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Realizing a holistic sexual and reproductive health care system

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Speaking to Sunday Island, Dr. Pramilla Senanayake, International Consultant in Sexual and Reproductive Health, former President of the Family Planning Association of Sri Lanka and Trustee of the AIDS Foundation, Sri Lanka, elucidates on the need for a more open dialogue about sexual and reproductive health among masses and enlightens on ‘myths and facts’ of sexual health which need to be mainstreamed. Following are the excerpts:

By Randima Attygalle

Q: As a woman who made a mark at a time when only a few women professionals were visible in sexual and reproductive health care, when you look back at your early years in the profession and now, do you notice any notable progress?

A:

If we look at statistics and numbers, we have done well. In terms of our contraceptive prevalence we are on par even with more developed countries. Our maternal mortality is quite low because our maternal health care system is effective. But still there are a lot of gaps – we see many unwanted pregnancies and abortions. Today the sexual debut is very early. A few decades ago, pre-marital sex was not as common as it is today. Yes, things have changed, we have moved on, but we still have a long way to go.

Q: In our much lauded public health care setting, what is the positioning of sexual and reproductive health care?

A: It is because of this effective public health care system that we have been able to introduce to it various elements that are relevant to reproductive health. But having said that, I must add that sexual and reproductive health is one of the neglected areas in the health setting. It is a subject that people are still reluctant to talk about openly as it involves sex and many ‘hush-hush’ aspects. Although more liberal-minded social levels of society are open about it, it is only a minority and sometimes they too can get wrong information about sexual health which needs to be dispelled. Certain other classes find the subject matter uncomfortable and even the term ‘sex education’ drives people into giggles and embarrassment. This is why we are trying to bring family life education into the school curriculum.

Q) What are your proposals to move forward and enable wider sexual health literacy?

A:

We need to talk to the public – parents, teachers, employers, employees etc. in a simple language without complicating things. For this, we need to engage competent professionals who can answer questions and debunk myths. The Family Planning Association of Sri Lanka has initiated programmes to reach out to young girls in the Free Trade Zone – to educate them on sexual health. This kind of intervention needs to be replicated in several other settings. Especially in this pandemic situation where there are lockdowns and restricted movement, sexual abuse is on the rise and the flipside is there is more opportunity now to get the message across. Our voices can be those in wilderness unless mass media joins hands. Mass media is an effective vehicle in communicating the message of sexual wellbeing.

Q: Sexual and reproductive health of those with disabilities still remains a less-talked about subject. Sexual needs of those with disabilities are often overlooked. What are your thoughts?

A:

We are all sexual beings including those with disabilities. Every human being has a right to a safe and rewarding sexual life and sexual health. We cannot afford to exclude those with disabilities; instead we need to assist them in finding other ways of gratification and work around such areas of gratification. Sexual life does not necessarily have to entail penetrative sex in a traditional sense, but it could involve sexual gratification in a broader sense which can be enjoyed by people with certain disabilities.

The issue is we don’t talk to them enough and educate them on sexual and reproductive health, clouded by the misconception that they have problems other than sexual needs to be burdened with. This is wrong. We need to be conscious of the fact that girls and women with disabilities are the most vulnerable to rape and sexual abuse. Institutions such as Ayathi affiliated to Ragama Rehabilitation Hospital addresses the concerns of those with disabilities, but there is an urgent need for many more similar institutions in the country.

Q: The aging population is on the rise worldover and Sri Lanka is no exception. In this context how important do you think it is to address the emotional and sexual concerns of this population?

A: It is very important to address their concerns. It is again similar to the case of those with disabilities – an often neglected topic. I’m a trustee of the Sunshine Senior Foundation which is dedicated to addressing areas of particular interest to senior citizens and we do enable dialogue on this topic. Yet we need to create a better dialogue at national level, challenging as it may be given our cultural context in which intimacy in old age is almost a taboo.

Q: Although Sri Lanka still remains an HIV low-prevalence country in a global context, HIV-positive cases are accelerating. As an activist fighting HIV, what are your comments on this rising trend?

