When she walked down the halls of a renowned hospital in Kathmandu, clutching her mother’s arms tightly, she was 15 years old. As she sat in the waiting room for her ultrasound exam (USG), she felt judged, scared and intimidated.
“I can still feel how everyone looked at me back then. The waiting room was full of pregnant women and their partners,” recalls Akriti Shrestha, who is now 24 and a fifth-year MBBS student at Kathmandu Medical College, Sinamangal. “I guess they all assumed I was pregnant too.”
Shrestha was not pregnant. She hadn’t had a period for four months. This led her to consult the gynecologist.
However, as a teenager, his visit was unpleasant.
“The doctor was so rude,” Shrestha said. “She looked us over from head to toe with a smirk on her face. “So you’re already married?” she snapped, assuming I was. ‘Do you have a husband?’ she asked, even though I was with my mother. I wish I never had to see a gynecologist again.
Women and young girls say they have had and still have such experiences with gynecologists because of the doctors’ approach to them.
Medical experts admit that many doctors lack the tact and sensitivity needed to deal with teenage girls. Such experiences highlight the lack of adolescent-friendly gynecology services for young girls, they say.
“Doctors learn to treat gynecology through an adult perspective,” said Anjana Karki, gynecologist at B&B Hospital. “And quite often they treat young girls with less sensitivity. Their privacy is not respected and when they are judged, it becomes intimidating for the youngest.
Gynecologists are experts on a wide range of women’s health issues, including menstruation and fertility issues, sexually transmitted infections (STIs), contraception, and hormonal disorders.
However, the majority of gynecologists are not trained to care for adolescents, and there are no adolescent-friendly health clinics, according to Karki.
Under the Ministry of Health and Population, the Adolescent Sexual and Reproductive Health (ASRH) program was included in the National Reproductive Health Strategy of Nepal in 1998.
The ASRH aimed to establish 1,000 adolescent-friendly health facilities by 2015. The government website claims that in 2016, 1,534 health facilities were already adolescent-friendly.
However, the service remains insufficient and inaccessible to adolescents.
Caring for teens and their health requires a great deal of tact and sensitivity, the lack of which leads to incorrect reporting of medical and sexual histories, misdiagnoses and horrific experiences with doctors for young girls, according to Karky.
Many young girls say they were discharged for their pain, told not to think about it, or morally examined by medical professionals.
When Aasna Sijapati, 22, was a teenager, her menstrual cycles were followed by excruciating pain. By consulting a gynecologist, her pain was dismissed and invalidated.
“I have incredibly awful menstrual cramps, to the point where I take about three to four painkillers during my period. When I was 13 the doctor literally said to me ‘what if you don’t think about it and you you were rather distracting,” said Sijapati, an assistant instructor in the Office of Social Accountability at New York University Abu Dhabi.
When Sijapati sought another gynecologist about four years later, she encountered a similar problem.
Her new doctor treated her better but did not counsel her on the condition itself, what the disease is and how it affects her body. The gynecologist instead said that they would not examine her condition until after her marriage.
“The doctor said ‘take these drugs for now; once you get married and do family planning, we can take care of that.” So all my pain and inconvenience and how it affects my lifestyle before marriage is just invalid and not a concern,” Sijapati said. “It’s so messed up.”
Sijapati points out that both of her experiences took place in expensive private hospitals in Kathmandu with “well-known” gynecologists who have years of experience.
Not only are adolescent girls’ health not prioritized unless it is for reproductive roles, but they are also subject to judgment and commentary. Moreover, they also express the feeling of a violation of their privacy and confidentiality. Many are not advised adequately either.
About a year ago, a 16-year-old girl was asked by a gynecologist if she had a boyfriend in front of her parents when she went for a breast exam. She says the doctor did not respect her privacy by asking the question in front of her mother.
Instead of inquiring about their sexual activity in a private, confidential and respectful manner, gynecologists often ask questions such as “are you married”, “where is your husband”, “do you have a boyfriend” and ” are you a virgin”. in front of their guardians, violating the girls’ privacy.
Often questions are dropped abruptly and impatiently, making young teens feel offended and intimidated.
According to medical experts, patients have the right to privacy, confidentiality and the right to refuse treatment. Medical ethics require doctors to respect patients’ rights while counseling them, says Karki.
“A young girl can confide in her doctor and share her medical history. This information should not be shared even with her parents if she does not wish to. Her privacy and confidentiality must be preserved,” says Karki, who is also a member of the Nepal Society of Obstetricians and Gynecologists (NESOG).
However, teenagers are not very aware of their rights. According to Karki, their dependence on their parents for their financial needs and signatures often makes them vulnerable to abuse.
Such negligence, by asking intrusive questions in front of the parents, is likely to cause an erroneous diagnosis. Young girls are reluctant to share their sexual history in front of their parents, which provides an inaccurate medical history.
“As a doctor, interacting with young girls requires a lot of tact. I usually ask the mother to leave before asking her about her sexual history. Teenagers are often dishonest about their medical histories in front of their guardians, leading to misdiagnoses,” says Karki. “Sometimes a misdiagnosis has led to girls coming three to four months pregnant, and sometimes even giving birth.”
Realizing the need for adolescent-friendly health clinics, NESOG had established an adolescent health clinic inside Bir Hospital in the early 2000s. However, the clinic was not prioritized by policy makers policies and was later dropped, says Karki.
Access to adequate, non-judgmental health care for adolescent girls is a concern. Physician bias has prevented many people from receiving respectful, timely and adequate medical care and treatment.
As a medical student herself, Shrestha understands the busy lives of medical professionals. However, she feels that a doctor has a greater responsibility to ensure that the patient is treated with respect.
“I understand that a doctor’s life is hectic,” says Shrestha. “However, caring for a patient is not just about performing surgery. It’s also about how you offer your services to patients who come to trust you.