in India. As a result, the Indian pharmaceutical industry developed quickly by creating less expensive forms of various medications patented for the local market and in the long run moved forcefully into the global market with generic drugs once the worldwide patents terminated. Furthermore, the Patents Act provides several safeguards to prevent abuse of patent rights and provide better access to drugs. The term of licenses on account of procedures or techniques for the production of a substance proposed to be utilized or fit for being utilized as food or as a medicine or drug is for a time of seven years from the date of documenting or five years from the date of fixing the patent, whichever is less. A patent relating with other inventions are allowed for a time of 14 years from the date of documenting the patent, except if demonstrated to be invalid. 

To secure their financial interests, various organisations concocted a strategy popularly known as “ever-greening.” The Companies roll out some minor changes in the current item with the same molecular formula but with an alternative structure, including some new fixing in the medication without changing the impact of the medication, and so forth. 

NOVARTIS AG v. UNION OF INDIA 

The judgment given by the two-judge bench of the Hon’ble Supreme Court of India in the case of Novartis AG v. Association of India is one of the milestone judgements in India. Novartis challenged the dismissal of its patent application by IPAB for Beta Crystalline form of “Imatinib mesylate” wherein it was dismissed by the Supreme Court of India on the ground that the said medicate didn’t deliver an improved or better remedial adequacy as looked at than the known substance i.e., “Imatinib mesylate” implies that the said medicine didn’t include a creative advance. One of the significant explanations behind dismissing the patent utilization of Novartis was to keep away from ever-greening of previously protected items by presenting minor changes.

FACTS

The largest international pharmaceutical companies, Novartis International AG filed the application according to the TRIPS agreement before the Chennai Indian patent office for awarding them the patent for an anticancer drug ‘Glivec’, used for treating Chronic Myeloid Leukaemia (CML) and Gastrointestinal Stromal Tumours (GIST) developed from Beta crystalline type of “Imatinib mesylate.” This medication is broadly utilized in the treatment of cancer and is licensed in more than 35 nations. When Novartis filed for the grant of the patent, it was limited to methods or processes and not for products, as defined under section 5 of the Patent Act, 1970. After the Patent (Amendment) Act, 2005 section 5 was cancelled and licenses became conceded for strategies or procedures yet additionally for items.  The application of Novartis International was rejected on the grounds that it did not qualify the requirements in section 3(d) of Patent Act 1970. 

After that Novartis filed two writ petitions in Madras High Court in the year 2006 under Article-226 of Constitution of India. The appeals, therefore, expressed that the section 3(d) of Patent Act, 1970 is unlawful because it isn’t in consistence with TRIPS agreement and furthermore violates Article-14 of Constitution of India and the other against the order passed by Madras Patent Office. Madras High Court moved the case to IPAB (Intellectual Property Appellant Tribunal) in 2007. Their appeal was heard and rejected by IPAB expressing that the innovation fulfilled the tests of novelty and non-obviousness however patentability of the product was hit by section-3(d) of the Patent Act, 1970. The judgment given by IPAB is to forestall ever-greening of already patented items by acquainting minor changes and to give simple access to the residents of India to life sparing medications.

Afterwards, Novartis filed an SLP (Special Leave Petition) before the Apex Court against the order passed by the IPAB under Article-136 of Constitution of India. 

ISSUE

1. According to the provision of section-3(d) of Patent Act, 1970 what is a known substance?
2. According to section-3(d) of Patent Act, 1970, what is the meaning of Efficacy?
3. According to section-3(d) of Patent Act, 1970 whether an increase in bioavailability qualifies as an increase in therapeutic efficacy?
4. Whether the invention “Beta crystalline form of imatinib mesylate” claimed by Novartis is more efficacious than the substance that it was derived from i.e. “Imatinib mesylate?”

JUDGEMENT 

 In April 2013, the two-judge bench of Supreme Court of India dismissed the application and maintained that the beta crystalline form of Imatinib Mesylate is another type of the known substance i.e., Imatinib Mesylate, wherein the efficacy was well known. The Apex Court made it clear that on account of medication “Efficacy” in section 3(d) just signifies “Therapeutic Efficacy” and states that all properties of the medication are not important, the properties which straightforwardly identify with viability in the event of medication is its restorative viability. The Supreme Court in the third issue decided that about 30% expansion in bioavailability qualifies as an increment in therapeutic efficacy under section 3(d) of Patent Act, 1970 if a proof is provided for the same. Supreme Court compared the efficacy of “Beta Crystalline form of Imatinib Mesylate” with “Imatinib Mesylate” concerning its flow properties, better thermodynamic stability and lower hygroscopicity, and found that none of these properties adds to increment in helpful adequacy as indicated by section 3(d) of Patent Act, 1970 and Novartis did not give any archive that shows that the adequacy of “Beta Crystalline type of Imatinib Mesylate” is more when compared with the efficacy  of “Imatinib Mesylate.” 

PHARMACEUTICAL PATENTS AND THE TRIPS AGREEMENT

The principle rule identifying with patentability is that patents will be accessible for any development, regardless of whether a product or process, in all fields of innovation without discrimination, where those creations fulfil the guidelines for patentability — to be specific, novelty, inventive step and industrial applicability. Likewise, Members are required to make the award of a patent dependent on adequate disclosure of the invention and may require information on the best mode for carrying it out. Revelation is a key piece of the implicit understanding that the award of a patent comprises since it makes openly accessible significant specialized data which might be useful to others in propelling innovation in the territory, even during the patent term, and guarantees that, after the expiry of the patent term, the creation falls into the public domain because others have the necessary information to carry it out. 

Three types of exclusion to the above rule on patentable subject-matter are allowed. These may be of interest from a public health perspective:

1. Inventions the prevention of whose commercial exploitation is necessary to protect ordre public or morality, including to protect animal or plant life or health;
2. Diagnostic, therapeutic and surgical methods for the treatment of humans or animals; and
3. Certain plant and animal inventions.