A:

It is a very worrying situation, especially since we are still considered a low-prevalence country. The biggest bottleneck in the fight against HIV is social stigma. Through the AIDS Foundation of Sri Lanka, we try to assist in providing accommodation for HIV-positive people. Despite our ability to fund houses for them, many landlords were reluctant to rent out houses and in certain situations, although the landlord was willing, there was enormous protest from neighbours.

Despite the country having a system for voluntary testing and counseling for HIV, not many come forward to be tested. Today there are many commercial sex workers and men who have sex with men, those with multiple partners. These are high risk groups. We should also not forget prison inmates who are another high risk group. Although the Family Planning Association of Sri Lanka and some other agencies are working with prison communities on this, there should be more muscle given to their work in preventing HIV.

In Sri Lanka many of the HIV positive cases are detected through pre-natal clinics where pregnant women are tested for it. But this is just the tip of the iceberg as a considerable percentage go unreported. Today with COVID taking the centre stage, many other health concerns including HIV have gone backstage. Yet we cannot afford to be complacent about these health issues which will take a toll on the entire national fabric of the country.

Although we have done quite well in our other health domains, the same cannot be said of HIV education. Several of our regional counterparts including Pakistan and India are using very innovative means of addressing this issue. Countries such as Japan, South Korea and Singapore have very good models on combating HIV from which we could learn a lot.

 

 

FACTS Vs MYTHS

 

*Myth: All birth control methods are equally effective at preventing pregnancy

*Fact: Each method has a different level of effectiveness. The ones that are best at preventing pregnancy (over 99% effective) are sterilization, IUDs, implants, and injectables. Pills, patches and the ring are about 91% effective. Condoms are 79-85% effective, emergency contraceptive pills are 89-95% effective, and withdrawal is much less effective. Using birth control consistently and correctly each and every time will increase the chances of their effectiveness

*Myth: Emergency contraception is only effective the morning after unprotected sex

*Fact: The emergency contraception pill (ECP) is sometimes called the ‘morning-after-pill’. Although the ECP should be taken as soon as possible, it does not have to be taken in the morning. There are two types of ECP that work for up to four or five days after sex and they are both more effective when taken as soon as possible. The ECP is not an abortion pill. If you are already pregnant, ECP will not work.

*Myth:

You can’t get pregnant during your period

*Fact:

It is unlikely, but still possible—especially if you’re not using birth control. Some women have long periods that overlap with the beginning of ovulation, which means they can be fertile even though they’re menstruating. If you have a short cycle (21 days, for example) and your period lasts a week and you have sex close to the end of your period, you could become pregnant since sperm can live for up to 72 hours in your reproductive tract.There’s also the infamous late-in-life pregnancy that can occur during perimenopause, when periods are erratic. It is not safe to ditch birth control until you haven’t had a period for a year.

*Myth:

You only need to worry about sexually transmitted infections (STIs) if you have multiple partners

*FACT:

As long as you are sexually active you should remember that contracting an STI is a possibility, even if you only have one sexual partner. It’s a good idea to make sure you and your partner(s) are tested for STIs before having sexual intercourse together for the first time. It’s also recommended that you regularly test for STIs if you are sexually active. 

*Myth:

You can’t get STIs if you don’t have penetrative sex.

* FACT:

STIs can spread from skin-to-skin contact and from bodily fluids. This means you can catch STIs from having any type of sex, including penetrative vaginal sex, but also from anal sex, oral sex , using your hands, intimate skin contact and sharing sex toys.

 

 



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Features

Her Majesty The Queen, A Style Legacy

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The familiarity of the hats, the quietly diplomatic choice of brooch, the shocks of colour and the sensible worn-in shoes will remain bastions of the 20th and 21st century style With the close of the modern Elizabethan era, legacy is a word that is reverberating strongly following the news of Her Majesty Queen Elizabeth’s death. She was 96-years-old.