What are the rights conferred by a patent under the TRIPS Agreement? 

The least rights that must be given by a patent under the TRIPS Agreement follow intently those that should have been found in many Patent laws, to be specific the privilege of the patent proprietor to keep unauthorized people from utilizing the patented procedure and making, utilizing, offering it to be purchased, or bringing in the protected item or an item got legitimately by the licensing procedure.

Term of Protection 

Under the TRIPS Agreement, the accessible term of security must lapse no sooner than 20 years from the date of recording the patent application. It ought to be noticed that, although the issue of patent term expansion to make up for administrative deferrals in the advertising of new pharmaceutical items was brought up in the Uruguay Round arrangements, the TRIPS Agreement doesn’t contain a commitment to present such a framework.

CONCLUSION

Making another medication and presenting it in the market is over the top expensive activity. The organization who are making new medications consistently hope to ensure their business and financial interests by protecting the product. For better development of the business, it is significant that the speculators have a sense of safety in putting their finances into that sector. The Patent Act gives security to pharmaceutical organizations. Be that as it may, it is likewise important to guarantee that there are a few defend additionally with the goal that a couple of organizations don’t assume control over the market for the sake of protected property rights. The safeguards are vital for the government assistance of the general public.

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WHAT ARE THE DIFFERENT TYPES OF ABUSE?

Abuse can be of many types and though this article will be focusing mainly on sexual abuse, it is important to understand most of them. Broadly there are 6 types of abuses: Physical, Verbal, Mental, Financial, Cultural and Sexual. Physical abuse or violence is to do with invading one’s personal space and hitting, beating etc. Linked to such abuse is domestic abuse or what is called Intimate Partner Violence. Verbal or Emotional abuse is also relevant to this paper. Emotional abuse can include belittling someone, making fun of someone, constantly critiquing someone etc. Unlike physical abuse, emotional abuse is harder to visibly identify. Mental abuse occurs when one is made to believe that one is crazy, where one is constantly made to reach the brink of a breakdown. Constant gaslighting, ‘victim playing’ etc are examples of mental abuse- a series of actions which wears away at the other’s sense of mental well being. When actions which amount to mental abuse occur over a sustained period they can make the person feel like they are “ going crazy”.

Financial abuse is essentially control of economic resources. Money is a huge source of power and withholding the same amounts to an abuse of power. This would include not letting the survivor open their bank accounts, not giving them money when they need it etc. Cultural abuse amounts to using a part of the survivor’s culture to abuse them. For example not letting a Muslim practice Ramdan or threatening to ‘out someone’ because of their sexual orientation. Sexual abuse includes various actions under it. This includes but is not limited to grabbing someone’s private parts, forcing anal sex, forcing vaginal penetration, forcing cunnilingus/oral sex. It also involves using sex as a weapon or using it as the basis for assigning someone value. It is essentially, “ unwanted sexual activity, with perpetrators using force, making threats or taking advantage of victims not able to give consent”. Usually, sexual abuse, in the case of women includes penetration as shown in a study in 1999. Studies have also found that there is no significant correlation between childhood emotional abuse, physical abuse and neglect in adult sexuality, independent of the other forms of abuse. Hence since sexual abuse is the only concept which has shown to have an independent impact on sexual health most of the times, I have focused on that. However, I also touch upon the impact of intimate partner violence and emotional abuse

SEXUAL SELF CONCEPT

Snell and Papini in 1989 came up with the concept of sexual self-concept- how an individual feels about his or her own sexuality. According to them, the sexual self-component has three components: “Sexual Self-Esteem (SSE) (dispositional tendency to positively evaluate one’s ability to relate sexually with others), Sexual Depression (SD) (chronic tendency to feel sad and discouraged about the sexual aspects of one’s life) and Sexual Preoccupation (SP); the continuing tendency to be absorbed and obsessed with sexual thoughts and behaviours that practically prevent one from thinking about other matters” (Snell, Fisher, & Schuh, 2001; Snell & Papini, 1989).

 SSE and SD were opposite constructs of the same psychological dimension that is if one believes one is satisfactorily being able to engage in sexual congress and relate sexually with others he/she will not face SD- feeling like one has failed to do ‘well’ sexually. Wiedemann & Allgeier, 1993 found a positive relationship between SP and SD in men which lead to overall low self-esteem and clinical depression. Heinrichs et al 2009 found that SSE is an important aspect of sexual health. SSE is learnt from one’s sexual history, relationships with peers and familial context (Gaynor and Underwood,1995). Studies show that SSE is negatively correlated to sexual risk behaviours and sexual abuse but is positively correlated to sexual assertiveness, sexual satisfaction, sexual identity, wellbeing, body image and perceptions of physical attractiveness. Lack of SSE has been found in women who are survivors of sexual abuse, cancer and women who use drugs. It is important to understand the concept of sexual self-concept because of its link to the concept of “traumatic sexualization” which is extremely relevant to this paper. Finklehor and Browne (1985) stated that because of childhood sexual abuse (CSA) one may be confused about one’s sexual self-concept and have unusual emotions attached to sex. Essentially CSA, according to this concept leads to an inappropriate sexual identity. For example, the belief that only by engaging in sexual congress will one be ‘loved and saved’.