As the role of the monarchy shifted during her 70-year reign, and the entire understanding of its existence was increasingly questioned, Her Majesty remained a popular, recognisable figure of quintessential Britishness. For those of us that have known no other British monarch, we are left with a legacy that will be marked by her inescapable sense of duty to the Crown and country, but also a decidedly strong sense of self and identity that feels singular in a world of chameleonic idols and a quickening trend cycle.

Few before, and likely few after, will have spent as long as a recognisable figure in the public eye, with such a reaching global impact. Like the tone of her reign, Her Majesty’s sartorial approach was informed by a quiet confidence and an assured concept of self that prized personal style over trends and fads. Sure, she might not have had the glamorous allure of a Hollywood star or the subversive ability to shift our notion of dress like others have done, but Her Majesty’s legacy will be a fashion journey that proves a lesson in unwavering integrity of identity.

The Queen’s fashion legacy will also be marked by a savvy, often understated, means of communicating with her people, which dates back to her coming of age in a post-war Britain. Married at Westminster Abbey in November 1947, her wedding dress was assembled using duchess satin bought with ration vouchers. Of course, unlike her peers, it was Norman Hartnell that designed the 13-foot gown, but the message of her purchasing her fabric through this ‘just like us’ nature was one of kinsmanship not lost on a recovering Britain.

Throughout her reign, other fashion choices have needed to be more diplomatic and significant in message. Arriving in Ireland in 2011, the first British monarch to do so in 100 years, the Queen wore a very specific shade of green. Not too emerald, not too bold, it was a careful choice that didn’t assume Her Majesty to be reclaiming Ireland, but instead proved a sensitive homage in the landmark moment.

Other sartorial decisions had a more sentimental attachment. Consider her brooch for the Duke and Duchess of Cambridge’s 2011 nuptials. From amongst her wealth of heritage jewels she chose The True Lover’s Knot, the largest in her hefty collection. Its sweet bow-like design was an emblem of the day’s significance in her life as a proud grandmother and for the line of succession.

Brooches, like dress suits, brimmed hats, patent pumps and top-handle Launer handbags, are amongst the pieces that made up Her Majesty’s uniform-like approach to her on-duty wardrobe. A dedicated Monarch, who always placed service first and foremost, it made sense that she treated her approach to dress with such regimented formula. It must also be noted how traditionally feminine these pieces are. The message she sent to the commonwealth and the wider world was one of feminine strength, never intimidated by the meetings of senior dignitaries her diary scheduled or falling victim to needing to dress to ‘keep up with the boys.’

In a more contemporary time, the Queen’s style legacy has impacted nowhere more than in the wardrobes of her family members. As protocol dictates, her tiaras and jewellery have often been borrowed by the family members for wedding days or state affairs, with Princess Beatrice even opting for one of granny’s dresses for her 2020 nuptials, but Her Majesty’s influence extended to the day-to-day too.

Look to the wardrobes of Duchesses Cambridge and Sussex and you’ll notice the Queen’s approach to colour permeating. A long-time fashion tool employed by Her Majesty, it has proven particularly useful in ensuring that royals can be spotted by those even at the farthest end of the waiting crowds. It’s clear to see that Catherine and Meghan have taken note.

The overarching message that the Queen’s wardrobe told was one of a quieter, more subtle influence. It’s long been clear that Her Majesty, who was most happy in her headscarf, Barbour and kilt in the countryside, was never as fussed about the flashier side of royal privilege as perhaps her sister, the Dior-wearing Princess Margaret, was.

For the last 20 years, Angela Kelly has been at the helm of the Queen’s wardrobe, becoming a close confidante of Her Majesty’s in the process. Yet, you couldn’t ever have imagined the pair conspiring — to use a modern glam squad term — to create a ‘moment’ throughout their time working together. As she entered her latter years, the formula that worked didn’t flinch apart from moving through the rainbow. But that’s not to say Her Majesty didn’t have fun with her wardrobe.