THE IMPACT ON FEMALE SEXUAL HEALTH

Generally, it has been found that women who have been sexually abused have a higher sexual drive, more number of sexual fantasies, engage in a lot of masturbation and sexual intercourse (Meston et al 1999) However conversely an older review by Browne and Finklehor (1986) found CSA to be linked in women to inhibited orgasm, lower sexual self-esteem and negative attitudes towards sexuality. Women have also reported their sexual abuse negatively. Such a stark difference between how men and women view sexual abuse can be explained by the following reasons. Women are more likely to face sexual abuse at a younger age compared to men. Child sexual abuse amongst females is more likely to involve incestuous acts whereas the same isn’t the case with men. Moreover, many men do not see sexual abuse as abuse because of the physiological response of an erection to forced stimulation of their genitals. Some men cannot discriminate between mental and physiological(which is out of their control when their prostate is stimulated) responses to abuse and hence incorrectly remember the event as something “ they enjoyed”. Female promiscuity which is a natural result of child sexual abuse goes against the feminine norm of submissiveness and restraint when it comes to initiating sexual congress, because of such a clash, women may come to see themselves as sexually atypical (unrestricted, damaged etc). However, for men, such a self-perception will not be formed because they are expected to be sexually unrestrained. Kinder and Bartoi, 2008 have reported that women who have been sexually abused are more sexually dissatisfied, more non-sensual and less satisfied with the overall quality of their recent sexual relationships as compared to non-abused women. Dore (1994) stated that a combination of childhood physical and sexual abuse results in unsafe sex and alcohol and drug-related sexual behaviour.  A study of a sample in Iran also found that women who experience Intimate partner violence show sexual dysfunction. Pulverman (2018) showed that repeated CSA leads to sexual dysfunction in women. This would include disorders of desires and arousal. CSA also leads to low sexual arousal in females. CSA is defined as unwanted sex between an adult and a child involving penetration vaginally, orally, anally using one’s organs or foreign objects. This link occurs for many reasons. Meston and Heiman 2000 found, using a card-sorting task that abused women who have been abused show that they perceive sexual stimuli negatively. Secondly, the Sympathetic nervous system activation may also explain why women who have experienced abuse do not find pleasure in sex. SNS activation (increased heart rate, breathing, muscle tension etc) occurs both during abuse and sex. However, it is possible that during chosen sexual congress as well, the survivor may relive portions of their abuse. It is because of this that SNS arousal in abused females is already high. Hence the ‘normal’ arousal which accompanies intercourse may make the cumulative SNS arousal too high for females, resulting in either pain or unsatisfactory sexual experiences. Low body image and a negative sexual self- concept have also been used to explain such a reaction. Jennie and Penelope also found that abused partners are more pre-occupied with sex, younger at first voluntary intercourse, are more likely to become a teenage mother and show lower birth control efficacy. They also show that if the girl has been abused by the biological father, it results in higher sexual ambivalence and aversion in her.

THE IMPACT ON MEN SEXUAL HEALTH

Meston et al 1999 found that for men frequency of emotional abuse independent to any other form of abuse was negatively correlated to sexual satisfaction and body image. One reason for this could be that because of said emotional abuse, global self-appraisal was affected, that is because of constantly being told one is worthless, ugly etc one may start viewing themselves as such and this may affect their body image. Another proposed reason was emotional abuse in men leads to a fall in self-efficacy which consequently leads to a fall in their dating efficacy. Therefore, this results in an inability to initiate dates as is assumed to be the norm for men, due to which their sexual pleasure may be impacted, however, further research needs to be done in this area. Romano and Luca 1999 found that men do not report sexual assault. This is because of many reasons, firstly because of the fear of being termed as homosexual. Since in most cases of male sexual abuse the abuser is also male, the survivors feel that if they report such a case they may invariably be termed as homosexuals. Secondly, men have to follow the pervasive norm of being stoic and restrained. By reporting their abuse men seek to violate this norm and hence usually opt for silence. Lastly, boys are given more freedom than girls during childhood. Fearing that this freedom will be snatched away from them if they report that they have been abused, they shy away from reporting child sexual abuse. Child sexual abuse in men leads to more externalising behaviour (aggression) whereas, for women, it leads to more internalising behaviour. It is a combination of the fear of being a homosexual (because of the fear that reporting abuse by a man may be synonymous to being gay) and a belief that the abuse happened because they were showing feminine attributes ( being a ‘sissy’, wearing ‘girly pants’, having fewer muscles and a soft voice), that sexual abuse in men leads to compensatory behaviours. This would include excessive masturbation, hypersexuality, aggressive sexual behaviours etc. Brie (1996) explained the cycle of compensatory sexual behaviours wherein the survivor seeks partners to receive nurturance, but then finds such a superficial contact unsatisfactory after the initial excitement fades which leads to the individual seeking another sexual partner. Moreover, if the survivor experiences an orgasm during the abuse it may lead to a life long obsession with abuse-related masturbation. However, it is important to point out here that the anus, for men, is extremely sensitive and when stimulated may lead to ejaculation or erection. This is because the stimulation of the prostate leads to physiological responses in men which are beyond their control. 

THE IMPACT ON THE LESBIAN GAY BISEXUAL COMMUNITY

CSA victims and LGB adolescence usually experience the same feelings. This is because both have similar feelings of sexual confusion, shame and have a stigmatised identity. Sexual abuse influences sexual identity formation. This is because many gay people explore sex with other people before coming out, and hence this “coming out” process may be affected. Specifically, some LGB individuals who have experienced CSA may engage in sex before their non-abused peers and some may avoid sex altogether.  Brady, 2014 explained how the coming out process may be affected by stating that CSA retards the Homosexual Identity formation(HIF) process (Cass, 1979).The  six stages of HIF are: (a) Identity Confusion, (b) Identity Comparison,(c)  Identity  Tolerance,  (d)  Identity  Acceptance,  (e)  Identity  Pride,  and(f) Identity Synthesis. The first three stages concern the question “Who am I?” while the latter three stages concern the question “Where do I belong?”.  CSA impacts homosexuals in a very unique manner, CSA, in any case, leads to confusion, inferiority and despair in individuals. If one adds to this a culture which disdains homosexuality it results in an entire population of people who have difficulty in reconciling an affirmative gay identity. For example, a case study shows that CSA in a 60+year-old man retarded the HIF process so much that he did not come out until he was above 65. This was because the first stage of identity confusion was prolonged. Studies have also shown that gay men are at a higher risk of physical and sexual abuse and Wrights (2001) stated that gay men engage in a spiral of risk wherein they perform high-risk sexual behaviour just so that they can belong avoid abandonment. This leads to a negative impact on self-esteem. Hall (1999) stated that problems in sexual relationships in lesbians as a result of sexual abuse arise in different forms. This includes high sex risk-taking behaviour, an inability to express sexual needs, fear of initiating sex, inability to discriminate between sex, love and intimacy etc. Herman 1992 stated that repeated trauma erodes the structure of personality already formed, but also repeated trauma during childhood forms and deforms the personality. It is perhaps because of this that gay men choose abused partners and have problems in finding love and managing their relationships. 

THE GENERAL IMPACT OF ABUSE ON SEXUAL HEALTH 

Dionne 2016 found that abuse of power in relationships which takes the form of sexual abuse has a two- dimensional impact. If the individual seeks to end their pain by using drugs, engaging in multiple sexual relationships, the risk of Sexually Transmitted Infections may increase. Whereas if the individual seeks to heal by participating in ceremonies, seeking out spirituality etc such risks reduce. Studies have also shown that In sexually abused individuals the following sexually inappropriate behaviours exist; Unplanned, interpersonal sexual behaviour, Self-focused sexual behaviour, Planned coercive interpersonal sexual behaviour. HAVOCA , a social group found that sexual abuse could also lead to sexual dysfunction, painful sex, celibacy, avoidance of sex in all genders. They may also become promiscuous if they feel they are only good for sex because survivors are not taught that their worth is independent of their sexual desirability. They face an inability today NO. This is because they fear if they do so their only worth as an individual will disappear or they will face punishment or rejection. Abused individuals may also prefer one night stands ( a study shows that women do) however the more they know a person the less they want sex. This is because survivors are unable to disconnect sex from intimacy and cannot connect sex and love. 

CONCLUSION

This paper is relevant for many reasons. Firstly because it provides an insight into why STI’s maybe so prevalent in gay men- as studies have shown that gay men are at a higher risk for sexual abuse. Secondly, it highlights research areas which haven’t been touched upon and need further academic evaluation. Thirdly, it allows us to understand why some men and women are so sexually promiscuous. The differential impact for men and women also indicated that the therapeutic process for both these sexes needs to be different. It is difficult to elaborate on how one can treat the impacts of abuse in short. Mostly therapy is the path which is heavily relied on. If an abused individual is in a relationship, interpersonal and intrapersonal communication can also go a very long way. Survivors often need to be the initiators of sex in order to feel in control. This is an important thing for partners to understand. Joining support groups also has a positive impact on abused individuals. Child- parent therapy and trauma-focused cognitive therapy are the two types of therapies that are usually recommended. Therapy usually allows the individual to develop healthy coping mechanisms, and understand the root of their maladaptive behaviours. One should always offer support to an abused individual, remind them that they were not at fault and if possible, help them feel safe (if your relationship with them is an intimate one). Equine-assisted therapy and mindfulness techniques have also helped abused individuals/survivors.

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No Mobile Phone Phobia or ‘Nomophobia’ is the irrational fear of being without your mobile phone or being unable to use your mobile phone for a certain reason. The condition is characterized by feelings of anxiety when people lose their phones, run out of battery life, or have no cellular coverage.

In today’s era when physical interactions have come to a halt and an air of uncertainty fills the surroundings, it’s our gadgets which keep us huddled together as a community. These days when our mobile phones serve as the sole source of connection with the world outside, the over-reliance on gadgets leads to the development of behavioural addiction.

Therefore, when a person is out of reach of her/his mobile phone, she/he often experiences anxiety, fear or even feelings of fear and panic. Experts believe that if left unsupervised, such a condition can be detrimental for physical and mental health in the long-run.

Unearthing the Statistics

In the 21st century, when technology has eclipsed all areas of human endeavour, a huge chunk of the population is vulnerable to develop symptoms of nomophobia. On average, a person checks her/his phone about 110 times a day without any concrete reason.

A study in Britain on mobile phone users suggests that 53% people tend to feel anxious when they lose their mobile phone, run out of battery or balance, or have no network coverage’. Nearly 72% of respondents admitted that there is a bleak chance that they will ever stay more than 5 feet away from their mobile phone.

In the United States, 66% people suffer from nomophobia. One in five people admit that they would rather go without shoes for a week than take a break from their phone.

A study conducted in India indicates that 43% of people use their phones more than 5 hours a day. Over 30% tend to check their phones more than 50 times a day while 31% check as frequently as every 10 minutes. It is reported that there is lesser number of calls or emails received and sent, than text messages.

These statistics suggest that mobile phones are primarily being used for accessing social media than for traditional ‘calling’ purposes. Around 85% use these palm-sized gadgets for simply ‘killing time’.

Who is Most Vulnerable?

Research investigations reveal that people falling between the age group of 18-24 are most prone to develop symptoms of nomophobia. It’s clearly evident that college students seem to fall under high levels of nomophobia than the working populace. This is primarily due to comparative higher availability of leisure time, a lesser number of responsibilities, curiosity to explore new technology at hand and extensive usage for educational and research purposes.

A research sample conducted with over 1500 students on prevalence of nomophobia in India point out to gender disparity in numbers. While women often fall under the category of ‘moderate’, ‘men’ usually show ‘mild’ symptoms. Though both have the tendency to develop ‘severe’ levels of the phobia.

Of the many reasons identified which increase vulnerability, one of the important causes is the easy and affordable access to internet. But even this luxury comes laced with potential risks as people spend hours lying on their couch, sending across text messages to their near and dear-ones with the help of free messaging applications, available just a finger-tap away.

Moreover, with the advent of social media, the entire planet has been woven into a tiny virtual space in our palms. It has got translated into our sole source of connection with the outside world. Therefore people are getting easily dependent on their phones to maintain affinity with their closed ones. Increased number of people are also using it as a tool to do away with their feelings of loneliness.