With what was arguably the world’s greatest dressing-up box at her disposal, there were flashes of experimentation and brilliance that hinted at a bolder experimentation. Think harlequin sequins, floral turbans or diaphanous candy pink gowns and fur stoles paired with dazzling diadems and parures. But the greatest smiles and moments of clear sartorial satisfaction were when Her Majesty was buttoned up in her cardigans, her signature neat perm wrapped in an Hermes scarf and heading out into the Highlands.

Though fashion is quick to praise reincarnation, Her Majesty will be celebrated for her opposite approach. The familiarity of the hats, the quietly diplomatic choice of brooch, the shocks of colour and the sensible worn-in shoes will remain bastions of the 20th and 21st century in style, no matter what else moved quicker or louder around it. The phrase style icon is too often touted or wasted on those that have spent little more than 18 months in the public eye, but, when it comes to Her Majesty The Queen, here is a chance to use it for all its worth. – Elle Mag

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Features

Mexico’s DJs make waves in Colombo

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Leading DJs from Mexico who have entertained crowds across Europe, North and South America, Marisol and Ivonne Grajales were touring Sri Lanka recently, storming some of Colombo’s most happening venues. The sisters, who have spun their vibrant sounds to full houses and performed at epic DJ sets across the world including the USA, Brazil, Honduras, Ecuador, Germany and Spain; kept the Sri Lankan party set grooving at some of the most exciting night spots in town over the last two weeks.

Marisol is ranked seventh as a DJane in Mexico and 38th in North America, has a degree in music production and released 12 singles which are featured on Beatport and Traxsource.

They performed at venues around Colombo including at The Love Bar, Industri, Botanik, Kava, The Travelling Bruncher and the Flamingo Breeze Pool Party, the latter which has fast become a trendy, sought after monthly event. In addition, Marisol and Ivonne spun discs at the chilled-out Sunday Smooth Drunch. Both these events were at the poolside of Cinnamon Grand.

The DJ sisters performed at C VIBES with renowned Sri Lankan artistes – ACE, Clifford, TrevD, Binu, Madaid and Shan. C VIBES is an entertainment entity which curates and hosts events at popular venues in Colombo which includes a roster of international DJs and artistes performing at select venues and a number of exciting party additions which promise great revelry and celebrations.

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Features

The future of shopping in Kandy

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Softlogic Holdings PLC launched its newest retail development – ‘ODEL Mall Kandy’, recently The 91,414 sq ft retail development is poised to be Kandy’s most sought-after state-of-the-art, premium lifestyle shopping destination situated at the heart of Sri Lanka’s hill capital.

Located at , Sirimavo Bandaranaike Mawatha, Peradeniya Road, Kandy, the retail development will house a premium collection of Softlogic’s most celebrated brands such as ODEL (the largest fashion retailer in Sri Lanka, that hosts an array of world renowned international fashion, jewellery, skincare and lifestyle brands); Baskin Robbins (the world’s largest chain of specialty ice cream operating over 5,000 parlours in 50+ countries); GLOMARK (Sri Lanka’s first inspirational global market which aims at revolutionising the country’s modern retail trade landscape; and POPEYES (one of the world’s leading fast-food chains)

The retail mall will in-turn launch two fast-popular brands, for the first time in Kandy – GLOMARK – which houses the widest selection of items sourced across the globe and uses the best of modern storage facilities, design and upgraded technology for a superlative consumer experience; and POPEYE’s – known for its signature slow cook method where fresh, locally sourced, chicken is marinated for 12 hours with a rich blend of proprietary seasoning and spices, and thereafter hand battered and breaded to produce chicken that is juicy on the inside while retaining a crispier crust on the outside, transporting customer taste buds to the wholesome goodness of Louisiana.

Commenting on the announcement, Chairman, Softlogic Holdings PLC – Ashok Pathirage stated: “We are pleased to announce the launch of ODEL Mall Kandy, which has been met with much excitement and support by the local community within Kandy and Kurunegala. Through the introduction of the mall, we look to enhance the retail and entertainment experiences available to both residents and tourists of this sacred and famous city.”

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