Symptoms of Nomophobia

A person symptomatic of nomophobia shows a number of physical, emotional and cognitive symptoms such as:

• Breathing at a faster rate, increased heart rate, sweating, shaking and trembling. People may also begin to feel weak or dizzy.
• The inability to turn off one’s phone
• Constantly checking the phone for missed messages, emails, or calls
• Charging the battery even when one’s phone is almost fully charged
• Fear of being without WiFi or being able to connect to a cellular data network

As the number of hours of mobile phone usage accelerates, the tendency to succumb to nomophobia increases. In the absence of their gadgets, some people may even start experiencing withdrawal symptoms.

Frequent or compulsive mobile phone use is also connected to increased stress, anxiety, and depression. Excessive phone use has been linked to a number of negative effects that include decreased grades, lower life satisfaction, and a lower sense of overall well-being.

Dealing with Nomophobia

Nomophobia if left unattended, can metamorphosise into a grave problem for mental and physical health. Therefore, taking timely action and repairing the faucet before it bursts can avert the impending danger. Some of the ways to keep a tab on mobile addiction are:

• One can design a sturdy schedule and adhere to it religiously. The time for using the phone can be determined in advance and alarms can also be set as reminders.
• A person must try to have more in-person interactions with people who are in physical proximity. Having a short conversation with a co-worker, chat with a classmate or neighbour can lower one’s feelings of loneliness and reduce the tendency of excessive usage of the phone.
• In India, we have a tradition of keeping fast on certain days. Likewise, one can set aside at least one day in a week as a ‘tech-free day’ and use the time to focus on oneself, one’s hobbies and even relax and do meditation.
• If possible, one can to try to leave the phone at home for short periods of time, such as while going for a walk, purchasing groceries etc. Just being mindful of one’s activities around can have a relaxing effect on the mind.

Lastly, in case one faces severe symptoms of nomophobia, then taking psychiatric aid is also an option available. Trained mental health experts can help a person with medications and therapies. Cognitive Behaviour Therapy (CBT) and Exposure Therapies have come a long way to help in reducing symptoms of nomophobia.

Conclusion

Nomophobia is just one example of the many health hazards posed by the over-dependence on technology. With unrestrained use of gadgets, the human populace seems to pave the trajectory towards its own doom. Being cautious of one’s mobile phone usage, taking timely action in case of adversity and maintaining good and healthy social relations can perhaps prevent the impending tragedy in the coming years.

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KIM NOBLE : AN ARTIST DIVIDED

“A lot of people are very frightened of us until they meet us”

~ Kim Noble

Kim Noble is a 59-year-old mother who lives in south London with her teenage daughter Aimee, two dogs and more than 20 separate personalities. 

Dawn is stuck in 1997, searching for her daughter Sky, who she believes was taken away.

Bonny had the strength to fight for her child through the courts.

Ken is a depressed gay man of 21.

Abi has loneliness in her life. 

Ria Pratt is 12 or 13, and is thought to have been abused.

Judy is a 15-year-old anorexic and bulimic, and is often a bit cheeky, but is very good at painting.

Patricia, in her 50’s, is strict and sensible and is the narrator of an intriguing new book called “All of Me.” She is the most consistent personality of Kim.

While all these personalities appear independent, each is a part of Kim Noble, whose main personality is split into several parts, each having an amnesic barrier between them. Her other alter egos include Salome the devout Catholic, a little boy who speaks only Latin, an elective mute, a sensible Hayley, and a handful of children “frozen” in time. While many of the alters are unaware of it, some of the alters know that Kim has Dissociative Identity Disorder or D.I.D—the preferred term for Split Personality Disorder or what used to be called Multiple Personality Disorder.

From the age of 14, Kim spent twenty years in and out of psychiatric hospitals because of being diagnosed with everything from schizophrenia to depression, hysterical amnesia, anorexia and bulimia. Finally, she met Dr Valerie Sinason and Dr Rob Hale at the Tavistock and Portman Clinics and in 1995 she began therapy and was diagnosed with Dissociative Identity Disorder. 

D.I.D is a rare reaction to severe trauma in which the brain splits into multiple personalities as a defence mechanism to cope with chronic trauma.  Kim is believed to have suffered severe trauma from sexual abuse as a young child that caused her mind to split into these multiple personalities and develop D.I.D as a “creative way to cope with unbearable pain”. 

In 2004, after spending a short time with an art therapist, Kim and 12 of her alter personalities developed an interest in painting despite having no formal art training. These 12 artists have their own distinctive artistic styles, colours and themes-

Bonny’s pictures often feature robotic dancing figures or “frieze people”, Suzy repeatedly paints a kneeling mother, Anon paints at night and uses texture in paintings, Abi’s paintings are usually people from a behind view, Patricia paints the desert landscapes which according to her are a “bit boring” and Judy’s canvasses are large, conceptual pieces which are usually portraits – some with their eyes open, others shut. Ria on the other hand paints very differently. Using bold bright colours, her childlike but disturbing pieces often reveal deeply traumatic events involving child abuse.

Art has definitely had a therapeutic effect on Kim and instead of coming out as words, the expression comes out in art. These personalities, combined, have had over 60 exhibitions, nationally and internationally.

Generally, Patricia’s personality switches around four or five times a day – a switch that can last five minutes, a few hours or several days. Stress or lack of sleep can increase the number of switches, as can painting – a sign, Patricia believes, that a personality just wants to come out and paint to express themselves.

Despite the fact that she has to live with several alter personalities –– Kim Noble is fortunate enough to be living a relatively normal life. To communicate with “Patricia,” “Judy”, “Salome”, “Ken” and the others, Kim’s therapist sends emails to each of them. All of the personalities have separate email addresses and passwords, and Patricia leaves notes for them. “Patricia” says her situation isn’t such where a single personality represents a specific mood (such as “anger” or “fear”). Instead, each of her 20 personalities has a full range of emotions and living with Dissociative Identity Disorder means “sharing a household—there are different clothes, closets and toothbrushes for each personality.”

In the past few years, Kim Noble was featured in national newspapers such as The Telegraph, The Guardian, The Independent and several others. She even appeared at the Oprah Show, This Morning Show, Anderson Cooper Show and BBC Radio1 with Victoria Derbyshire.

DISSOCIATIVE IDENTITY DISORDER

Dissociative disorders involve problems with memory, emotion, identity, perception, behaviour and sense of self. 

Dissociative Identity Disorder is caused by “overwhelming experiences, traumatic events, and/or abuse occurring in childhood.” 

The DSM-5 gives the following diagnostic criteria for Dissociative Identity Disorder: 

1. “Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behaviour, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual. 
2. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. 
3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 
4. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play. 
5. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behaviour during alcohol intoxication) or another medical condition (e.g., complex partial seizures).” 

Treatment

Treatment typically involves psychotherapy through which people gain control over the symptoms and the dissociative process. Therapy aims at helping individuals integrate the different elements of identity. 

Therapy for this trauma based disorder may be difficult and intense as it requires remembering and coping with traumatic experiences of the past. Cognitive behavioural therapy and dialectical behavioural therapy are two commonly used types of therapy. Like in the case of Kim Noble, art can have a therapeutic effect on individuals with Dissociative Identity Disorder. Hypnosis has also been found to be helpful in some cases. There are no medications which specifically threat the symptoms of D.I.D, but doctors may prescribe medicines such as anti-psychotic drugs or anti-depressants which may be helpful in the treatment of those specific symptoms. 

Thus, with appropriate treatment, most of the people suffering from Dissociative Identity Disorder are successful in coping with the major symptoms of this rare mental illness and improving their ability to function and live a productive and fulfilling life. 

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When we talk about India, we do have a provision for abortions, sections 312-316 of the Indian Penal Code (IPC) and the provisions of the Medical Termination of Pregnancy (MTP) Act, 1971 covers the abortion laws in India. The IPC sections 312-316 criminalise abortion; “the person undertaking the abortion as well as the doctor (or registered medical practitioner) facilitating the abortion are liable to be prosecuted.”

The government of India, though in 1971, enacted the MTP Act as an exception to the IPC. The act was enacted to exempt medical experts from the criminal obligation on the condition that they terminate the pregnancy as per sections 3 and 5 of the act. The prelude to the act expresses that it is, “An act to provide for the termination of certain pregnancies by registered medical practitioners and for matters connected therewith or incidental thereto.” Therefore this whole system of legal abortion is doctor centric and prescribes abortion in specific circumstances.

The Proposed Amendment 2020

The MTP act was enacted in 1971 and hence the law needed changes, activists in India for the last decade have been pushing for legislative changes to the law.

The central cabinet’s sanction of the Medical Termination of Pregnancy (Amendment) Bill 2020 was reported on January 29. According to Prachin Kumar, “The amendment was long due and has made some anticipated changes demanded by women’s groups and courts, including the Supreme Court.”

Vrinda Grover in her column for the Hindustan Times wrote in March, that it’s a welcome amendment. She further states that the bill among other things, “proposes to place an unmarried woman and her partner at par with a married woman and her husband, in securing abortion due to contraceptive failure.” This is an idea that carries forward the rationale of the domestic violence act. The law on domestic violence makes no distinction between the rights and protections available to a married woman or a woman who is in a live-in relationship.

The Press Information Bureau on 29th January 2020 published the amendment, it stated that “The salient features of this act is enhancing the upper gestation limit from 20 weeks to 24 weeks for special categories of women which will be defined in the amendment to the MTP rules and would include vulnerable women, including survivors of rape, victims of incest and other vulnerable women like differently-abled women and minors.”

The MTP (amendment) bill still requires or rather proposes that a doctor sign off on termination of pregnancies up to 20 weeks old, and two doctors do the same for pregnancies between 20-24 weeks old.

The bill also intends to expand access to “safe and legal abortion services on therapeutic, eugenic, humanitarian or social grounds”, in case of foetal “abnormalities”. The proposed amendment makes it mandatory for the government to set up a medical board in all the states  and union territories. The responsibility of the board will be for the diagnosis of substantial foetal “abnormalities” that need termination after 24 weeks.

These are some of the proposed changes in the law. Now although there are certain good points in the amendment, a lot of activists think that this amendment missed to address some of the important issues.

Criticism of the Amendment

Shampa Sengupta in an online session organised by the Centre for Health Law, Ethics and Technology at Jindal (CHLET), Global Law School, Sonipat, strongly objected to the language used by the PIB in its announcement of 29th January 2020 regarding the amendment. “It’s not from the department that looks into the disability affairs.. But that does not mean you can use a word as ‘differently-abled’, it is not legally accepted in our country”, said Sengupta about the announcement.

Dr. Aqsa Shaikh in the same series of sessions organised by the CHLET said that it’s very unfortunate that it took almost 50 years for the government to realize that the MTP Act needed some changes. According to her, these changes are still insufficient, stakeholders have not been consulted, and a very patriarchal approach has been adopted. Shaikh further stated that “Under the MTP, the pregnant person does not have a choice, the person must seek permission. If the permission is granted then the doctor will conduct the procedure, else, the doctor will not. So that approach has to change.”

Tejasvi Savekari of Saheli Sangh in the session pointed out that during this Covid-19 pandemic, and because of the resultant lockdown, a lot of abortion cases have been seen. In most of these cases, safe abortions could not be done because of a lack of access to safe abortions.

She raised a very valid question, “who will take responsibility for this? Instead of simplifying the system, the law is making it more complicated. Firstly one has to take permission from two registered doctors and then from the medical board. So much time will be lost in all this, so will a woman be able to get a safe abortion done? Does she not have a right over her own body? Is she not capable enough to make her own decisions?” She asserted the fact that there are absolutely no answers to these questions. She said that it’s unfortunate that the law had no consultation and it saw no protest at all.

Sex Workers and Their Plight

The life of a sex worker is not easy. There are various stereotypes associated with the profession and the sex workers have to deal with stereotypes when it comes to their abortion rights as well. Kiran Deshmukh of National Network of Sex Workers CHLET session revealed that sex workers are always treated unfairly and are discriminated most of the time.

Deshmukh said that when a sex worker is pregnant and when she goes to a civil hospital, the staff of the hospital does not treat her well because they know that she is a sex worker. The strong stereotype that a sex worker can’t have a child is visible in the actions of the hospital staff. According to Deshmukh, matters get worse when a pregnant person is also HIV positive. Then that person is discriminated against more than anyone else. She stated that “we consider this form of discrimination as violence and this violence will not end till we do not collectivize. Collectivizing is very important if we want to fight against this violence. The womb is mine, it is my right to decide to continue or to terminate the pregnancy. But the doctors do not listen to us, especially in civil hospitals.” She further added, “when we collectively say the same thing, they have to listen to us, and provide us services because the power of a finger is different from the power of a fist.”

The government has not taken into account the problems of the sex workers as is clear from Deshmuk’s statement and above discussed amendments.

No Consideration for Differently Abled

The proposed amendments have not given due consideration to the needs of the differently-abled persons. Rupasa Malik of CREA is of the view that proposed amendments to the MTP Bill 2020 are limited and that it, in no way, reflects the ‘transformative changes’ which are vital to the MTP Act which is extremely dated. Malik said, “there exists this idea that all women and girls with disabilities are asexual and, therefore, what is the need for even thinking about them in this context of abortion access?”

Shivangi Agrawal of Determined Art Movement, in another session organised by the CHLET on the topic ‘A Disability Rights Perspective on Abortion: A Nuanced Understanding’, said “When I first read the MTP Amendment, it said to me that disabled people are irrational for having lives, for existing in the world. I feel like the government has continuously ignored disabled activities and they do not value the decision-making capacity that disabled people have.” She further added, “I feel like this bill encompasses the idea that providing for disabled people is too much.”

Dipika Jain in her column in TheWire mentioned about the ‘abnormalities’. She wrote “disability rights advocates have argued that foetuses with potential disabilities should not be singled out for abortions. This reinforces the notion that persons with disabilities have less value than persons without disabilities, and that all fetuses with ‘abnormalities’ should be terminated. It should be the sole discretion of the pregnant person, in consultation with their doctor, to carry a pregnancy to full term or to abort, even if the foetus has a potential disability, cognitive impairment and/or other medical conditions.

Conclusion

Abortion is a matter of rights of a woman. Even the Supreme Court of India has recognized that in the landmark case of 2009, Suchita Srivastava v. Chandigarh Administration. The court said, “There is no doubt that a woman’s right to make reproductive choices is also a dimension of ‘personal liberty’ as understood under Article 21 of the Constitution of India. It is important to recognise that reproductive choices can be exercised to procreate as well as abstain from procreating. The crucial consideration is that a woman’s right to privacy, dignity and bodily integrity should be respected.”

In 2017 in the case of Justice K.S. Puttaswamy v. Union of India, the SC identified privacy as a fundamental right under the Indian Constitution. The right to privacy within its scope includes the rights to bodily integrity, reproductive choice and decisional autonomy. Justice D.Y. Chandrachud cited the landmark 2009 case Suchita Srivastava v. Chandigarh Administration, in the Puttaswamy case.

It’s unfortunate that even after such decisions, the proposed amendments continue to maintain the original paternalistic doctor-centric framework of the MTP Act. The decision to terminate is still in the hands of the doctor and not the pregnant person. This needs to change.

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Challenging Factors

While the sector continues to grow, there are some factors that may challenge its growth in the near future. Lack of stable pricing, drugs in India is not affordable for some people. 60% of the population in India does not have regular access to essential medicines just because they are pricey. Drugs Price Control Order (DPCO) and National Pharmaceutical Pricing Authority (NPPA) work hand in hand to review the prices that are carried out on such products. Currently, the DPCO regulates 74 bulk medications. The second factor is the lack of technological capabilities. So maybe improving the innovation space would help with pharmaceutical growth.

Jan Aushadhi

The Indian Government’s Department of Pharmaceuticals has also initiated operations for a people’s medicines shop, called ‘Jan Aushadhi’, in various locations. These shops sell generic medicines at much cheaper rates than the price of corresponding branded medicines.

Vaccines

Vaccines are another prominent area of growth. India is one of the largest vaccine producers in the world, with many new vaccines set to be launched in the next 5 years. India currently exports vaccines to about 150 countries. PWC says that it meets around 40-70% of the World Health Organization’s demand for the DPT (diphtheria, pertussis or whooping cough, and tetanus).

OTC and Ayurvedic Medicines

Indian consumers also put greater focus on prevention and well-being, which should lead to continued growth in the sales of OTC vitamins and mineral products. The demand is already starkly rising. Artificial sweeteners, emergency contraceptive pills and nutritional supplements are some profitable OTC drugs.  Some of the leading OTC brands in India are registered as ‘Ayurvedic Medicines’ because of their plant-based natural active ingredients. There are no price controls on ‘Ayurvedic Medicines’.

Joint Clinic Trials for Ayurveda

India and the US intend to launch joint clinical trials against the novel coronavirus for formulations of Ayurveda. The two countries partnered to support Ayurveda through a joint program of research, teaching and training. Via collaborative activities the Indo-US Science Development Forum has also been instrumental in fostering excellence in science, technology and innovation. 

Ministry of AYUSH

AYUSH stands for Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy. The Ministry of Ayush focuses on developing education, research, and propagation of alternative indigenous medicine systems in India. It has faced strong criticism of funding schemes. Clinical quality was poor, and medicines were implemented without any clinical trials and studies. Concerns have been raised about AYUSH based healthcare.

Future Prospects

The future of the pharmaceutical sector in India would be good because-increase in the burden of diseases, rising income of individuals, improvement in healthcare infrastructure and many more things. The sector is already growing so much because of the leading coronavirus pandemic.

Pharma and Coronavirus

The impact of the pandemic and the lockdown triggered a visible effect in financial markets. Drugs that are Made in India are supplied to developed countries such as the US, EU and Japan. These drugs are known for their well-being and standards. People are going crazy over a bottle of Sanitizer. Hospitals are full. Pharmacies are always crowded. If we talk about the future, we don’t know what is ahead of us. Corona is probably here for a long time. We can’t say that no other disease will hit India in the future, so, pharmaceutical sector is expected to grow multifold and continue to be an attractive investment destination.

Economic Boost

India’s population is increasing day by day, as its economy, so demand is likely to increase for the drugs. Income levels of households will rise very steadily. Government coming with ‘Below Poverty Line’ (BPL) segment will also be profitable for the pharma sector. Also, the acceptability of modern medicine and newer therapies will increase due to aggressive market creation by players.

Conclusion

India’s pharmaceuticals industry has risen in faith and firmly moved onto an accelerated growth course. The main issue now lies around the real culture and the full scope of this market ‘s ability. Backed by strong fundamentals, the market is giving rise to a range of business opportunities.

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Poverty, maternal health and hygiene practice are some factors that contribute to Malnourishment. In India, there are around 46.5 million children who have stunted growth due to this malady. Lack of food security and infective Food Distribution System in India has further aggravated the situation. It is reported that, that India will miss the expected global nutrition target by 2025, according to the Global Nutrition Report 2020.

Neelesh Singh, founder of Pehchaan NGO in Ghaziabad has personally taken the responsibility to do something about undernourished and malnourished children, who are facing a hunger crisis due to the initial lockdown and resulting economic crisis. He reaches out to children in the Pratap Vihar and Vijay Nagar areas of Delhi NCR.

What is the situation regarding malnourishment in India?

Since COVID-19 happened, according to the WHO reports, 3 lac children are suffering, and due to the pandemic, their life is at threat. Tentatively this can happen within 3 months. It may not be as big of a problem now compared to the COVID-19, but it has the potential to become worse.

Those who are unemployed, are mainly daily wage earners. Their children were already undernourished. Now, that since their jobs have gone, the families with whom I am in touch with, due to Covid-19 they didn’t get their income, and for two to three days the families didn’t eat. Today, many families are dependent on me. I am feeding their children but also offer food to their parents. I think, if I don’t feed them (parents) they will sleep with their stomach empty. Our responsibility is to get proper food for these affected families.

What is your food distribution frequency and quantities?

In one aluminum foil container, it commonly has rice and chhole, the net quantity of these food packets are 500 gm. We make the food ourselves in our family, in our house. We make sure the quality and the nutrition of the food is good. The food we distribute amongst the families, we eat it ourselves within our family.

We are member of 4 people in our house; My parents, my younger brother and me. we make the food.

Earlier, COVID-19, in the initial period of lockdown, we had 35 volunteers from Ghaziabad for food distribution. They used to distribute food and worked without money, for social work purposes only. Now, what happened, ever since the numbers corona cases of escalated, it was hard to decide for us, who was infected and who wasn’t. Earlier we used to make food for 1000 families, feeding them twice a day. That time, it was easier since there were not many cases, I had the help of my team. We had cooks also involved. This is about 30^th March to 31^st May. Since 1^st June we are focussing on 500 families.

Then we noticed, from the 1000 families who were dependent on me, few families got some jobs and went back to work. We removed them from our list and sorted out those 500 families who haven’t got any employment. This was done due to the limited resources and funding on our part. We started food distribution with the help of our family. We didn’t take the help of any volunteers since we did not want to risk the health of these families. We stopped taking volunteers because we did not their travel history, where they are going, and if they are taking precautions. So we removed the halwai and everyone, and on our own, we started cooking food and distributing them amongst kids and their parents.

Support or response from Government?

Our organisation is four years old, and we are supported by individual people.. Like people who are watching our activities telecasted live on Facebook. They sometimes help us with ration and food stock. We have a camp for old clothes, we collect these clothes from several societies and give them to the children for free. Now by collecting clothes, more people got to know about us. To them, we requested to help us with food and ration, and we did not take monetary relief from them. Many people helped, and are continuing to help.

From our understanding, there are almost 2 lac children within Ghaziabad who are undernourished. It is as it is difficult with our limited means to extend support to the 500 families we are connected with. We provide 200 ml Amul milk every day in the morning and one banana to the children.

There are some families who are in dire need of food, and their conditions are not favourable, to them we provide Emergency Ration Kit. In Emergency Ration Kit, 10 kg Atta, 1 litre oil, 4-5 kg rice, and condiments such as salt, masalas and pulses. With this Emergency Ration Kit, ours is that for them at least 10-15 days they can comfortably eat and survive.

I regularly visit families who are unemployed. I first approach the kids, I do talk to the elders, and they can lie, so I ask the children first. We ask them “beta, kal kya khaya tha shaam ko?” ya “din mein kya khaya tha” Children are innocent, and they won’t lie on these matters, I believe. They say what they had the other day, then they say what they had, and we on that basis judge how equipped the family is.

Are the kids aware of the global situation, how things have suddenly changed for them? Do they ask you anything?

In my last, I know of children who are not aware of the current situation. Many of the children are infants who haven’t started speaking yet. We saw many of these children begging around the streets. Many of them were our students, and it really affected us seeing them begging for food. From there I decided to focus on this food relief.

We used to provide nutrition before this as well. But on that day, we realized how grave the situation is. One of us asked the kids why were they begging, and they said, “Sir, hamare paas khaane ke liye kuchh bhi nahi.” I was really moved by this, and have been focussing on the food relief and provide nutritional food to children so they don’t go to bed hungry.

Neelesh Singh was approached by BBC World and BBC Hindi, and his efforts were highlighted on the NDTV news channel as well.

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